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BACKGROUND: The horizontal 'bikini' incision for direct anterior approach (DAA) total hip arthroplasty has gained popularity due to its early wound healing characteristics; however, the nonextensile nature of this approach may pose problems in treating early complications. This study sought to characterize the outcomes of early revision (<90 days) in patients who underwent anterior hip arthroplasty utilizing either a traditional longitudinal incision or a horizontal (bikini) incision. METHODS: This retrospective study identified patients who underwent DAA primary total hip arthroplasty with a subsequent DAA revision within 90 days. Patients were divided into two cohorts based on the orientation of their incision: either 'longitudinal incision' (in accordance with the Smith Peterson interval) or 'horizontal bikini incision' (in accordance with the hip flexion crease). RESULTS: There were 74 patients who underwent DAA revision arthroplasty within 90 days of primary arthroplasty; 65 had a longitudinal incision, and 9 had a horizontal (bikini) incision. In the longitudinal incision group, 2 patients (3.1%) required plastic surgery closure, and 11 patients (16.9%) required additional operations. Of the 9 bikini incision patients, 6 patients required the assistance of plastic surgery closure, and 7 patients required multiple orthopaedic operations. CONCLUSIONS: Our study suggests that a horizontal bikini incision is less forgiving in the early postoperative period if a more extensile exposure is needed for revision surgery, as measured by the need for plastic surgery and additional returns to the operating room. In our cohort, the longitudinal incision allowed for the management of early surgical complications with less morbidity.
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Artroplastia de Quadril , Reoperação , Humanos , Artroplastia de Quadril/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Adulto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologiaRESUMO
BACKGROUND: This study aimed to characterize changes in patient demographics and outcomes for same-day discharge total hip arthroplasty (THA) over a 10-year period at a single orthopaedic specialty hospital. METHODS: A consecutive series of 1,654 patients between 2013 and 2022 who underwent unilateral THA and were discharged on the same calendar day were retrospectively reviewed. Patient demographics, including age, sex, body mass index (BMI), age-adjusted Charlson Comorbidity Index, and American Society of Anesthesiologists (ASA), were collected. Readmissions, complications, and unplanned visits were recorded for 90 days postoperatively. In order to compare the demographics of patients over time, patients were divided into 3 groups: Time Group A (2013 to 2016), Time Group B (2017 to 2019), and Time Group C (2020 to 2022). RESULTS: The mean age, BMI, ASA score, and CCI increased significantly across each time group. Age increased from 57 years (range, 23 to 77) to 60 years (range, 20 to 87). The BMI increased from 28.1 (range, 18 to 41) to 29.4 (range, 18 to 47). The percentage of patients aged > 70 years almost doubled over time, as did the percentage of patients who had a BMI > 35. Overall complications increased from 3.44 to 6.82%, reflective of the changing health status of patients. Readmissions increased from 0.57 to 1.70% over time. Despite this, there were no readmissions for any patient within the first 24 hours of surgery. CONCLUSIONS: Our study has 3 important findings. We identified a worsening patient demographic over time with an increasing percentage of patients of advanced age and higher BMI, ASA, and age-adjusted Charlson Comorbidity Index. Also, there was also an increase in readmissions, complications, and unplanned visits. In addition, despite this worsening patient demographic, there were no readmissions within 24 hours and a low rate of readmissions or unplanned visits within the first 48 hours across all time periods, suggesting that same-day discharge-THA continues to be safe in properly selected patients.
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Procedimentos Cirúrgicos Ambulatórios , Artroplastia de Quadril , Alta do Paciente , Readmissão do Paciente , Humanos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Adulto , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adulto Jovem , Resultado do Tratamento , Índice de Massa Corporal , Fatores EtáriosRESUMO
BACKGROUND: There are myriad strategies to reduce opioid consumption after total knee arthroplasty (TKA). Recent studies have suggested that preoperative counseling may reduce opioid use after a variety of orthopedic procedures. The purpose of this study was to investigate whether preoperative video-based patient education regarding opioid use and abuse reduces opioid consumption after TKA. METHODS: In this prospective randomized controlled trial, patients were randomized before TKA to either receive preoperative video-based counseling or not. Counseling involved a pretaped 5-minute video that educated patients on statistics regarding the "opioid epidemic" and discussed safe use and alternatives to opioids after TKA. There were no significant differences in baseline patient demographics between groups. All patients received a similar multimodal perioperative pain management protocol and completed a daily diary for 2 weeks postoperatively. Diary records measured pain levels using a visual analog score, opioid consumption, side effects experienced, and patient opinion and satisfaction regarding their pain control. RESULTS: Patients in the counseling group consumed significantly less morphine milligram equivalents on postoperative days 0 to 3 (78.8 versus 106.1, P = .020) and in week one postoperatively (129.9 versus 180.7, P = .028), with a trend of less consumption over 2 weeks postoperatively (186.9 versus 239.1, P = .194). There were no significant differences in the number of patients requiring refills, side effects, or daily pain levels between the 2 groups. CONCLUSIONS: This study found significantly decreased opioid consumption within the first week after TKA in patients who received preoperative video counseling.
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Analgésicos Opioides , Artroplastia do Joelho , Aconselhamento , Dor Pós-Operatória , Educação de Pacientes como Assunto , Cuidados Pré-Operatórios , Humanos , Artroplastia do Joelho/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Masculino , Feminino , Estudos Prospectivos , Idoso , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Manejo da Dor/métodos , Medição da Dor , Gravação em Vídeo , Resultado do TratamentoRESUMO
Background: The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes. Methods: This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor-impregnated drape. Results: Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine. Sixteen patients had a cluster of iodine-related allergies. There were no intraoperative reports of an allergic reaction to this drape. There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery. Conclusions: Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodiphor impregnated drapes in these patients.
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Peripheral vascular disease (PVD), defined as decreased arterial perfusion to the lower extremities due to atherosclerotic obstruction, is known to occur in patients undergoing total knee arthroplasty with described rates of between 2% and 4.5% PVD is of significance for patients undergoing TKA as it can increase wound healing and infection complications after TKA and is an independent risk factor for arterial complications following TKA. Our goal is to provide a comprehensive review of the pathophysiology of PVD as it relates to TKA, associated outcomes of patients undergoing TKA in the setting of PVD, diagnostic pearls, and current management strategies recommended in the published literature.
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Artroplastia do Joelho , Doenças Vasculares Periféricas , Humanos , Artroplastia do Joelho/efeitos adversos , Doenças Vasculares Periféricas/complicações , Fatores de Risco , Extremidade Inferior , Cicatrização , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Variable results have been reported regarding the clinical outcomes in Total hip arthroplasty (THA) based on the surgical approach. The aim of this study is to compare the clinical outcomes between Direct anterior (DA) and direct lateral (DL) approaches in THA when performed immediately after fellowship training. METHODS: During the 1st year of practice, all consecutive patients who underwent THA via DA and DL hip approaches were retrospectively investigated. Patients'demographics, diagnosis, American society of Anesthesiology (ASA) score, route of anesthesia, length of hospital stay (LOS), leg length discrepancy (LLD), radiographic parameters, operative time, number of opioids refills postoperatively, and complications were collected and compared between the two groups. The short form of Hip Disability and Osteoarthritis Outcome score, Joint Replacement (HOOS, JR) was prospectively collected pre and postoperatively. The minimum follow-up period was 2 years. RESULTS: Forty patients in DA group and 38 patients in DL group were included. No statistically significant difference was found between the two groups in terms of demographics, diagnosis, ASA scores, route of anesthesia at the time of THA, postoperative radiographic parameters, LOS, LLD, opioid refills and HOOS scores (p > 0.05). Patients in the DA group had shorter operative time (83 ± 17 min) when compared to the DL group (93 ± 24 min) (p = 0.03). No major complications were found except for one early deep infection patient in DL group. CONCLUSION: Both DA and DL approaches resulted in satisfactory outcomes in THA when performed by a fellowship trained surgeon.
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Artroplastia de Quadril , Humanos , Artroplastia de Quadril/métodos , Estudos Retrospectivos , Bolsas de Estudo , Tempo de Internação , Resultado do TratamentoRESUMO
BACKGROUND: Postoperative urinary retention is a common concern after total joint arthroplasty (TJA) and can cause discomfort, incontinence and, if left untreated, myogenic changes to the bladder. However, overdiagnosis of postoperative urinary retention by bladder scans may lead to unnecessary interventions and delayed discharges. The purpose of this study was to compare the safety of two bladder management protocols following TJA. METHODS: From January 3, 2022 to April 29, 2022, 519 consecutive patients operated on by thirteen surgeons underwent routine postoperative bladder scanning (standard protocol). From February 28, 2022 to April 29, 2022, a new protocol was introduced by three surgeons in 209 consecutive patients using a specific algorithm (selective protocol) so that only symptomatic patients had bladder scans. The primary outcome of interest was catheterization rate. Chi-square and Students t-tests were used for analyses. There were 37.7% of patients in the selective group who received scans. RESULTS: Times to catheterization, readmissions, emergency department visits, and straight catheterization rates (15.0 versus 14.8% P = .999) were similar. More scans in the selective group resulted in intervention (39.2 versus 15.0%, P < .001). Prevoid volumes were higher in the selective protocol (608 versus 448 mL, P < .001). Postvoid volumes were similar (233 versus 223 mL, P = .497). There was one readmission for a urinary tract infection in the standard group and no urinary-related readmissions in the selective group. CONCLUSION: The selective protocol had a higher rate of same day discharge, fewer bladder scans, and did not lead to increased rates of urinary-related complications. These findings suggest that selective bladder scanning for symptomatic patients can be safely instituted for TJA patients.
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Artroplastia de Quadril , Artroplastia do Joelho , Retenção Urinária , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Cateterismo Urinário/efeitos adversos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologiaRESUMO
AIMS: Dislocation is a major cause of early failure after THA and is highly influenced by surgical approach and component positioning. Robotic-arm assisted arthroplasty has been developed in an attempt to improve component positioning and reduce postoperative complications.The purpose of this study was to compare the rate of dislocation after robotic total hip arthroplasty through 3 different surgical approaches. MATERIALS AND METHODS: All patients who had undergone robotic arm-assisted THA at 3 centres between 2014 and 2019 were reviewed. After applying exclusion criteria, 1059 patients were included in the study. An anterior approach was used in 323 patients, a lateral approach in 394 and a posterior approach in 342 patients.Episodes of dislocation were recorded after 6 months follow-up. Stem anteversion, cup anteversion, cup inclination and combined anteversion were collected using the integrated navigation system.Cumulative incidence (CI), incidence rate (IR) and risk ratio (RR) were calculated with a confidence interval of 95%. RESULTS: 3 cases of dislocation (2 posterior approach, 1 anterior approach) were recorded, with a dislocation rate of 0.28% and an IR of 0.14%.The rate of placement of the cup in the Lewinnek safe zone was 82.2% for the posterior approach, 82.0% for the lateral approach and 95.4% for the anterior approach.The rate of placement in the combined version safe zone was 98.0% for the posterior approach, 73.0% for the lateral approach and 47.1% for the anterior approach.The incidence rate of dislocation was 0.30% for the anterior approach, 0.34% for the posterior approach and 0% for the lateral approach. CONCLUSIONS: The robotic arm-assisted technique is associated with a low risk of dislocation. The combined version technique appears to be a reliable way to reduce the risk of dislocation through the posterolateral approach but does not appear to be essential when using the lateral and anterior approaches.
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Artroplastia de Quadril , Prótese de Quadril , Luxações Articulares , Procedimentos Cirúrgicos Robóticos , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Acetábulo/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Prótese de Quadril/efeitos adversos , Resultado do Tratamento , Luxações Articulares/cirurgiaRESUMO
BACKGROUND: Robot-assisted total knee arthroplasty (RA-TKA) has become a popular technology. Studies have investigated the learning curve for surgeons incorporating RA-TKA into practice, but less is known regarding the change in operative efficiency when introducing RA-TKA into a facility. The purpose of this study was to investigate the effects of RA-TKA on operative and turnover time at an orthopaedic specialty hospital. METHODS: A total of 148 cases (74 RA-TKA and 74 conventional TKA [C-TKA]) performed by 2 surgeons with previous robotic experience were identified following the introduction of RA-TKA at our facility. Patient demographics, comorbidities, and operative times (ie, wheels-in to incision, incision to closure, closure to wheels-out, and turnover time) were recorded. Cumulative summation analyses were used to investigate learning curves of factors extraneous to surgeon proficiency with RA-TKA. RESULTS: While RA-TKA had a slightly longer set up (3 minutes; range, 12-45), surgical (5 minutes; range, 33-118), and breakdown time (3 minutes; range, 2-7), there was no difference in turnover time between the groups. The learning curve for surgeon A was 6 robotic cases, whereas surgeon B demonstrated no learning curve. There was no identifiable learning curve for turnover time. CONCLUSION: There was a mean of 8 minutes of increased time required to perform a RA-TKA compared to C-TKA. However, these small increases for the RA-TKA group for set-up, surgical, and breakdown times are not likely to be clinically relevant compared to the C-TKA. It appears that the RA-TKA technology was able to be incorporated into this specialty hospital with minimal changes to surgical efficiency.
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Artroplastia do Joelho , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Curva de Aprendizado , Duração da Cirurgia , Hospitais , Articulação do Joelho/cirurgiaRESUMO
Background: New "hyperspecialty" ambulatory surgical centers (HASCs) have been introduced to deliver safe and cost-efficient care, allowing patients to spend additional nights in an extended care suite before discharge. This study compared the 90-day complications and readmissions of total joint arthroplasty (TJA) at an HASC and inpatient TJA at a tertiary hospital. Methods: We retrospectively reviewed 1365 primary, unilateral, TJAs (658 total hip arthroplasty, 707 total knee arthroplasty) performed at 4 HASCs in 2017-2021. Following their outpatient procedure, patients were discharged to an extended care suite staffed full-time by nurses and physical therapists. These patients were matched 1:1 with 1365 inpatient TJAs (628 total hip arthroplasty, 737 total knee arthroplasty) based on demographics, joint, and American Society of Anesthesiologists (ASA) score. Ninety-day complications and readmissions were compared. Results: The mean age was 60.0 ± 9.8 years and 59.4 ± 8.1 years in the inpatient and outpatient groups, respectively (P = .106). There was no difference in ASA≥3 patients (16.4% vs 17.7%; P = .387) and operative time (86.9 ± 31.8 vs 88.7 ± 27.9 minutes; P = .118). Five patients (0.4%) in the outpatient group were transferred to an acute hospital. When comparing 90-day outcomes between the inpatient and outpatient groups, there was no difference in pulmonary embolism (0.1% vs 0.0%; P = .317), mechanical complications (0.3% vs 0.7%; P = .165), periprosthetic joint infections (0.5% vs 1.1%; P = .092), or readmissions (1.2% vs 1.5%; P = .513). A subgroup analysis of ASA≥3 patients yielded similar findings. Conclusions: Patients undergoing outpatient TJA at a novel HASC had similar complication and readmission rates as those undergoing TJA at a tertiary hospital. Based on these data, such facilities seem appropriate for the care of outpatient TJA patients with ASA<4.
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Background: Robotic arm-assisted total knee arthroplasty (RATKA) has demonstrated improved patient-reported outcome measures. Less evidence has been reported on how frequently patients return to complex activities of daily living. Our purposes were to investigate (1) hospital lengths of stay (LOSs) (2) discharge dispositions and (3) the rates and postoperative time intervals at which patients returned to driving and working. Methods: A total of 50 RATKA patients who were employed prior to surgery were included. Outcomes included hospital LOS, discharge dispositions, return to driving, and return to work. Results: A total of 48 patients (96%) were discharged home with self-care or health aid discharge after a mean LOS of 1.2 ± 0.6 days. Twelve patients (24%) returned to driving within 3 weeks of surgery. In our study, 100% of patients who underwent RATKA returned to driving after a mean of 29 days (range, 4 to 62 days). Forty-five patients (90%) returned to their preoperative level of work after a mean of 46 days (range, 2 to 96 days). Nineteen patients (38%) returned to work within 3 weeks. Conclusions: This study showed fast recovery after RATKA, with >90% returning to driving and working at full capacity within 2 months. Many (38%) returned to work within 3 weeks. Further studies to demonstrate the value of RATKA with respect to recovery of complex activities are needed. Compared to controls from previously published literature on manual total knee arthroplasties, it appears that patients who undergo RATKA have similar or better outcomes in reference to return to driving.
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BACKGROUND: Using a modular dual-mobility (MDM) bearing in primary total hip arthroplasty (THA) has not been widely evaluated. The purpose of this study is to evaluate clinical outcomes and survivorship following MDM bearings in primary THA. METHODS: We used our registry database for patients with an MDM bearing on primary THA, performed by 6 surgeons through supine direct lateral or direct anterior approach. MDM bearings were used most often when impingement or subluxation was present intraoperatively despite proper component position. Another indication was a patient with planned activities who might be at a higher risk of instability postoperatively. RESULTS: A total of 127 MDM bearings were used in primary THA in 119 patients. Mean follow-up was 6.77 years (range 5-8.9). Five hips were revised, none of which were due to MDM bearing failure. Preoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Veterans RAND/Short Form 12 Physical Health Score and Mental Health Score increased from 25.81 to 52.40 (P < .0001), 30.42 to 44.50 (P < .0001), and 36.21 to 52.70 (P < .0001) at latest completed survey follow-up, respectively. CONCLUSION: This MDM bearing shows excellent functional outcomes at a minimum 5 years of follow-up with no bearing-related failures. It can be an excellent choice in primary THA specifically in females where the use of increased head size to prevent instability is not possible due to anatomical restrictions and liner thickness.
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Artroplastia de Quadril , Prótese de Quadril , Feminino , Articulação do Quadril/cirurgia , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos RetrospectivosRESUMO
INTRODUCTION: Metaphyseal bone defects seen at revision total knee replacement (TKA) have traditionally been treated with bone graft or cement. Recently, metal augments have surfaced as viable alternatives to conventional methods previously used in these patients. Newer 3D-printed metal cones offer better biological fixation as a means of improving construct stability. This study aimed to determine clinical and radiographic outcomes of the novel 3D-printed titanium cone augments for femoral and tibial metaphyseal bone defects. MATERIALS AND METHODS: A retrospective review was undertaken of 72 patients who underwent revision TKA with metaphyseal cones (Stryker) and stemmed implants from 2015-2017. Knee Injury and Osteoarthritis Outcome Scores (KOOS Jr) and VR/SF-12 scores were recorded. Knee Society radiographic scores were calculated at latest follow up to evaluate for radiolucency and biological fixation. Loosening noted on radiographs and reoperation for any reason were the endpoints to determine survivorship. RESULTS: A total of 68 patients with 78 cones (58 tibial, 20 femoral) met inclusion criteria. Mean follow up was 3.4 years (range 2-5.4 years). The average KOOS Jr score increased from 38 preoperatively to 66 at two years. The average VR/SF-12 PH score increased from 33 preoperatively to 37 at two years. The average VR/SF-12 MH score increased from 46 preoperatively to 54 at two years. Twelve percent of tibial implants and 10% of femoral implants with cones were found to have lucency in at least one radiographic zone. Overall survivorship at latest follow up was 93% with two patients requiring revision for infection, two revised following mechanical complications, and one patient who underwent polyethylene exchange after experiencing mechanical complications. When considering only aseptic loosening, survivorship was 100%. CONCLUSION: This 3D-printed titanium femoral and tibial cone augment system showed excellent survivorship, biological fixation, clinical outcomes, and radiographic outcomes in the setting of TKA. Further studies are needed for assessment of long-term survivorship.
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INTRODUCTION: Lumbar spinal fusion (LSF) may increase the risk of dislocation in patients who have undergone total hip arthroplasty (THA), especially when the LSF was done before the THA. Most publications evaluated patients who had undergone THA using a posterior approach to the hip, yet there are little data on the influence of other surgical approaches. The goal of this study was to evaluate the risk of THA dislocation with anterior supine-based surgical approaches to the hip in patients who have undergone surgical management of concurrent hip and spine pathology. METHODS: Patients older than 18 years who underwent an LSF and THA using a supine approach-either direct anterior (DA) or direct lateral (DL)-between 2000 and 2018 were identified. Only standard bearings (28-32-36-40 mm) were used. The dislocation rate was determined in this cohort. A subsequent analysis was conducted, stratifying patients based on the order in which they received the LSF or THA. RESULTS: A total of 582 surgical hip-spine patients were retrospectively identified and included in the cohort. Of total, 332 patients (57.0%) received an LSF before the THA; 250 (43.0%) had the fusion after a primary hip replacement. There were 143 patients (24.6%) in the DA group and 439 (75.4%) in the DL group. Overall, there were five dislocations (0.9%) in the entire cohort. CONCLUSIONS: In patients with simultaneous degenerative hip and lumbar spine pathology, anterior supine-based approaches demonstrate a low (<1%) risk of instability. Given the small number of total dislocation events (n = 5), additional analysis is warranted to assess the effect of different anterior approaches (DA versus DL) or timing of lumbar spinal surgery (before or after THA). LEVEL OF EVIDENCE: Level III.
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Artroplastia de Quadril , Luxação do Quadril , Fusão Vertebral , Luxação do Quadril/cirurgia , Humanos , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversosRESUMO
BACKGROUND: Cemented total knee arthroplasty (TKA) has been shown to have higher failure rates in obese patients, and cementless TKA may provide more durable fixation. This study compared outcomes and survivorship of obese patients undergoing cemented and cementless TKA of the same modern design. METHODS: We identified a consecutive series of 406 primary cementless TKA performed in obese patients with body mass index (BMI) ≥35 kg/m2 in 2013-2018. Each case was matched 1:1 with 406 cemented TKA based on age, sex, BMI, bearing surface, and year of surgery. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Short Form-12 were collected preoperatively, at 6 months and 2 years. Implant survivorship was recorded at mean 4.0 years (range 2.0-7.8). RESULTS: There was no difference in mean BMI between the cemented (38.6 ± 3.4 kg/m2; range, 35-60) and cementless cohorts (38.7 ± 3.3 kg/m2; range, 35-54; P = .706). Both groups had similar final postoperative scores and improvement in scores at 2 years. Furthermore, a similar percentage met the minimal clinically important difference (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, 70.0% vs 71.2%, P = .700; Short Form-12 Physical, 74.1% vs 70.4%, P = .240). Both groups demonstrated high 7-year survivorship free from aseptic revision (99.0% vs 99.5%, P = .665). CONCLUSION: Obese patients with BMI ≥35 kg/m2 undergoing cementless and cemented TKA of the same modern design had similar outcomes and survivorship at early to mid-term follow-up. Continued surveillance of this high-risk population is necessary.
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Artroplastia do Joelho , Traumatismos do Joelho , Prótese do Joelho , Osteoartrite , Índice de Massa Corporal , Cimentos Ósseos , Humanos , Obesidade/complicações , Falha de Prótese , Reoperação , Resultado do TratamentoRESUMO
BACKGROUND: Most studies on cementless total knee arthroplasty (TKA) have excluded patients >75 years due to concerns that older patients have poorer bone mineral density and osteogenic activity. This study compared the midterm outcomes and survivorship of cemented and cementless TKA of the same modern design performed in patients >75 years. METHODS: We identified a consecutive series of 120 primary cementless TKA performed in patients >75 years. Each case was propensity score matched 1:3 with 360 cemented TKA of the same modern design based on age, sex, body mass index, Charlson Comorbidity Index, bilateral procedures, liner type, and year of surgery. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and Short Form-12 (SF-12) were collected preoperatively, at 6 months and 2 years. Implant survivorship was recorded at mean 4.2 years (range, 2.0-7.9). RESULTS: Mean age was 79.0 ± 3.4 years (range, 75-92) in the cemented cohort and 78.9 ± 3.5 (range, 75-91) in the cementless cohort (P = .769). There was no difference in final postoperative scores or improvement in scores at 2 years. The percentage of patients that met the minimal clinically important difference was also similar (KOOS-JR, 68.9% vs 69.2%, P = .955; SF-12 Physical, 71.7% vs 66.7%, P = .299). Seven-year survivorship free from aseptic revision was 99.4% for cemented knees and 100% for cementless knees (log-rank, P = .453). CONCLUSION: Patients over 75 years undergoing cementless or cemented TKA of the same modern design had comparable outcomes and survivorship in the midterm. The theoretical risks of cementless fixation in this age group were not realized in this study.
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Artroplastia do Joelho , Prótese do Joelho , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Cimentos Ósseos , Humanos , Falha de Prótese , Reoperação , Sobrevivência , Resultado do TratamentoRESUMO
Robotic-arm assisted total knee arthroplasty (rTKA) was developed to provide for increased accuracy of component placement compared with conventional manual TKA (mTKA). Whether or not rTKA is cost-effective in a bundled payment model has yet to be addressed. The purpose of this comparative study was to evaluate the short-term clinical outcomes of rTKA and mTKA. We retrospectively reviewed a series of 4,086 consecutive primary TKA performed by one of five surgeons across six different hospitals at our institution from January 2016 to December 2018. Outcomes for rTKA cases (n = 581) and mTKA cases (n = 3,505) were compared using unmatched multivariate analysis and a matched cohort. We analyzed 90-day outcomes, episode-of-care claims data, and short form (SF-12) outcome scores to 2 years postoperatively. In matched bivariate analysis, there was no difference in episode-of-care costs, postacute care costs, complications, 90-day readmission rates, emergency department/urgent care visits, reoperations, and mortality between rTKA and mTKA patients (p > 0.05). Matched patients undergoing rTKA did have a shorter hospital length of stay (1.46 vs. 1.80 days, p < 0.001) and decreased rates of discharge to rehabilitation facilities (5.5 vs. 14.8%, p < 0.001). SF-12 scores were clinically similar. Multivariate analysis demonstrated no differences in any 90-day outcome. We conclude that patients undergoing rTKA have comparable costs, 90-day outcomes, and clinically similar improvements in functional outcome scores compared with mTKA patients. Further study is needed to determine whether rTKA will result in improved implant survivorship and long-term functional outcomes (Level of evidence III).