Liver Disease Increases the Risk of Postoperative Complications in Patients Undergoing Aseptic Revision Total Hip and Knee Arthroplasty.

Background: Due to the multiorgan effects of liver disease, surgical patients with liver disease have an increased risk of perioperative complications. With revision total hip and knee arthroplasty surgeries increasing, it is important to determine the effects of liver disease in this patient population. The purpose of this study was to evaluate the impact of underlying liver disease on postoperative outcomes following revision total joint arthroplasty (TJA). Methods: The National Surgical Quality Improvement Program database was used to identify patients undergoing aseptic revision TJA from 2006-2019 and group them based on liver disease. The presence of liver disease was assessed by calculating the Model for End-Stage Liver Disease-Sodium score. Patients with a Model for End-Stage Liver Disease-Sodium score of > 10 were classified as having underlying liver disease. In this analysis, differences in demographics, comorbidities, and postoperative complications were assessed. Results: Of 7102 patients undergoing revision total hip arthroplasty, 11.6% of the patients had liver disease. Of 8378 patients undergoing revision total knee arthroplasty, 8.4% of the patients had liver disease. Following adjustment on multivariable regression analysis, patients with liver disease undergoing revision total hip arthroplasty or revision total knee arthroplasty had an increased risk of major complications, wound complications, septic complications, bleeding requiring transfusion, extended length of stay, and readmission compared to those without liver disease. Conclusions: Patients with liver disease have an increased risk of complications following revision TJA. A multidisciplinary team approach should be employed for preoperative optimization and postoperative management of these vulnerable patients to improve outcomes and decrease the incidence and severity of complications. Level of evidence: This is retrospective cohort study and is level 3 evidence.

Identifying high-risk groups for deep vein thrombosis after primary total knee arthroplasty using preoperative Caprini scores and D-dimer levels.

BACKGROUND: Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce. METHODS: In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively. RESULTS: Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1-2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1 mg/L, higher than the 8.98% in those with levels of < 0.5 mg/L, and 10.61% in those with levels 0.5-1 mg/L (P < 0.05). In patients with Caprini scores of 1-2 and D-dimer levels ≤ 0.5 mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0 mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group. CONCLUSION: Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0 mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions to mitigate the risk of DVT.

Incidence and risk factors for chronic pain following primary total knee arthroplasty in an irish surgical population.

OBJECTIVES: To identify the incidence and characteristics of chronic post-surgical pain (CPSP) following total knee arthroplasty and determine peri-operative influencing factors. METHODS: A representative, retrospective random sample was taken of patients who underwent total knee arthroplasty in the South Infirmary University Hospital Cork for an 18-month period. Two hundred fourteen patient charts were reviewed out of a total of 507 charts for that period to provide a 90% confidence interval. RESULTS: The incidence of CPSP in an Irish population 6 months after total knee arthroplasty was found to be 36.5%. The following factors were found to be statistically significant with respect to the incidence of CPSP: female sex, lack of multimodal analgesia (consisting of paracetamol, NSAID, and opioids), general anaesthesia, and lower Oxford Knee Scores at 6 months post-surgery. Age, the knee operated on, ASA grade, or greatest acuity pain, were not found to be statistically significant factors in the development of CPSP. CONCLUSIONS: CPSP is common after total knee arthroplasty with an incidence of 36.5% at 6 months post procedure. Female sex, lack of multimodal analgesia, and lower Oxford Knee Scores were associated with increased CPSP.

Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up.

INTRODUCTION: The total number of total knee arthroplasty performed is rising, and the number of revisions is rising accordingly. Periprosthetic joint infection emerged in recent years as a leading cause of total knee revisions. Bone loss is a real challenge when facing septic knee revisions since radical debridement is crucial to overcome infection. Many devices have already demonstrated to reliably address bone loss and guarantee enhanced fixation. However, the role of balancing metaphyseal fixation and its interplay with the level of constraint has not been elucidated yet. MATERIAL AND METHODS: An institutional arthroplasty registry was retrospectively reviewed looking for patients who underwent two-stage revision of the knee and metaphyseal cones implantation. Patients were divided into two groups based on the presence of cones only on one side (femoral or tibial, Group U) or both femoral and tibial side (Group B). Failure, aseptic loosening, and revision rates were compared between groups, as were values of patient-reported outcome measure. Kaplan-Meier analysis was used to assess survival of implants. RESULTS: A total of 65 patients were included in the analysis and were evaluated at a mean final follow-up of 4 years (range, 2-7). Mean age was 67 (range, 43-81) years. Mean BMI was 27.4 (range, 20-37) kg/m2. The overall mean KSS, OKS, ROM significantly increased from baseline values to last follow-up (p < 0.001). Kaplan-Meier analysis demonstrated that patients included in Group U had a significantly lower rate of implant survival compared to those included in Group B. CONCLUSIONS: Patients undergoing revision total knee arthroplasty for periprosthetic infection present considerable rates of complication and failure. Management of bone loss represents a concern for the surgeon, who must achieve a stable fixation. Our study demonstrated that implants characterized by an unbalanced metaphyseal fixation are at higher risk of aseptic loosening and consequent revision, especially when coupled with hinged inserts.

Comparative analysis of medial pivot vs. posterior stabilized total knee arthroplasty in patients with valgus deformed osteoarthritic knees: a retrospective cohort study.

PURPOSE: Total knee arthroplasty (TKA) is highly effective for end-stage knee osteoarthritis, providing long-term benefits and anticipated increased prevalence. The study compares Medial Pivot TKA's (MP-TKA) historical success for varus deformities with recent findings suggesting comparable outcomes for valgus deformities. Despite prevalent use of Posterior Stabilized TKA (PS-TKA) for valgus deformities, this research explores the unexplored comparative efficacy of MP-TKA vs. PS-TKA in knee osteoarthritis patients with valgus deformity. METHODS: This single-centre cohort study focused on 57 knees in 53 patients undergoing TKA for knee osteoarthritis with valgus deformity. Conducted between January 2013 and April 2021, the study compared MP-TKA and PS-TKA. Surgeries adhered to a medial parapatellar approach and modified gap technique, with perioperative interventions for pain, bleeding, and swelling. Outcome measurements included knee joint range of motion, radiographic evaluation, patients-reported outcomes, operative time, blood laboratory tests, estimated blood loss, and postoperative adverse events, and analyzed between the two groups. RESULTS: Postoperative hip-knee-ankle angles showed no significant difference between MP-TKA and PS-TKA. The pie crust technique was similarly used in both groups, and deformity correction showed no significant difference. Range of motion and clinical outcomes, measured by WOMAC and JOA scores, were comparable postoperatively. MP-TKA had a shorter surgical duration (p = 0.01), and PS-TKA exhibited higher estimated blood loss (p = 0.01) without significant complications in either group. CONCLUSIONS: This pioneering study compares the outcomes of MP TKA and PS TKA in patients with valgus-deformed osteoarthritic knees. Compared to PS TKA, MP TKA shows a prolonged operative duration and increased blood loss, likely due to the requirement for patellar replacement. However, postoperative range of motion and clinical outcomes are similar. Both groups exhibit favorable midterm clinical results, supporting the viability of MP TKA for valgus deformed knees. The study, consistent in surgical approach, highlights MP TKA's effectiveness for valgus deformities.

Evaluation of a radiological grading system for the early detection of total knee arthroplasties at risk for revision surgery.

INTRODUCTION: X-rays are regularly performed after primary total knee arthroplasty (TKA). While soft tissue management and ligament tension cannot be evaluated, important information, such as inadequate component positioning and loose cement location, as well as subsequent loosening, can be detected. The aim of this study was to correlate radiological findings, referring to the radiological grading system (previously published by the same study group, henceforth abbreviated as "RGS"), with long-term outcomes and implant survival. MATERIALS AND METHODS: A total of 266 patients who underwent titanium-coated TKA were included. In addition to implant survival, visual analogue scale score, Tegner activity score, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, and short form-12 score as well as range of motion were evaluated. Clinical examination as well as anterior-posterior, lateral, full-length weight bearing, and patellar view radiographs were performed pre- and postoperatively, at the 3-, 6-, and 12-month postoperative follow-ups and at the final follow-up. The radiological grading system was evaluated and correlated with long-term outcome and survivorship. RESULTS: The revision-free survival rate was 88.4% at a median follow-up of 9.8 years (IQR: 9.3-10.3 years; range: 0.1-11.8 years). Revision surgery was required in 31 TKAs (11.7%). The multivariate Cox regression model showed a significant association between an RGS score ≥ 3 deviation points (DP) and an increased risk for revision (hazard ratio: 2.092; 95% CI: 1.020-4.290; p = 0.044). Moreover, the KSS for pain was significantly worse in patients with a RGS score ≥ 3 DP (median, 85 [74-92] vs. 90 [80-94]; p = 0.007). CONCLUSIONS: This is the first study indicating that deviation in component positioning, having an inadequate long leg axis, the presence of free cement or residual bony structures on postoperative X-rays significantly correlate with TKA outcome and implant survival. Therefore RGS can be of high predicable value for the survivorship of the prosthesis. LEVEL OF EVIDENCE: Level IV - retrospective cohort study.

Conversion of Tibial Plateau Fractures to Total Knee Arthroplasty is Associated With Worse Patient-Reported Outcomes, Increased Operative Times, and Increased Complications.

BACKGROUND: Prior open reduction and internal fixation (ORIF) of tibial plateau fracture (TPF) adds complexity to subsequent total knee arthroplasty (TKA). The purpose of this study was to compare the outcomes of patients undergoing a TKA following prior ORIF of TPF to patients undergoing a primary TKA for osteoarthritis and an aseptic revision TKA. METHODS: There were 52 patients who underwent primary TKA following prior ORIF of TPF between January 2009 and June 2021, who were included and matched in a 1:4 ratio to 208 patients undergoing primary TKA. A second 1:1 matched comparison to 52 aseptic revision TKA patients was also included. The Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores were obtained preoperatively and at two years postoperatively. Independent t-tests and Chi-square tests were used for statistical comparisons. RESULTS: The TPF patients were significantly younger than both primary and revision cohorts (55 ± 14.0 versus 63 ± 16.3 versus 64 ± 9.5, P < 0.001). Compared to primary TKA patients, the TPF group had worse Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores at two years (46.9 ± 18.5 versus 66.2 ± 17.8, P = 0.0152), higher rates of wound complications (15.4 versus 3.9%, P = 0.0020), and increased operative times (140.2 ± 45.3 versus 95.2 ± 25.7, P < 0.0001). Additionally, TPF patients were more likely to require a manipulation under anesthesia than both primary and revision patients (21.2 versus 5.8 versus 5.8%, P = 0.001). CONCLUSIONS: The TKAs following ORIF of TPF are more like revision TKAs than primary TKAs in terms of patient-reported outcomes, operative times, and wound complications. The rate of manipulation under anesthesia was higher than in both matched groups. These findings provide valuable information that can affect preoperative patient education and postoperative management regimens. They also emphasize the need for a conversion TKA code due to increased complexity and complications seen in this more difficult subset of TKAs.

Association of intraoperative medial joint gap laxity in the flexion position with subjective knee instability after fixed-bearing posterior-stabilised total knee arthroplasty.

BACKGROUND: Postoperative subjective knee instability is an important clinical outcome after total knee arthroplasty (TKA), however the association with intraoperative soft tissue balance remains unclear. This study aimed to assess the association between intraoperative soft tissue balance and postoperative subjective knee instability in fixed-bearing posterior-stabilised (PS) TKA. METHODS: This retrospective case-control study included 457 patients who underwent fixed-bearing PS TKA. Intra-articular distraction force was quantitatively applied to measure the gap parameters (length and angle) during surgery. The intraoperative joint gap parameters and postoperative clinical outcomes between the patients with (n = 90) and without (n = 367) subjective knee instability were compared. The risk factors for subjective postoperative knee instability were analysed using multivariate logistic regression analysis. RESULTS: The patients with subjective knee instability demonstrated a medially wider intra-articular gap angle and worse Knee Society Score 2011 symptoms (18 vs. 21; p < 0.01), satisfaction (27 vs. 30; p < 0.01), functional activity (55 vs. 65; p < 0.01), and Forgotten Joint Score 12 items (51 vs. 65; p < 0.01) than those in the patients without subjective knee instability. The use of measured resection technique (odds ratio, 2.3; 95% CI, 1.1-4.8; p = 0.02) and the medial laxity of joint gap balance in the flexion position (odds ratio, 1.2; 95% CI, 1.0-1.4; p = 0.04) were detected as risk factors for postoperative subjective knee instability. CONCLUSION: In fixed-bearing PS TKA, intraoperative medial joint laxity in the flexion position was associated with postoperative subjective knee instability, and surgical techniques to achieve sufficient soft tissue balance contributed to improve postoperative subjective clinical outcomes. LEVEL OF EVIDENCE: Ⅲ (case-control study).

Progress in Computer-Assisted Navigation for Total Knee Arthroplasty in Treating Knee Osteoarthritis with Extra-Articular Deformity.

Total knee arthroplasty (TKA) is a well-established treatment for end-stage knee osteoarthritis. However, in patients with concomitant extra-articular deformities, conventional TKA techniques may lead to unsatisfactory outcomes and higher complication rates. This review summarizes the application of navigated TKA for treating knee osteoarthritis with extra-articular deformities. The principles and potential benefits of computer navigation systems, including improved component alignment, soft tissue balancing, and restoration of mechanical axis, are discussed. Research studies demonstrate that navigated TKA can effectively correct deformities, relieve pain, and improve postoperative joint function and quality of life compared with conventional methods. The advantages of navigated TKA in terms of surgical precision, lower complication rates, and superior functional recovery are highlighted. Despite challenges like the learning curve and costs, navigated TKA is an increasingly indispensable tool for achieving satisfactory outcomes in TKA for knee osteoarthritis patients with extra-articular deformities.

Influencing factors on the quality of recovery after total knee arthroplasty: development of a predictive model.

Introduction: Total Knee Arthroplasty (TKA) is a widely performed procedure that significantly benefits patients with severe knee degeneration. However, the recovery outcomes post-surgery can vary significantly among patients. Identifying the factors influencing these outcomes is crucial for improving patient care and satisfaction. Methods: In this retrospective study, we analyzed 362 TKA cases performed between January 1, 2018, and July 1, 2022. Multivariate logistic regression was employed to identify key predictors of recovery within the first year after surgery. Results: The analysis revealed that Body Mass Index (BMI), age-adjusted Charlson Comorbidity Index (aCCI), sleep quality, Bone Mineral Density (BMD), and analgesic efficacy were significant predictors of poor recovery (p < 0.05). These predictors were used to develop a clinical prediction model, which demonstrated strong predictive ability with an Area Under the Receiver Operating Characteristic (AUC) curve of 0.802. The model was internally validated. Discussion: The findings suggest that personalized postoperative care and tailored rehabilitation programs based on these predictors could enhance recovery outcomes and increase patient satisfaction following TKA.

Angle Accuracy of Intramedullary Bone Resection Guides for Total Knee Arthroplasty.

The importance of proper prosthetic placement has been confirmed in numerous studies. The objective of this study was to compare the planned resection angles to the verified intraoperative angles of femoral and tibial varus/valgus, tibial slope, and femoral flexion for each total knee performed using intramedullary (IM) cut guides for both distal femur and proximal tibia cuts. A total of 1,000 total knee arthroplasties (TKAs) were evaluated for this study. Intraoperative cut-check technology was used to show real-time validation of these resection angles. Assuming an acceptable range of within 2° of the planned cuts, results show the femoral varus/valgus angles were 75% accurate, the femoral flexion angles were 50.8% accurate, the tibial cuts were 95.2% accurate in the coronal plane, and the tibial slope was the least accurate with only 50.3% within the acceptable range. This showed that IM guides are reasonably accurate in producing desired angles in the coronal plane but less accurate in the sagittal plane, with a greater number of outliers in femoral flexion and posterior slope. Surgeons need to be aware of potential cutting errors when using IM guides as they affect the overall alignment of the implant, and real-time verification technology is available to verify the accuracy of the cuts.

Analysis of causes for revision in unicompartmental knee arthroplasty.

The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty (UKA) in their patients. These factors include substandard suturing of the wound, the presence of osteophytes and intra-articular loose bodies causing impingement, premature loosening of the tibial component, choosing unsuitable patients for the procedure, dislocation of the movable insert, and damage to the anterior cruciate ligament and medial collateral ligament. The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.

Life-Threatening Transfusion Reaction in Postoperative Total Knee Arthroplasty: A Unique Case and Comprehensive Insights.

Introduction: Blood transfusions are essential for managing blood loss in surgical patients but can lead to life-threatening reactions. This report presents a severe transfusion reaction in a postoperative total knee arthroplasty (TKA) patient, emphasizing the need for vigilant monitoring and timely intervention. Case Report: A 70-year-old male with a history of bilateral knee pain underwent right-sided TKA. Preoperative evaluations were normal. Post-surgery, significant blood loss led to a one-pint packed red blood cell transfusion. The patient developed fever, chills, palpitations, and rapid breathing, indicating a transfusion reaction. Despite immediate treatment, the patient's condition deteriorated, requiring ICU admission. Complications included acute kidney injury (AKI), metabolic acidosis, thrombocytopenia, pleural effusion, and aspiration pneumonitis. Multiple organ dysfunction syndrome (MODS) developed, necessitating hemodialysis. Despite comprehensive care, the patient passed away. Conclusion: This case highlights the critical need for rigorous pre-transfusion screening, vigilant monitoring, and immediate intervention in managing severe transfusion reactions in postoperative TKA patients. Comprehensive patient care strategies are essential to mitigate the multifocal complications associated with transfusion reactions. Additional research is needed to understand and prevent such life-threatening reactions.

Episode-of-care costs of total knee arthroplasty: Outpatient versus inpatient postoperative care protocol.

BACKGROUND: Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in North America. Few studies have successfully evaluated the episode-of-care cost (EOCC) of common elective orthopedic procedures using an activity-based costing (ABC) framework. The objective of this study is to compare the EOCC of same-day discharge versus inpatient TKA using an activity-based costing methodology. METHODS: An observational case-control study was conducted comparing the EOCC of 25 consecutive patients who underwent same-day discharge (SDD) TKA and 25 consecutive patients who underwent same-day admission (SDA) TKA at an academic center. The EOCC was generated using an ABC framework. RESULTS: The median total EOCC for outpatient TKA was $7,243.26 CAD (IQR=614.12), while the median EOCC in the inpatient group was $8,303.94 CAD (IQR=1,157.77). The costs incurred secondary to the hospital admission were the main driver of the increased cost for inpatients. The mean length of stay for admitted patients was 2.45 days (SD=1,52). Patients in the outpatient group were younger (p < 0.01) and had a lower mean Charlson Comorbidity Index group (p = 0.01). There was no significant difference in gender, BMI, ASA scores, and complication rates between the two groups. CONCLUSION: Through the application of an ABC framework, this value-based healthcare study demonstrates that outpatient procedures are a cost-effective approach to knee arthroplasty. Our findings demonstrate that the total cost of outpatient TKA was on average 15% ($1,060 CAD) lower than the cost of TKA with the standard inpatient postoperative care protocol.

Factors Influencing the Postoperative Flexion Angle in Cruciate-Sacrificing Rotating Platform of Total Knee Arthroplasty.

BACKGROUND: Various factors affect the improvement of range of motion (ROM) after total knee arthroplasty (TKA). However, there are few reports specific to cruciate-sacrificing rotating platform (CSRP) TKA. In this study, factors affecting postoperative ROM improvement of CSRP TKA were investigated. METHODS: The study included 79 patients with knee osteoarthritis who underwent unilateral CSRP TKA at our institution. The group with an improvement of 5° or more (Δflexion angle) than the preoperative was defined as the good Δflexion group (38 knees), and that with less than 5° was defined as the poor Δflexion group (41 knees). The assessments were performed one day before and one year after surgery. Factors including rest and walking pain, knee flexion and extension angle, isometric knee extension strength, the five subscales of Knee injury and Osteoarthritis Outcome Score (KOOS), α, ß, γ and δ angles, femoro-tibial angle (FTA), and condylar twist angle were assessed. Unpaired t-test, Mann-Whitney U test, and Chi-square test were used to test differences between the good and poor Δflexion groups. Multiple logistic regression examined the association between each factor and the dependent variables (good Δflexion or poor Δflexion). RESULTS: Significant differences in the preoperative knee flexion, postoperative knee flexion, preoperative knee extension, and postoperative knee extension angles, postoperative KOOS pain and activity of daily living, ß, ɤ angles were observed between the good and poor Δflexion groups. The model Chi-squared test revealed that the ɤ angle was significantly affected by the Δflexion angle. CONCLUSIONS: With the CSRP TKA, flexion insertion of the femoral component was associated with postoperative flexion ROM improvement.

No Difference in 30-day Mortality Between Patients Undergoing Bilateral Simultaneous Total Knee Arthroplasty With Technology Assistance Compared to Conventional Instrumentation.

Background: Bilateral simultaneous total knee arthroplasty (BSTKA) has decreased in frequency due to concerns about higher rates of early mortality and complications than unilateral or staged surgeries. Purpose: We sought to evaluate whether technology assistance (encompassing robotics and computer assistance) decreases early mortality following BSTKA. Methods: We conducted a retrospective cohort study using a national all-payer claims database. Patients who underwent BSTKA from October 2015 to December 2020 were identified. Univariate and multivariable analyses were conducted to compare outcomes in patients who underwent BSTKA with technology assistance compared to conventional instrumentation. The primary outcome was 30-day postoperative mortality. Secondary outcomes were respiratory failure and fat embolism. A post-hoc analysis was performed to evaluate length of stay, readmission, and other medical complications. Results: A total of 14,870 patients who underwent BSTKA were included in this study. Of these, 860 patients underwent technology-assisted BSTKA, and 14,010 patients underwent BSTKA without technology assistance. After a multivariable analysis, patients who underwent technology-assisted BSTKA had equivalent odds of 30-day mortality compared to those who underwent BSTKA without technology assistance. Technology assistance was not protective against the development of acute respiratory failure or fat embolism. Conclusion: This retrospective cohort study found no differences in the rates of 30-day mortality, respiratory failure, or fat embolism after technology-assisted BSTKA compared to conventional BSTKA. On the post-hoc analysis, technology use was associated with a decreased length of stay, lower readmission risk, and decreased rates of deep vein thrombosis, pulmonary embolism, and blood transfusion.

Comparative efficacy of aspirin versus direct oral anticoagulants for venous thromboembolism prophylaxis following primary total hip arthroplasty or total knee arthroplasty: A systematic review and meta-analysis of randomised controlled trials.

Introduction: Venous thromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary embolisms (PE), are common after total knee (TKA) and hip arthroplasty (THA). Recent studies suggest that aspirin effectively prevents VTE following major orthopaedic surgery. This meta-analysis compares randomised controlled trials (RCTs) evaluating aspirin versus direct oral anticoagulants (DOACs) for VTE prevention after primary THA and TKA. Methods: We included RCTs from 2017 to 2023 that looked at aspirin versus DOACs for VTE prophylaxis in primary THA and TKA. A search strategy was conducted which used Boolean operators and MESH terms. Primary outcomes included VTE rates, symptomatic, asymptomatic DVT and PE. Secondary outcomes were mortality and bleeding complications. Statistical analysis was performed using REVMAN software. An odds ratio with a 95% confidence interval was generated for the pooled studies. Heterogeneity was assessed using the I 2 variable, and publication bias was evaluated with a funnel plot. Results: Seven RCTs with 3967 patients were included for analysis. Rivaroxaban 10 mg OD was compared to varying doses of aspirin (81-300 mg). There were no significant differences between the groups in the incidence of VTE (OR: 1.21, 95% CI: 0.72-2.01), PE (OR: 1.01, 95% CI: 0.39-2.61), asymptomatic DVT (OR: 1.39, 95% CI: 0.64-3.00), suspected DVT (OR: 1.13, 95% CI: 0.49-2.61) and major bleeding (OR: 0.84, 95% CI: 0.55-1.27). Discussion: Aspirin is as effective as rivaroxaban for primary thromboprophylaxis post-THA and TKA, without increased incidence of complications. Further research is needed to determine the optimal dosing regimen of aspirin and its long-term efficacy in preventing VTE. Level of Evidence: Level I.

Short-term survival of the cementless triathlon total knee arthroplasty in a young patient cohort.

BACKGROUND: The purpose of this study is to assess the short-term survivorship of a new cementless total knee arthroplasty (TKA) design in comparison to its cemented predecessor design in a young patient cohort less than 65 years of age. METHODS: We performed a retrospective cohort study of all primary TKAs (cemented and cementless) in patients under the age of 65 at the time of the index procedure, in a single institution between May 2018 and May 2019. Primary outcome variables included aseptic revision and all-cause revision. Operative time was a secondary variable. Independent variables considered included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, implant type (cruciate-retaining (CR) or posterior-stabilised (PS)) and the use of cemented or cementless implants. RESULTS: There were 106 cemented TKAs and 152 cementless TKAs (Triathlon, Stryker Inc, Mahwah, NJ ) implanted. The minimum follow-up for all cases was 2 years (mean cementless 32.5 months, mean cemented 34.9 months). Of the entire 258 implants only 2 were revised. Both revisions occurred in the cemented cohort for prosthetic joint infection (PJI). The all-cause revision rate in the cementless cohort was 0% compared to 1.8% in the cemented cohort (p = 0.168). Operative times were significantly reduced from 62 min in the cemented cohort to 52.2 min in the cementless cohort (p < 0.001). CONCLUSION: In a young patient cohort, the cementless Triathlon TKA demonstrates excellent survivorship at short-term follow-up with significant reductions in operative times when compared to the cemented Triathlon TKA.

Conversion of UKA to TKA using identical standard implants-How does it compare to primary UKA, primary TKA and revision TKA?

BACKGROUND: UKA is a well-established treatment option for anteromedial osteoarthritis of the knee, resulting in superior functional outcomes but also higher revision rates than TKA. This study aimed to compare the outcomes of UKA, TKA, UKA converted to TKA using identical standard implants and revised TKA to support clinical decision-making. METHODS: In this study, we retrospectively examined 116 patients who underwent UKA, 77 patients who received TKA, 28 patients whose UKA was converted to TKA using identical standard implants, and 21 patients who had a one-stage revision of TKA. The mean age at operation was 66.5 years (39-90 years), with a mean BMI of 28.8 kg/m2 (17.4-58.8) and a mean follow-up period of four years (0.9-9.9 years). We assessed various PROMs, including Oxford Knee Score, UCLA score, KSS score, and a modified WOMAC-Score as well as patient satisfaction and ability to resume daily activities, work, and sports. RESULTS: The highest patient satisfaction was seen in the UKA. All scores were significantly higher for UKA than for TKA, converted UKA, and revised TKA. None of the scores showed a significant inferiority of converted UKA to TKA. In the case of revision, two scores showed significantly better results for converted UKA than for revised TKA. CONCLUSIONS: Our results indicated that patients initially treated with UKA did not have significantly worse functional outcomes after conversion to TKA, given the use of identical standard implants. This highlights the effectiveness of UKA as a therapeutic option with outcomes superior to those of primary TKA and the importance of a bone-sparing procedure. Conversely, revision TKA is linked to poorer functional outcomes compared to both primary arthroplasties.

Systematic review and meta-analysis of long term outcomes and innovations in Total Knee Arthroplasty: KINEMATIC, PERSONALIZED KNEE vs. CONVENTIONAL.

Background: Kinematic alignment is an emerging approach for total knee arthroplasty, with the aim to restore patient's individual pre-arthritic joint kinematics. In this systematic review and meta-analysis, we compared the kinematic alignment with the conventional mechanical alignment for total knee arthroplasty. Methods: We searched PubMed, Web of Science, Cochrane Library, and Scopus on June 2, 2024. We screened the retrieved studies for eligibility. Then extracted the data from the included studies, and then pooled the data as mean difference (MD) or odds ratio (OR) with a 95% confidence interval using Review Manager Software (ver. 3.5). Results: There was no significant difference between KA and MA in the different reported scores: combined KSS score at 6 months (P = 0.23) and 1 years (P = 0.60), KSS Patient satisfaction (P = 0.33), KSS function score (P = 0.07), Oxford score at 6 months (P = 0.45) and 2 years (P = 0.41), KOOS score (P = 0.26). Moreover, there was statistically significant difference in range of motion for flexion and extension at 1 and 2 years, incision length, the length of hospital stay, or the duration of surgery. Conclusion: Although kinematic alignment showed slightly better clinical outcomes than mechanical alignment, the difference between the two techniques is not statistically significant.