The effect of HIV prevalence, CD4 counts and disease severity on the outcome of total knee arthroplasty for haemophilic arthropathy: a systematic review and meta-analysis.

PURPOSE: End-stage knee arthropathy is a recognised complication of haemophilia. It is often treated by total knee arthroplasty (TKA), which is more technically challenging in patients with haemophilia (PwH). It remains unclear what factors may predict implant survivorship and deep infection rate. Therefore, we systematically review the evidence regarding TKA survivorship and infection in PwH, compared to the general population, and determine the important factors influencing survivorship, particularly HIV and CD4 + count. METHODS: A systematic literature review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting Kaplan-Meier survivorship for TKA in PwH (PROSPERO CRD42021284644). Meta-analysis was performed for survivorship, and the results compared to < 55-year-olds from the National Joint Registry (NJR). Meta-regression was performed to determine the impact of relevant variables on 10-year survivorship, with a sub-analysis focusing on HIV. RESULTS: Twenty-one studies were reviewed, totalling 1338 TKAs (average age 39 years). Implant survivorship for PwH at 5, 10, and 15 years was 94%, 86%, and 76% respectively. NJR-reported survivorship for males < 55 years was 94%, 90%, and 86%. Survivorship improved over time (1973-2018), and correlated inversely with HIV prevalence. Infection rate was 5%, compared to 0.5-1% in the NJR. Infection was not significantly increased with higher HIV prevalence, and CD4 + count had no effect. Complications were inconsistently reported. CONCLUSION: Survivorship was similar at 5 years but declined thereafter, and infection rate was six-fold higher. HIV was related to worse survivorship, but not increased infection. Meta-analysis was limited by inconsistent reporting, and standardised reporting is required in future studies.

Is success written in the stars? The effect of zodiac sign on the outcome of total knee arthroplasty.

AIM: There are 12 signs of the zodiac, each attributed with its own specific personality traits, desires and attitudes. The aim of the study was to evaluate the effect of zodiac sign on patient-reported outcome measures (PROMS) following primary total knee arthroplasty (TKA). METHOD: Patients undergoing primary TKA during a 2-year period (January 2019 to December 2020) were identified retrospectively. Patient demographics, Oxford Knee Score (OKS), EuroQol 5-dimension (EQ-5D) (baseline, 1 and 2 years) and patient satisfaction scores (1 and 2 years) were collected. Each patient's zodiac sign was assigned from their date of birth. RESULTS: There were 509 patients (228 males [44.8%] and 281 females [55.2%]) with a mean age of 70.9 years and a mean BMI of 30.3. There were no significant differences in gender (p=0.712), age (p=0.088), BMI (p=0.660), or pre-operative OKS (p=0.539). Aries and Gemini (0.366) had the worst and Pisces the best (0.595) pre-operative EQ-5D scores (p=0.038). When adjusting for confounding, Aries (p=0.031) had a greater improvement in EQ-5D at 1 year, although this was not maintained at 2 years. When adjusting for confounding, Pisceans had significantly less of an improvement in OKS at both 1 (p=0.022) and 2 years (p=0.042) and also had a significantly lower risk of satisfaction at 2 years (odds ratio 0.41, p=0.043). CONCLUSION: Zodiac sign was associated with outcome following TKA. Pisceans had the best pre-operative EQ-5D scores, but the least improvement in the post-operative joint specific score (OKS) and were less likely to be satisfied, despite achieving an equal improvement in their health-related quality of life (EQ-5D). Aries started with the lowest pre-operative EQ-5D scores but achieved the best scores at 1 year. Our study shows that an individual's zodiac sign may serve as a useful predictive factor for functional outcomes and satisfaction following TKA. However, our findings are the result of multiple testing in a large dataset following a data trawl, and correlation does not necessarily equal causation even in a real-world registry.

Mapping analysis to predict the associated EuroQol five-dimension three-level utility values from the Oxford Knee Score : a prediction and validation study.

AIMS: The aims of this study were to assess mapping models to predict the three-level version of EuroQoL five-dimension utility index (EQ-5D-3L) from the Oxford Knee Score (OKS) and validate these before and after total knee arthroplasty (TKA). METHODS: A retrospective cohort of 5,857 patients was used to create the prediction models, and a second cohort of 721 patients from a different centre was used to validate the models, all of whom underwent TKA. Patient characteristics, BMI, OKS, and EQ-5D-3L were collected preoperatively and one year postoperatively. Generalized linear regression was used to formulate the prediction models. RESULTS: There were significant correlations between the OKS and EQ-5D-3L preoperatively (r = 0.68; p < 0.001) and postoperatively (r = 0.77; p < 0.001) and for the change in the scores (r = 0.61; p < 0.001). Three different models (preoperative, postoperative, and change) were created. There were no significant differences between the actual and predicted mean EQ-5D-3L utilities at any timepoint or for change in the scores (p > 0.090) in the validation cohort. There was a significant correlation between the actual and predicted EQ-5D-3L utilities preoperatively (r = 0.63; p < 0.001) and postoperatively (r = 0.77; p < 0.001) and for the change in the scores (r = 0.56; p < 0.001). Bland-Altman plots demonstrated that a lower utility was overestimated, and higher utility was underestimated. The individual predicted EQ-5D-3L that was within ± 0.05 and ± 0.010 (minimal clinically important difference (MCID)) of the actual EQ-5D-3L varied between 13% to 35% and 26% to 64%, respectively, according to timepoint assessed and change in the scores, but was not significantly different between the modelling and validation cohorts (p ≥ 0.148). CONCLUSION: The OKS can be used to estimate EQ-5D-3L. Predicted individual patient utility error beyond the MCID varied from one-third to two-thirds depending on timepoint assessed, but the mean for a cohort did not differ and could be employed for this purpose. Cite this article: Bone Jt Open 2022;3(7):573-581.