{"title":"Letter to the Editor on \"A Longitudinal Analysis of Weight Changes before and after Total Knee Arthroplasty: Weight Trends, Patterns, and Predictors\".","authors":"Daniel L Riddle","doi":"10.1055/a-2411-0835","DOIUrl":"10.1055/a-2411-0835","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Yu, Vidushi Tripathi, Patrick Magahis, Michael Ast, Peter K Sculco, Ajay Premkumar
Introduction: Randomized controlled trial (RCT) studies in revision total joint arthroplasty (rTJA) are essential to investigate the effectiveness of interventions. However, there has been limited research investigating how patient cohorts comprising rTJA RCT samples resemble the US patient population undergoing rTJA in terms of demographic and clinical characteristics. Thus, the purpose of this systematic review was to compare the patient characteristics of rTJA RCT cohorts with the characteristics of national patient database cohorts.
Methods: RCT studies for rTJA were aggregated. Patient demographics in this group were compared against HCUP NIS and ACS-NSQIP patient cohorts.
Results: Forty-six RCTs met inclusion criteria. There were 3,780 total patients across 46 RCTs. The average age of patients in the rTJA RCT cohort was 66.4 9.4 while the NIS cohort was 67.3 11.1 (d=0.08, effect size=small). The average BMI of the rTJA RCT cohort was 31.1 5.7 while the NSQIP cohort was 31.7 8.3 (d=0.08, effect size=small). For rTJA, effect sizes for age, BMI, sex, ethnicity, smoking, and diabetes were all small or very small.
Conclusions: Overall, the rTJA RCT patient cohort does not differ significantly compared to the general patient population undergoing rTJA. Differences in demographic and clinical characteristics between the rTJA RCT cohort and database cohorts were minimal to small, indicating that these differences are unlikely to impact clinical outcomes.
{"title":"Characterization and Potential Relevance of Randomized Controlled Trial Patient Populations in Revision Total Joint Arthroplasty: A Systematic Review.","authors":"Jonathan Yu, Vidushi Tripathi, Patrick Magahis, Michael Ast, Peter K Sculco, Ajay Premkumar","doi":"10.1055/a-2428-1058","DOIUrl":"https://doi.org/10.1055/a-2428-1058","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trial (RCT) studies in revision total joint arthroplasty (rTJA) are essential to investigate the effectiveness of interventions. However, there has been limited research investigating how patient cohorts comprising rTJA RCT samples resemble the US patient population undergoing rTJA in terms of demographic and clinical characteristics. Thus, the purpose of this systematic review was to compare the patient characteristics of rTJA RCT cohorts with the characteristics of national patient database cohorts.</p><p><strong>Methods: </strong>RCT studies for rTJA were aggregated. Patient demographics in this group were compared against HCUP NIS and ACS-NSQIP patient cohorts.</p><p><strong>Results: </strong>Forty-six RCTs met inclusion criteria. There were 3,780 total patients across 46 RCTs. The average age of patients in the rTJA RCT cohort was 66.4 9.4 while the NIS cohort was 67.3 11.1 (d=0.08, effect size=small). The average BMI of the rTJA RCT cohort was 31.1 5.7 while the NSQIP cohort was 31.7 8.3 (d=0.08, effect size=small). For rTJA, effect sizes for age, BMI, sex, ethnicity, smoking, and diabetes were all small or very small.</p><p><strong>Conclusions: </strong>Overall, the rTJA RCT patient cohort does not differ significantly compared to the general patient population undergoing rTJA. Differences in demographic and clinical characteristics between the rTJA RCT cohort and database cohorts were minimal to small, indicating that these differences are unlikely to impact clinical outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashwin Garlapaty, Joshua A Scheiderer, Kylee Rucinski, Steven F DeFroda
Introduction Anterior cruciate ligament (ACL) tears in National Football League (NFL) players are devastating injuries that take nearly a year to recover. Players that do return to sport have worse overall performance compared to pre-ACL tear. NFL players typically play regular season games on Sunday with the next game played on the following Sunday, allowing for 7 days between games. Deviation from the usual 7-day rest week has been proposed as a potential risk for ACL tear. The main objective of this study is to evaluate the risk of decreased rest or increased rest on ACL tear rates in NFL players. Methods ACL injury data of NFL players from the 2012-2013 season and 2022-2023 season were gathered from publicly available sources. Player demographic data, position, age at time of injury, seasons played, injury mechanism, and playing surface type were recorded. Injuries were characterized as short, normal, or long week injuries. ACL tears that occurred during the preseason, postseason, or during week 1 were excluded. Descriptive statistics were calculated to report means, ranges, and percentages. Data were analyzed to determine statistically significant differences using Fisher's exact, chi-square, or one-way ANOVA tests. Results A total of 524 ACL tears were recorded in NFL players during the study window. 304 ACL tears were excluded and 220 fit inclusion criteria. 24 ACL tears occurred during short weeks, 68 during long weeks, and 128 during normal weeks. Players were 1.8 times more likely to tear their ACL during a long week compared to a normal week (p<.001), and 1.5 times more likely to tear their ACL during a short week compared to a normal week (p=.02). Conclusion The findings from this study suggest that deviation from the normal 7-day NFL week increases the risk of an ACL tear in NFL players when increasing or decreasing rest time. Further research exploring the impact short and long rest times on player injury risk should be conducted to prevent season ending injuries.
{"title":"Risk of Anterior Cruciate Ligament Tears in National Football League Players by Short, Normal, or Long Rest Weeks.","authors":"Ashwin Garlapaty, Joshua A Scheiderer, Kylee Rucinski, Steven F DeFroda","doi":"10.1055/a-2428-0119","DOIUrl":"https://doi.org/10.1055/a-2428-0119","url":null,"abstract":"<p><p>Introduction Anterior cruciate ligament (ACL) tears in National Football League (NFL) players are devastating injuries that take nearly a year to recover. Players that do return to sport have worse overall performance compared to pre-ACL tear. NFL players typically play regular season games on Sunday with the next game played on the following Sunday, allowing for 7 days between games. Deviation from the usual 7-day rest week has been proposed as a potential risk for ACL tear. The main objective of this study is to evaluate the risk of decreased rest or increased rest on ACL tear rates in NFL players. Methods ACL injury data of NFL players from the 2012-2013 season and 2022-2023 season were gathered from publicly available sources. Player demographic data, position, age at time of injury, seasons played, injury mechanism, and playing surface type were recorded. Injuries were characterized as short, normal, or long week injuries. ACL tears that occurred during the preseason, postseason, or during week 1 were excluded. Descriptive statistics were calculated to report means, ranges, and percentages. Data were analyzed to determine statistically significant differences using Fisher's exact, chi-square, or one-way ANOVA tests. Results A total of 524 ACL tears were recorded in NFL players during the study window. 304 ACL tears were excluded and 220 fit inclusion criteria. 24 ACL tears occurred during short weeks, 68 during long weeks, and 128 during normal weeks. Players were 1.8 times more likely to tear their ACL during a long week compared to a normal week (p<.001), and 1.5 times more likely to tear their ACL during a short week compared to a normal week (p=.02). Conclusion The findings from this study suggest that deviation from the normal 7-day NFL week increases the risk of an ACL tear in NFL players when increasing or decreasing rest time. Further research exploring the impact short and long rest times on player injury risk should be conducted to prevent season ending injuries.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-05-24DOI: 10.1055/a-2333-1619
Joshua R Giordano, Lucas Bartlett, Fernando Huyke, Puru Sadh, Kiara Thompson, Obinnah Ajah, Jonathan Danoff
The necessity of immediate postoperative radiographs following total knee arthroplasty (TKA) has long been debated. With the increasing use of robotic-assisted TKA (RTKA), and thus more precise implant placement, the need for immediate postoperative radiographs to determine implant positioning may be unnecessary. We sought to evaluate implant position on the immediate postoperative radiographs following RTKA to determine their necessity. A retrospective review of 150 RTKAs was performed. The posterior slopes for all TKAs were recorded based on the preoperative three-dimensional template. Additionally, two independent trained researchers (J.G./L.B.) each measured the posterior slope of the postoperative day 0 (POD0) radiograph and postoperative week 2 radiograph. The difference in posterior slope measurement between template and POD0, between template and postoperative week 2, and between POD0 and postoperative week 2 was calculated. Of the 150 TKAs performed, there were no periprosthetic fractures found on the POD0 radiograph. The mean difference between the templated posterior slope and measured posterior slope on POD0 was 0.04 degrees (standard deviation [SD], 1.01; p = 0.615). There was a weak correlation between the two values (rs [95% confidence interval (CI)], 0.38 [0.21, 0.53]). When comparing the template to the postoperative week 2 radiographs, there was a mean difference of 0.02 degrees (SD, 0.48; p = 0.556). However, a moderate to strong correlation was noted (rs [95% CI], 0.71 [0.61, 0.79]). Comparison of the mean posterior slope from POD0 radiograph to that of postoperative week 2 radiograph showed a mean difference of 0.06 degrees (SD, 1.0; p = 0.427). A weak correlation was found between these two values (rs [95% CI], 0.43 [0.26, 0.56]). Given the accuracy and precision of RTKA, along with the ability to decrease cost and radiation, immediate postoperative radiograph may be unnecessary, when pertaining to the uncomplicated RTKA. However, if there is concern for intraoperative fracture, long stems placed in a revision arthroplasty, or other intraoperative complications, then postoperative radiographs are encouraged.
{"title":"Is Immediate Postoperative Radiograph Necessary Following Robotic-Assisted Total Knee Arthroplasty?","authors":"Joshua R Giordano, Lucas Bartlett, Fernando Huyke, Puru Sadh, Kiara Thompson, Obinnah Ajah, Jonathan Danoff","doi":"10.1055/a-2333-1619","DOIUrl":"10.1055/a-2333-1619","url":null,"abstract":"<p><p>The necessity of immediate postoperative radiographs following total knee arthroplasty (TKA) has long been debated. With the increasing use of robotic-assisted TKA (RTKA), and thus more precise implant placement, the need for immediate postoperative radiographs to determine implant positioning may be unnecessary. We sought to evaluate implant position on the immediate postoperative radiographs following RTKA to determine their necessity. A retrospective review of 150 RTKAs was performed. The posterior slopes for all TKAs were recorded based on the preoperative three-dimensional template. Additionally, two independent trained researchers (J.G./L.B.) each measured the posterior slope of the postoperative day 0 (POD0) radiograph and postoperative week 2 radiograph. The difference in posterior slope measurement between template and POD0, between template and postoperative week 2, and between POD0 and postoperative week 2 was calculated. Of the 150 TKAs performed, there were no periprosthetic fractures found on the POD0 radiograph. The mean difference between the templated posterior slope and measured posterior slope on POD0 was 0.04 degrees (standard deviation [SD], 1.01; <i>p</i> = 0.615). There was a weak correlation between the two values (<i>rs</i> [95% confidence interval (CI)], 0.38 [0.21, 0.53]). When comparing the template to the postoperative week 2 radiographs, there was a mean difference of 0.02 degrees (SD, 0.48; <i>p</i> = 0.556). However, a moderate to strong correlation was noted (<i>rs</i> [95% CI], 0.71 [0.61, 0.79]). Comparison of the mean posterior slope from POD0 radiograph to that of postoperative week 2 radiograph showed a mean difference of 0.06 degrees (SD, 1.0; <i>p</i> = 0.427). A weak correlation was found between these two values (<i>rs</i> [95% CI], 0.43 [0.26, 0.56]). Given the accuracy and precision of RTKA, along with the ability to decrease cost and radiation, immediate postoperative radiograph may be unnecessary, when pertaining to the uncomplicated RTKA. However, if there is concern for intraoperative fracture, long stems placed in a revision arthroplasty, or other intraoperative complications, then postoperative radiographs are encouraged.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Total knee arthroplasty (TKA) is a common surgical procedure to treat end-stage knee osteoarthritis. This study compared blood loss volume and other clinical outcomes between bi-cruciate retaining (BCR) and bi-cruciate stabilized (BCS) TKA. Materials and Methods Ninety-seven participants who underwent unilateral TKA were enrolled. The BCS-TKA and BCR-TKA groups comprised 78 and 19 participants, respectively. Blood loss was calculated using preoperative and postoperative hematocrit values, height, weight, and sex. Measurements were taken immediately after surgery, on days 1 and 7, and total blood loss was calculated up to day 7. Operation time, range of motion at 7 and 14 days postoperatively, blood transfusion requirement, and postoperative complications such as infection, hematoma, and deep vein thrombosis were compared between the groups. Results Blood loss was comparable between groups at all time points (125.7 vs. 105.4 mL, 57.9 vs. 43.5 mL, and 68.2 vs. 41.7 mL for immediate, day 1, and day 7 postoperatively, respectively; all p>0.05) except for total blood loss, which was significantly lower in the BCR group compared with the BCS group (190.7 vs. 251.1 mL; p<0.05). The BCR group also had a longer operation time than the BCS group (131.2 vs. 112.4 min; p<0.05). No other significant differences were observed in other outcomes. Conclusion Total blood loss up to seven days postoperatively was significantly lower in the BCR group than in the BCS group despite a longer operation time. This may be attributed to the reduced bone resection and greater soft tissue preservation, including the anterior cruciate and posterior cruciate ligaments, in the BCR technique. Keywords: total knee arthroplasty, bi-cruciate retaining, bi-cruciate stabilized, blood loss volume, osteoarthritis.
{"title":"Lower blood loss with bi-cruciate retaining total knee arthroplasty compared with bi-cruciate stabilized total knee arthroplasty.","authors":"Takashi Kozu, Takanori Iriuchishima, Keinosuke Ryu, Kazuyoshi Nakanishi","doi":"10.1055/a-2428-1293","DOIUrl":"https://doi.org/10.1055/a-2428-1293","url":null,"abstract":"<p><p>Introduction Total knee arthroplasty (TKA) is a common surgical procedure to treat end-stage knee osteoarthritis. This study compared blood loss volume and other clinical outcomes between bi-cruciate retaining (BCR) and bi-cruciate stabilized (BCS) TKA. Materials and Methods Ninety-seven participants who underwent unilateral TKA were enrolled. The BCS-TKA and BCR-TKA groups comprised 78 and 19 participants, respectively. Blood loss was calculated using preoperative and postoperative hematocrit values, height, weight, and sex. Measurements were taken immediately after surgery, on days 1 and 7, and total blood loss was calculated up to day 7. Operation time, range of motion at 7 and 14 days postoperatively, blood transfusion requirement, and postoperative complications such as infection, hematoma, and deep vein thrombosis were compared between the groups. Results Blood loss was comparable between groups at all time points (125.7 vs. 105.4 mL, 57.9 vs. 43.5 mL, and 68.2 vs. 41.7 mL for immediate, day 1, and day 7 postoperatively, respectively; all p>0.05) except for total blood loss, which was significantly lower in the BCR group compared with the BCS group (190.7 vs. 251.1 mL; p<0.05). The BCR group also had a longer operation time than the BCS group (131.2 vs. 112.4 min; p<0.05). No other significant differences were observed in other outcomes. Conclusion Total blood loss up to seven days postoperatively was significantly lower in the BCR group than in the BCS group despite a longer operation time. This may be attributed to the reduced bone resection and greater soft tissue preservation, including the anterior cruciate and posterior cruciate ligaments, in the BCR technique. Keywords: total knee arthroplasty, bi-cruciate retaining, bi-cruciate stabilized, blood loss volume, osteoarthritis.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. The three common goniometric devices were a universal goniometer, an inclinometer, and a smartphone app. During a single-visit, knee extension ROM was measured in both knees of 92 ACL-injured or -reconstructed patients by two testers blinded to the other's measures. Intrarater, interrater, and test-retest intraclass correlation coefficients (ICC2,1) were calculated. Intrarater ICC2,1 was excellent for the three devices ranging from 0.92 to 0.94, with the inclinometer yielding the best results (ICC2,1 = 0.94 [95% confidence interval, CI: 0.91-0.96]). Interrater ICC2,1, however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95% CI: 0.71-0.86) and 0.79 (95% CI: 0.70-0.86), respectively, whereas the universal goniometer was 0.36 (95% CI: 0.17-0.53). Test-retest ICC2,1 for the inclinometer was 0.89 (95% CI: 0.84-0.93), 0.86 (95% CI: 0.79-0.91) for the app, and 0.83 (95% CI:0.74-0.89) for the goniometer. The intrarater, interrater, and test-retest MDC95 values ranged from 2.0 to 3.5, 3.7 to 10.4, and 2.6 to 5.4 degrees, respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its highest ICC scores among the three devices and ease of use.
{"title":"Inclinometers and Apps Are Better than Goniometers, Measuring Knee Extension Range of Motion in Anterior Cruciate Ligament Patients: Reliability and Minimal Detectable Change for the Three Devices.","authors":"Michail Pantouveris, Roula Kotsifaki, Rodney Whiteley","doi":"10.1055/a-2321-0516","DOIUrl":"10.1055/a-2321-0516","url":null,"abstract":"<p><p>Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. The three common goniometric devices were a universal goniometer, an inclinometer, and a smartphone app. During a single-visit, knee extension ROM was measured in both knees of 92 ACL-injured or -reconstructed patients by two testers blinded to the other's measures. Intrarater, interrater, and test-retest intraclass correlation coefficients (ICC<sub>2,1</sub>) were calculated. Intrarater ICC<sub>2,1</sub> was excellent for the three devices ranging from 0.92 to 0.94, with the inclinometer yielding the best results (ICC<sub>2,1</sub> = 0.94 [95% confidence interval, CI: 0.91-0.96]). Interrater ICC<sub>2,1</sub>, however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95% CI: 0.71-0.86) and 0.79 (95% CI: 0.70-0.86), respectively, whereas the universal goniometer was 0.36 (95% CI: 0.17-0.53). Test-retest ICC<sub>2,1</sub> for the inclinometer was 0.89 (95% CI: 0.84-0.93), 0.86 (95% CI: 0.79-0.91) for the app, and 0.83 (95% CI:0.74-0.89) for the goniometer. The intrarater, interrater, and test-retest MDC<sub>95</sub> values ranged from 2.0 to 3.5, 3.7 to 10.4, and 2.6 to 5.4 degrees, respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its highest ICC scores among the three devices and ease of use.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-06-03DOI: 10.1055/a-2337-2402
Sven E Putnis, Antonio Klasan, Brendan Bott, William Ridley, Bernard Hudson, Myles R J Coolican
Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry. The time between procedures, type of revision strategy, and any subsequent further revision operations were collected. At minimum 2-year follow-up, 174 revision TKA were identified, with a mean patient age of 69 ± 11 years. A broad range of pathogens were identified. Fifty cases (29%) had persistent infection requiring at least one further operative procedure, 13 cases required 3 or more. Coagulase-negative Staphylococcus species (CNS) was seen most with failed surgery, polymicrobial infections also posing a significant risk factor. The best chance of a successful PJI surgical strategy was < 12 months from primary TKA, with the greatest risk between 3 and 5 years (p < 0.05). Younger age significantly increased the risk of further surgery (p < 0.05). Management varied; 103 (59%) debridement, antibiotic therapy and implant retention, with further surgery in 29%; 45 (17%) single-stage revision, with further surgery in 13%; and 26 (15%) two-stage revision, with further surgery in 12%. This study presents the most common causative pathogens for PJI in TKA, and the high rate of persistent infection after initial revision surgery. Risk factors for persistent infection and further revision surgery were polymicrobial and CNS infections, patients who presented between 3 and 5 years following primary TKA, and younger age. This study therefore raises important risk factors and areas for future research to reduce the burden of multiple operations after PJI.
{"title":"The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection.","authors":"Sven E Putnis, Antonio Klasan, Brendan Bott, William Ridley, Bernard Hudson, Myles R J Coolican","doi":"10.1055/a-2337-2402","DOIUrl":"10.1055/a-2337-2402","url":null,"abstract":"<p><p>Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry. The time between procedures, type of revision strategy, and any subsequent further revision operations were collected. At minimum 2-year follow-up, 174 revision TKA were identified, with a mean patient age of 69 ± 11 years. A broad range of pathogens were identified. Fifty cases (29%) had persistent infection requiring at least one further operative procedure, 13 cases required 3 or more. Coagulase-negative <i>Staphylococcus</i> species (CNS) was seen most with failed surgery, polymicrobial infections also posing a significant risk factor. The best chance of a successful PJI surgical strategy was < 12 months from primary TKA, with the greatest risk between 3 and 5 years (<i>p</i> < 0.05). Younger age significantly increased the risk of further surgery (<i>p</i> < 0.05). Management varied; 103 (59%) debridement, antibiotic therapy and implant retention, with further surgery in 29%; 45 (17%) single-stage revision, with further surgery in 13%; and 26 (15%) two-stage revision, with further surgery in 12%. This study presents the most common causative pathogens for PJI in TKA, and the high rate of persistent infection after initial revision surgery. Risk factors for persistent infection and further revision surgery were polymicrobial and CNS infections, patients who presented between 3 and 5 years following primary TKA, and younger age. This study therefore raises important risk factors and areas for future research to reduce the burden of multiple operations after PJI.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-06-12DOI: 10.1055/a-2343-2444
Philip Huang, Michael Cross, Anshu Gupta, Dhara Intwala, Jill Ruppenkamp, Daniel Hoeffel
Robotic-assisted total knee arthroplasty (TKA) has been developed to improve functional outcomes after TKA by increasing surgical precision of bone cuts and soft tissue balancing, thereby reducing outliers. The DePuy Synthes VELYS robotic-assisted solution (VRAS) is one of the latest entrants in the robotic TKA market. Currently, there is limited evidence investigating early patient and economic outcomes associated with the use of VRAS. The Premier Healthcare Database was analyzed to identify patients undergoing manual TKA with any implant system compared with a cohort of robotic-assisted TKAs using VRAS between September 1, 2021 and February 28, 2023. The primary outcome was all-cause and knee-related all-setting revisits within 90-day post-TKA. Secondary outcomes included number of inpatient revisits (readmission), operating room time, discharge status, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. The cohorts included 866 VRAS and 128,643 manual TKAs that had 90-day follow-up data. The rates of both all-cause and knee-related all-setting follow-up visits (revisits) were significantly lower in the VRAS TKA cohort compared with the manual TKA cohort (13.86 vs. 17.19%; mean difference [MD]: -3.34 [95% confidence interval: -5.65 to -1.03] and 2.66 vs. 4.81%; MD: -2.15 [-3.23 to -1.08], respectively, p-value < 0.01) at 90-day follow-up. The incidence of knee-related inpatient readmission was also significantly lower (53%) for VRAS compared with manual TKA. There was no significant difference between total cost of care at 90-day follow-up between VRAS and manual TKA cases. On average, the operating room time was higher for VRAS compared with manual TKA (138 vs. 134 minutes). In addition, the discharge status and revision rates were similar between the cohorts. The use of VRAS for TKA is associated with lower follow-up visits and knee-related readmission rates in the first 90-day postoperatively. The total hospital cost was similar for both VRAS and manual TKA cohort while not accounting for the purchase of the robot.
{"title":"Early Clinical and Economic Outcomes for the VELYS Robotic-Assisted Solution Compared with Manual Instrumentation for Total Knee Arthroplasty.","authors":"Philip Huang, Michael Cross, Anshu Gupta, Dhara Intwala, Jill Ruppenkamp, Daniel Hoeffel","doi":"10.1055/a-2343-2444","DOIUrl":"10.1055/a-2343-2444","url":null,"abstract":"<p><p>Robotic-assisted total knee arthroplasty (TKA) has been developed to improve functional outcomes after TKA by increasing surgical precision of bone cuts and soft tissue balancing, thereby reducing outliers. The DePuy Synthes VELYS robotic-assisted solution (VRAS) is one of the latest entrants in the robotic TKA market. Currently, there is limited evidence investigating early patient and economic outcomes associated with the use of VRAS. The Premier Healthcare Database was analyzed to identify patients undergoing manual TKA with any implant system compared with a cohort of robotic-assisted TKAs using VRAS between September 1, 2021 and February 28, 2023. The primary outcome was all-cause and knee-related all-setting revisits within 90-day post-TKA. Secondary outcomes included number of inpatient revisits (readmission), operating room time, discharge status, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. The cohorts included 866 VRAS and 128,643 manual TKAs that had 90-day follow-up data. The rates of both all-cause and knee-related all-setting follow-up visits (revisits) were significantly lower in the VRAS TKA cohort compared with the manual TKA cohort (13.86 vs. 17.19%; mean difference [MD]: -3.34 [95% confidence interval: -5.65 to -1.03] and 2.66 vs. 4.81%; MD: -2.15 [-3.23 to -1.08], respectively, <i>p</i>-value < 0.01) at 90-day follow-up. The incidence of knee-related inpatient readmission was also significantly lower (53%) for VRAS compared with manual TKA. There was no significant difference between total cost of care at 90-day follow-up between VRAS and manual TKA cases. On average, the operating room time was higher for VRAS compared with manual TKA (138 vs. 134 minutes). In addition, the discharge status and revision rates were similar between the cohorts. The use of VRAS for TKA is associated with lower follow-up visits and knee-related readmission rates in the first 90-day postoperatively. The total hospital cost was similar for both VRAS and manual TKA cohort while not accounting for the purchase of the robot.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-05-24DOI: 10.1055/s-0044-1787268
Matthew T Weintraub, Steven J Kurina, Joseph T Cline, Enrico M Forlenza, Richard A Berger, Tad L Gerlinger
The purpose of this study was to evaluate outcomes of late manipulation under anesthesia (MUA) for stiffness performed from ≥12 weeks to more than a year after primary total knee arthroplasty (TKA). A total of 152 patients receiving MUA ≥12 weeks after primary TKA from 2014 to 2021 were reviewed. The primary outcome measured was change in range of motion (ROM). We tracked intraoperative complications and the need for repeat MUA or open procedure for continued stiffness after initial MUA. Three subgroups were analyzed: Group 1 included 58 knees between 12 weeks and 6 months after TKA, Group 2 included 44 knees between 6 and 12 months after TKA, and Group 3 included 50 knees ≥12 months after TKA. Analysis included descriptive statistics and univariate analysis, with α <0.05. Groups 1 to 3 all significantly increased their overall ROM by 20.9, 19.2, and 22.0 degrees, respectively. All groups significantly increased their flexion and extension from preoperatively. Group 1 had one intraoperative supracondylar femur fracture (1.7%) requiring open reduction and internal fixation, and five patients required repeat MUA or open procedure (8.6%). Group 2 had no intraoperative fractures, and five patients required repeat MUA or open procedure (11.4%). Group 3 had one intraoperative tibial tubercle avulsion fracture managed conservatively (2.0%) and one repeat MUA (2.0%). Late MUA resulted in significantly improved ROM in all groups. ROM improved more as the time from index TKA increased, although statistically insignificant. Repeat MUA or open procedure rate decreased with MUA ≥12 months from TKA, although statistically insignificant. The overall intraoperative fracture risk was 1.3%.
{"title":"Late Manipulation under Anesthesia after Total Knee Arthroplasty: Improved Range of Motion and a Low Complication Rate.","authors":"Matthew T Weintraub, Steven J Kurina, Joseph T Cline, Enrico M Forlenza, Richard A Berger, Tad L Gerlinger","doi":"10.1055/s-0044-1787268","DOIUrl":"10.1055/s-0044-1787268","url":null,"abstract":"<p><p>The purpose of this study was to evaluate outcomes of late manipulation under anesthesia (MUA) for stiffness performed from ≥12 weeks to more than a year after primary total knee arthroplasty (TKA). A total of 152 patients receiving MUA ≥12 weeks after primary TKA from 2014 to 2021 were reviewed. The primary outcome measured was change in range of motion (ROM). We tracked intraoperative complications and the need for repeat MUA or open procedure for continued stiffness after initial MUA. Three subgroups were analyzed: Group 1 included 58 knees between 12 weeks and 6 months after TKA, Group 2 included 44 knees between 6 and 12 months after TKA, and Group 3 included 50 knees ≥12 months after TKA. Analysis included descriptive statistics and univariate analysis, with α <0.05. Groups 1 to 3 all significantly increased their overall ROM by 20.9, 19.2, and 22.0 degrees, respectively. All groups significantly increased their flexion and extension from preoperatively. Group 1 had one intraoperative supracondylar femur fracture (1.7%) requiring open reduction and internal fixation, and five patients required repeat MUA or open procedure (8.6%). Group 2 had no intraoperative fractures, and five patients required repeat MUA or open procedure (11.4%). Group 3 had one intraoperative tibial tubercle avulsion fracture managed conservatively (2.0%) and one repeat MUA (2.0%). Late MUA resulted in significantly improved ROM in all groups. ROM improved more as the time from index TKA increased, although statistically insignificant. Repeat MUA or open procedure rate decreased with MUA ≥12 months from TKA, although statistically insignificant. The overall intraoperative fracture risk was 1.3%.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-06-19DOI: 10.1055/s-0044-1787829
Mehmet Ekinci, Taha Bedir Demir, Turker Sahinkaya, Sertac Yakal, Gokhan Polat, Bulent Bayraktar
The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score-Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively (p = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements.
我们的研究旨在评估在前交叉韧带重建(ACLR)手术中保留腓肠肌肌腱及其对膝关节屈曲、胫骨内旋力量和膝关节稳定性的影响。对使用全内侧技术和腘绳肌腱自体移植进行初级单束关节镜前交叉韧带重建的患者进行了回顾性评估。患者被分为两组,即腓肠肌保留组(St)和腓肠肌移植组(StG)。国际膝关节文献委员会(IKDC)评分、Lysholm、膝关节损伤和骨关节炎结果评分-膝关节相关生活质量(KOOS-QOL)评分、前交叉韧带-损伤后恢复运动量表评分作为术后最后一次随访的功能评分。使用 KT-1000 设备评估胫骨前移。膝关节屈曲、伸展和内旋力量使用等速测力计进行评估。动态平衡性能使用 Biodex 平衡系统进行测量。St 组有 24 名患者,StG 组有 23 名患者。人口统计学数据和临床结果均无明显差异。在 89 N 和 134 N 的测量中,StG 组的胫骨前后移动明显高于 St 组(p = 0.01 和 p = 0.01)。
{"title":"The Effect of Gracilis Tendon Preservation on Postoperative Knee Joint Stability and Muscle Strength in Arthroscopic Anterior Cruciate Ligament Reconstruction Surgery.","authors":"Mehmet Ekinci, Taha Bedir Demir, Turker Sahinkaya, Sertac Yakal, Gokhan Polat, Bulent Bayraktar","doi":"10.1055/s-0044-1787829","DOIUrl":"10.1055/s-0044-1787829","url":null,"abstract":"<p><p>The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score-Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively (<i>p</i> = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}