Patient Dissatisfaction with Rehabilitation Following Primary Total Knee Arthroplasty

Racial and ethnic disparities in total joint replacements have been documented. Our objective was to determine the rates of total joint replacements for Alaska Native/American Indian (AN/AI) individuals compared with non-AN/AI individuals in Alaska and investigate the differences in characteristics and outcomes by race. We used hospital discharge data from the Alaska Health Facilities Data Reporting Program from 2015 to 2018. We identified people with an inpatient primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA). We determined the population proportion of each procedure, age-adjusted rates by race, age-specific rates, and multivariable adjusted rate ratios for TKA or THA. We compared the characteristics of people undergoing primary TKA and THA by race. In 2,195,806 person-years, there were 8,131 arthroplasty procedures (4,594 primary TKAs, 2,791 primary THAs, 378 revision TKAs, and 368 revision THAs). Primary TKAs and THAs were less likely in people of AN/AI or "Other" race compared with people of White race, with some heterogeneity in the "Other" race category. In multivariable models, the adjusted rate ratio for AN/AI compared with White race for TKA was 0.70 (95% confidence interval [CI] 0.60-0.82) and for THA was 0.69 (95% CI 0.55-0.85). AN/AI individuals undergoing TKA and THA were more likely to reside in rural locations, be younger than 65 years, have longer hospital stay, and discharge to home. This study confirmed the existence of racial disparities in TKA and THA in Alaska. There may be many underlying causes, and future research should focus on improving access to care.

Prolonged wound drainage following total hip or total knee arthroplasty has been associated with an increased risk of postoperative morbidity. The purpose of this study was to determine the pharmacologic, surgical, and patient-specific factors that are associated with prolonged wound drainage and the relationship of this complication to the length of hospital stay and the rate of wound infections. We conducted a retrospective observational study of 1211 primary total hip arthroplasties and 1226 primary total knee arthroplasties. Prospectively collected data included body mass index, intraoperative blood loss, surgical time, type of prophylaxis against deep venous thrombosis, and length of hospital stay. The association of these factors with the duration of postoperative wound drainage was analyzed. An acute infection developed after fifteen primary total hip arthroplasties and ten primary total knee arthroplasties. The patients with an acute postoperative infection were compared with their uninfected counterparts, and an odds ratio was determined to estimate the risk of prolonged wound drainage resulting in a wound infection. Morbid obesity was strongly associated with prolonged wound drainage in the total hip arthroplasty group (p = 0.001) but not in the total knee arthroplasty group (p = 0.590). An increased volume of drain output was an independent risk factor for prolonged wound drainage in both groups. Patients who received low-molecular-weight heparin for prophylaxis against deep venous thrombosis had a longer time until the postoperative wound was dry than did those treated with aspirin and mechanical foot compression or those who received Coumadin (warfarin); this difference was significant on the fifth postoperative day (p = 0.003) but not by the eighth postoperative day. Prolonged wound drainage resulted in a significantly longer hospital stay in both groups (p < 0.001). Each day of prolonged wound drainage increased the risk of wound infection by 42% following a total hip arthroplasty and by 29% following a total knee arthroplasty. Morbid obesity, the use of low-molecular-weight heparin, and a higher drain output were associated with a prolonged time until the postoperative wound was dry following a primary total hip arthroplasty, whereas a higher drain output was the only risk factor associated with prolonged drainage following a primary total knee arthroplasty. Prolonged drainage was associated with a higher rate of infection following a primary total hip arthroplasty, whereas obesity was the only identified independent risk factor for postoperative infection following a primary total knee arthroplasty.

BackgroundAccording to the results of previous studies, it has been reported that rheumatoid arthritis (RA) patients receive total knee arthroplasty (TKA) at a younger age than osteoarthritis (OA) patients. However,...

Several patient-reported outcome measures (PROMs) have been used to assess improvement in the quality of life following total knee arthroplasty (TKA). However, there is paucity of studies evaluating the sleep quality and knee function following TKA. The primary aim of our study was to evaluate the sleep quality and knee function in primary TKA patients using the Pittsburgh Sleep Quality Index (PSQI) and Knee Society Score (KSS), respectively. The secondary aim was to assess the correlation between the two outcome measures over the course of first post-operative year following TKA. One hundred sixty-eight patients (female-140/male-28) with mean age of 64.63years (± 7.50) who underwent 168 primary unilateral TKA using a cemented posterior-stabilised implant without patella resurfacing between June 2018 and October 2018 were included in the study. Global PSQI and KSS were recorded pre-operatively and post-operatively weekly up to sixweeks and at oneyear. Body mass index (BMI) and Charlson comorbidity index (CCI) were recorded during pre-operative assessment. Mean(± SD) BMI and CCI were 28.45(± 4.64) and 2.48(± 0.93), respectively. Pre-operative global PSQI of 1.98(± 0.97) increased to 13.48(± 3.36) in the first post-operative week (p < 0.001) and remained high during all the sixweeks following TKA (p < 0.001), whereas at the first post-operative year, it reduced to 2.10(± 1.15) (p = 0.15). Pre-operative KSS of 52.00(± 9.98) increased to 71.67(± 6.58) and 85.49(± 4.67) at 6weeks and the first post-operative year respectively (p < 0.001). Pre-operative global PSQI had moderate correlation with pre-operative KSS (r = 0.39) (p < 0.001). Strong correlation was noted between pre-operative global PSQI and sixweek post-operative KSS (r = 0.47) (p < 0.001). Low correlation was noted between pre-operative global PSQI and KSS at the first post-operative year (r = 0.10, p = 0.19) following TKA. Multiple regression analysis revealed age, CCI, and pre-operative range of motion as independent predictors of global PSQI. Patients undergoing TKA experience changes in sleep quality but report an overall improvement in knee function during the first post-operative year. Sleep quality has moderate to strong correlation with knee function in the early post-operative period beyond which there is a low correlation with knee function thereby suggesting a transient phenomenon. Hence patients undergoing TKA can be appropriately counselled regarding the variation in sleep quality in the post-operative period and reassured accordingly.

Highlights of the 2021 American Joint Replacement Registry Annual Report.

Postoperative patient satisfaction is related to preoperative expectations. Information regarding expected results following surgery is therefore important. This study evaluated patient-reported outcome measures (PROMs) and patient satisfaction up to 1 year after primary and aseptic revision total knee arthroplasty (TKA). The study included 2151 primary and 235 aseptic revision TKA surgeries conducted between 2010 and 2018. Pain, Knee Injury and Osteoarthritis Outcome Score-Physical Function-Short Form and European Quality of Life-5 Dimension surveys were recorded preoperatively and at 8 weeks and 1 year. To determine satisfaction, patients were asked to rate their knee function compared with that before surgery and to answer whether they would undergo the surgery again given their current knowledge. Patients who had primary TKA improved in all PROMs in each follow-up up to 1 year, whereas patients who had revision TKA showed improvement at 8 weeks with no further improvement at 1 year. In terms of patient satisfaction, 88% of patients in the primary TKA group reported better knee function, and 87% were willing to have the surgery again at 1 year; the proportions were lower for patients who underwent revision TKA (66% and 68%, respectively). Aseptic revision TKA demonstrates inferior PROMs compared with those of primary TKA 1 year after surgery, and more than 30% of the patients who underwent revision TKA stated that they would not have their TKA revised or were uncertain, given the outcome of the procedure. Thus, patients who are candidates for revision TKA should be informed to expect less of an improvement following revision surgery than with the primary TKA. Our findings can facilitate the shared decision-making process by surgeons and patients based on realistic expectations of surgical outcomes. [Orthopedics. 2023;46(1):e52-e57.].

<h3>Background and Aims</h3> The use of tranexamic acid (TXA) has reduced rates of perioperative blood transfusion for total hip arthroplasty (THA) and total knee arthroplasty (TKA)¹. While oral rather than intravenous (IV) dosing of TXA at the time of surgery may simplify perioperative protocols and reduce costs, it is not clear whether oral TXA is as effective as IV TXA in reducing blood loss and transfusion rates. <h3>Methods</h3> This randomized controlled trial compared the use of one preoperative dose of oral TXA (1,950mg) to one preoperative dose of IV TXA (1,000mg) in THA (N=200) and TKA (N=200). Consecutive patients undergoing primary THA or TKA under regional anesthesia with sedation were enrolled. The primary outcome was calculated blood loss (CBL). Secondary outcomes were transfusions and complications, including cardiac events and venous thromboembolism. The study was designed as a non-inferiority trial with an intention-to-treat analysis. <h3>Results</h3> Oral TXA was non-inferior to IV TXA (p&lt;0.001). Mean CBL values were 842.21 mL versus 860.45 mL for THA and 798.48 mL versus 878.13 mL for TKA in the oral and IV arms, respectively. There was one postoperative transfusion, which occurred in the IV TXA arm of the study. There was no difference in complication rates between the two arms of the study. <h3>Conclusions</h3> Oral TXA can be feasibly administered in the preoperative setting prior to THA or TKA and is non-inferior to IV TXA with respect to CBL and transfusion rates in this setting.

The aims of this study were to characterize antibiotic choices for perioperative total knee arthroplasty (TKA) and total hip arthroplasty (THA) prophylaxis, assess antibiotic allergy testing efficacy, and determine rates of prosthetic joint infection (PJI) based on perioperative antibiotic regimen. We evaluated all patients undergoing primary TKA or THA at a single academic institution between January 2004 and May 2017, yielding 29 695 arthroplasties (22 705 patients), with 3411 arthroplasties in 2576 patients (11.5%) having undergone preoperative allergy testing. A series of institutional databases were combined to identify allergy consultation outcomes, perioperative antibiotic regimen, and infection-free survivorship until final follow-up. Among 2576 allergy-tested patients, 2493 patients (97%) were cleared to use cephalosporins. For the entire cohort, 28 174 arthroplasties (94.9%) received cefazolin and 1521 (5.1%) received non-cefazolin antibiotics. Infection-free survivorship was significantly higher among arthroplasties receiving cefazolin compared with non-cefazolin antibiotics, with 0.06% higher survival free of infection at one month, 0.56% at two months, 0.61% at one year, and 1.19% at ten years (p < 0.001). Overall, the risk of PJI was 32% lower in patients treated with cefazolin after adjusting for the American Society of Anesthesiologists (ASA) classification, joint arthroplasty (TKA or THA), and body mass index (BMI; p < 0.001). The number needed to treat with cefazolin to prevent one PJI was 164 patients at one year and 84 patients at ten years. Therefore, potentially 6098 PJIs could be prevented by one year and 11 905 by ten years in a cohort of 1 000 000 primary TKA and THA patients. PJI rates are significantly higher when non-cefazolin antibiotics are used for perioperative TKA and THA prophylaxis, highlighting the positive impact of preoperative antibiotic allergy testing to increase cefazolin usage. Given the low rate of true penicillin allergy positivity, and the readily modifiable risk factor that antibiotic choice provides, we recommend perioperative testing and clearance for all patients presenting with penicillin and cephalosporin allergies. Cite this article: Bone Joint J 2019;101-B(6 Supple B):9-15.

Clinical experience suggests that patients with osteoarthritis (OA) undergoing revision total knee arthroplasty (TKA) experience more chronic complications after surgery compared with patients receiving primary TKA. This study aimed to investigate the difference in pain, mobility, and quality of life (QoL) in patients after revision TKA compared with patients after primary TKA. A total of 99 OA patients after revision TKA surgery and 215 patients after primary TKA surgery were investigated in a cross-sectional study using: a pain description of current pain (non-existent, mild, moderate, severe, or unbearable), the pain intensity visual analogue scale, the Knee Society Score, and the Osteoarthritis Research Society International questionnaire. Nineteen percent after primary TKA surgery and 47% after revision TKA surgery experienced severe to unbearable chronic postoperative pain. After revision TKA surgery patients reported higher pain intensities during rest (P=0.039), while walking (P=0.008), and on average over the last 24 hours (P=0.050) compared with the patients after primary TKA surgery. Patients after revision TKA surgery had reduced walking distance (P=0.001), increased use of walking aids (P=0.015), and showed an overall decreased QoL (P<0.001) compared with patients after primary TKA surgery. No significant improvement was found in walking distance (P=0.448) for patients before revision TKA surgery compared with after revision TKA surgery. More than twice as many patients have pain after revision surgery compared with patients after primary TKA. Patients after revision TKA surgery have reduced function, poorer QoL, and higher pain intensity compared with patients after primary TKA surgery.

Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty

Perioperative Outcomes of Immersive Virtual Reality as Adjunct Anesthesia in Primary Total Hip and Knee Arthroplasty

The incidence of inpatient pulmonary embolism in patients who have elective primary hip and knee arthroplasty in the United States is unknown. Prior studies have included patients with cancer, trauma, or revisions. The goal of this study was to determine the incidence and risks of inpatient pulmonary embolism after elective arthroplasty by type of procedure. We used the 1998 to 2009 Healthcare Cost and Utilization Project Nationwide Inpatient Sample for this retrospective cohort study. Patients who were sixty years of age or older and underwent elective primary total hip or knee arthroplasty were included. The study variable was the type of arthroplasty: total hip, total knee, or two joints. Inpatient pulmonary embolism was the primary outcome; mortality was secondary. Logistic regression determined the adjusted odds ratios of inpatient pulmonary embolism by procedure, adjusting for age, sex, Charlson Comorbidity Index, atrial fibrillation, and surgical indication. Records represented 5,044,403 hospital discharges after primary total hip or knee arthroplasty. Total knee arthroplasty comprised 66% of the admissions. Less than 5% of patients had two joint procedures. The overall incidence of pulmonary embolism was 0.358% (95% confidence interval [CI], 0.338, 0.378). The incidence of pulmonary embolism differed by procedure and was highest among patients who had two-joint arthroplasty (0.777%; 95% CI, 0.677, 0.876), was lowest in recipients of total hip arthroplasty (0.201%; 95% CI, 0.179, 0.223), and was intermediate in patients who had total knee arthroplasty (0.400%; 95% CI, 0.377, 0.423). The adjusted odds ratios of pulmonary embolism in patients who had two joint procedures were 3.89 times higher than among patients who had total hip arthroplasty, controlling for other factors. Elective total knee arthroplasty is associated with a higher incidence and odds of inpatient pulmonary embolism than is total hip arthroplasty; multiple procedures pose the highest risk for pulmonary embolism and associated mortality.

Orthopedic Specialty Hospital Reasons for Transfer and Subsequent Outcomes.

A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty

Objective To analyze the anatomical distribution of lower extremity deep vein thrombosis (DVT) after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).Methods Data of 272 patients with lower extremity DVT confinned by venography after TKA and THA performed from June 2007 to May 2012 in our hospital were retrospectively analyzed.There were 110 cases in TKA group and 162 cases in THA group.The anatomical distribution of lower extremity DVT after TKA and THA was analyzed and compared.Results In TKA group,there were 10 cases of central DVT,6 cases of mixed DVT,and 94 cases of peripheral DVT.In THA group,there were 3 cases of central DVT,19 cases of mixed DVT,and 140 cases of peripheral DVT.There was a significant difference between two groups in the distribution of DVT.In all DVT patients,intramuscular veins were involved most frequently (71.0％,193/272),followed by posterior tibial veins (36.0％,98/272),peroneal veins (31.3％,85/272),anterior tibial veins (8.8％,24/272),popliteal veins (8.8％,24/272),and iliofemoral veins (7.4％,20/272).For patients with peripheral DVT,the isolated DVT was more frequent in THA group,while multiple DVT was more common in TKA group,and the differences were significant between two groups.No isolated DVT was found in anterior tibial veins.In patients with multiple DVT,the thrombi were commonly found in two or three of posterior tibial veins,peroneal veins and intramuscular veins.Conclusion There is a significant difference in the anatomical distribution of DVT after TKA and THA. Key words: Venous thrombosis; Phlebography; Arthroplasty, replacement