Analysis of Total Knee Arthroplasty revision causes

Postler, Anne; Lützner, Cornelia; Beyer, Franziska; Tille, Eric; Lützner, Jörg

doi:10.1186/s12891-018-1977-y

Cited by 279 publications

(219 citation statements)

References 16 publications

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“…Incorrect positioning of the implant and improper mechanical axis of the lower limb can lead to accelerated implant wear and loosening, as well as suboptimal function. Aseptic loosening, instability, and malalignment were the most common reasons for late revision [52][53][54][55]. In this study, no differences were found in the value of or in the outliers of the radiographic assessment angles.…”

Section: Discussionmentioning

confidence: 47%

Comparisons among three approaches—two minimally invasive and one conventional—for total knee arthroplasty: a retrospective cohort study with minimum follow-up of 10 years

Yuan

Sun

Fan

et al. 2019

Preprint

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BackgroundFew studies have investigated whether the mini-medial parapatellar (MMP) and quadriceps-sparing (QS) approaches have good long-term results compared to the conventional medial parapatellar (MP) approach in terms of clinical evaluations and radiographic assessments for total knee arthroplasty (TKA). The purpose of this study was to perform comparisons among the MMP, QS and MP approaches with a follow-up at 10 to 17 years.MethodsThis is a retrospective comparative study of 93 patients who underwent MMP TKA (32 TKAs), QS TKA (47 TKAs) or MP TKA (31 TKAs) with the same arthroplasty system. The clinical evaluations were performed according to the new American Knee Society score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analogue scale (VAS), range of motion (ROM), incidence of anterior knee pain (AKP), the Feller patellofemoral score (PFS), the reoperation rate and the complication rates. Radiographic assessments included observation of the mechanical axis of the lower limb and calculations of the lateral distal femoral angle (LDFA), femoral flexion angle (FFA), medial proximal tibial angle (MPTA), tibial slope angle (TSA), lateral patella displacement (LPD), and lateral patella tilt (LPT).ResultsThere were no differences in the long-term follow-up results of the new KSS, WOMAC score, ROM, VAS, patellofemoral functions, reoperation rate or complication rates among the groups. In addition, no radiographic differences in terms of lower limb mechanical axis or femoral, tibial or patellar position were observed.ConclusionThese results provide conclusive evidence that equivalent, long-term clinical results can be obtained using any one of these three approaches.

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Section: Discussionmentioning

confidence: 47%

Comparisons among three approaches—two minimally invasive and one conventional—for total knee arthroplasty: a retrospective cohort study with minimum follow-up of 10 years

Yuan

Sun

Fan

et al. 2019

Preprint

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“…Propensity scores matching provided a method to control for selection bias between the TKA with PSI patients and TKA without PSI patients by matching the TKA with PSI patients with a subset of the TKA without PSI patient cohort has been well described in the medical literature for use in observational studies. 1,2,5,6 We included all patients' demographics, patients' clinical, and providers characteristics included in the model to calculate propensity score, and used 1:1 nearest neighbor matching of the TKA with PSI patients with TKA without PSI patients within an appropriate caliper. To examine the effectiveness of propensity score matching in balancing baseline characteristics within the matched cohorts, standardized differences (STD) were calculated for the variables included in the propensity score model.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Total knee arthroplasty (TKA) is one of the most frequent surgical procedures and a very effective treatment option for advanced osteoarthritis of the knee, which decreases pain and improves function. 1 Because of the aging population and demands for a better quality of life, experts expect the number of TKAs to increase steadily in the next two decades. By 2030, the demand for primary total knees is projected to grow by 673% to 3.48 million procedures.…”

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confidence: 99%

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

Thomas

Patrick

et al. 2020

J Knee Surg

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Despite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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“…delnden und kostenintensiven Patienten großzügig dorthin verlegt werden. Im eigenen Krankengut sind periprothetische Infektionen bereits die häufigste Revisionsursache, wobei > 90 % der Patienten in anderen Kliniken voroperiert wurden[45]. Bei frühen und akuten Infektionen mit kurzer Anamnesedauer ist der Versuch einer gelenkerhaltenden Revision mit Debridément und Wechsel der mobilen Komponenten indiziert.…”

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Primäre Endoprothetik bei Kox- und Gonarthrose

et al. 2019

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ZusammenfassungDer primäre Hüft- und Kniegelenkersatz sind ein sehr häufig durchgeführtes und erfolgreiches Behandlungsverfahren bei fortgeschrittener Arthrose. Für moderne Hüft- und Knietotalendoprothesen wird über sehr gute Langzeitüberlebensraten berichtet. Vor dem Hintergrund steigender Aktivitätsansprüche und der zunehmend häufigeren Behandlung von Patienten mit schwererem Nebenerkrankungsprofil gewinnt die Analyse von patientenbezogenen Einflussfaktoren und Outcome-Kriterien weiterhin an Bedeutung. Mit der Etablierung interdisziplinärer Behandlungskonzepte zur rascheren Genesung und Komplikationsreduktion wird auf diese Entwicklung eingegangen. Bei einer Versorgung in zertifizierten Endoprothetikzentren (EndoCert©) sind standardisierte Behandlungspfade und die Vorhaltung spezialisierter Infrastruktur gewährleistet. In die Ergebnisbewertung gehen neben Routine-Indikatoren der externen Qualitätssicherung mittlerweile auch Daten aus dem Deutschen Endoprothesenregister (EPRD©) ein, das von der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC) etabliert wurde. Dieser Übersichtsbeitrag berichtet über die Versorgungssituation in der Hüft- und Knieendoprothetik bei Arthrose in Deutschland. Es wird auf Indikationsstellung, Prinzipien der Operationsmethodik, Implantatsysteme sowie aktuelle Entwicklungen und Behandlungskonzepte eingegangen.

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Analysis of Total Knee Arthroplasty revision causes

Cited by 279 publications

References 16 publications

Comparisons among three approaches—two minimally invasive and one conventional—for total knee arthroplasty: a retrospective cohort study with minimum follow-up of 10 years

Comparisons among three approaches—two minimally invasive and one conventional—for total knee arthroplasty: a retrospective cohort study with minimum follow-up of 10 years

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

Primäre Endoprothetik bei Kox- und Gonarthrose

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