Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

Abstract

Background With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. Methods This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. Results TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group ( p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). Conclusions Screening and RM can reduce 90-day complications in patients undergoing TKA.

No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study

“…Recently, PBM has been increasingly implemented in all surgical procedures, especially in those involving large blood loss, such as bilateral TKA [ 12 , 25 ]. PBM is not defined by a single protocol and can be implemented in various modes depending on the institutional context and the surgeon’s experience [ 26 ].…”

Postoperative Hemodynamics of Total Knee Arthroplasty Unaffected by Cementless Approach under Contemporary Patient Blood Management Protocol: A Propensity Score-Matched Study

“…Although now generally accepted by many surgical departments, there is no universal PBM protocol to date [29]. Nonetheless, reports of reduced blood loss, lower transfusion rates, and better Hb recovery after a TKA continue to accumulate [3,13,[29][30][31][32]. Recently, the most representative PBM protocol incorporates hypotensive anesthesia, drain clamping, application of pneumatic tourniquets, strict transfusion triggers, IV or topical administration of TXA, and delivery of IV FCM.…”

“…There is a notable trend change in the demographic field of lower-extremity arthroplasty. Particularly, younger and more active patients who undergo total knee arthroplasties (TKAs) are witnessing a decline in the 10-year implant survival rates compared to older recipients, and they are rapidly increasing in number [1][2][3][4][5]. Consequently, biologic fixation through a cementless TKA has regained popularity [6][7][8].…”

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

“…Total knee arthroplasty (TKA) is a validated and effective surgical treatment for the functional recovery of and significant improvements in the quality of life of patients with end-stage knee osteoarthritis (OA) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. TKA is performed in over 1 million cases in the United States annually and is expected to continue to increase in frequency [ 9 ].…”