Identifizierung von Risikofaktoren postoperativer Komplikationen in der primären Knieendoprothetik

Claus, Annika; Asche, G; Brade, Joachim; Bosing-Schwenkglenks, M.; Horchler, H.; Müller-Färber, J.; Schumm, W.; Weise, K.; Scharf, Hanns‐Peter

doi:10.1007/s00113-005-0992-2

Cited by 15 publications

(5 citation statements)

References 10 publications

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“…Cemented fixation is the so-called gold standard and accounts for 95% of all primary knee replacements 2 . However, current cemented knee replacements have a postoperative complication rate of approximately 11% 3 . Additionally, younger patients have up to twice the rate of implant failure 4-6 , believed to be secondary to increased stress on the fixation interface in active patients 7 .…”

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confidence: 99%

A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements

Mohammad

Judge

Murray

2021

Journal of Bone and Joint Surgery

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Background: Total knee replacement (TKR) can be implanted with or without the use of cement. It is currently unknown how cemented and cementless TKRs compare overall and in different age groups of the population in the long term. Methods:The National Joint Registry collects information on knee replacements inserted in England, Wales, Northern Ireland and Isle of Man and was linked for multiple confounders to the National Health Service Hospital Episode Statistics database. Using propensity matched scoring techniques 44,954 cemented and cementless TKRs were compared. Regression models were used to compare the outcomes revision, two stage revision, reoperation and mortality both overall and in different age strata. Results:The 10 year implant survival (revision endpoint) for cemented and cementless TKRs were 96.0% and 95.5% (Hazard Ratio (HR) 1.14, p=0.01). The 10 reoperation endpoint was 82.7% and 81.4% respectively (HR 1.08, p=0.001). The rates of pain were higher in cementless TKRs (0.5% vs 0.7%, p=0.002) but the rates of infection were lower (0.7% vs 0.5%, p=0.003). No significant interactions with age existed for outcomes of; revision (p=0.24), reoperation (p=0.30) or mortality (p=0.58). Conclusions:We found that matched cemented and cementless TKRs both have 10 year implant survivals over 95%. Cementless TKRs had a higher absolute difference in revision rates (0.5%) and reoperation rates (1.3%). The rates of revision for infection were lower in the cementless group, although rates of revision for pain were higher. Age did not significantly affect the relative performances.

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confidence: 99%

A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements

Mohammad

Judge

Murray

2021

Journal of Bone and Joint Surgery

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“…A p value of <0.05 indicated significance. We used R software (R Foundation for Statistical Computing) and IBM SPSS to conduct the statistical analyses 24 .…”

Section: Discussionmentioning

confidence: 99%

Ideal Timing of Reimplantation in Patients with Periprosthetic Knee Infection Undergoing 2-Stage Exchange

Ascione,

Balato,

Festa

et al. 2024

Journal of Bone and Joint Surgery

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Background: This study evaluated appropriate thresholds for serum biomarkers, synovial fluid white blood cell (SF-WBC) count, and synovial fluid neutrophil (polymorphonuclear leukocyte [PMN]) percentage to predict infection in a patient group who underwent definitive reimplantation after receiving a continuous course of antibiotic therapy for chronic knee periprosthetic joint infection (PJI). These thresholds were then used to generate a scoring system to predict recurrence (or persistence) of infection. Methods: The study included 153 patients with a median age of 73 years (range, 46 to 91 years) who underwent 2-stage revision for chronic knee PJI. Staphylococci were identified at baseline in 107 (70%) of the patients. After the 96-week follow-up period, 12% (19) of the 153 patients had recurrence of the PJI. A receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of common serum biomarkers and SF aspiration before reimplantation, and the area under the curve (AUC) was evaluated. Variables that were significantly different between patients with and without infection recurrence were evaluated using a multivariable logistic regression model. A half-integer-point scoring system was created based on the final beta coefficients. Results: Regarding the prediction of recurrent infection, a D-dimer level of >1110 ng/mL yielded a sensitivity of 74%, specificity of 61%, and AUC of 0.69; an SF-WBC count of >934 cells/µL showed a sensitivity of 68%, specificity of 90%, and AUC of 0.79; and an SF-PMN percentage of >52% showed a sensitivity of 73%, specificity of 90%, and AUC of 0.82. The beta coefficients were approximated to 1.5 for the D-dimer level and to 2 for the SF-WBC count and SF-PMN percentage. A total score of >2 was used to classify patients with a high risk of infection recurrence. The ability to discriminate infection recurrence was demonstrated by an AUC of 0.90 (95% confidence interval: 0.82 to 0.99). Conclusions: Patients with a score of >2 on our proposed scoring system based on serum biomarkers, SF-WBC count, and SF-PMN percentage should not undergo reimplantation, as they are at a high risk for recurrent PJI. Patients with a score of ≤2 can undergo definitive reimplantation with the lowest risk of recurrence. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…When is the use of autologous procedures such as autologous donation of blood or autotransfusion using a Cell Saver profitable? Previous studies reveal that the donation of foreign blood can imply a higher risk for inpatients with hip or knee TEP to suffer from complications during hospital stay [1]. As this results in an increased length of hospital stay and increased procedure costs, it is obvious that such a situation is extremely disadvantageous in the age of the DRG system.…”

Section: Procedures Costsmentioning

confidence: 91%

Assessment of Autologous Procedures under Conditions of the Current G-DRG System

Schleppers

2006

Transfus Med Hemother

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Autologous hemotherapy does not have any relevance in the current reimbursement system but can be reflected by coding in the OPS catalogue 2006 within the G-DRG (German Refined Diagnosis Related Group) system. Code quality of these procedures can certainly be improved in order to ameliorate the basis of calculation within the DRGs. Autologous procedures play an important role within the perioperative DRG process with respect to quality improvement and cost reduction. Calculation algorithms which are generally valid should be established to precisely evaluate previous findings.

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Identifizierung von Risikofaktoren postoperativer Komplikationen in der primären Knieendoprothetik

Abstract: Postoperative complications in total knee replacement are increased in males and elder patients. Increased time of surgery and allogeneic blood transfusions also represent important risk factors for postoperative complications following primary total knee replacement.

Cited by 15 publications

References 10 publications

A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements

A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements

Ideal Timing of Reimplantation in Patients with Periprosthetic Knee Infection Undergoing 2-Stage Exchange

Assessment of Autologous Procedures under Conditions of the Current G-DRG System

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