Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty

Zmistowski, Benjamin; Restrepo, Camilo; Kahl, Lauren K.; Parvızı, Javad; Sharkey, Peter F.

doi:10.1007/s11999-010-1558-3

Cited by 63 publications

(42 citation statements)

References 20 publications

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“…The most common reason for unplanned readmission following total knee arthroplasty in the present study was stiffness (2.7%, 141 of 5207). A previous study from our institution likewise demonstrated that the most common reason for reoperation within one year following this procedure was stiffness, with >58% of the non-revision reoperations (involving 2.3% of all total knee arthroplasties) being manipulation under anesthesia 6 . Overall, the most common cause of unplanned readmission following total joint arthroplasty in the present study was joint-related infection (1.4%, 150 of 10,633).…”

mentioning

confidence: 64%

“…With this projected exponential growth in total joint arthroplasty, there are concerns of an overwhelming workload for the medical community and an increasing financial burden on society 4 . Despite the great success of arthroplasty, complications associated with surgery occur, leading to prolonged inpatient care, hospital readmission, or even reoperation [5][6][7][8] . Minimization of such complications, always an important goal for patients and their surgeons, would have a major impact on reducing the health-care burden.…”

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confidence: 99%

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Unplanned Readmission After Total Joint Arthroplasty

Zmistowski

Restrepo

Hess

et al. 2013

The Journal of Bone & Joint Surgery

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228

165

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mentioning

confidence: 64%

mentioning

confidence: 99%

Unplanned Readmission After Total Joint Arthroplasty

Zmistowski

Restrepo

Hess

et al. 2013

The Journal of Bone & Joint Surgery

Self Cite

228

165

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“…One patient in both the experimental and the control groups (1.3%) required irrigation and débride-ment with tibial polyethylene exchange for persistent wound drainage/hematoma evacuation; however, of the entire cohort of 150 patients, this would be within the historically typical range for a reoperation rate at our institution after TKA [34]. In addition, the incidence of manipulation under anesthesia for postoperative stiffness/ arthrofibrosis was 4% (three patients of 75 total) in the experimental group and 6.7% (five patients of 75 total) in the control group.…”

Section: Discussionmentioning

confidence: 96%

The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study

Goyal

McKenzie

Sharkey

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Providing a balance of adequate analgesia while limiting the functional impact of regional anesthesia and minimizing opioid side effects is critical to minimize adverse events and improve patient satisfaction. Questions/Purposes We asked whether bupivacaine delivered through an elastomeric device decreases the (1) patients' perception of pain after TKA; (2) narcotic consumption; and (3) narcotic-related side effects as compared with a placebo.Methods In this prospective, double-blind, placebocontrolled study, all patients received standardized regional anesthesia, a preemptive and multimodal analgesic protocol, and a continuous intraarticular infusion at 5 mL/hour through an elastomeric infusion pump. The patients were randomized to receive either an infusion pump filled with (1) 300 mL of 0.5% bupivacaine, the experimental group (n = 75); or (2) 300 mL of 0.9% normal saline solution, the control group (n = 75). Data concerning postoperative pain levels through a visual analog scale, postoperative opioid consumption, opioid-related side effects, and complications were collected and analyzed.

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“…According to gait analyses and biomechanical studies, patients require at least 83°of flexion to ascend stairs, 90°to 100°to descend stairs, 93°to 105°to rise from a standard or short chair, and more than 115°to squat or kneel [3,11,13]. However, up to 20% of patients may develop knee stiffness and achieve knee flexion of less than 90°after their index arthroplasty [12,17,19,28]. If left untreated, knee stiffness reduces the functional outcomes of patients including their daily living activities and satisfaction [25,26].…”

Section: Introductionmentioning

confidence: 99%

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Issa

Rifai

Boylan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living. Questions/purposes The purpose of this study was to evaluate the effect of various (1) demographic factors;(2) comorbidities; and (3) knee-specific factors on the frequency of manipulation under anesthesia, which was used as an indicator of knee stiffness after a primary TKA. Methods We evaluated the registries of two high-volume centers and reviewed all 3182 TKAs that were performed between 2005 and 2011 to identify all patients who had undergone manipulation under anesthesia (MUA). A total of 156 knees in 133 patients underwent MUA after an index arthroplasty. These patients were compared in a one-to-four ratio with a group of patients with satisfactory ROM drawn from the same database who met prespecified criteria and who had not undergone MUA. Effects of various factors, including age, sex, body mass index, race, comorbidities, and the underlying cause of knee arthritis, were compared between these two cohorts using multivariable logistic regressions. Results After controlling for various confounding, nonwhite race was associated with an increase (odds ratio [OR], 2.01; p = 0.03), and age C 65 years (OR, 0.17; 95% confidence interval [CI], 0.04-0.74; p = 0.0179) was associated with a reduction in the incidence of MUA. In comorbidities, diabetes (OR, 1.72; 95% CI, 1.02-2.32; p = 0.03), high cholesterol levels (OR, 2.70; p = 0.03), and tobacco smoking (OR, 1.59; 95% CI, 1.03-2.47; p = 0.03) were associated with an increase in frequency of MUA. In knee-specific factors, preoperative knee ROM of less than 100°(OR, 0.80; p \ 0.0001) and knee osteonecrosis (p = 3.61; 95% CI, 1.29-10.1; p = 0.014) were associated with increased frequency of MUA. Conclusions We identified several demographic, medical, and knee-specific factors that were associated with poor

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Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty

Cited by 63 publications

References 20 publications

Unplanned Readmission After Total Joint Arthroplasty

Unplanned Readmission After Total Joint Arthroplasty

The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

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