Looks Good But Feels Bad: Factors That Contribute to Poor Results After Total Knee Arthroplasty

Fisher, David A.; Dierckman, Brian D.; Watts, Melanie; Davis, Kenneth

doi:10.1016/j.arth.2007.04.011

Cited by 201 publications

(113 citation statements)

References 9 publications

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“…21 studies from the original search met the inclusion and exclusion criteria and data were extracted from these. Of the 21 included studies 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65, 13 included patients with THA 45,49-54,56,59-63 , 4 with TKA 47,55,58,64 , 3 with patients THA or THA 46,48,57 and 1 was a statistical modeling exercise 65 . No additional studies were identified from the reference lists of included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes demographic characteristics of patient populations in the included 21 observational studies 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65, of which one was a statistical modeling study 65 (which provided no usable data). Most studies compared smokers to non-smokers, with few studies categorizing patients into former, current and non-smokers.…”

Section: Resultsmentioning

confidence: 99%

“…We present data from studies that provided multivariable analyses 45464748495051 followed by those that performed univariate analyses 52535455565758596061626364 . The quality score for each study is based on the Newcastle-Ottawa scale (range, 0-9) provided in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Smoking was a significant predictor for charges (p=0.03), operative time (p=0.01) and anesthesia time (p=0.003). Fisher et al found that smoking was protective and associated with lower risk of painful/stiff knee in 71 patients who underwent TKA 47 . Moller et al performed an observational study of 811 patients with THAs or TKAs 48 .…”

Section: Resultsmentioning

confidence: 99%

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Smoking and Outcomes After Knee and Hip Arthroplasty: A Systematic Review

Singh¹

2011

J Rheumatol

178

100

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Background Studies have suggested higher rates of peri- and post-operative complications in smokers compared to non-smokers. The objective of this systematic review was to assess the association of smoking and post-operative outcomes following total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods A search of six databases (The Cochrane Library, Scopus, Proquest Dissertation abstracts, CINAHL, OVID MEDLINE and EMBASE) was performed by a Cochrane librarian. All titles and abstracts were screened by two independent reviewers, with expertise in performing systematic reviews. Studies were included if they were fully published reports that included smoking and any perior post-operative clinical outcome in patients with either TKA or THA. Results 21 studies were included for the review, of which six included multivariable-adjusted analyses, 14 univariate analyses and one statistical modeling. For most outcomes, results from 1-2 studies could be pooled. Current smokers were significantly more likely to have any post-operative complication (risk ratio, 1.24 [95% confidence interval, 1.01 to 1.54]) and death (risk ratio, 1.63 [95% confidence interval, 1.06 to 2.51]), compared to non-smokers. Former smokers were significantly more likely to have any post-operative complication (risk ratio, 1.32 [95% confidence interval, 1.05 to 1.66]) and death (risk ratio, 1.69 [95% confidence interval, 1.08 to 2.64]). Conclusion This systematic review finds that smoking is associated with significantly higher risk of post-operative complication and mortality following THA or TKA. Studies examining long-term consequences of smoking on implant survival and complications are needed. Smoking cessation may improve outcomes after THA or TKA.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Smoking and Outcomes After Knee and Hip Arthroplasty: A Systematic Review

Singh¹

2011

J Rheumatol

178

100

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“…Poor outcome after primary TKA, apart from the revision, is between 6% and 14% (Anderson et al 1996, Hawker et al 1998, Heck et al 1998, Robertsson et al 2000, Robertsson and Dunbar 2001, Brander et al 2003, Noble et al 2006, Fisher et al 2007, Wylde et al 2008, Kim et al 2009, Bourne et al 2010, Scott et al 2010). The reason for poor outcome after TKA may be related to problems with the knee surgery itself, although it has been suggested that extra-articular causes such as hip disease, spine disorder, vascular disease, or reflex sympathetic dystrophy may contribute.…”

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confidence: 99%

Dissatisfied patients after total knee arthroplasty

Ali¹,

Sundberg²,

Robertsson³

et al. 2014

Acta Orthopaedica

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Background and purposeIn 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2–7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients.Patients and methods118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009–2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0–100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD).ResultsMean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography.InterpretationThe patients who reported poor response after TKA continued to be unhappy after 8–13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.

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