Total Knee Arthroplasty After Previous Knee Surgery

Brophy, Robert H.; Gray, Benjamin L.; Nunley, Ryan M.; Barrack, Robert L.; Clohisy, John C.

doi:10.2106/jbjs.m.00105

Cited by 95 publications

(39 citation statements)

References 19 publications

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“…45 Furthermore, patients who have had previous knee surgery undergo total knee replacement at a substantially younger age than those without previous knee surgery. 46 unanswered questions and future research The common presumption that individuals with traumatic tears experience greater improvements in patient reported outcomes than those with degenerative tears after arthroscopic partial meniscectomy was not supported by our results. Given the lack of effect of arthroscopic partial meniscectomy compared with placebo surgery for degenerative meniscal tears, 43 and the positive effects of exercise for patients with degenerative meniscal tears 29 and anterior cruciate ligament injury, 28 the efficacy of arthroscopic partial meniscectomy for traumatic meniscal tears should be compared in controlled trials with placebo or non-operative treatment such as exercise.…”

Section: Meaning Of the Studycontrasting

confidence: 59%

Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study

Thorlund

Englund

Christensen

et al. 2017

BMJ

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Objectives To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears. Design Comparative prospective cohort study. Setting Four public orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015. Participants Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset). Interventions Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information on knee pathology. Patient reported outcomes were recorded via online questionnaires. Main outcome measures Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms, sport and recreational function, and quality of life (KOOS4). A 95% confidence interval excluding differences greater than 10 KOOS points between groups was interpreted as absence of a clinically meaningful difference. Analyses adjusted for age, sex, and body mass index. Results 397 eligible adults (42% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically, participants with degenerative meniscal tears had a significantly larger improvement in KOOS4 scores than those with traumatic tears (adjusted between-group difference −5.1 (95% confidence interval −8.9 to −1.3); P=0.008). In the analysis including KOOS4 score at all time points, a significant time-by-group interaction was observed in both the unadjusted (P=0.025) and adjusted analysis (P=0.024), indicating better self-reported outcomes in participants with degenerative tears. However, the difference between groups was at no time point considered clinically meaningful. Conclusions These results question the current tenet that patients with traumatic meniscal tears experience greater improvements in patient reported outcomes after arthroscopic partial meniscectomy than patients with degenerative tears. Trial registration ClinicalTrials.gov identifier NCT01871272.

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Section: Meaning Of the Studycontrasting

confidence: 59%

Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study

Thorlund

Englund

Christensen

et al. 2017

BMJ

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“…[5] It is increasingly recognized that the acute injury to the ACL signals the onset of a molecular stage of the disease process where an early therapeutic intervention could be useful,[6,7] particularly if the molecular processes that are elicited in the joint tissues at the time of injury are known. [8]…”

Section: Introductionmentioning

confidence: 99%

Immediate Administration of Intraarticular Triamcinolone Acetonide After Joint Injury Modulates Molecular Outcomes Associated With Early Synovitis

Sieker

Ayturk

Proffen

et al. 2016

Arthritis & Rheumatology

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Objective To test if intraarticular corticosteroid injection mitigates injury-induced synovitis and collagen degradation after anterior cruciate ligament (ACL) transection and characterize the synovial response using a functional genomics approach in a preclinical model of post- traumatic osteoarthritis. Methods Yorkshire pigs received untreated unilateral ACL transection (ACLT, n=6) or transection with immediate injection of 20mg triamcinolone acetonide (STEROID, n=6). Total synovial membrane cellularity and synovial fluid concentration of COL-2 3/4C short neoepitope bearing collagen fragments at 14 days post-injury were primary endpoints and compared between ACLT, STEROID and INTACT (n=6 uninjured knees). Cells were differentiated by histological phenotype and counted, while RNA-seq was used to quantify transcriptome-wide gene expression, monocyte, macrophage and lymphocyte markers. Results Total cellularity of 13% (95% confidence interval of 9–16) and COL-2 3/4C short levels of 0.24 Kg/ml (0.08–0.39) were determined in INTACT. Significant increases in total cellularity to 21% (16–27) and COL-2 3/4C short to 0.49 Kg/ml (0.39–0.59) were observed in ACLT. Compared to ACLT, total cellularity was non-significantly and COL-2 3/4C short was significantly decreased in STEROID to 17% (15–18, p=0.26) and 0.29 Kg/ml (0.23–0.35). Between ACLT and INTACT, 255 genes were differentially expressed and enriched pathways related to cellular immune response and proteolysis. Mononuclear leukocytes were the dominant cell type in cell dense areas. MARCO, SOCS3, CCR1, IL4R and MMP2 expression was significantly associated with COL-2 3/4C short levels. Conclusions Early intraarticular immunosuppression mitigated the injury-induced increase of collagen fragments, an outcome better predicted by specific marker expression than histological measures of synovitis.

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“…Accordingly, among ACL-injured patients undergoing ACL reconstruction, being younger and male had a protective effect on the risk of knee arthroplasty [43]. A recent study reported that patients with a history of ACL reconstruction underwent TKR at a younger age (average 50.2 years) than those who underwent other knee surgeries (average 59.9 years), including arthroscopy, meniscectomy, open reduction and internal fixation, chondroplasty, tibial tubercle transfer, and osteotomy [44]. Other studies have reported that patients with prior ACL reconstruction who underwent TKR were younger (average 58.1 years) than patients without ACL injury or prior knee surgery who underwent TKR (average 63.4 years), but this difference was not significant [45].…”

Section: Discussionmentioning

confidence: 99%

Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database

et al. 2017

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ObjectiveThis study aimed to support the potential protective role of anterior cruciate ligament (ACL) reconstruction against the development of osteoarthritis (OA).MethodsIn this retrospective cohort study, the long-term results of ACL reconstruction in Taiwan were evaluated based on data from the National Health Insurance Research Database (NHIRD). In total, 8,769 eligible cases were included from 11,921 ACL-injured patients. The cumulative incidence rates of OA and total knee replacement (TKR) were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of OA.ResultsThere was a lower cumulative incidence of OA among ACL-reconstructed patients (271, 33.1%) than among non-reconstructed patients (1,874, 40.3%; p < 0.001). Patients who underwent ACL reconstruction had a lower cumulative incidence of TKR during the follow-up period (0.6%) than the non-reconstructed patients (4.6%, p < 0.001). After adjusting for covariates, ACL-injured patients who underwent reconstruction within one month after ACL injury showed a significantly lower risk of OA than those who never underwent reconstruction (adjusted HR = 0.83, 95% CI = 0.69–0.99).ConclusionsThese results indicate that ACL reconstruction might not provide complete protection from OA development after traumatic knee injury but does yield a lower cumulative incidence of OA development and TKR. Moreover, based on the present study, ACL-injured patients should undergo reconstruction as early as possible (within one month) to lower the risk of OA.

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Total Knee Arthroplasty After Previous Knee Surgery

Abstract: Background: With more than 650,000 knee arthroscopies and 175,000 anterior cruciate ligament reconstructions per-

Cited by 95 publications

References 19 publications

Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study

Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study

Immediate Administration of Intraarticular Triamcinolone Acetonide After Joint Injury Modulates Molecular Outcomes Associated With Early Synovitis

Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database

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