Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Palazzuolo, Michele; Antoniadis, Alexander; Mahlouly, Jaad; Wegrzyn, Julien

doi:10.1007/s00264-020-04917-y

Cited by 20 publications

(17 citation statements)

References 32 publications

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“…Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis, as it can significantly alleviate pain symptoms and improve knee function [ 1 ]. Knee functional activities may be limited to a certain extent after TKA, especially when a kneeling or squatting position is involved [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Wei

Tang

et al. 2021

BMC Musculoskelet Disord

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Background Enhanced recovery after surgery (ERAS) protocols were rapidly adopted in many surgeries such as fast-track arthroplasty. The study aimed to investigate the impact of ERAS protocols on the clinical effect of total knee arthroplasty (TKA) via the midvastus approach. Methods A total of 69 patients who underwent primary unilateral TKA via the midvastus approach from October 2018 to June 2019 were enrolled and randomly divided into two groups: ERAS group and Control group. The ERAS protocols were adopted for the ERAS group and consisted of pure juice drinking 2 h before the surgery, optimization of the preoperative anesthesia plan, phased use of tourniquets, and the use of tranexamic acid as well as a drug cocktail. The operative time, first postoperative walking time, first straight leg elevation time, postoperative hospitalization time, visual analogue scale score (VAS score), Hospital for Special Surgery score (HSS score), conventional Knee Society score (KSS), and knee range of motion (ROM) were used to assess the clinical effects in the two groups. All the included patients were followed up for 12 months. Results There were no significant differences in the basic demographic information and operation time between the ERAS and Control groups (P > 0.05). The first postoperative walking time (2.11 ± 0.11 h) and first postoperative straight leg elevation time (6.14 ± 1.73 h) in the ERAS group were significantly earlier than those in the Control group (P < 0.001) and the postoperative hospitalization time was significantly shorter (3.11 ± 0.32 days). The postoperative mean VAS scores in both groups were significantly reduced compared with those before surgery (P < 0.001). The VAS scores for the ERAS group were significantly lower than those for the Control group at 1, 2, and 7 days after surgery (P < 0.001). The mean HSS scores, KSS, and knee ROM were significantly increased in both the ERAS and Control groups at 1, 3, 6, and 12 months after surgery (P < 0.001). In addition, the HSS scores, KSS, and knee ROM in the ERAS group were significantly higher than those in the Control group at 1 month after surgery (P < 0.001). Conclusions ERAS protocols improved the clinical effects of TKA via the midvastus approach, facilitating early out-of-bed activity and comfortable postoperative rehabilitation exercise, and further increasing patient satisfaction. Trial registration ClinicalTrials.gov Identifier: NCT04873544.

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Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Wei

Tang

et al. 2021

BMC Musculoskelet Disord

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“…Clinically, postoperative morphine consumption at 24 and 48 h was significantly lower in the CoQ10 group when compared to the control and CoQ10 + IPC groups (Median [P25-P75] at 24 h; CoQ10 3.5 [ 1 , 2 , 3 , 4 , 5 , 6 ] vs. placebo 6 [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ] vs. CoQ10 + IPC 9 [6–13.5] mg, p = 0.037) ( Figure 5 A). In accordance with the cumulative morphine dose, the NRS at 24 h was significantly lower in the CoQ10 group when compared to the placebo and the CoQ10 + IPC groups (Median [P25-P75]; CoQ10 2.5 [ 2 , 3 , 4 ] vs. placebo 5.5 [ 3 , 4 , 5 , 6 ] vs. CoQ10 + IPC 5.5 [ 3 , 4 , 5 , 6 ] mg, p = 0.013) ( Figure 5 B).…”

Section: Resultsmentioning

confidence: 99%

“…Total knee arthroplasty (TKA), an effective surgical treatment for end-stage knee osteoarthritis (OA), successfully provides pain relief and improves the quality of life [ 1 ]. Perioperative care of TKA becomes more challenging in patients with increasing age and multiple comorbidities [ 1 , 2 ]. Also, TKA has a trend toward an ambulatory setting [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

CoenzymeQ10 and Ischemic Preconditioning Potentially Prevent Tourniquet-Induced Ischemia/Reperfusion in Knee Arthroplasty, but Combined Pretreatment Possibly Neutralizes Their Beneficial Effects

et al. 2022

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Tourniquet (TQ) use during total knee arthroplasty (TKA) induces ischemia/reperfusion (I/R) injury, resulting in mitochondrial dysfunction. This study aims to determine the effects of coenzyme Q10 (CoQ10) and ischemic preconditioning (IPC), either alone or in combination, on I/R-induced mitochondrial respiration alteration in peripheral blood mononuclear cells (PBMCs) and pain following TKA. Forty-four patients were allocated into four groups: control, CoQ10, IPC, and CoQ10 + IPC. CoQ10 dose was 300 mg/day for 28 days. IPC protocol was three cycles of 5/5-min I/R time. Mitochondrial oxygen consumption rates (OCRs) of PBMCs were measured seven times, at baseline and during ischemic/reperfusion phases, with XFe 96 extracellular flux analyzer. Postoperative pain was assessed for 48 h. CoQ10 improved baseline mitochondrial uncoupling state; however, changes in OCRs during the early phase of I/R were not significantly different from the placebo. Compared to ischemic data, IPC transiently increased basal OCR and ATP production at 2 h after reperfusion. Clinically, CoQ10 significantly decreased pain scores and morphine requirements at 24 h. CoQ10 + IPC abolished analgesic effect of CoQ10 and mitochondrial protection of IPC. In TKA with TQ, IPC enhanced mitochondrial function by a transient increase in basal and ATP-linked respiration, and CoQ10 provides postoperative analgesic effect. Surprisingly, CoQ10 + IPC interferes with beneficial effects of each intervention.

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“…Pre and post-TKR sample sizes of different magnitudes were reported in ten studies [13,30,31,34,36,38,40,43,46,50]. The remaining seventeen studies [32,33,35,37,39,41,42,44,45,[47][48][49][51][52][53][54][55] reported only one sample size and one can assume that the pre and post-TKR samples were of the same size in those studies. Eighteen studies [33][34][35][37][38][39][41][42][43]45,[48][49][50][51][52][53][54][55] included exclusively TKR as their intervention, while remaining studies included hip arthroplasty (seven studies) [30][31][32]36,…”

Section: Description Of Studies Included (Non-review Articles)mentioning

confidence: 99%

Clinical outcomes and quality of life after Total Knee Replacement (TKR) - A systematic review

Dutta

Qadeer

Rachel

et al. 2022

Preprint

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Background The current review aimed to refresh the existing evidence on clinical effectiveness of Total Knee Replacement (TKR) in various settings, using a wide follow-up window, and to examine the determinants influencing the success of TKR, so the evidence can be systematically synthesized. Methodology Studies only with pre-post study designs, measuring patient reported outcome measures (PROMs) at two time points, pre-TKR and post-TKR, were included. Commonly used PROMs, such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF-36) were harmonized across studies from worst to best and in the range of 0-100 scale. Effect Sizes (ES) were computed using pre-post mean differences in PROMs, quantifying post-TKR changes in the OA-affected knee. Results A total of 27 studies were included in this review. During short-term follow-up (≤ 6 months), greater improvement in WOMAC components such as pain (ES = 2.0) and function (ES = 2.3) was observed as opposed to stiffness. There was an improvement in all the scales of SF-36 except general health post-TKR. Gender (female), co-morbidities and post-operative complications were associated with poor outcomes of TKR. Discussion Improvement in clinical outcomes and performance was observed after TKR, especially between 6 months and 1 year. There was less improvement in PROMs in the long term but without any deterioration within 10 years of follow-up period. Conclusion The overall findings of this review conclude the confirmation of older knowledge with fresh evidence that TKR is definitely a clinically effective and beneficial treatment for individuals with OA knee and that too in different settings. Systematic review registration The systematic review protocol was registered in INPLASY (Registration No: INPLASY202240166)

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Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Cited by 20 publications

References 32 publications

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

CoenzymeQ10 and Ischemic Preconditioning Potentially Prevent Tourniquet-Induced Ischemia/Reperfusion in Knee Arthroplasty, but Combined Pretreatment Possibly Neutralizes Their Beneficial Effects

Clinical outcomes and quality of life after Total Knee Replacement (TKR) - A systematic review

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