Journal articles on the topic 'Knee Surgery Risk factors'
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Chaiyakit, Pruk, Weeranate Umpanpong, and Tawipat Watcharotayangkoon. "Risk factors of blood transfusion in knee arthroplasty." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0001. http://dx.doi.org/10.1177/2325967120s00018.
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Objectives: The amount of blood transfusion after knee arthroplasty seem to vary in different reported study. We carried out a retrospective study to analysis pre-operative risk factors for blood transfusion in patient whom underwent knee arthroplasty in our institution. Methods: A retrospective study of 190 patients treated with 194 procedure (186 unilateral knee arthroplasty, 4 bilateral knee arthroplasty) from November 2014 to October 2015 was analyzed. A univariate analysis was performed to establish the relationship between all variables and the need for postoperative transfusion. Variables that were determined to have significant relationship were include in a multivariable analysis.. Results: The univariate analysis revealed a significant relationship between need for postoperative blood transfusion and preoperative hemoglobin levels, surgical technique, arthrotomy approach, DVT prophylaxis, operative blood loss, surgical technique and surgeon experience. The multivariate analysis identified a significant relationship between need for transfusion and preoperative hemoglobin level, surgical technique and operative blood loss. Patients with a preoperative hemoglobin less than 12 g/dL had a 5.1 times greater risk of having a transfusion than those with a hemoglobin level ≥ 12 g/dL. The surgical technique with computer assisted surgery had a 0.15 times lesser risk of having a transfusion than those with the conventional technique. Conclusion: The preoperative hemoglobin level < 12 g/dL was shown to increase risk of the need for blood transfusion after knee arthroplasty, while computer assist surgery total knee arthroplasty was shown to decrease risk of blood transfusion. We suggest that patients with preoperative hemoglobin < 12 g/dL need to be crossmatching PRC in pre-operative steps.
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Parikh, Shital, and Neil Rajdev. "ARE THERE SIDE-TO-SIDE DIFFERENCES IN KNEE MORPHOLOGY IN PATIENTS WITH BILATERAL PATELLAR INSTABILITY." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0011. http://dx.doi.org/10.1177/2325967119s00117.
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Introduction It is not known if there are side-to-side differences in knee morphology in patients with bilateral patellar instability (BPI). Such knowledge would help to answer the question whether similar treatment and prognosis could be expected for both knees in patients with BPI. The purpose of our study was to evaluate and compare anatomic / morphologic risk factors between knees in patients with BPI. Materials and Methods Of 294 patients who underwent surgical stabilization for patellar instability (2008-2017), 32 patients were identified who underwent staged or simultaneous bilateral surgery. This formed the study cohort. Demographic data, mechanism of initial injury and first knee side to be symptomatic were recorded. Radiographs and MRI of these 64 knees were evaluated for trochlear dysplasia (trochlear depth), patellar height (Caton-Deschamps index, Insall-Salvati ratio), patellar tilt, TT-TG distance, sulcus angle (cartilaginous and bony) and trochlear bump (cartilaginous and bony). The number and percentage of knees with pathologic values for measured risk factors were analyzed. For each risk factor, 15% side-to-side differences were considered significant. Statistical correlation was calculated between the time of presentation (first symptomatic knee) and magnitude of risk factors. All measurements were repeated after a 3-week interval and ICC was calculated to determine intraobserver reliability. Results The mean age of 32 patients was 14.6 years. 17/32 patients were females. 29 patients had staged surgery with mean interval of 21 months between surgeries; 3 patients had simultaneous surgery on each knee. Patients with BPI had multiple risk factors. 22/32 patients (69%) had the same Dejour type of trochlear dysplasia. For each measured risk factor, the number and percentage of patients with 15% or more side-to-side differences is shown (Table 1). There were significant side-to-side differences in patellar height ratios, TT-TG distance, and trochlear bump. The timing of presentation did not correlate with increased risk factors, i.e, the knee that presented earlier did not have increased risk factors compared to contralateral knee. ICC showed excellent intraobserver reliability. Conclusion There were significant side-to-side differences between knees in patients with BPI. Treatment and prognosis should be based on anatomic risk factors for each knee in patients with BPI. [Table: see text]
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Davis, Brent R., Jason Chen, Maria C. S. Inacio, Rebecca Love, Heather A. Prentice, and Gregory B. Maletis. "The Incidence of Subsequent Meniscal Surgery Is Higher in the Anterior Cruciate Ligament–Reconstructed Knee Than in the Contralateral Knee." American Journal of Sports Medicine 45, no. 14 (August 28, 2017): 3216–22. http://dx.doi.org/10.1177/0363546517721685.
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Background: A goal of anterior cruciate ligament (ACL) reconstruction is to provide a meniscal protective effect for the knee. Purpose: (1) To evaluate whether there was a different likelihood of subsequent meniscal surgery in the ACL-reconstructed knee or in the normal contralateral knee and (2) to compare the risk factors associated with subsequent meniscal surgery in the ACL-reconstructed knee and contralateral knee. Study Design: Cohort study; Level of evidence, 3. Methods: Using an integrated health care system’s ACL reconstruction registry, patients undergoing primary ACL reconstruction, with no meniscal injury at the time of index surgery and a normal contralateral knee, were evaluated. Subsequent meniscal tears associated with ACL graft revision were excluded. Subsequent meniscal surgery in either knee was the outcome of interest. Sex, age, and graft type were assessed as potential risk factors. Survival analysis was used to compare meniscal surgery–free survival rates and to assess risk factors of subsequent meniscal surgery. Results: Of 4087 patients, there were 32 (0.78%) patients who underwent subsequent meniscal surgery in the index knee and 9 (0.22%) in the contralateral knee. The meniscal surgery–free survival rate at 4 years was 99.08% (95% CI, 98.64%-99.37%) in the index knee and 99.65% (95% CI, 99.31%-99.82%) in the contralateral knee. There was a 3.73 (95% CI, 1.73-8.04; P < .001) higher risk of subsequent meniscal surgery in the index knee compared with the contralateral knee, or a 0.57% absolute risk difference. After adjustments, allografts (hazard ratio [HR], 5.06; 95% CI, 1.80-14.23; P = .002) and hamstring autografts (HR, 3.11; 95% CI, 1.06-9.10; P = .038) were risk factors for subsequent meniscal surgery in the index knee compared with bone–patellar tendon–bone (BPTB) autografts. Conclusion: After ACL reconstruction, the overall risk of subsequent meniscal surgery was low. However, the relative risk of subsequent meniscal surgery in the ACL-reconstructed knee was higher compared with the contralateral knee. Only graft type was found to be a risk factor for subsequent meniscal surgery in the ACL-reconstructed knee, with a higher risk for allografts and hamstring autografts compared with BPTB autografts.
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van Eck, Carola Francisca, Drew Burleson, and Daniel Fariborz Kharrazi. "Worker compensation status increases the risk for presence of pain in the contralateral knee at final follow-up after arthroscopic knee surgery." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 4, no. 2 (March 2019): 82–85. http://dx.doi.org/10.1136/jisakos-2019-000281.
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ObjectivesIn patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population.MethodsAll patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery.ResultsA total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient (<1%) reported pain in the contralateral knee, which increased to 113 patients (80%) at final follow-up surgery. Of the assessed risk factors, only worker compensation status was significant for the development of contralateral knee pain (OR 2.93 95% CI 1.08 to 7.95, p=0.040).ConclusionPain in the contralateral knee is uncommon prior to arthroscopic knee surgery, but common after. The risk for the development of contralateral knee pain is increased if the index injury was workers compensation related.Level of evidenceLevel IV case series.
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Flynn, Megan, Anthony Egger, Yuxuan Jin, Elizabeth Sosic, Greg Strnad, Kurt Spindler, and Paul Saluan. "What are the Risk Factors for Worse Outcomes of Meniscus Surgery in 23-39-Year-Old Patients Ligamentously Stable Knees?" Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0046. http://dx.doi.org/10.1177/2325967120s00468.
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Objectives: Meniscus tears are a common and significant source of knee dysfunction in active young adult patients, and no high-quality prospective cohort or RCTs studies exist evaluating patient-reported outcomes in patients in this age group with ligamentously stable knees. Our objective was to identify patient-reported outcomes and patient-specific risk factors from a prospective cohort with a minimum of one-year follow-up following meniscal repair or excision in patients with ligamentously stable knees. We hypothesized that both groups would have significant improvement in outcomes; patients undergoing meniscal repair would have a higher reoperation rate; and articular cartilage injuries, subsequent knee surgery, and certain demographic characteristics would be significant risk factors to inferior outcomes at one year. Methods: Between February 2015 and December 2017, ligamentously stable meniscal procedures were enrolled and prospectively followed using the outcomes management evaluation system (OME) at Cleveland Clinic. Patients aged 23-39 preoperatively completed a series of validated outcome measurements including the Knee Injury and Osteoarthritis Outcome Score for both Pain (KOOS Pain) and Quality of Life (KOOS QoL). At the time of surgery, physicians documented all intra-articular findings, treatment, and surgical techniques utilized. Patients were followed at minimum of 1-year postoperatively through the OME platform and asked to complete the same outcome instruments done at baseline as well as a question designed to evaluate the Patient Acceptable Symptom State (PASS). The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of outcomes. Results: A total of 371 patients aged 23-39 underwent meniscus excision or repair during the study period. One hundred ninety-four met inclusion criteria, and one-year follow-up was obtained on 72% (n = 139) of the cohort (67% male; median age 32). Both KOOS Pain and KOOS QoL improved significantly at one-year for the entire cohort. Fourteen percent of the cohort (9% on the ipsilateral knee, 5% on the contralateral knee) underwent subsequent surgery at a minimum of one-year postoperatively. The patient-specific risk factors for worse one-year outcomes included preoperative baseline mental capacity score (VR-12 MCS), lower baseline KOOS QoL score, and the intraoperative finding of any grade 3 or 4 chondral changes. Conclusion: Young adult patients with ligamentously stable knees undergoing meniscal surgery have significantly improved patient-reported outcomes regardless of excision or repair; however, 14% of patients underwent additional knee surgery at a minimum of one-year postoperatively. The risk factors for worse outcomes include lower baseline mental health score, lower baseline KOOS QoL score, and any grade 3 or 4 chondromalacia scene.
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Jämsen, Esa, Heini Huhtala, Timo Puolakka, and Teemu Moilanen. "Risk Factors for Infection After Knee Arthroplasty." Journal of Bone and Joint Surgery-American Volume 91, no. 1 (January 2009): 38–47. http://dx.doi.org/10.2106/jbjs.g.01686.
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Fournier, Gaspard, Romain Gaillard, John Swan, Cécile Batailler, Sébastien Lustig, and Elvire Servien. "Stiffness after unicompartmental knee arthroplasty: Risk factors and arthroscopic treatment." SICOT-J 7 (2021): 35. http://dx.doi.org/10.1051/sicotj/2021034.
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Introduction: One of the principal complications after total knee arthroplasty (TKA) is stiffness. There are no publications concerning stiffness after unicompartmental knee arthroplasty (UKA). Study objectives were to describe the incidence of stiffness after UKA, to look for risk factors, and to describe safe and effective arthroscopic treatment. Methods: There were 240 UKA performed between March 2016 and January 2019 included. Robotic-assisted surgery was performed in 164 patients and mechanical instrumentation in 76 patients. Stiffness was defined as flexion < 90° or a flexion contracture > 10° during the first 45 post-operative days. Patients with stiffness were treated with arthroscopic arthrolysis. Several factors were studied to look for risk factors of stiffness: body mass index, gender, age, mechanical or robotic instrumentation, preoperative flexion, previous meniscectomy, and anticoagulant treatment. Arthrolysis effectiveness was evaluated by flexion improvement and UKA revision rate. Results: 22 patients (9%) developed stiffness. Mechanical instrumentation significantly increased the risk of stiffness with OR = 0.26 and p = 0.005. Robotic-assisted surgery decreased the risk of stiffness by five-fold. Before arthrolysis, mean knee flexion was 79°, versus 121° (53% improvement) after arthroscopic arthrolysis. Only 2 patients (9%) underwent UKA revision after arthrolysis. Discussion: Stiffness after UKA is an important complication with an incidence of 9% in this study. Arthroscopic arthrolysis is a safe and effective treatment with a range of motion improvement of > 50%. Robotic-assisted surgery significantly decreases the risk of postoperative stiffness. Level of evidence: Level III, therapeutic study, retrospective cohort study
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Ristic, Vladimir, Sinisa Ristic, Mirsad Maljanovic, Vladimir Djan, Vukadin Milankov, and Vladimir Harhaji. "Risk factors for bilateral anterior cruciate ligament injuries." Medical review 68, no. 5-6 (2015): 192–97. http://dx.doi.org/10.2298/mpns1506192r.
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Introduction. The aim of this study has been to identify which risk factors can influence bilateral anterior cruciate ligament injury. Material and Methods. Thirty-two operated patients took part in this survey during the period of ten years. There were 5 women and 27 men, with average age of 30.46 years (19-55). The respondents filled in the questionnaire by answering the questions regarding the time when getting injured and operated, mechanism of injuries, genetic and anthropometric data, characteristics of sports and every day activities. Results. The incidence of reconstructed bilateral injuries in relation to unilateral ones was 2.3% (50/2168). The age of respondents and side of the injured knee did not correlate significantly with the achieved subjective physical activity level after the second knee surgery. The average time from the first injury to operation was 10 months and 4.3 years since that moment up to the injury of the other knee. It took more than 9 months on average until the reconstruction of contralateral anterior cruciate ligament. The most of athletes were injured in football matches. Three-quarters of athletes returned to competition activities after the first operation, which caused the same injury of the contralateral knee. Discussion and Conclusion. Anterior cruciate ligament rupture of the contralateral knee most often occurs in young active athletes within the first four years after the initial reconstruction. Its frequency is not affected by sex, side of extremity, genetic predisposition, type of sport, concomitant injuries and the choice of graft. Returning to the same or higher level of sports activities after the first reconstruction is one of the preconditions for injuring the other knee in the same way.
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GANDHI, RAJIV, FAHAD RAZAK, J. RODERICK DAVEY, and NIZAR N. MAHOMED. "Metabolic Syndrome and the Functional Outcomes of Hip and Knee Arthroplasty." Journal of Rheumatology 37, no. 9 (July 15, 2010): 1917–22. http://dx.doi.org/10.3899/jrheum.091242.
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Objective.Patients with an elevated systemic inflammatory state are known to report greater pain with knee osteoarthritis (OA). We investigated the influence of risk factors of metabolic syndrome (MetS) on patient function before and after hip and knee replacement surgery.Methods.A total of 677 consecutive patients with primary knee replacement and 547 consecutive patients with primary hip replacement with at least one MetS risk factor were reviewed from our joint registry. Demographic variables of age, sex, and comorbidity were retrieved. MetS risk factors were defined as body mass index (BMI) > 30 kg/m2, diabetes, hypertension, and hypercholesterolemia. Baseline and 1-year Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores were compared across patients by number of MetS risk factors, ranging from 1 to 4. Linear regression modeling was used to evaluate the effects of the MetS risk groups and the individual metabolic abnormalities on predicting baseline and 1-year WOMAC scores. Knee and hip patients were reviewed separately.Results.The knee and hip patients showed a significant difference in sex distribution, BMI, and mean comorbidity across risk groups (p < 0.05). Unadjusted analysis showed that baseline and 1-year WOMAC scores, for both knee and hip patients, increased significantly with increasing number of MetS risk factors (p < 0.05). The linear regression model with the individual metabolic abnormalities was found to be more predictive of outcome than one with the number of MetS risk factors. Hypertension and obesity were the metabolic factors most predictive of a poorer outcome following hip surgery as compared to just obesity for knee patients.Conclusion.Patient function following joint replacement surgery, particularly hip surgery, is negatively affected by metabolic abnormalities perhaps secondary to the systemic proinflammatory state. This knowledge should be used when counseling patients prior to surgery.
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Jid, Lee Qunn, Mak Wai Ping, Wong Yiu Chung, and Wai Yuk Leung. "Visible glove perforation in total knee arthroplasty." Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901769561. http://dx.doi.org/10.1177/2309499017695610.
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Purpose: The risk of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) after glove perforation is not evident. This study was to identify risk factors for glove perforation in primary TKR (total knee replacement) and the risk of subsequent superficial SSI and PJI. Methods and materials: Results of visible glove perforation of both inner and outer gloves during TKR were reviewed. A case–control analysis was performed on the preoperative and operative variables to identify predictive risk factors for glove perforation. Rate of SSI and PJI was compared between perforation and non-perforation groups, including 1226 series and 183 case–control subset. Results: One thousand two hundred twenty-six primary TKR from 2011 to 2014 was reviewed. Fifty-five knees had visible glove perforations. The operation perforation rate was 4.5%. Risk factors identified were body mass index (BMI) > 30, bilateral surgery, operation time >120 min and non-trainee surgeons. Superficial SSI was significantly higher in glove perforation group (9.15 vs. 0.51% and 0.55%). PJI was not significantly different (1.82% vs. 0.60% and 1.1%). The adjusted odds ratio for superficial SSI after perforation was 15.2, independent of BMI and operation time. Conclusion: Visible glove perforation in TKR is associated with several risk factors. The risk of superficial SSI is higher after perforation.
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Reahl, G. Bradley, Dimitrius Marinos, Nathan N. OʼHara, Andrea Howe, Yasmin Degani, Brent Wise, Michael Maceroli, and Robert V. OʼToole. "Risk Factors for Knee Stiffness Surgery After Tibial Plateau Fracture Fixation." Journal of Orthopaedic Trauma 32, no. 9 (September 2018): e339-e343. http://dx.doi.org/10.1097/bot.0000000000001237.
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Harrison-Brown, Meredith, Corey Scholes, Stephen L. Douglas, Sami B. Farah, Dennis Kerr, and Lawrence Kohan. "Multimodal thromboprophylaxis in low-risk patients undergoing lower limb arthroplasty: A retrospective observational cohort analysis of 1400 patients with ultrasound screening." Journal of Orthopaedic Surgery 28, no. 2 (January 1, 2020): 230949902092679. http://dx.doi.org/10.1177/2309499020926790.
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Purpose: This study reports the results of a multimodal thromboprophylaxis protocol for lower limb arthroplasty involving risk stratification, intraoperative calf compression, aspirin prophylaxis and early (within 4 h) post-operative mobilisation facilitated by the use of local infiltration analgesia. The study also aimed to identify risk factors for venous thromboembolism (VTE) within a 3-month period following surgery for patients deemed not at elevated risk. Methods: Patients undergoing knee/hip arthroplasty or hip resurfacing were preoperatively screened for VTE risk factors, and those at standard risk were placed on a thromboprophylaxis protocol consisting of intraoperative intermittent calf compression during surgery, 300 mg/day aspirin for 6 weeks from surgery and early mobilisation. Patients were screened bilaterally for deep vein thrombosis (DVT) on post-operative days 10–14. If proximal DVT was detected, patients were anticoagulated and outcomes were recorded. Symptomatic VTE within 3 months of surgery were recorded separately. Patient notes were retrospectively collated and cross-validated against ultrasound reports. Results: At initial screening, the rate of proximal DVT was 0.54% (1.1% for knee and 0.27% for hip), and distal DVT was 6.63% (20.11% for knee and 2.31% for hip). One small, nonfatal pulmonary embolism (PE) was detected within 3 months of surgery (0.28% of total knee arthroplasty patients or 0.07% of total). All proximal DVTs were treated successfully with anticoagulants; however, one patient suffered a minor PE approximately 10 months post-operatively. Regression analysis identified knee implant and advanced age as independent risk factors for VTE in this cohort. Conclusion: Although knee arthroplasty patients remained at higher risk than hip replacement/resurfacing patients, the incidence and outcomes of VTE remained positive compared with protocols involving extended immobilisation, and episodes of PE were extremely rare. Thus, we conclude that patients at standard preoperative risk of VTE may safely be taken through the post-operative recovery process with a combination of intraoperative mechanical prophylaxis, early mobilisation and post-operative aspirin, with closer attention required for older patients and those undergoing knee surgery.
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Hartwell, Matthew J., Allison M. Morgan, Daniel J. Johnson, Richard W. Nicolay, Robert A. Christian, Ryan S. Selley, Michael A. Terry, and Vehniah K. Tjong. "Risk Factors for 30-Day Readmission following Knee Arthroscopy." Journal of Knee Surgery 33, no. 11 (July 3, 2019): 1109–15. http://dx.doi.org/10.1055/s-0039-1692631.
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AbstractThis study evaluates knee arthroscopy cases in a national surgical database to identify risk factors associated with readmission. The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2012 to 2016 for billing codes related to knee arthroscopy. International Classification of Diseases diagnostic codes were then used to exclude cases which involved infection. Patients were subsequently reviewed for readmission within 30 days. Univariate and multivariate analyses were then performed to identify risk factors associated with 30-day readmission. A total of 69,022 patients underwent knee arthroscopy. The overall 30-day complication rate was 1.75% and the 30-day readmission rate was 0.92%. On multivariate analysis, age > 60 years (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.07–1.55), smoking (OR, 1.40; 95% CI, 1.15–1.70), recent weight loss (OR, 13.22; 95% CI, 5.03–34.73), chronic obstructive pulmonary disease (OR, 1.98; 95% CI, 1.39–2.82), hypertension (OR, 1.48; 95% CI, 1.23–1.78), diabetes (OR, 1.92; 95% CI, 1.40–2.64), renal failure (OR, 10.65; 95% CI, 2.90–39.07), steroid use within 30 days prior to the procedure (OR, 1.91; 95% CI, 1.24–2.94), American Society of Anesthesiologists (ASA) class ≥ 3 (OR, 1.69; 95% CI, 1.40–2.04), and operative time > 45 minutes (OR, 1.68; 95% CI, 1.42–2.00) were identified as independent risk factors for readmission. These findings confirm that the 30-day overall complication (1.75%) and readmission rates (0.92%) are low for knee arthroscopy procedures; however, age > 60 years, smoking status, recent weight loss, chronic obstructive pulmonary disease, hypertension, diabetes, chronic steroid use, ASA class ≥ 3, and operative time > 45 minutes are independent risk factors for readmission.
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Balato, G., S. Di Donato, T. Ascione, A. D'Addona, F. Smeraglia, G. Di Vico, and D. Rosa. "Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate." Joints 05, no. 02 (June 2017): 107–13. http://dx.doi.org/10.1055/s-0037-1603901.
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Purpose Septic knee arthritis following arthroscopy is a rare but dreaded complication. Definition and management of knee deep infections are quite discussed in literature. In this review, literature regarding infections after knee arthroscopy is analyzed highlighting the incidence, causative bacteria, risk factors as well as clinical outcomes. Methods We performed a review of the literature matching the following key words: “septic arthritis” OR “infection” AND “arthroscopy” AND “knee.” Knee arthroscopic procedures, such as debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release, were considered. Complex procedures, such as ligament reconstruction, fractures, or complex cartilage repair techniques, were not included. Results Thirteen studies were included in this review. Incidence of infection ranged from 0.009 to 1.1% in patients undergoing simple arthroscopic procedures. Staphylococci are the most commonly isolated organisms from postarthroscopy infection. Use of intraoperative intra-articular steroids, smoking, obesity, male sex, diabetes, number of procedures performed during surgery, time of surgery, and tourniquet time of more than 60 minutes have been certified as risk factors for knee infection. Conclusion Postarthroscopy septic arthritis of the knee causes significant morbidity, usually requiring readmission to the hospital, at least one additional operation, and prolonged antibiotic therapy, both intravenous and oral. Prompt diagnosis and treatment are associated with a high success rate. Level of Evidence Level IV, systematic review of I-IV studies.
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Davis, Brian, Todd Phillips, Olivia Barron, Brett Heldt, Andrew Bratsman, Rowland Pettit, and Anup Shah. "Venous thromboembolism prophylaxis after ambulatory arthroscopic knee surgery: a systematic review and meta-analysis of incidence and risk factors (109)." Orthopaedic Journal of Sports Medicine 9, no. 10_suppl5 (October 1, 2021): 2325967121S0025. http://dx.doi.org/10.1177/2325967121s00259.
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Objectives: Over 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the United States annually, yet the reported incidence of venous thromboembolism (VTE) and the use of VTE thromboprophylaxis after ACL reconstruction and other arthroscopic knee surgeries still varies widely. Current VTE risk assessment scores, for example the Caprini score, incorporate arthroscopic surgery as a known risk factor but were not developed for stratification of an outpatient ambulatory surgical patient population. There is no current consensus to guide the orthopedic surgeon in prescribing chemoprophylactic agents after arthroscopic knee surgery. The objectives of this study were to determine the incidence, efficacy, and risk factors for VTE specifically following knee arthroscopic procedures. The null hypotheses of this study was that previously defined risk factors for VTE after ambulatory knee arthroscopy (age over 60 years, BMI greater than 30 kg/m2, tobacco use, prior VTE, malignancy, coagulopathy, oral contraceptive use, family history of coagulopathy, and prolonged tourniquet time greater than 90 minutes) would not reach statistical significance when compared across multiple cohorts. Our hypothesis is that a systematic review and meta-analysis of these variables will reject the null hypotheses with a significance of level of p < .05. Methods: A systematic review and meta-analysis was performed using data collected from 30 cohort and therapeutic trials (721,005 patients) published between January 2000 and April 2020 to compare both the incidence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and associated risk factors after knee arthroscopy with or without thromboprophylaxis in adults. Ultrasound, venography, and International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes were deemed acceptable detection methods for VTE. We also performed a meta-analysis of published patient characteristics and risk factors in developing VTE after arthroscopic knee procedures. Individual studies were not evaluated for symptomatic versus asymptomatic VTE detection criteria or methods. Results: Of 331 eligible articles, 6 therapeutic RCTs and 24 cohort studies met the inclusion criteria. Overall incidence of DVT and PE was found to be 0.97% and 0.03% respectively. Analysis of the RCTs was found to support the use of prophylactic anticoagulation in preventing DVTs (relative risk: 0.24, 95% confidence interval [CI]: 0.13-0.44). After analysis of the cohort studies, age greater than 60 years was found to be a statistically significant risk factor for VTE (OR: 1.84, 95% CI: 1.03 – 3.29; p=.04) while a history of malignancy (OR: 2.61, 95% CI: 0.97 – 7.00; p=.06), and history of previous VTE (OR: 4.14, 95% CI: 0.90 – 19.14, p=.07) trended toward significance. Other factors such as BMI greater than 30 kg/m2, tobacco use, tourniquet time, personal or family history of coagulopathy, and oral contraceptive use were not found to be statistically significant risk factors for VTE after knee arthroscopy, however there were limited studies (one to three studies per risk factor) available to distinguish of a majority of these variables. Conclusions: Our results show that the overall incidence of DVT in adults after arthroscopic knee surgery is approaching 1% and that of PE is exceedingly rare, however this may be underestimated if asymptomatic VTE is not identified. Despite a low incidence of VTE after knee arthroscopy, thromboprophylaxis is effective in preventing VTE and trends in risk factors exist in ambulatory sports medicine patients diagnosed with VTE post-operatively. The risk for adverse bleeding events while taking chemoprophylaxis and requires further research. Only rejection of the null hypothesis on age over 60 years was statistically significant, however other defined risk factors may be clinically significant. With these results, we conclude that a preoperative assessment may be warranted in identifying at-risk, high risk, or multi-risk patients for which prophylactic anticoagulation postoperatively after knee arthroscopic procedures may be beneficial. A modified version of the Caprini score specifically stratifying these risk factors in an ambulatory sports medicine population may be valuable to the practicing orthopedic arthroscopic surgeon. More research is warranted for identifying risk factors to better stratify this unique patient population.
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Gomero-Cure, Wadi, John J. Ricotta, Susanna Shin, Fred Beavers, Cameron Akbari, and Paul Foley. "Risk Factors for Below-the-Knee Amputation Failure Requiring Above-the-Knee Revision." Journal of Vascular Surgery 58, no. 4 (October 2013): 1150. http://dx.doi.org/10.1016/j.jvs.2013.07.052.
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Chodór, Paweł, and Jacek Kruczyński. "Preoperative Risk Factors of Persistent Pain following Total Knee Arthroplasty." BioMed Research International 2022 (December 15, 2022): 1–7. http://dx.doi.org/10.1155/2022/4958089.
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Background. Despite good results of total knee arthroplasty (TKA) as a treatment of idiopathic osteoarthritis (OA) of the knee, significant number of patients (16-33%) complain of persistent pain of unknown origin. This phenomenon is the major cause of patient’s dissatisfaction. It has been theorized that certain preoperative factors may increase the risk of persistent pain; hence, their identification should enable proper preoperative education and development of realistic expectations regarding results of TKA. This study is aimed at identifying the preoperative chronic pain predictors in patients undergoing TKA. Methods. In this prospective cohort study, patients scheduled for TKA were examined one day prior to surgery. Demographics, comorbidities, pressure pain thresholds, pain intensity and duration, radiographic OA grade, and range of motion were recorded. Questionnaires such as Beck Depression Inventory (BDI) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected. Study cohort was evaluated approximately 6 months following surgery. Patients were assigned to group A if they had no pain and to group B if they complained of any pain. Collected data was analyzed by biostatistician. Results. 64 patients were included in final analysis, 49 (76,6%) females and 15 (23,4%) males. Mean age was 67,6 yrs (48-84, ±7,42). Group A consisted of 21 patients (33%) while group B consisted of 43 patients (67%). There were no statistically significant differences regarding preoperative factors except for duration of preoperative pain, which was shorter in group A (36 (12-180) vs. 72 (24-180), p = 0,011 ). Every 12 months of preoperative pain were found to increase risk of persistent pain by 1,27 ( p = 0,009 ). Conclusions. Preoperative duration of pain is a risk factor for chronic pain following TKA. Therefore, patients should be operated on as soon as indications arise. Should the surgical treatment of knee arthritis be postponed, intensive and individualized pain management is highly recommended.
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Berteau, Jean-Philippe. "Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions." Journal of Clinical Medicine 11, no. 12 (June 7, 2022): 3252. http://dx.doi.org/10.3390/jcm11123252.
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For patients presenting knee pain coming from osteoarthritis (OA), non-pharmacological conservative treatments (e.g., physical therapy interventions) are among the first methods in orthopedics and rehabilitation to prevent OA progression and avoid knee surgery. However, the best strategy for each patient is difficult to establish, because knee OA’s exact causes of progression are not entirely understood. This narrative review presents (i) the most recent update on the pathogenesis of knee OA with the risk factors for developing OA and (ii) the most recent evidence for reducing knee pain with physical therapy intervention such as Diathermy, Exercise therapy, Ultrasounds, Knee Brace, and Electrical stimulation. In addition, we calculated the relative risk reduction in pain perception for each intervention. Our results show that only Brace interventions always reached the minimum for clinical efficiency, making the intervention significant and valuable for the patients regarding their Quality of Life. In addition, more than half of the Exercise and Diathermy interventions reached the minimum for clinical efficiency regarding pain level. This literature review helps clinicians to make evidence-based decisions for reducing knee pain and treating people living with knee OA to prevent knee replacement.
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Patel, Neel K., Jayson Lian, Michael Nickoli, Ravi Vaswani, James J. Irrgang, Bryson P. Lesniak, and Volker Musahl. "Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury." Orthopaedic Journal of Sports Medicine 9, no. 3 (March 1, 2021): 232596712199420. http://dx.doi.org/10.1177/2325967121994203.
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Background: Many factors can affect clinical outcomes and complications after a complex multiligament knee injury (MLKI). Certain aspects of the treatment algorithm for MLKI, such as the timing of surgery, remain controversial. Purpose: To determine the risk factors for common complications after MLKI reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted on 134 patients with MLKI who underwent reconstruction between 2011 and 2018 at a single academic center. Patients included in the review had a planned surgical reconstruction of >1 ligament based on clinical examination and magnetic resonance imaging. Complications were categorized as (1) wound infection requiring irrigation and debridement, (2) arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions, (3) deep venous thrombosis, (4) need for removal of hardware, and (5) revision ligament surgery. The potential risk factors for complications included patient characteristics, injury pattern categorized according to Schenck classification (knee dislocation [KD] I–KD IV), and timing of surgery. Significant risk factors for complications were analyzed by t test, chi-square test, and Fisher exact test. Results: A total of 108 patients met the inclusion criteria; of these, 29.6% experienced at least 1 complication. Smoking (odds ratio [OR], 3.20 [95% CI, 1.28-8.02]; P = .01) and planned staged surgery (OR, 2.71 [95% CI, 1.04-7.04]; P = .04) significantly increased the overall risk of complication, while increased time from injury to surgery (OR, 0.99 [95% CI, 0.98-0.998]; P < .01) significantly decreased the risk. Increasing time from injury to surgery (OR, 0.99 [95% CI, 0.97-0.998]; P = .02) also led to a slightly but significantly decreased risk for arthrofibrosis. Conclusion: The study findings suggest that smoking, decreased time from injury to initial surgery, and planned staged procedures may increase the rate of complications. Further studies are needed to determine which changes in the treatment algorithm are most effective to reduce the complication rate in patients.
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Novakov, V. B., O. N. Novakova, and M. I. Churnosov. "Risk factors and molecular entities of the etiopathogenesis of the knee osteoarthritis (literature review)." Genij Ortopedii 27, no. 1 (February 2021): 112–20. http://dx.doi.org/10.18019/1028-4427-2021-27-1-112-120.
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Introduction Osteoarthritis (OA) is a heterogenic group of disorders of different etiology with similar biological, morphological and clinical manifestations and outcomes. OA is now considered a disease of the whole joint, including alterations in the articular cartilage, subchondral bone, synovial membrane, ligaments, capsule and periarticular muscles. OA of the knee as the most commonly affected joint accounts for the great medical, medical, social and economic impact. Material and methods A literature review assessing Russian and foreign studies on molecular mechanisms of etiology and pathogenesis of knee OA identified a set of factors for which there was consistent evidence for their association with onset of knee OA. A search of studies published in Russian and in English for the last ten years was conducted using bibliographic databases, including PubMed, PubMedCentral, GoogleScholar, eLIBRARY. Search terms included 'knee osteoarthritis', 'etiology', 'pathogenesis', 'risk factors'. Results Review of the literature showed that patients with knee OA are characterized by changes in cartilage, subchondral bone, synovium, suggesting common mechanisms of joint degeneration during OA development. Osteoarthritis (OA) is multifactorial in origin and closely associated with a wide spectrum of local (previous injury, muscle weakness, knee malalignment, knee surgeries, abnormal mechanical loading, excessive high impact sports, occupational physical activities) and systemic risk factors (advanced age, female sex, height, greater body mass index and obesity, hormone status, family history, mineral bone density, vitamin D deficiency, ethnicity). The prevalence of the knee OA and patterns of joint involvement vary among different racial and ethnic groups. Conclusion The literature review allowed us to identify the molecular mechanisms of etiopathogenesis of knee OA and the major risk factors for the pathology.
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Khokhlova, O. I., E. M. Vasilchenko, and A. M. Berman. "The role of classical risk factors for knee osteoarthritis in unilateral transtibial amputation." Kazan medical journal 102, no. 6 (December 13, 2021): 893–901. http://dx.doi.org/10.17816/kmj2021-893.
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The study aimed to review the literature on the classical risk factors for knee osteoarthritis and their possible role in the development of this pathology in patients with unilateral transtibial amputation in terms of potential rehabilitation prospects. A search of publications was carried out using PubMed databases of the US National Center for Biotechnology Information and the website of the Elsevier publishing house. Well-established increased risk factors for knee osteoarthritis are old age, female gender, lower limb muscle weakness, low or excessive physical activity, overweight, a history of knee joint injury or surgery, chronic knee pain. These factors are common for disabled persons with unilateral transtibial amputation, which, combined with specific mechanical factors, makes these persons more vulnerable to the development and progression of osteoarthritis. Programs aimed at eliminating modifiable risk factors for the development of knee osteoarthritis can contribute to the preservation of knee joint function in the long term and improve the quality of life of persons with unilateral transtibial amputation. This requires the well-coordinated efforts of a multidisciplinary team, as well as the participation of the disabled persons themselves. Identification and management of the potentially modifiable classical risk factors for the development of knee osteoarthritis are one of the promising pathways of rehabilitation of persons with unilateral transtibial amputation.
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White, Richard H., and Mark C. Henderson. "Risk factors for venous thromboembolism after total hip and knee replacement surgery." Current Opinion in Pulmonary Medicine 8, no. 5 (September 2002): 365–71. http://dx.doi.org/10.1097/00063198-200209000-00004.
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Ferguson, KB, A. Winter, L. Russo, A. Khan, M. Hair, MS MacGregor, and G. Holt. "Acute kidney injury following primary hip and knee arthroplasty surgery." Annals of The Royal College of Surgeons of England 99, no. 4 (April 2017): 307–12. http://dx.doi.org/10.1308/rcsann.2016.0324.
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Acute kidney injury (AKI) is a recognised postoperative complication following primary hip/knee arthroplasty surgery. The aim of this study was to determine causative and potentially modifiable risk factors associated with postoperative AKI. Standard data were collected for 413 consecutive arthroplasty patients, both retrospectively and prospectively. Univariate and multivariate analyses were performed to identify any potential causative factors. Eight percent of patients developed postoperative AKI. Univariate analysis found increasing age, history of previous chronic kidney disease and requirement for postoperative intravenous fluids to be risk factors for AKI. The multivariate regression analysis model identified age and volume of postoperative fluid prescription as predictive of postoperative AKI. Antibiotic regime and prescription of non-steroidal anti-inflammatory drugs had no significant effect on the risk of AKI. No patients required dialysis but length of stay increased by 50% in the AKI group. Postoperative AKI may result in significant postoperative morbidity and increased length of stay, and may necessitate invasive therapies such as dialysis. Episodes of AKI could also predispose to future similar episodes and are associated with a long-term decrease in baseline renal function. This study has demonstrated that the identified risk factors are generally non-modifiable. Further work is suggested to determine whether targeted interventions in high risk patients would reduce the incidence of AKI.
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Bayer, Steve, Sean J. Meredith, Kevin W. Wilson, Darren de SA, Thierry Pauyo, Kevin Byrne, Christine M. McDonough, and Volker Musahl. "Knee Morphological Risk Factors for Anterior Cruciate Ligament Injury." Journal of Bone and Joint Surgery 102, no. 8 (January 21, 2020): 703–18. http://dx.doi.org/10.2106/jbjs.19.00535.
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Guo, Heng, Chi Xu, and Jiying Chen. "Risk factors for periprosthetic joint infection after primary artificial hip and knee joint replacements." Journal of Infection in Developing Countries 14, no. 06 (June 30, 2020): 565–71. http://dx.doi.org/10.3855/jidc.11013.
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Introduction: We aimed to explore the risk factors for periprosthetic joint infection (PJI) after primary artificial hip and knee joint replacements by performing a case-control study.
Methodology: The clinical data of patients receiving primary hip and knee joint replacements were retrospectively analyzed. The case group included 96 patients who suffered from PJI, comprising 42 cases of hip joint replacement and 54 cases of knee joint replacement. Another 192 patients who received joint replacement at the ratio of 1:2 in the same period and did not suffer from PJI were selected as the control group. Differences between the two groups were compared in regard to etiology, pathogen, blood type, urine culture, body mass index (BMI), surgical time, intraoperative blood loss, postoperative 1st day and total drainage volumes, length of hospitalization stay, and history of surgery at the affected sites.
Results: Gram-positive bacteria were the main pathogens for PJI. The most common infection after hip joint replacement was caused by Staphylococcus epidermidis, which accounted for 38.10%, while Staphylococcus aureus was mainly responsible for the infection of knee joint (40.74%). High BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were independent risk factors (p < 0.05).
Conclusions: PJI after primary replacement was mainly caused by gram-positive bacteria, and patients with high BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were more vulnerable.
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Hoogeboom, Thomas J., Nico L. U. van Meeteren, Kristin Schank, Raymond H. Kim, Todd Miner, and Jennifer E. Stevens-Lapsley. "Risk Factors for Delayed Inpatient Functional Recovery after Total Knee Arthroplasty." BioMed Research International 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/167643.
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Purpose. To determine the predictive value of surgery-related variables for delayed inpatient functional recovery (i.e., ≥3 days to reach functional independence) after TKA.Method. 193 consecutive people undergoing TKA were included in this prospective cohort study. Inpatient functional recovery was measured daily using the Iowa Level of Assistance scale (ILAS). Two persons reviewed medical records to extract patient characteristics (i.e., age, sex, and BMI) and surgical factors (i.e., blood loss, tourniquet time, postoperative morphine use, and surgical experience). Odds ratios (OR) and area under the curves (AUC) were calculated to determine the predictive value of the putative factors and of the model on delayed functional recovery, respectively.Results. Delayed functional recovery was apparent in 76 (39%) people. Higher age, female sex, and higher BMI were all independent risk factors for delayed functional recovery (AUC (95%-CI); 0.72 (0.65–0.80)), whereas blood loss (OR (95%-CI); 1.00 (0.99–1.01)), tourniquet time (OR = 1.00 (0.98–1.02)), and postoperative morphine use (OR = 0.88 (0.37–2.06)) did not statistically improve the predictive value of the model, while surgical experience did (OR = 0.31 (0.16–0.64); AUC = 0.76 (0.69–83)).Conclusions. Surgery-related factors contribute little to the patient-related characteristics in a predictive model explaining delayed functional recovery after TKA in daily orthopaedic practice.
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Yip, Vincent S. K., Nee Beng Teo, Robert Johnstone, Andrew G. N. Robertson, John H. P. Robertson, George H. Welch, and Stephen Kettlewell. "An Analysis of Risk Factors Associated with Failure of Below Knee Amputations." World Journal of Surgery 30, no. 6 (April 27, 2006): 1081–87. http://dx.doi.org/10.1007/s00268-005-0737-y.
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Hamrin Senorski, Eric, Eleonor Svantesson, Kurt P. Spindler, Eduard Alentorn-Geli, David Sundemo, Olaf Westin, Jon Karlsson, and Kristian Samuelsson. "Ten-Year Risk Factors for Inferior Knee Injury and Osteoarthritis Outcome Score After Anterior Cruciate Ligament Reconstruction: A Study of 874 Patients From the Swedish National Knee Ligament Register." American Journal of Sports Medicine 46, no. 12 (August 13, 2018): 2851–58. http://dx.doi.org/10.1177/0363546518788325.
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Background: Factors relating to the patient and anterior cruciate ligament (ACL) reconstruction may help to identify prognostic factors of long-term outcome after reconstruction. Purpose: To determine 10-year risk factors for inferior knee function after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospectively collected data from the Swedish National Knee Ligament Register were extracted for patients who underwent ACL reconstruction between January 2005 and December 2006. Patients who had no data at the 10-year follow-up for the Knee injury and Osteoarthritis Outcome Score (KOOS) were excluded. Multivariable proportional odds regression modeling was used to assess 10-year patient- and surgery-related risk factors across all the KOOS subscales and the KOOS4 (mean score of 4 subscales: pain, knee-related symptoms, function in sport and recreation, and knee-related quality of life). Results: A total of 874 (41%) patients were included (male, 51.5%; median age at the time of ACL reconstruction, 27.5 years [range, 11.2-61.5 years]). An increase in the severity of concomitant articular cartilage injuries resulted in a reduced KOOS on 4 subscales (odds ratio, 0.64-0.80; P < .05). A higher preoperative KOOS pain score increased the odds of a higher score on the pain, symptoms, and sport subscales and the KOOS4. In addition, a higher preoperative body mass index was a significant risk factor for lower scores on 3 KOOS subscales and the KOOS4. No patient- or surgery-related predictor was significant across all KOOS subscales. Conclusion: This 10-year risk factor analysis identified several factors that can affect long-term knee function after ACL reconstruction. Most risk factors were related to preoperative patient-reported outcome and potentially modifiable. On the other hand, most of the surgery-related risk factors were nonmodifiable. Nevertheless, this information may be helpful to physicians and physical therapists counseling patients on their expectations of outcome after ACL reconstruction.
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Minnema, Brian, Mary Vearncombe, Anne Augustin, Jeffrey Gollish, and Andrew E. Simor. "Risk Factors for Surgical-Site Infection Following Primary Total Knee Arthroplasty." Infection Control & Hospital Epidemiology 25, no. 6 (June 2004): 477–80. http://dx.doi.org/10.1086/502425.
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AbstractObjective:To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).Design:A case-control study.Setting:A 1,100-bed, university-affiliated, tertiary-care teaching hospital.Methods:Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.Results:Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.Conclusions:The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.
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Redondo-Trasobares, B., A. Torres-Campos, J. R. Calvo-Tapies, N. Gran-Ubeira, N. Blanco-Rubio, and J. Albareda-Albareda. "Risk factors of periprosthetic femoral fracture after total knee arthroplasty." Revista Española de Cirugía Ortopédica y Traumatología (English Edition) 64, no. 4 (July 2020): 258–64. http://dx.doi.org/10.1016/j.recote.2020.03.011.
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Hägglund, Martin, and Markus Waldén. "Risk factors for acute knee injury in female youth football." Knee Surgery, Sports Traumatology, Arthroscopy 24, no. 3 (December 24, 2015): 737–46. http://dx.doi.org/10.1007/s00167-015-3922-z.
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Chimutengwende-Gordon, Mukai, Wasim Khan, and David Johnstone. "Recent Advances and Developments in Knee Surgery: Principles of Periprosthetic Knee Fracture Management." Open Orthopaedics Journal 6, no. 1 (July 27, 2012): 301–4. http://dx.doi.org/10.2174/1874325001206010301.
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The management of distal femoral, tibial and patellar fractures after total knee arthroplasty can be complex. The incidence of these fractures is increasing as the number of total knee arthroplasties being performed and patient longevity is increasing. There is a wide range of treatment options including revision arthroplasty for loose implants. This review article discusses the epidemiology, risk factors, classification and treatment of these fractures.
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Levinger, Pazit, Hylton B. Menz, Elin Wee, Julian A. Feller, John R. Bartlett, and Neil R. Bergman. "Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery." Knee Surgery, Sports Traumatology, Arthroscopy 19, no. 7 (November 24, 2010): 1082–89. http://dx.doi.org/10.1007/s00167-010-1325-8.
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Edwards, Paul, Simon Mears, and C. Barnes. "Preoperative Care of the TKA Patient." Journal of Knee Surgery 31, no. 07 (February 23, 2018): 618–24. http://dx.doi.org/10.1055/s-0038-1629905.
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AbstractTotal knee arthroplasty continues to increase in popularity and remains the most common joint replacement surgery. The success of total knee replacement surgery is attributed to improved outcomes, a better patient experience, and lower cost. Rapid recovery total knee replacement protocols have led to these advances by decreasing length of hospital stay, minimizing readmissions, and reducing the cost of surgery. Rapid recovery total knee replacement pathway efforts should focus on preoperative education, optimization of modifiable risk factors, and identification of patients that may not be suitable for this pathway.
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Mohammad, Hasan Raza, Rachael Gooberman-Hill, Antonella Delmestri, John Broomfield, Rita Patel, Joerg Huber, Cesar Garriga, et al. "Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme." PLOS ONE 16, no. 12 (December 31, 2021): e0261850. http://dx.doi.org/10.1371/journal.pone.0261850.
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Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.
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Zantop, Thore, Yusuke Hashimoto, and Hiroaki Nakamura. "Prevalence, Development, and Factors Associated with Cyst Formation after Meniscal Repair with the All-Inside Suture Device." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0032. http://dx.doi.org/10.1177/2325967120s00321.
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Aims and Objectives: The aim of this study is to investigate the prevalence of cyst formation as a complication of all-inside meniscal suture device using magnetic resonance imaging (MRI) and analyze the risk factors. Materials and Methods: Of the patients who had undergone meniscal repair surgery 46 cases (46 knees) were selected to be in the case-control study. 51 menisci (34 medial menisci, 17 lateral menisci) of 46 cases were included to the study. Out of 51 menisci, 46 menisci combined anterior cruciate ligament (ACL) ruptures and had performed ACL reconstruction (ACLR). 5 cases (5 menisci) had been performed meniscal repair (MR). MRIs of the knee were performed 6, 12 and 24 months post-meniscal surgery. The MRIs were examined to detect the new development of cysts encasing the suture anchors and evaluate meniscal healing. Univariate and multivariate risk factor analyses was used to account for the suture technique (suture device alone versus suture device and inside-out suture repair), concurrent operation (MR alone versus MR with ACL reconstruction), patient gender, medial versus lateral menisci, number of device use, side-to-side difference of knee arthrometer, type of anchor (acetal resin versus PEEK material) and clinical scores (Lysholm score, Tegner activity scale, IKDC score). Results: MRI examinations revealed cyst formation in 15 of 51 menisci. 3 menisci were detected cyst formation at 6 months of surgery, 9 at 12 months and 3 at 24 months. Only 3 patients (6.5%) were symptomatic. Tecxhniques using suture device alone was more likely to develop cysts: odds ratio (OR) was 10.67 (95% confidence interval (CI) 1.25 to 91.41). Medial meniscus statistically tended to develop cyst compared with lateral meniscus and OR was 7.92 (95% confidence interval (CI) 1.23 to 51.07). Patients who have instability (side-to-side difference of knee arthrometer > 3mm) are more likely to develop cysts than that ofless than or equal to 3mm (p = 0.06). Conclusion: This study revealed the risk factors and prevalence rate for cyst formation after using the all-inside meniscal suture device. The prevalence rate of cyst formation around suture implant was 29%, however most cases didn’t have any symptoms. Suture device only and medial meniscus were significant risk factors for cyst formation. Knee instability was greater in the cyst developed menisci though it was not significant, which suggested that knee instability could affect cyst formation around suture anchors.
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Blagojevic, Z., V. Stevanovic, and N. Radulovic. "ACL reconstruction with BTB graft: Unusual evolution of knee arthrofibrosis case report." Acta chirurgica Iugoslavica 52, no. 2 (2005): 125–29. http://dx.doi.org/10.2298/aci0502125b.
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Knee arthrofibrosis, which usually occurs after trauma or surgery, can inhibit joint biomechanics. An elaborated interaction of growth factors and other inflammatory mediators initiates and coordinates this deleterious tissue proliferation. Knowledge of risk factors can aid clinicians in helping patients avoid knee arthrofibrosis. Once the condition is present, a history and examination are imperative to institute the most appropriate treatment regimen. Nonoperative measures can be used as therapy, though surgery is often necessary for optimal results. We have analyzed problems in patient with uncommon evolution of knee arthrofibrosis following ACL recontruction with BTB autograft.
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Hasegawa, Masahiro, Shine Tone, Yohei Naito, Hiroki Wakabayashi, and Akihiro Sudo. "Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain." Journal of Knee Surgery 32, no. 10 (November 9, 2018): 1020–23. http://dx.doi.org/10.1055/s-0038-1675415.
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AbstractThe present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires. Risk factors for these types of pain were determined. The ratio of patients with moderate-to-severe pain was 28% (62 knees). Thirteen patients (21 knees; 9%) experienced unclear pain. Patients with moderate-to-severe or unclear pain had malalignment and lower Knee Society knee scores. In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain.
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Schippinger, Gert, Gerhard H. Wirnsberger, Andrea Obernosterer, and Kari Babinski. "Thromboembolic complications after arthroscopic knee surgery: Incidence and risk factors in 101 patients." Acta Orthopaedica Scandinavica 69, no. 2 (January 1998): 144–46. http://dx.doi.org/10.3109/17453679809117615.
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Heijboer, Reinout R. O., Bart Lubberts, Daniel Guss, A. Holly Johnson, and Christopher W. DiGiovanni. "Incidence and Risk Factors Associated with Venous Thromboembolism After Orthopaedic Below-knee Surgery." Journal of the American Academy of Orthopaedic Surgeons 27, no. 10 (May 2019): e482-e490. http://dx.doi.org/10.5435/jaaos-d-17-00787.
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Orfanos, Georgios, Justin Lim, and Bishoy Youssef. "Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties." Archives of Orthopaedic and Trauma Surgery 139, no. 4 (December 7, 2018): 475–82. http://dx.doi.org/10.1007/s00402-018-3084-9.
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Saylık, Murat, Ali Erkan Yenigul, and Teoman Atıcı. "Outcome of mobile and fixed unicompartmental knee arthroplasty and risk factors for revision." Journal of International Medical Research 50, no. 8 (August 2022): 030006052211153. http://dx.doi.org/10.1177/03000605221115383.
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Objectives In this study, we aimed to evaluate the outcomes of patients undergoing unilateral knee arthroplasty (UKA) and to analyze risk factors that may lead to revision in patients who undergo UKA. Methods We included patients who underwent mobile or fixed UKA owing to osteoarthritis and who had at least 24 months of follow-up in the postoperative period. We recorded information on patient age, sex, side, body mass (kg/m2), follow-up duration, Knee Society Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, WOMAC function, WOMAC stiffness, mechanical axle angle, femoral component compliance, tibial component compliance, accumulated experience of the surgeon, and revision status. Results In total, we evaluated 131 knees in 118 patients. 50 (38%) who underwent mobile UKA and 81 (62%) who underwent fixed UKA. The effect of obesity on mobile and fixed UKA revision was significant. The likelihood of revision decreased with greater experience of the surgeon performing UKA. Conclusion Our study showed that the clinical results of mobile and fixed UKA procedures are similar. We also revealed that obesity poses a risk for revision in both fixed and mobile UKA, and the revision rate decreases with increased experience of the surgeon.
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Braginа, S. V., V. P. Moskalev, A. L. Petrushin, and P. A. Berezin. "Perioperative prognosis of infectious complications after total hip and knee arthroplasties. Part II (literature review)." Genij Ortopedii 28, no. 4 (August 2022): 608–18. http://dx.doi.org/10.18019/1028-4427-2022-28-4-608-618.
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Introduction Risk factors in the perioperative period are important for reduction of the infection rate following total hip and knee arthroplasty. The objective of the review was to systematize information on potentially modifiable risk factors for infectious complications following total hip and knee arthroplasty and the possibilities to control them. Material and methods For a comprehensive search, PubMed, eLIBRARY, Scopus, Dimensions were used. The search depth was 30 years. Results The review reports potentially modifiable risk factors and the possibility to control them in the perioperative period. Patients undergoing total joint replacements often suffer comorbid conditions that must be addressed preoperatively and postoperatively. Comorbidities can be associated with such joint pathologies as oligo-, polyosteoarthrosis, arthroplasty of other joints, septic arthritis or with a history of periprosthetic joint infection. Somatic disorders can be associated with abnormal laboratory findings. All these risk factors cannot be eliminated completely and are detrimental for hip and knee arthroplasty. Discussion The current level of information on the risks of infectious complications following total hip and knee arthroplasty may be insufficient to reduce the spread of an infectious agent. There is controversy regarding some predictors of surgical site infection and periprosthetic joint infection. There may be equivocal cause-effect relationships between the patient's potentially unfavorable features and the adverse outcome, which requires further in-depth study of this problem.
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Blanco, Juan F., Agustín Díaz, Francisco R. Melchor, Carmen da Casa, and David Pescador. "Risk factors for periprosthetic joint infection after total knee arthroplasty." Archives of Orthopaedic and Trauma Surgery 140, no. 2 (November 9, 2019): 239–45. http://dx.doi.org/10.1007/s00402-019-03304-6.
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Slobodskoy, A. B., E. Yu Osintsev, A. G. Lezhnev, I. V. Voronin, I. S. Badak, and A. G. Dunaev. "Risk Factors for Periprosthetic Infection after Large Joint Arthroplasty." Vestnik travmatologii i ortopedii imeni N.N. Priorova, no. 2 (June 30, 2015): 13–18. http://dx.doi.org/10.32414/0869-8678-2015-2-13-18.
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Risk factors for the development of purulent complications after large joints arthroplasty were studied by the results of 3641 operations (3210 patients). Hip, knee, shoulder and elbow arthroplasty was performed in 2523, 881, 105 and 132 patients, respectively. Hip and knee revision replacements were performed in 221 cases and in 492 cases surgical interventions were performed for dysplastic coxarthrosis, congenital and acquired deformities, under conditions of bone tissue deficit and other complicated cases. Three hundred fifty one patients were operated on due to acute injury. Periprosthetic infection was diagnosed in 58 cases (1.59%). It was stated that risk factors for periprosthetic infection development included severe concomitant pathology (diabetes mellitus,operations somatic diseases, degree of their severity and duration, HIV infection and other conditions), surgical interventions for dysplastic coxarthrosis and complex total hip replacement. In those cases the risk of complications increased by 1.5-3.5 times. Pyo-inflammatory process in the area of hip joint in history as well as every repeated surgery on the hip increased therisk of postoperative complications significantly. No differences in complication rate depending on the type of fixation and implant manufacturers were noted.
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Slobodskoy, A. B., E. Yu Osintsev, A. G. Lezhnev, I. V. Voronin, I. S. Badak, and A. G. Dunaev. "Risk Factors for Periprosthetic Infection after Large Joint Arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 22, no. 2 (June 15, 2015): 13–18. http://dx.doi.org/10.17816/vto201522213-18.
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Risk factors for the development of purulent complications after large joints arthroplasty were studied by the results of 3641 operations (3210 patients). Hip, knee, shoulder and elbow arthroplasty was performed in 2523, 881, 105 and 132 patients, respectively. Hip and knee revision replacements were performed in 221 cases and in 492 cases surgical interventions were performed for dysplastic coxarthrosis, congenital and acquired deformities, under conditions of bone tissue deficit and other complicated cases. Three hundred fifty one patients were operated on due to acute injury. Periprosthetic infection was diagnosed in 58 cases (1.59%). It was stated that risk factors for periprosthetic infection development included severe concomitant pathology (diabetes mellitus,operations somatic diseases, degree of their severity and duration, HIV infection and other conditions), surgical interventions for dysplastic coxarthrosis and complex total hip replacement. In those cases the risk of complications increased by 1.5-3.5 times. Pyo-inflammatory process in the area of hip joint in history as well as every repeated surgery on the hip increased therisk of postoperative complications significantly. No differences in complication rate depending on the type of fixation and implant manufacturers were noted.
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Baghdadi, Soroush, David Isaacs, Calvin Chan, Lawrence Wells, Theodore J. Ganley, and John Todd Lawrence. "COMPLICATIONS OF ARTHROSCOPIC DRILLING IN THE TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE IN CHILDREN AND ADOLESCENTS." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (July 1, 2021): 2325967121S0009. http://dx.doi.org/10.1177/2325967121s00099.
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Background: Arthroscopic drilling is a well-established treatment for stable intact OCDs of the knee in children when non-operative treatment fails. The decision to proceed to operative treatment requires a discussion regarding the risks and benefits of surgical intervention. While there is abundant data suggesting that OCD drilling is a highly effective treatment strategy, there is little data specifically evaluating the risks and complications of this procedure. Purpose: The goal of this study was to assess the complications of drilling of stable OCDs of the knee, and the risk factors for developing complications. Methods: In a retrospective chart review from 2009-2017, data from patients <18 years old who underwent arthroscopic drilling for stable intact OCD lesions of knee were collected. Lesions treated with other techniques (fixation, chondroplasty, OATS), and those with <3 months of follow-up were excluded. Characteristics of the lesions, treatment approach, and post-operative course were recorded. For bilateral surgeries, each knee was considered a separate record. Results: 139 knees in 131 patients were evaluated, of which 102 (73%) were male. The mean age was 12.7years. 108 knees (77%) had an open physis at the time of operation. Patients were managed conservatively for a mean of 6.76 months pre-operatively (SD=6.6). Average follow-up was 14.8 months after the initial surgery (SD=13.25). 53 patients (38%) were obese or overweight at the time of surgery. All patients regained full ROM within 5° of the contralateral knee at a mean 12.9 weeks post-op (SD=3.2), with all but 7 (5 %) returning to activities of daily living at the 3-month visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. 6 knees (4.3%) underwent 7 additional surgeries during the follow-up period, all of which were for treatment failure in non-healing lesions (loose body removals, chondroplasty, or repeat drilling). In a multiple logistic regression model, age, gender, status of the physis at the time of surgery, BMI percentile, and OCD size were not predictive of the need for additional surgeries. Discussion: Our findings suggest that arthroscopic drilling for OCDs of the knee is a safe procedure with minimal risk of complications. The majority of patients return to their pre-operative daily activity level with full ROM by 3 months after surgery. Complications, including reoperation, were related to the progression of the OCD, rather than the surgical procedure.
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Skaarup, Anette West, Per Rotbøll Nielsen, and Hanne Tønnesen. "Experience of pain and lifestyle risk factors." Clinical Health Promotion - Research and Best Practice for patients, staff and community 5, no. 3 (December 2015): 74–80. http://dx.doi.org/10.29102/clinhp.15011.
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Background Patients with acute and chronic pain have a significantly reduced quality of life, and it is a clinical impression that unhealthy lifestyle influences the experience of pain. To evaluate this, surgery can be seen as a controlled trauma and acute pain model with standardised guidelines. The aim was to investigate the association between lifestyle risk factors and experience of heavy postoperative pain and their duration after major orthopaedic surgery. Methods 109 patients undergoing spine, hip or knee surgery were included. Lifestyle was recorded as self-reported alcohol consumption, smoking, physical inactivity, obesity and risk of malnutrition based on the HPH DATA Model. Pain experience was measured on a visual analogue scale of 0-100mm for the nociceptive and the less frequent neuropathic pain. Heavy pain was defined as maximal pain >30mm at rest or 50mm as dynamic or duration of maximal pain >40min. Preoperative pain history and the methods of pain relief were noted. The postoperative pain was followed for three days. Results Univariate analyses were performed prior to the final multi-variate analyses. Interestingly, unhealthy lifestyle, age or gender were not associated with heavy postoperative pain, except for physical inactivity being negatively associated with the rare neuropathic pain. Unsurprisingly, the study confirmed the significant associations between preoperative and postoperative heavy pain. Conclusion The results showed no or very little support to the clinical impression that patients with poor lifestyle experience pain different from patients with a healthy lifestyle.
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Weber, Alexander E., Philip H. Locker, Erik N. Mayer, Gregory L. Cvetanovich, Annemarie K. Tilton, Brandon J. Erickson, Adam B. Yanke, and Brian J. Cole. "Clinical Outcomes After Microfracture of the Knee: Midterm Follow-up." Orthopaedic Journal of Sports Medicine 6, no. 2 (February 1, 2018): 232596711775357. http://dx.doi.org/10.1177/2325967117753572.
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Background: Microfracture is a single-stage arthroscopic procedure used to treat small- and medium-sized cartilage defects, the clinical results of which have been mixed to date. Purpose: To retrospectively evaluate prospectively collected patient-reported outcomes (PROs) after microfracture as well as to determine patient-related and defect-related factors associated with clinical outcomes and which factors predict the need for additional surgery. Study Design: Case-control study; Level of evidence, 3. Methods: All patients between the ages of 10 and 70 years who underwent microfracture by the senior author for a focal chondral defect of the knee between January 1, 2005, and March 1, 2010, were eligible for study enrollment. Patients were excluded if they underwent concomitant procedures that violated the subchondral bone. Functional outcomes were determined using preoperative and final follow-up PROs, including the Lysholm, International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form–12 (SF-12), and overall satisfaction scores. Patient-related factors (sex, age, body mass index [BMI]) and defect-related factors (lesion size, location, concomitant procedures, prior procedures) were analyzed for correlations with outcome scores. All patient-related and defect-related factors were also analyzed as predictors for subsequent surgery. Results: Overall, 101 patients (102 knees; 55 male, 46 female; mean age, 35.87 ± 12.52 years; mean BMI, 26.3 ± 5.5 kg/m2; mean defect size, 2.635 ± 1.805 cm2) were included. Lesion location included 44.90% at the medial femoral condyle, 21.43% at the trochlea, 11.22% at the lateral femoral condyle, 10.20% at multiple sites, 8.16% at the patella, and 4.08% at the tibial plateau. Microfracture was performed alone in 72 of 102 (71%) knees. At a mean follow-up of 5.66 ± 2.54 years (range, 2-11 years), clinically meaningful and statistically significant improvements were seen in all PROs ( P < .05) except the SF-12 mental component score. Patients who had an isolated tibial plateau defect or multiple defects demonstrated reduced improvements in the symptom rate ( P = .0237). Patients with a BMI >30 kg/m2 had lower postoperative scores on the KOOS activities of daily living subscale ( P = .0261) and poorer WOMAC function and WOMAC pain scores ( P = .029 and .0307, respectively). Patient BMI, age, sex, defect location, concomitant procedures, and operative side were not significant predictors for additional surgery. Larger defect size (>3.6 cm2) and prior knee surgery were independent risk factors for additional knee surgery after microfracture. Conclusion: After microfracture, all PROs demonstrated clinically and statistically significant improvements at 5.7 years. Functionally, male patients benefited more from microfracture than female patients. Microfracture of tibial lesions and multisite microfracture provided less benefit than microfracture of isolated femoral defects. Larger lesion size (>3.6 cm2) and prior knee surgery predicted the need for additional knee surgery after microfracture.
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Quarto, Gennaro, Bruno Amato, Giacomo Benassai, Marco Apperti, Antonio Sellitti, Luigi Sivero, and Ermenegildo Furino. "Prophylactic GSV surgery in elderly candidates for hip or knee arthroplasty." Open Medicine 11, no. 1 (January 1, 2016): 471–76. http://dx.doi.org/10.1515/med-2016-0083.
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AbstractAging is one of the major risk factors for varicose veins. The same is for Knee and Hip Osteoarthritis. Most of the patients undergoing to Hip (THA) or Knee (TKA) arthroplasty are over sixteen. Varicose veins, excluding thrombophilia, are the most significant risk factors for VTE after THA and TKA.This study investigates on the usefulness of prophylactic treatment of GSV insufficiency in elderly patients undergoing to orthopedic surgery.A retrospective study enrolling 44 over-sixty five patients, undergoing to TKA or THA. 24 patients underwent to traditional surgery and 20 to EVLA.The presence of evident varicosities and/or a saphenic reflux lasting > 500 ms has been considered as operability criterion. Both in surgery and EVLA group has been performed the ablation of visible varicosities and only saphenic refluxing traits.Results: 1 case of symptomatic DVT was recorded after arthroplasty. A statistically significant difference (p = 0.006) of recovery time between surgery and EVLA groups has been detected. There is not a statistically significant difference in long-term recurrence rate between surgery and EVLA.Conclusions: It is useful to program GSV surgery, before treat hip or knee. This study showed a 50% decrease in the incidence of postoperative DVT.