Biological sex has No impact on postoperative complications following simultaneous bilateral total knee arthroplasty.
Ontology highlight
ABSTRACT: Introduction
Simultaneous bilateral total knee arthroplasty (bTKA) is a viable option for treatment of bilateral knee osteoarthritis. The aim of this study is to identify the impact of biological sex on postoperative outcomes.Methods
A retrospective cohort study was conducted utilizing the ACS-NSQIP database. bTKA patients were identified and stratified into groups based upon biological sex. Adverse events after surgery was evaluated with univariate and multivariate analysis.Results
Biological sex is not an independent risk factor for development of postoperative complications.Conclusion
When determining patient qualification of simultaneous or staged bTKA, biological sex should not be taken into consideration.
SUBMITTER: Chen AZ
PROVIDER: S-EPMC6919355 | biostudies-literature | 2020 Jan-Feb
REPOSITORIES: biostudies-literature
Publications
Biological sex has No impact on postoperative complications following simultaneous bilateral total knee arthroplasty.
Chen Aaron Z AZ Gu Alex A Chen Frank R FR Malahias Michael-Alexander MA Thomas Caroline E CE Liu Jiabin J Ast Michael P MP Sculco Peter K PK
Journal of orthopaedics 20190606
<h4>Introduction</h4>Simultaneous bilateral total knee arthroplasty (bTKA) is a viable option for treatment of bilateral knee osteoarthritis. The aim of this study is to identify the impact of biological sex on postoperative outcomes.<h4>Methods</h4>A retrospective cohort study was conducted utilizing the ACS-NSQIP database. bTKA patients were identified and stratified into groups based upon biological sex. Adverse events after surgery was evaluated with univariate and multivariate analysis.<h4> ...[more]
Similar Datasets
Project description:IntroductionThe infrapatellar branch of the saphenous nerve is often injured during total knee arthroplasty (TKA), leading to numbness in its distribution distal to the incision. This is illustrated in a patient who suffered full-thickness burns to the lateral aspect of the knee from a hot water bottle. However, the proportion of patients who are informed of this phenomenon (as well as the effect of informing the patient of numbness) has not previously been studied according to the authors' knowledge. The aim of this study was to establish the proportion of patients with whom postoperative numbness was discussed during the consent procedure and whether this discussion was documented.MethodsA total of 73 patients (103 TKAs) agreed to take part in this study between 16 May and 9 July 2011. Patients were asked about their recollection of numbness being mentioned prior to the procedure as well as whether they experienced postoperative numbness. Statistical analysis was performed using SPSS®.ResultsSubjective numbness was noted in 27% of the patients in this study. The prevalence of numbness decreased with time. Patients whose consent process included a discussion of numbness were 3.3 times more likely to report numbness after TKA (p=0.003).ConclusionsPatient education regarding postoperative numbness increases the patient's awareness of any insensate skin that may develop. Numbness after TKA does improve with time but does not resolve completely. It is therefore recommended by the authors that numbness is discussed preoperatively with the patient and that this discussion is documented.
| S-EPMC4311531 | biostudies-literature
Project description:BackgroundThere is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTKA.Materials and methodsA retrospective review was performed on BTKA patients between March 2013 and May 2018. A total of 285 patients were divided into 2 cohorts. Patients in the simultaneous cohort had concomitant elevation of both tourniquets, but the sequential cohort did not. Perioperative variables were collected, and postoperative complications were tracked for a minimum of 90 days. Patients followed a uniform postoperative protocol. Complications were grouped by category to increase statistical power and compared using a noninferiority test. "Clinically noninferior" was defined as a margin ≤5%.ResultsThe simultaneous cohort had significantly (P < .05) higher American Society of Anesthesiologists class and smokers. Tourniquet time, delta hemoglobin, and surgical time were significantly lower. For the complication categories of "Any Thrombotic Event", "Respiratory", and "Soft Tissue/Wound", the difference in occurrence rates was no more than 2.8%, 2.8%, and 5.2% between cohorts, respectively. The "Cardiovascular (non-MI)" group was no more than 9.3% different, that is, authors are 95% confident that 3 of 4 complication categories meet the clinically noninferior threshold.ConclusionThe study demonstrates the noninferiority of simultaneous as compared to sequential tourniquet inflation in BTKA. Patients with cardiac history may need sequential inflation or staged TKA. The information presented in the study assists surgeons in safely and efficiently performing BTKA.
| S-EPMC7970319 | biostudies-literature
Project description:Simultaneous bilateral TKA (SBTKA) has been a favored surgical solution due to reduced costs and patient suffering. The purpose of the present study was to investigate the risk factors of asymmetric recovery in patients who underwent SBTKA and whether that affected quality of life. A total of 187 patients undergoing SBTKA were included. During this study, patients underwent physical examination (knee swelling, active range of motion (ROM) of knee and quadriceps strength) and completed three surveys (VAS pain rating, Short Form-36 and requisite information lists in this study). Our results reveal interlimb asymmetries existed at least two years postoperatively. Between-limb differences in active ROM, quadriceps strength, and VAS pain scores were significantly detected in our study. Risk factors included being female, being older, and having high BMI and high levels of anxiety and depression; different diagnosis and different component size could be risk factors. Finally, interlimb differences in VAS pain scores and active ROM were negatively associated with SF-36 scores. However, interlimb differences in swelling and quadriceps strength were unrelated to SF-36 scores. Risk factors of asymmetric recovery should be evaluated and appreciated due to their significant impact on patients' quality of life. Before performing SBTKA, clinicians should consider possible risk factors and inform patients of asymmetric recovery between limbs, which could help decrease the unnecessary consultations and postoperative patient dissatisfaction.
| S-EPMC4479550 | biostudies-other
Project description:Periprosthetic joint infection (PJI) can be protracted, incapacitating, needing multiple interventions and could even lead to mortality. Early post-operative PJI has been ascribed to peri-operative introduction of highly virulent bacteria, while delayed post-operative to low-virulence bacteria. Non-tuberculous mycobacteria (NTM) do not figure in the usual list of etiological agents. We report a case of difficult diagnosis of bilateral PJI caused by Mycobacterium abscessus, following bilateral total knee arthroplasty in an elderly male, but treated successfully despite prolonged infection. M. abscessus complex comprises a group of rapidly growing, multidrug-resistant NTM, capable of forming biofilms on prostheses, responsible for wide spectrum of hospital acquired infections. M. abscessus as a cause of PJI is not reported widely. There are a few cases described in literature worldwide. There are no policy guidelines available for treating such cases. High clinical suspicion, with a concerted effort to grow and identify the causal pathogen is important. Standard anti-tubercular therapy is not recommended for treatment due to inherent resistance. Complete excision of infected tissues and removal of prosthesis along with prolonged combination antimicrobial regimen is the treatment of choice.
| S-EPMC6505037 | biostudies-literature
Project description:BackgroundSurgeon and hospital volumes may affect outcomes of various orthopedic procedures. The purpose of this study is to characterize the volume dependence of both facilities and surgeons on morbidity and mortality after total knee arthroplasty.MethodsAdults who underwent total knee arthroplasty for osteoarthritis from 2011 to 2015 were identified using International Classification of Diseases-9 Clinical Modification diagnostic and procedural codes in the New York Statewide Planning and Research Cooperative System database. Readmission, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression, while controlling for patient demographic and clinical factors. Surgeon and facility volumes were compared between the lowest and highest 20%.ResultsOf 113,784 identified patients, 71,827 were treated at a high- or low-volume facility or by low- or high-volume surgeon. Low-volume facilities had higher 1-month, 3-month, and 12-month rates of readmission, urinary tract infection, cardiorespiratory arrest, surgical site infection, and wound complications; higher 3- and 12-month rates of pneumonia, cellulitis, and in-facility mortality; and higher 12-month rates of acute renal failure and revision. Low-volume surgeons had higher 1-, 3-, and 12-month rates of readmission, urinary tract infection, acute renal failure, pneumonia, surgical site infection, deep vein thrombosis, pulmonary embolism, cellulitis, and wound complications; higher 3- and 12-month rates of cardiorespiratory arrest; and higher 12-month rate of in-facility mortality.ConclusionsThese results suggest volume shifting toward higher volume facilities and/or surgeons could improve patient outcomes and have potential cost savings. Furthermore, these results can inform healthcare policy, for example, designating institutions as centers of excellence.
| S-EPMC9059075 | biostudies-literature
Project description:Pyoderma gangrenosum is a neutrophilic dermatosis, which mimics both infection and necrotizing fasciitis, that can present after surgical interventions. We present the case of a 62-year-old male who underwent one-stage bilateral total knee arthroplasty. Nine days after the surgery, he presented with wound breakdown, high fever, and elevated white blood cell count. Repeated debridement was performed, and empiric antibiotics were given. All tissue cultures and aspirates remained negative throughout treatment course, and the patient remained unresponsive to therapy. The patient was eventually diagnosed with pyoderma gangrenosum after infectious etiologies were ruled out and after a skin biopsy and dermatologic consultation. His condition rapidly improved after treatment with corticosteroids, and soft-tissue defects were repaired with skin substitute and full-thickness skin grafting. In patients with aseptic wound breakdown after total knee arthroplasty, pyoderma gangrenosum is a rare but devastating complication and should be considered.
| S-EPMC8397920 | biostudies-literature
Project description:BackgroundThere is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA).MethodsWe performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA.ResultsOur cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n = 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision.ConclusionSimultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.
| S-EPMC6910974 | biostudies-literature
Project description:A 16-year-old girl who had Morquio syndrome presented with severe bilateral hip pain and limited mobility because of bilateral hip osteoarthritis and fixed flexion deformities. She was wheelchair bound for the previous 6 months. Cervical spine flexion-extension views showed mild subluxation (<3 mm), and there was thoracolumbar spine kyphosis. Magnetic resonance imaging of the cervical and thoracolumbar spine showed hypoplasia of the odontoid and vertebral bodies, but no spinal cord compression. Bilateral cemented total hip arthroplasty was performed through a posterior approach under general anesthesia with fiberoptic intubation. The femoral canals accepted a small-diameter stem, the right femoral head was used as a graft for superior right acetabular deficiency, and low-profile all-polyethylene acetabular cups were implanted. Follow-up at 15 years after surgery showed that the patient was fully ambulatory without pain or supports, and radiographs showed no loosening. In summary, total hip arthroplasty at a young age may be necessary in patients who have Morquio syndrome because of severe arthritis and soft tissue contractures. Extensive preoperative evaluation that includes imaging of the entire spine is mandatory because of the risk of developing spinal cord compression.
| S-EPMC5585770 | biostudies-literature
Project description:Transcriptome profiling was performed on muscle biopsies from patients immediately before Total Knee Arthroplasty and two hours after TKA and tourniquet application.
2016-02-01 | GSE75432 | GEO
Project description:BackgroundPostoperative pain after total knee arthroplasty (TKA) can cause negative emotions, such as anxiety and depression, which can severely affect a patient's long-term quality of life.ObjectiveThis study aimed to investigate the impact of multimodal analgesia (MMA) on postoperative anxiety and depression following total knee arthroplasty.MethodsThis study included 161 patients who underwent TKA from October 2020 to October 2022 in the First Affiliated Hospital of Wannan Medical College, including 79 cases in the control group and 82 cases in the multimodal analgesia group (MMA). The MMA group were administered acetaminophen 0.5 g/d orally 3 days before the surgery, and an ultrasound-guided fascia iliac compartment block (FICB) with 0.25% ropivacaine 30 ml in the inguinal region ipsilateral to the surgery was performed 1 h before surgery. After the surgery, 100 ml solution includes 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Postoperative conventional intravenous analgesia was used in the control group, including 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Patients were scored for pain, anxiety, and depression in the ward at 3 and 7 days postoperatively, and postoperative patients were scored using telephone callbacks at 3 months postoperatively.ResultsIt was found that the visual analog scale (VAS) scores for pain at rest at 3 days, 7 days, and 3 months postoperatively were significantly lower in the MMA group than in the control group (P < 0.05). The scores for pain with movement were significantly lower in the MMA group than in the control group at 3 days and 7 days postoperatively (P < 0.01), but they were similar at 3 months postoperatively. Compared to the control group, the MMA group had significantly higher American Knee Society scores (AKS) at 3 days, 7 days, and 3 months postoperatively (P < 0.05). Compared to the control group, the MMA group had significantly higher Lower Extremity Functional Scale and Hospital Anxiety and Depression Scale scores (HADS) (P < 0.05) at 3 days and 7 days postoperatively; compared to the control group, the MMA group had a significantly shorter hospital stay (P < 0.01).ConclusionMultimodal analgesia can alleviate postoperative anxiety and depression in the short term, reduce perioperative pain, improve postoperative recovery, and shorten the length of hospital stay.
| S-EPMC10515006 | biostudies-literature