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Predictors of extended length of stay after unicompartmental knee arthroplasty.

ABSTRACT: Purpose:To identify factors that independently predict extended length of stay after unicompartmental knee arthroplasty (UKA) surgery (defined as length of stay longer than 3 days), and to identify factors predicting early post-operative complications. Methods:A retrospective analysis of all patients undergoing UKA from January 2016-January 2019?at our institution was performed. Clinical notes were reviewed to determine the following information: Patient age (years), gender, American Society of Anesthesiologists (ASA) grade, weight (kg), height (meters), body mass index (BMI), co-morbidities, indication for surgery, surgeon, surgical volume, surgical technique (navigated or patient-specific instrumentation), implant manufacturer, estimated blood loss (ml), application of tourniquet during the surgery, application of drain, hospital length of stay (days) and surgical complications. Results:Multivariate regression analysis showed that ASA 3-4 vs. ASA 1-2 [OR 4.4 (CI; 1.8-10.8, p?=?0.001)] and a history of cardiovascular disease [OR 2.8 (CI; 1.4-5.5), p?=?0.004)] were significant independent predictors of prolonged length of stay. Hosmer-Lemeshow goodness of fit of the model showed a p-value of 0.214. Nagelkerke R-Square was 0.2. For complications, multivariate regression analysis showed that ASA 3-4 vs. ASA 1-2 [OR 5.8 (CI; 1.7-20.7)] and high BMI (BMI >30) [OR 4.3 (CI; 1.1-17.1)] were significant independent predictors of complications. Hosmer-Lemeshow goodness of fit was 0.89 and Nagelkerke R-Square was 0.2. Patients treated with robotics (Navio) techniques had shorter length of stay median 51?h (IQR; 29-96) when compared to other techniques 72?h (IQR; 52-96), p?=?0.008. Conclusion:Based on the results of our study, high ASA grade (?3) appears to be the most important factor excluding eligibility for fast-track UKA. Any number of co-morbidities may increase ASA, but in and of themselves, apart from a history of cardiovascular disease, they should not be seen as contraindications. Appropriate patient selection, technical tools and details during the surgery could facilitate fast track surgery.

SUBMITTER: Sephton BM

PROVIDER: S-EPMC7067998 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Predictors of extended length of stay after unicompartmental knee arthroplasty.

Sephton B M BM Bakhshayesh P P Edwards T C TC Ali A A Kumar Singh V V Nathwani D D

Journal of clinical orthopaedics and trauma 20190911 Suppl 2

<h4>Purpose</h4>To identify factors that independently predict extended length of stay after unicompartmental knee arthroplasty (UKA) surgery (defined as length of stay longer than 3 days), and to identify factors predicting early post-operative complications.<h4>Methods</h4>A retrospective analysis of all patients undergoing UKA from January 2016-January 2019 at our institution was performed. Clinical notes were reviewed to determine the following information: Patient age (years), gender, Ameri ...[more]

PMID: 32189948

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Project description:OBJECTIVES:Outcomes in total hip and knee arthroplasty (THA and TKA), such as allogeneic transfusions or extended length of stay (LoS), can be used to compare the performance of hospitals. However, there is much variation in these outcomes. This study aims to rank hospitals and to assess hospital differences of two outcomes in THA and TKA: allogeneic transfusions and extended LoS, and to additionally identify factors associated with these differences. DESIGN:Cross-sectional medical record review study. SETTING:Data were gathered in 23 Dutch hospitals. PARTICIPANTS:1163 THA and 986 TKA patient admissions. OUTCOMES:Hospitals were ranked based on their observed/expected (O/E) ratios regarding allogeneic transfusion and extended LoS percentages (extended LoS was defined by postoperative stay >4 days). To assess the reliability of these rankings, we calculated which percentage of the existing variation was based on differences between hospitals as compared with random variation (after adjustment for variation in patient characteristics). Associations between hospital-specific factors and O/E ratios were used to explore potential sources of differences. RESULTS:The variation in O/E ratios between hospitals ranged from 0 to 4.4 for allogeneic transfusion, and from 0.08 to 2.7 for extended LoS. Variation in transfusion could in 21% be explained by hospital differences in THA and 34% in TKA. For extended LoS this was 71% in THA and 78% in TKA. Better performance (low O/E ratios) in transfusion was associated with more frequent tranexamic acid (TXA) use in TKA (R=-0.43, p=0.04). Better performance in extended LoS was associated with more frequent TXA use in THA (R=-0.45, p=0.03) and TKA (R=-0.65, p<0.001) and local infiltration analgesia (LIA) in TKA (R=-0.60, p=0.002). CONCLUSIONS:Ranking hospitals based on allogeneic transfusion is unreliable due to small percentages of variation explained by hospital differences. Ranking based on extended LoS is more reliable. Hospitals using TXA and LIA have relatively fewer patients with transfusions and extended LoS.

Project description:ObjectiveTo explore the outcome and surgical technique of minimally invasive unicompartmental knee arthroplasty (UKA) for spontaneous osteonecrosis of the knee.MethodsTwenty-seven patients with medial compartmental spontaneous osteonecrosis treated by minimally invasive Oxford phase 3 UKA from January 2009 to June 2013 were reviewed retrospectively. Twelve subjects were men and 15 women, with an average age of 64.6 ± 8.6 years (52-82 years). At the time of diagnosis, 11 patients had with grade III necrosis and 16 grade IV according to Mont's classification. Pain, range of motion (ROM) and Hospital for Special Surgery (HSS) knee scores were evaluated before and after UKA. Pre-and postoperative alignment of the lower limbs was measured and compared. Postoperative radiographic assessments were made according to the guidelines proposed by the Oxford group at the final follow-up.ResultsAll patients were followed for a mean time of 27.8 ± 15.9 months (6-59 months). There were no serious adverse events, such as infection, bearing dislocation, aseptic loosening, pulmonary embolism, deep venous thrombosis, cardio-cerebral vascular incident or psychological problems. One revision was required for unrelated causes (fracture of tibia plateau) 3 years after arthroplasty. One femoral component was tilted with a postoperative radiographic angle >10°. One radiolucent line was observed in a patient with spontaneous osteonecrosis of the knee. The two patients with implant failure had no symptoms at last follow-up. Visual analogue scale scores decreased from 6.9 ± 0.9 to 2.0 ± 1.1 (t = 19.27, P = 0.00). Pain was relieved in 96.3% of subjects (26/27). The mean post-operative ROM and femorotibial angle were 125.7° ± 9.6° and 177.7° ± 3.1°, respectively. HSS scores increased from 61.3 ± 9.7 to 93.0 ± 4.8 (t = 14.46, P = 0.00). Of the 27 patients, 26 (96.3%) were satisfied with the outcome of this surgical procedure.ConclusionMinimally invasive UKA is an effective means of managing spontaneous osteonecrosis of the knee. The short-term outcome of UKA is encouraging.

Project description:Background/objectiveUnicompartmental knee arthroplasty (UKA) is a low-invasive knee surgery that enables early recovery. Stress fracture of the medial tibial plateau (MTP) is a complication of UKA that prolongs treatment once it has occurred. We investigated factors affecting its occurrence.MethodsThe study subjects were 167 patients who underwent fixed-bearing UKA between 2009 and 2016 (45 men and 122 women of mean age 77 years, including 134 with osteoarthritis of the knee and 33 with spontaneous osteonecrosis). We measured bone mineral density, installation angle of the tibial component, and leg alignment in those patients who developed stress fracture within 3 months after UKA.ResultsStress fracture did not occur in 155 patients (N group, 45 men and 110 women) and did occur in 12 (SF group, 12 women). The bone mineral density (BMD) of the proximal femur was significantly lower in the SF group, indicating that bone fragility may have contributed to stress fractures at this site. There was no significant difference in the preoperative tibio-femoral angle (TFA), however, postoperative TFA was larger and the magnitude of the change in the valgus direction (ΔTFA) was smaller in the SF group.DiscussionIn usual UKA for medial compartment, the leg is more extroverted postoperatively than preoperatively, and leaving the knee in the genu varus position, which places a greater load on the tibial component, may raise the risk of stress fracture. Although there was no difference between the two groups in the varus angle of the tibial component, in a scatter plot of postoperative TFA and the installation angle of the tibial component members of the SF group were concentrated in the region of high TFA and low varus angle. Varus of the leg and a low varus angle of the tibial component may thus be factors in the occurrence of stress fracture.ConclusionOur results suggested that low BMD in the affected femur, large postoperative TFA, and a combination of large postoperative TFA and small varus angle of the tibial component may contribute to stress fracture of the MTP following UKA.

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Predictors of extended length of stay after unicompartmental knee arthroplasty.

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Predictors of extended length of stay after unicompartmental knee arthroplasty.

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