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To enhance the success of total knee arthroplasty (TKA), clinicians must identify factors that may impede functional recovery. Multiple comorbidities may affect outcomes, and our purpose was to identify the role of overall disease burden, as well as individual comorbidities, on post-TKA outcomes. We prospectively reviewed 283 TKA patients (172 women, 111 men). Preexisting comorbidities were weighted using the Charlson comorbidity index (CCI). Patients were divided into four groups: CCI score of 0 to 1, 2, 3, or 4 or more and followed up at 6 weeks, 3 months, 1 year, and annually until 5 years. The most prevalent comorbidities were also individually assessed at these follow-ups. The effect of these on outcomes was evaluated using the Knee Society Score (KSS), Short Form 36 (SF-36), and lower extremity activity scale (LEAS). Patients who had lower CCI scores had significant improvements in KSS at 2- and 5-year follow-up (+34 and +38 points, respectively; p < 0.01). CCI scores of 0 to l demonstrated significantly greater improvement in the SF-36 physical component score (PCS) at final follow-up (+16 points; p < 0.05) and higher LEAS scores at 2 years postoperatively (p = 0.001), compared with the remaining cohorts. Endocrine disease and hypertension yielded significantly lower KSS at follow-up (-5 and -5 points, respectively; p < 0.05). Patients who had hypertension or gastrointestinal disease had significantly lower SF-36 PCS at final follow-up compared with those who did not (45 vs. 48 points and 47 vs. 49 points; p < 0.035 and 0.041, respectively), as well as lower activity scores (11 vs. 12 points for both comorbidities; p < 0.05). Patients who had cardiovascular disease had significantly lower SF-36 MCS (53 vs. 56 points, respectively; p = 0.03) at 4 years postoperatively than those without, as well as lower activity scores (11 vs. 12 points, respectively; p = 0.024). Patients who have lower CCIs may have improved activity and functional levels following TKA. Hypertension, cardiovascular disease, endocrine disease, and gastrointestinal disease may correlate with poorer functional and activity outcomes postoperatively.

In selected patients, long-term survival can be obtained. Mucinous histology, absence of signet ring cells, negative peritoneal cytology, PCI ≤ 20, and response/stable disease after neoadjuvant chemotherapy are important selection criteria for CRS and HIPEC.

Rationale: Measures of unstable ventilatory control (loop gain) can be obtained directly from the periodic breathing duty ratio on polysomnography in patients with Cheyne-Stokes respiration/ central sleep apnea and can predict the efficacy of continuous positive airway pressure (CPAP) therapy.Objectives: In this pilot study, we aimed to determine if this measure could also be applied to patients with complex sleep apnea (predominant obstructive sleep apnea, with worsening or emergent central apneas on CPAP). We hypothesized that loop gain was higher in patients whose central events persisted 1 month later despite CPAP treatment versus those whose events resolved over time.Methods: We calculated the duty ratio of the periodic central apneas remaining on the CPAP titration (or second half of the split night) while patients were on optimal CPAP with the airway open (obstructive apnea index , 1/h). Loop gain was calculated by the formula: LG = 2p/[(2pDR 2 sin(2pDR)]. Patients were followed on CPAP for 1 month. Post-treatment apnea-hypopnea index and compliance data were recorded from smart cards.Measurements and Main Results: Thirty-two patients with complex sleep apnea were identified, and 17 patients had full data sets. Eight patients continued to have a total of more than five events per hour (11.8 6 0.5/h) (nonresponders). The remaining nine patients had an apnea-hypopnea index less than 5/h (2.2 6 0.4/h) (responders). Loop gain was higher in the nonresponders versus responders (2.0 6 0.1 vs. 1.7 6 0.2, P = 0.026). Loop gain and the residual apnea-hypopnea index 1 month after CPAP were associated (r = 0.48, P = 0.02). CPAP compliance was similar between groups.Conclusions: In this pilot study, loop gain was higher for patients with complex sleep apnea in whom central apneas persisted after 1 month of CPAP therapy (nonresponders). Loop gain measurement may enable an a priori determination of those who need alternative modes of positive airway pressure.