Arthrofibrosis after total knee arthroplasty: patients with keloids at risk

Flick, Travis R.; Wang, Cindy X.; Patel, Akshar H.; Hodo, Thomas W.; Sherman, William F.; Sanchez, Fernando L.

doi:10.1186/s10195-020-00563-7

Cited by 12 publications

(7 citation statements)

References 38 publications

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“…Up to now, the system has not recovered, there are limitations in operating rooms, waiting lists for patients, hospital staff and services (anesthesiology, ICU, etc.) even for non-urgent but debilitating orthopedic pathologies [ 20 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic

Aprato

Guindani

Massè

et al. 2021

IJERPH

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Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors’ viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.

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Section: Discussionmentioning

confidence: 99%

Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic

Aprato

Guindani

Massè

et al. 2021

IJERPH

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“…These rooms were marked with clearly visible door sign, and specific pathways were created to connect the wards with the operating rooms with the purpose of preventing contamination of other “clear” pathways for employees and SARS-CoV-2-negative patients. All personnel were specifically trained to don, doff and dispose of personal protective equipment including masks, eye protection, double gloves, gowns, suits and caps, both for the operating rooms and for the wards dedicated to COVID-19 patients [ 15 , 16 ]. Ways in and out of these spaces were separated for the staff.…”

Section: Methodsmentioning

confidence: 99%

Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

et al. 2021

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Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. Materials and methods Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien–Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. Results Median age was 81 years (range 70–96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1–4), median VAS score on admission was 3 (range, 0–6), median CFS was 4 (range, 1–8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1–5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1–5). The median LOS was 12.8 days (range 2–36 days), and 21 patients (55.3%) were discharged home. Conclusions The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. Level of evidence IV.

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“…Patients with keloids have also been shown to have increased odds of developing arthrofibrosis after TKA 54 . A genetic predisposition has been proposed, given that individuals of Black, Hispanic, and Asian ancestry are more likely to form keloids [55][56][57] .…”

Section: Risk Factors Preoperativementioning

confidence: 99%

“…A genetic predisposition has been proposed, given that individuals of Black, Hispanic, and Asian ancestry are more likely to form keloids [55][56][57] . Further study is needed to determine whether the relationship between keloid formation and arthrofibrosis is causative or simply correlative 54 .…”

Section: Risk Factors Preoperativementioning

confidence: 99%

Arthrofibrosis After Total Knee Arthroplasty

Ramos,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.

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Arthrofibrosis after total knee arthroplasty: patients with keloids at risk

Cited by 12 publications

References 38 publications

Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic

Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic

Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

Arthrofibrosis After Total Knee Arthroplasty

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