Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action

Anis, Hiba K.; Warren, Jared A.; Klika, Alison K.; Navale, Suparna M.; Barsoum, Wael K.

doi:10.1055/s-0040-1713756

Cited by 14 publications

(9 citation statements)

References 44 publications

(68 reference statements)

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“…The baseline VR-12 MCS also contributed greatly to the prediction of hospital stay (AIC increase, 20) and 90-day readmission (AIC increase, 5.3), ranking fourth in importance for both outcomes. Previous literature has demonstrated a notable prevalence of mental health dysfunction among candidates for TKA 51 and its effect on postoperative pain and function 46,52 , quality of life 53 , and hospital readmission 54,55 . The findings of the present study further quantify the impact of baseline mental health status on postoperative outcomes and emphasize the need to include preoperative mental health in model-fitting for patient-reported outcome measures after TKA.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA

Sinclair¹,

Klika

Jin

et al. 2022

Journal of Bone and Joint Surgery

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Background: Studies involving total knee arthroplasty (TKA) have focused on patient-related factors as drivers of outcomes.Although some studies have investigated surgeon and/or surgery-level factors (i.e., approach, volume), the measure of variance in postoperative outcomes across surgeons following TKA has not been determined. The aim of the current study was to evaluate the relationship between the surgeon and 1-year patient-reported outcome measures, the length of stay, the discharge disposition, and 90-day readmission after TKA, as well as the differences in these variables among surgeons.Methods: Data were prospectively collected for 5,429 patients who underwent TKA at a large health-care system with 36 surgeons between 2016 and 2018. Likelihood ratio tests were performed to investigate the relationship between surgeon and the 1-year Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain subscale, KOOS-Physical Function Shortform (KOOS-PS), KOOS for Joint Replacement (KOOS-JR), patient acceptable symptom state (PASS), length of stay, discharge disposition, and 90-day readmission. The minimal clinically important difference (MCID) was used to assess meaningful outcomes. Variable importance was determined by the Akaike information criterion (AIC) increase, using ordinal and binary-response mixed-effect models.Results: There was a significant association between surgeon and KOOS-Pain (p < 0.001), KOOS-PS (p = 0.001), KOOS-JR (p < 0.001), PASS (p = 0.024), length of stay (p < 0.001), discharge disposition (p < 0.001), and 90-day readmission (p < 0.001). When modeling 1-year KOOS-Pain (AIC increase, 15.6), KOOS-PS (AIC increase, 6.8), KOOS-JR (AIC increase, 13.5), PASS (AIC increase, 1.9), length of stay, and discharge disposition, the surgeon variable contributed more to the 1-year outcome than some patient-level factors (e.g., body mass index, Charlson Comorbidity Index). The difference between the highest and lowest median probabilities of attaining the same value for the KOOS-Pain (11.2%), KOOS-PS (9.4%), KOOS-JR (11.8%), PASS (5.9%), length of stay (46.6%), discharge disposition (22.8%), and readmission (13.1%) indicated surgeon-level variability.Conclusions: Surgeon-related factors may be stronger contributors to the 1-year patient-reported outcome measures and length of stay than patient characteristics emphasized in the literature. Current findings have suggested variability in patient-reported outcome measures, length of stay, discharge location, and 90-day readmission among surgeons. Surgeon variability should be considered when model-fitting in the setting of TKA.

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Section: Discussionmentioning

confidence: 99%

The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA

Sinclair¹,

Klika

Jin

et al. 2022

Journal of Bone and Joint Surgery

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“…A recent retrospective study showed that more than 30% of PJI patients reveal moderate to severe symptom burden on an ICD-10 based symptom rating even years after successful treatment [ 7 ]. Also, it was shown that the prevalence of mental health conditions was higher in patients undergoing septic revision total knee arthroplasty (TKA) compared to aseptic revision TKA and primary TKA, suggesting that a call for action for mental health support for PJI patients is required [ 26 ]. Whereas the need for psychological support has been explicitly reported by patients [ 9 ], the mental well-being of infection patients has hitherto rarely been focused in trauma surgery.…”

Section: Discussionmentioning

confidence: 99%

Managing periprosthetic joint infection—a qualitative analysis of nursing staffs’ experiences

et al. 2022

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Background Periprosthetic joint infection represents a major complication in orthopaedics and trauma surgery. For an ideal management approach, it is important to understand the distinct challenges for all persons involved in the treatment. Therefore, it was aimed at investigating (1) the impact of periprosthetic joint infection (PJI) on the well-being of nursing staff to (2) identify challenges, which could be improved facilitating the management of PJI. Methods This is a qualitative interview study. In total, 20 nurses of a German university orthopedic trauma center specialized on infectious complications were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between March 2021 and June 2021. Results Three major themes could be extracted including (i) feelings associated with the management of PJI and the need for emotional support, illustrating the negative emotional impact on nurses, whereby receiving collegial support was perceived as an important coping strategy, (ii) patients’ psychological burden, highlighting the nurses’ lack of time to address mental issues adequately and, (iii) realization of the severity of PJI and compliance problems. Conclusion Identified facilitating factors for PJI management include strengthening of mental care in the treatment of PJI, providing opportunities for exchange among multidisciplinary team members and implementing compliance-enhancing strategies. The findings of this study can be beneficial for improving professionals’ satisfaction, optimising the work environment, creating organizational structures which enhance opportunities for exchange and preventing mental health issues among the nursing team.

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“…Infection is currently the fourth most common reason for revision following THA and the second most common cause for revision following TKA in the UK ( 6 ). Its adverse effects on function, pain and mental wellbeing, as well as its economic impact, are well documented ( 10 , 11 , 12 ). In addition to these factors, patient morbidity and mortality are also grossly affected ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Articular spacers in two-stage revision arthroplasty for prosthetic joint infection of the hip and the knee

et al. 2022

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Use of articular antibiotic-eluting cement spacers during two-stage revision arthroplasty for prosthetic joint infection (PJI) is a long-established and proven adjunctive technique during first-stage surgery. Articular spacers come in many forms, either static or dynamic. The authors present an instructional review of current evidence regarding their use. A total of 45 studies (for spacer use in PJI involving either hip or knee) were analysed for data regarding eradication rate, functional outcomes, mechanical complications and the impact on second-stage surgery. A large number of case series and retrospective cohort studies were retrieved, with only a small number of prospective studies (2). High levels of infection eradication were commonly reported (>80%). Outcome scores were commonly reported as indicating good-to-excellent function and pain levels. Second-stage procedures were often not required when dynamic spacers were used. Static spacers were associated with more mechanical complications in both the hip and the knee. In the hip, dynamic spacers were more commonly associated with instability compared to static spacers. Consideration should be given to the use of dual-mobility or constrained definitive acetabular components in these cases at second-stage surgery. The use of antibiotic-eluting polymethylmethacrylate articular spacers in two-stage revision for PJI of hip and knee arthroplasty achieves a high rate of infection eradication. Dynamic spacers may confer a variety of benefits compared to static spacers, with a similar rate of infection eradication.

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Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action

Cited by 14 publications

References 44 publications

The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA

The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA

Managing periprosthetic joint infection—a qualitative analysis of nursing staffs’ experiences

Articular spacers in two-stage revision arthroplasty for prosthetic joint infection of the hip and the knee

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