How Fast Should a Total Knee Arthroplasty Be Performed? An Analysis of 140,199 Surgeries

George, Jaiben; Mahmood, Bilal; Sultan, Assem A.; Sodhi, Nipun; Mont, Michael A.; Higuera, Carlos A.; Stearns, Kim L.

doi:10.1016/j.arth.2018.03.012

Cited by 34 publications

(28 citation statements)

References 22 publications

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“…Therefore, the longer No number, C closing, O opening, D dome, RHTO revising high tibial osteotomy to total knee arthroplasty, PTKA primary total knee arthroplasty, BMI body mass index, KSS Knee Society Score, IS ratio Insall-Salvat ratio, NA not available operative time required for TKA following HTO is probably due to the increased surgical difficulty compared with primary TKA. Moreover, some studies [39,40] reported that prolonged operative times were associated with an increased risk of surgical site infection, and related studies have also shown an increased risk of infection in patients undergoing TKA after prior knee surgery [41,42]. The present metaanalysis revealed a higher infection rate in the RHTO group than in the PTKA group, which is in accordance with previous studies.…”

Section: Discussionsupporting

confidence: 91%

A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty

Sun

Wang

2020

Arch Orthop Trauma Surg

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Background This study was performed to compare the clinical and radiographic outcomes of total knee arthroplasty (TKA) following high tibial osteotomy (HTO) versus primary TKA. Methods Relevant trials were identified via a search of Ovid, PubMed and the Cochrane Central Register of Controlled Trials from inception to 10 January 2019. A meta-analysis was performed to compare postoperative outcomes between revising HTO to TKA (RHTO) and primary TKA (PTKA) with respect to Knee Society Score (KSS), 10-year survival rate, operative time, flexion and extension angle, infection rate and radiographic results. Results Sixteen of 340 studies involving 103,552 adult patients (RHTO group, n = 3955; PTKA group, n = 99,597) were eligible for inclusion in the meta-analysis. Compared with primary TKA, revising HTO to TKA required longer operative time and had a higher infection rate (P < 0.05). The PTKA group had better flexion angle than the RHTO group (P < 0.05). There were no significant differences between the two groups in the KSS, extension angle, radiographic results and 10-year survival rate (P > 0.05). Conclusion Patients who undergo conversion of HTO to TKA have similar 10-year survival rate, KSS, extension angle and radiographic results as patients who undergo primary TKA. However, conversion of HTO to TKA required longer operative time and had a higher infection rate than performing primary TKA. Moreover, conversion of HTO to TKA is associated with poorer flexion angle than primary TKA.

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Section: Discussionsupporting

confidence: 91%

A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty

Sun

Wang

2020

Arch Orthop Trauma Surg

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“…In addition, the low incidence of wound complications and infection in the setting of primary joint surgery may render these studies inappropriately powered. A recent study using the National Surgical Quality Improvement Project database to review over 140,000 primary TKA patients reported a 0.2% incidence of wound dehiscence and 0.8% incidence of SSI [39]. ciNPWT, closed incisional negative pressure wound therapy.…”

Section: Discussionmentioning

confidence: 99%

Use of Closed Incisional Negative Pressure Wound Therapy After Revision Total Hip and Knee Arthroplasty in Patients at High Risk for Infection: A Prospective, Randomized Clinical Trial

Newman

Siqueira

Klika

et al. 2019

The Journal of Arthroplasty

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Background: Continuous wound drainage after arthroplasty can lead to the development of a periprosthetic joint infection. Closed incisional negative pressure wound therapy (ciNPWT) has been reported to help alleviate drainage and other wound complications. The purpose of this prospective randomized controlled trial is to compare the use of ciNPWT with our standard of care dressing in revision arthroplasty patients who were at high risk to develop wound complications. Methods: A total of 160 patients undergoing elective revision arthroplasty were prospectively randomized to receive either ciNPWT or a silver-impregnated occlusive dressing after surgery in a single institution. Patients were included if they had at least 1 risk factor for developing wound complication(s): wound complication, readmission, and reoperation rates were collected at 2, 4, and 12 weeks postoperatively. Results: The postoperative wound complication rate was significantly higher in the control cohort compared to the ciNPWT cohort (19 [23.8%] vs 8 [10.1%], P ¼ .022). There was no significant difference between the control and ciNPWT cohorts in terms of readmissions (19 [23.8%] vs 16 [20.3%], P ¼ .595). Reoperation rate was higher in controls compared to ciNPWT patients (10 [12.5%] vs 2 [2.5%], P ¼ .017). After adjusting for the history of a prior periprosthetic joint infection and inflammatory arthritis, the ciNPWT cohort had a significantly decreased wound complication rate (odds ratio 0.28, 95% confidence interval 0.11-0.68). Conclusion: ciNPWT may decrease the rate of postoperative wound complications in patients who are at an increased risk of such wound issues after revision arthroplasty.

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“…This is further suggested by our findings regarding the decreased incidences of various complications as well as the overall decrease in LOS. This may reflect that providers are more cognizant of the various adverse outcomes that can be associated with prolonged operative time [2]. Additionally, preoperative planning and an increased effort to mitigate these risks postoperatively may have further contributed to these decreased incidences.…”

Section: Discussionmentioning

confidence: 99%

“…As the volume of total knee arthroplasty (TKA) continues to grow [1], there has similarly been an increasing need for information regarding surgeon-related and patient-related factors influencing patient outcomes. Operative time has been extensively explored in this domain [2,3], with multiple studies indicating that prolonged duration can increase patient risk for various adverse outcomes [4e6]. Subsequently, various analyses have focused on factors influencing operative time in order to better understand how to improve results and decrease costs procedural code revaluation by CMS, current information associated with primary TKA [3,7e11].…”

mentioning

confidence: 99%

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

Acuña

Samuel

Karnuta

et al. 2020

The Journal of Arthroplasty

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How Fast Should a Total Knee Arthroplasty Be Performed? An Analysis of 140,199 Surgeries

Cited by 34 publications

References 22 publications

A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty

A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty

Use of Closed Incisional Negative Pressure Wound Therapy After Revision Total Hip and Knee Arthroplasty in Patients at High Risk for Infection: A Prospective, Randomized Clinical Trial

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

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