Impact of time to surgery from injury on postoperative infection and deep vein thrombosis in periprosthetic knee fractures

Lee, Sung Ro; Shrestha, Kevin S.; Staggers, Jackson; Liu, Mingchun; Naranje, Sameer; Shah, Ashish

doi:10.1016/j.cjtee.2018.03.005

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…Their study also dichotomized the time to surgery at 48 h. Following the statements of Bovonratwet et al, neither mortality nor a variety of different perioperative complications (e.g., urinary tract infection, wound complication, pneumonia) were influenced by a delay in time to surgery [ 16 ]. Similar results were published by Lee and coworkers, who reported 263 patients with TKA suffering from PFF [ 20 ]. Their analysis focused on rates of intra- and postoperative complications dependent on early or delayed surgical treatment.…”

Section: Discussionsupporting

confidence: 90%

“…Their analysis focused on rates of intra- and postoperative complications dependent on early or delayed surgical treatment. Additionally, in their patient population the different types of complications remained unaffected by time to surgery at a 48 h cutoff [ 20 ]. Nevertheless, Bhattacharyya et al reported inferior outcomes following delayed surgical treatment in patients with PFF and dichotomization at 48 h [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aim of the study was to analyze the differences in mortality rate during the stay in an acute care hospital and at the 120-day follow-up, depending on the time to surgery. In accordance with current research, early surgical stabilization was defined as surgical treatment performed within the first 48 h after hospital admission, whereas late stabilization was defined as surgical treatment after 48 h [ 16 , 18 , 19 , 20 ]. Univariable outcomes were examined separately for patients who received an implant exchange and those who received an osteosynthesis ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

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Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Bliemel

Rascher²,

Knauf

et al. 2021

Medicina

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Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Bliemel

Rascher²,

Knauf

et al. 2021

Medicina

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“…Four studies reported on transfusion rate with a dichotomised delay to surgery [4,6,7,18]. On meta-analysis, there was a significantly lower transfusion rate for those with an early operation, compared to those with a delay to surgery (RR 0.51; 95% CI 0.31, 0.82; p = < 0.001, Supplementary Fig.…”

Section: Transfusionmentioning

confidence: 98%

“…Mean time to surgery from admission for reporting studies was 64 h. In the two studies that reported dichotomous time to surgery at 24 h [6,7], 46.9% (402/857) and 77.9% (377/484) participants were found to have received surgery within 24 h respectively. Three studies reported dichotomous time to surgery at 48 h [8,18,24], with 31.1% (56/180), 60.1% (409/681), and 216/263 (82%) of individuals receiving surgery within this time frame. All 11 articles included in the study were of a retrospective cohort design.…”

Section: Study Characteristicsmentioning

confidence: 99%

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

Farrow

Ablett

Sargeant

et al. 2021

Arch Orthop Trauma Surg

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Introduction Previous evidence has established that early surgery is beneficial to improve outcomes for individuals with native hip fractures in the elderly population. Patients who sustain a periprosthetic fracture have been demonstrated to have similar demographics and outcomes as those with native fractures around the hip and knee. We therefore set out to determine if there is a similar difference in perioperative outcomes between early and delayed surgery for periprosthetic fractures of the hip and knee through a systematic review and meta-analysis. Methods Literature search outputs were screened for studies meeting the inclusion criteria. The groups of early surgery and delayed surgery were defined by study authors. The primary outcome measure was 30 day mortality. Where there was sufficient study homogeneity, a random-effects meta-analysis was performed. Individual study risk of bias was assessed using the ROBINS-I criteria, with the GRADE criteria used for independent outcome evaluation. The review protocol was registered on PROSPERO prior to commencement (Registration number CRD42019149360). Results The inclusion criteria was met in 11 studies (n = 3006). Mean time to surgery from admission for reporting studies was 64 h. 59.6% patients underwent early surgery as defined by the study authors. We identified a significantly lower risk of 30 day mortality for those with early surgery versus delayed surgery (RR 0.21; 95% CI 0.05, 0.90; p = 0.04, n = 2022). There were also significantly better outcomes for early versus delayed surgery regarding: medical complications, length of stay, transfusion risk, and reoperation. The quality of evidence for all the individual outcomes was low or very low. Conclusions There is evidence that delaying surgery in those with periprosthetic fractures of the hip and knee has a deleterious impact on mortality and other important patient outcomes. There are, however, notable limitations to the existing available literature, with further appropriately designed large-scale studies required to confirm these findings.

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Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study

Jin,

Wang,

et al. 2024

Open Medicine

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Purpose To explore the effect of AFN on knee function and complications in patients after TKA. Methods We evaluated 150 patients undergoing unilateral TKA, specifically including 102 patients with varying degrees of AFN after selection. They were divided into four groups based on AFN grade. About 48 patients did not produce AFN, 63 patients were grade I, 29 patients were grade II, and 10 patients were grade III. All patients were followed up for 24 months, and knee function, pain, complications, and other indicators were compared between the four groups. Correlation analysis and regression analysis were used to study the relationship between AFN and other indicators. Results Two cases of periprosthetic fractures (PPF) occurred in our study, with an incidence of 1.35%, which did not show a significant association with AFN. The changes in knee social score (ΔKSS), Western Ontario and McMaster Universities Osteoarthritis Index (ΔWOMAC), and postoperative anterior knee pain visual analog scale (VAS) score were higher in patients with AFN than in those without. Particularly, grades II and III AFN demonstrated superior efficacy. Pearson’s correlation analysis showed that AFN grade is positively correlated with both ΔKSS and ΔWOMAC (r = 0.44, P < 0.001), and AFN grade had a negative correlation with the anterior knee pain VAS (r = −0.250, P < 0.05). In linear regression analysis, AFN grade was positively correlated with both ΔKSS (β = 5.974, 95% CI: 3.968–7.981, P < 0.001) and ΔWOMAC (β = 6.356, 95% CI: 4.223–8.490, P < 0.001). Besides that, there was a negative correlation between AFN grade and anterior knee pain (β = 5.974, 95% CI: 3.968–7.981, P < 0.05). Conclusion Patients with grade II and III AFN who underwent TKA exhibited better knee function and lower levels of anterior knee pain post-surgery.

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Impact of time to surgery from injury on postoperative infection and deep vein thrombosis in periprosthetic knee fractures

Cited by 3 publications

References 31 publications

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study

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