Preoperative risks and outcomes of hip and knee arthroplasty in the veterans health administration

Weaver, Frances M.; Hynes, Denise M.; Hopkinson, William; Wixson, Richard L.; Khuri, Shukri F.; Daley, Jennifer; Henderson, William G.

doi:10.1016/s0883-5403(03)00259-6

Cited by 129 publications

(113 citation statements)

References 18 publications

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“…Therefore, delaying TKR by incorporating hylan G-F 20 into the treatment plans for these patients is advantageous. Avoiding surgical treatment might also prevent complications that can arise from TKR, including, but not limited to, infection, 9,10 pulmonary embolism, 11,12 11,12 and even death for some. [26][27][28] In addition, risk for complication in an older patient due to the delay in TKR is dependent on individual patient factors.…”

Section: Ss Discussionmentioning

confidence: 99%

“…surgery have been reported, including infection, 9,10 pulmonary embolism, 11,12 thromboses, 11,[13][14][15] fat embolism, 16 hemarthrosis, 17 patellar fracture, 18 heterotopic ossification, 19,20 stiffness, 21,22 nerve damage, 11,23 vascular injuries, 11,14,24,25 and urinary complications. 11,12 The perioperative mortality rate has been reported at 0.17%-0.46% for primary total knee arthroplasty within 90 days [26][27][28] and 0.33%-0.78% for bilateral knee replacements within 30 days.…”

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confidence: 99%

“…11,12 The perioperative mortality rate has been reported at 0.17%-0.46% for primary total knee arthroplasty within 90 days [26][27][28] and 0.33%-0.78% for bilateral knee replacements within 30 days. [28][29][30] Hylan G-F 20 (Synvisc) is a cross-linked hyaluronan derivative approved for the treatment of pain due to OA of the knee after other conservative approaches have failed.…”

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confidence: 99%

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Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Waddell¹,

Bricker²

2007

JMCP

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steoarthritis (OA) and other rheumatic conditions are the leading cause of disability in the United States. 1 The prevalence of OA of the knee in various countries can be estimated as 18% of men and women as inferred by a recent meta-analysis.2 OA can also result in significant direct and indirect costs, which are higher with greater disability. 3 Current therapeutic options for OA are approved to treat the pain associated with the disorder. The American College of Rheumatology recommends the initial use of nonpharmacologic techniques, such as patient education, weight loss, and physical therapy, followed by pharmacologic therapies such as acetaminophen and cyclooxygenase (COX)-2-specific inhibitors. 4 Intra-articular hyaluronan therapy is recommended for patients who are no longer responsive to nonpharmacologic and pharmacologic treatments or who may be experiencing adverse side effects with nonselective nonsteroidal inflammatory drugs or COX-2-specific inhibitors. 4 Total knee replacement (TKR) is considered a last resort for treatment of OA knee pain in appropriate patients when other therapies fail. According to the National Hospital Discharge Survey published by the U.S. Department of Health & Human Services, approximately 326,000 patients in the United States received a TKR in 2001. 5 In a sample of 6,856 decedents aged ≥65 years, 2.1% were found to have received knee replacements. 6 The cost of knee replacement surgery at patient discharge was reported as $24,045 for 2001. 7 The success of TKR in most patients has been supported by more than 20 years of follow-up data. 8 While TKR is an effective option for OA pain relief for many patients, it is not medically desirable for some patients (age, heart disease, diabetes, pulmonary disease, obesity, or generalized medical debilitation) or is not preferred by others. Additionally, complications of the ABSTRACT BACKGROUND: Total knee replacement (TKR), a last resort for treating knee pain due to osteoarthritis (OA), is not always medically indicated or preferred by many patients. Hylan G-F 20 is a cross-linked hyaluronan derivative approved for the treatment of pain due to OA of the knee after other conservative approaches have failed.OBJECTIVE: The objectives of this study were to (1) determine the effect of hylan G-F 20 on patient need for TKR as measured by time from hylan G-F 20 injection to TKR, and (2) assess patient factors that might influence time from hylan G-F 20 therapy to TKR.METHODS: This is a retrospective case series review of the medical records of patients seen in 1 orthopedic specialty practice. The incidence and time to TKR in patients who were TKR candidates (100% grade IV OA [severe]) treated with 1 or more courses of intra-articular hylan G-F 20 injections (3 weekly injections per course) were determined from October 1997 to November 2003. Survival analysis was used to evaluate time to TKR and the effects of age, gender, ethnicity, body mass index (BMI), and presence of effusion on this outcome. Logistic regression was also used to assess...

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Section: Ss Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Waddell¹,

Bricker²

2007

JMCP

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“…In an earlier examination of surgical outcomes following knee or hip arthroplasty based on NSQIP data, Weaver and colleagues identified race/ethnicity as a predictor of poor outcome of total joint arthroplasty (20). That study also demonstrated that female sex was associated with a significantly higher risk of complications following knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Yet very few data document racial/ethnic differences in health outcomes following knee or hip arthroplasty. A previous VA-based study that focused on male/female variation in joint arthroplasty outcomes also assessed variation by race/ethnicity and showed that nonwhite race was related to poor outcomes of total joint replacement (20). However, the older data used in that study may not accurately reflect improvements in surgical outcomes associated with more recent technological advances in joint arthroplasty.…”

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confidence: 98%

Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty

Ibrahim

Stone

Han

et al. 2005

Arthritis & Rheumatism

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Objective. The utilization of joint arthroplasty for knee or hip osteoarthritis varies markedly by patient race/ethnicity. Because of concerns about surgical risk, black patients are less willing to consider this treatment. There are few published race/ethnicity-specific data on joint arthroplasty outcomes. The present study was undertaken to examine racial/ethnic differences in mortality and morbidity following elective knee or hip arthroplasty.Methods. Using information from the Veterans Administration National Surgical Quality Improvement Program database, data on 12,108 patients who underwent knee arthroplasty and 6,703 patients who underwent hip arthroplasty over a 5-year period were analyzed. Racial/ethnic differences were determined using prospectively collected data on patient characteristics, procedures, and short-term outcomes. The main outcome measures were risk-adjusted 30-day mortality and complication rates. Conclusion. Although absolute risks of complication are low, our findings indicate that, after adjustment, black patients have significantly higher rates of infection-related and non-infection-related complications following knee arthroplasty, compared with white patients. In addition, adjusted rates of infection-related complications after knee arthroplasty are higher in Hispanic patients than in white patients. Such differences between ethnic groups are not seen following hip arthroplasty. These groups do not appear to differ significantly in terms of post-arthroplasty mortality rates. Results. Adjusted rates of both non-infectionrelated and infection-related complicationsOsteoarthritis (OA) is among the most prevalent chronic conditions in the US, affecting nearly 70 million Americans (1,2). Knee and hip OA are associated with major morbidity and are among the leading causes of disability in the US (3-5). Although there is currently no cure for OA, total joint arthroplasty is a cost-effective treatment option for end-stage knee or hip OA (6-9).

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Association of peptic ulcer disease and pulmonary disease with risk of periprosthetic fracture after primary total knee arthroplasty

Singh¹,

Lewallen²

2011

Arthritis Care & Research

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Objective To assess the association of specific comorbidities with periprosthetic fractures after primary total knee replacement (TKA) Methods We used the prospectively collected data in the Mayo Clinic Total Joint Registry from 1989-2008 on all patients who had undergone primary TKA. The outcome of interest was postoperative periprosthetic fractures during the follow-up. Main predictors of interest were comorbidities grouped from the validated Deyo-Charlson index. Multivariable-adjusted Cox regression analyses adjusted for gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, operative diagnosis and implant fixation. Hazard ratios and 95% confidence intervals were calculated. Results We included 17,633 primary TKAs with a mean follow-up of 6.3 years. The mean age was 68 years, 55% were women and mean BMI was 31. There were 188 postoperative periprosthetic fractures on postoperative day one or later; 162 fractures (86%) occurred postoperative day 90 day or later. In multivariable analyses that simultaneously adjusted for all comorbidities and other variables (age, gender, BMI, ASA, operative diagnosis, cement status), two conditions were significantly associated with increased hazard of postoperative periprosthetic fractures: peptic ulcer disease, hazard ratio of 1.87 (95% confidence interval:1.28, 2.75; p=0.0014); and chronic obstructive pulmonary disease (COPD) hazard ratio of 1.62 (95% confidence interval:1.10, 2.40; p=0.02). Conclusions Peptic ulcer disease and COPD are associated with higher risk of periprosthetic fractures after primary TKA. This may be related to the disease or their treatments, which needs further study. Identification of specific risk factor may allow for implementation of intervention strategies to reduce this risk.

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Preoperative risks and outcomes of hip and knee arthroplasty in the veterans health administration

Cited by 129 publications

References 18 publications

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty

Association of peptic ulcer disease and pulmonary disease with risk of periprosthetic fracture after primary total knee arthroplasty

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