Total knee arthroplasty in multiple sclerosis

Hughes, K; Nickel, Darren; Gurney-Dunlop, Tanner; Knox, Katherine

doi:10.1016/j.artd.2015.12.002

Cited by 9 publications

(6 citation statements)

References 34 publications

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“…4 Moreover, immunomodulatory and immunosuppressive medications for MS may impair healing and lead to higher infection rates. 5 Thus, outcomes of arthroplasty in the general population cannot be extrapolated to persons with MS. At the same time, the need for joint replacement may be higher in people with MS than in the general population because people with MS, in addition to primary osteoarthritis, also develop secondary osteoarthritis and are prone to traumatic falls and avascular necrosis (AVN) due to corticosteroid use. Prevalence estimates of knee replacement in MS range from 1% to 1.5% and of hip replacement, from 0.5% to 1.5%.…”

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confidence: 99%

“…3 To our knowledge, a systematic review of outcomes of knee and hip replacements in persons with MS has not been performed. The literature is limited to case reports and case series that focus on adverse events, [4][5][6][7][8] such as a series of four patients with MS with knee replacement, all of whom required repeated operation for aseptic failure or instability. 5 These reports, although instructive, cannot be used to assess risks and benefits of these procedures in people with MS.…”

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confidence: 99%

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Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

Gutman¹,

Kim²,

Schwarzkopf³

et al. 2018

International Journal of MS Care

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CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Accreditation Statement: In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Credit The CMSC designates this journal-based activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Credit The CMSC designates this enduring material for 0.5 contact hours (none in the area of pharmacology). Disclosures: Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed no relevant financial relationships.Francois Bethoux, MD, has served as reviewer for this activity. She has disclosed no relevant financial relationships.Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.Josef Maxwell Gutman, MD, has disclosed no relevant financial relationships.Kelvin Kim, BA, has received consulting fees from Smith & Nephew and Intelijoint that are unrelated to this work.Ran Schwarzkopf, MD, MSc, served on the scientific advisory boards for Biogen and Genentech and received research support from the Guthy-Jackson Charitable Foundation, National Multiple Sclerosis Society, Biogen, EMD Serono, Genzyme, and Novartis.Ilya Kister, MD, One peer reviewer for the IJMSC has received consulting fees from Biogen, Sanofi Genzyme, Ibsen Pharmaceutical, and Teva and has done contracted research for Astellas, Merck, and Biogen. The other peer reviewer has disclosed no relevant financial relationships. The staff at the IJMSC, CMSC, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Disclosures listed for authors are those applicable at the time of their work on this project and within the previous 12 months. Method of Participation: Release Date: October 1, 2018 Valid for Credit Through: October 1, 2019 In order to receive CME/CNE credit, participants must: Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

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confidence: 99%

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confidence: 99%

Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

Gutman¹,

Kim²,

Schwarzkopf³

et al. 2018

International Journal of MS Care

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“…28 The higher proportion of spasticity seen in the MS group could be expected, since it is a common symptom in this disease. [13][14][15]17 The annual number TKAs performed in MS patients increased a Data missing or unknown for some patients: for gender, N ¼ 9,563 missing for controls. Fig.…”

Section: Discussionmentioning

confidence: 99%

“…14 The development of end-stage knee osteoarthritis is usually independent of the disease, and when MS patients become TKA candidates, surgeons may be faced with a more challenging postoperative rehabilitation process. 15 This is particularly true when the patients' have limited range-ofmotion, flexion contractures, and poor physical function. 12,15,16 Furthermore, the current literature on MS patients who undergo TKA is lacking and limited to a few case reports.…”

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confidence: 99%

“…15 This is particularly true when the patients' have limited range-ofmotion, flexion contractures, and poor physical function. 12,15,16 Furthermore, the current literature on MS patients who undergo TKA is lacking and limited to a few case reports. 15,[17][18][19] Due to limited data describing the unique characteristics and short-term clinical outcomes of patients with MS who undergo primary TKA, this study was conducted to evaluate: (1) unique characteristics of MS patients and (2) short-term clinical outcomes, of primary TKA in patients with MS (MS-TKA) compared with a matched non-MS patients.…”

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What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

et al. 2018

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Due to the paucity of evidence, this study was conducted to evaluate: (1) unique characteristics of multiple sclerosis (MS) patients and (2) short-term clinical outcomes, of primary total knee arthroplasty (TKA) in patients with MS (MS-TKA) compared with matched non-MS patients. MS patients who underwent TKA were identified using the Nationwide Inpatient Sample (NIS) database. The study sample consisted of 10,884 patients with MS and 56,45,227 control cohort. Various patient factors were compared. To control for potential confounders, with the use of propensity scores, MS-TKA patients were matched (1:3) to non-MS-TKA patients and regression analyses were performed to compare perioperative complications, length of stay (LOS), and discharge dispositions. Patients with MS were younger, more likely to be females, on corticosteroids, and more likely to have muscle spasms and gait abnormalities. Annual frequency of TKAs in MS patients increased from 1.16/1,000 TKAs in 2002 to 2.48/1,000 TKAs in 2013 ( < 0.001). Compared with the matched cohort, MS patients had significantly greater odds for any medical complication (odds ratio [OR] = 1.26; 95% confidence interval [CI], 1.11-1.44), longer mean LOS (mean difference: 0.15; 95% CI, 0.09-0.22), and had a greater chance of being discharged to a care facility (OR = 2.17; 95% CI, 1.96-2.40). In this study, we identified specific characteristics of patients with MS who had TKA and analyzed and compared their short-term TKA outcomes to non-MS patients. It was demonstrated that more patients with MS are undergoing TKA, and these patients were at a higher risk of perioperative complications, had longer LOS, and were more likely to be discharged to a sub-acute or inpatient facility. Orthopaedic surgeons should be cognizant of the increased risks and provide proper counseling to MS patients who are candidates for TKA.

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Baclofen/oxybutynin

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Total knee arthroplasty in multiple sclerosis

Cited by 9 publications

References 34 publications

Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

Baclofen/oxybutynin

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