Trend Shift in the Cause of Revision Total Knee Arthroplasty over 17 Years

Na, Bo-Ram; Kwak, Woo-Kyoung; Lee, Nam-Hun; Song, Eun-Kyoo; Seon, Jong Keun

doi:10.4055/cios21106

Cited by 9 publications

(15 citation statements)

References 26 publications

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“…Inclusion criteria were as follows: (1) clinical studies comparing septic and aseptic revision TKAs, and (2) usable data on clinical outcomes of the septic and aseptic revision TKAs (reporting of the mean and standard deviation [SD] for each group, or the ability to calculate them from the available data). We excluded studies that (1) reported clinical outcomes of only septic or only aseptic revision TKAs, (2) lacked usable data, (3) presented registry data (to avoid duplication with our separate analysis of joint registries), (4) presented earlier or less complete data from the same authors (to avoid duplicate data from the same cohort), (5) included revision TKAs with tumor prostheses, (6) were published in a language other than English, and (7) included <10 cases in each group. For the purposes of this study, revision TKA was defined as exchange of the femoral and/or tibial components.…”

Section: Eligibility Criteriamentioning

confidence: 99%

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Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Kim,

Bae

2023

Journal of Bone and Joint Surgery

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Background: Although several studies have compared the clinical outcomes of septic and aseptic revision total knee arthroplasty (TKA), their results have been controversial. Therefore, this study aimed to compare clinical outcomes and complications of septic and aseptic revision TKA through a systematic review and meta-analysis. Methods: The PubMed (MEDLINE) and Embase databases were searched for studies evaluating the clinical outcomes and complications of 2-stage septic revision and aseptic revision TKAs. A systematic review of clinical outcomes (Knee Society Knee and Function Scores and range of motion) and complications (reoperation, infection, and failure rates) was conducted. Results: Thirteen studies were included in the systematic review. The mean MINORS (Methodological Index for NOn-Randomized Studies) score of the included studies was 20.5 (range, 18 to 22). The meta-analysis revealed higher reoperation (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.50 to 2.62; p < 0.00001), infection (RR, 4.08; 95% CI, 2.94 to 5.64; p < 0.00001), and failure rates (RR, 2.88; 95% CI, 1.38 to 6.03; p = 0.005) in septic revision TKAs than in aseptic revision TKAs. Moreover, septic revision TKAs showed lower Knee Society Knee Scores compared with aseptic TKAs (mean difference [MD], −6.86; 95% CI, −11.80 to −1.92; p = 0.006). However, the Knee Society Function Score (MD, −1.84; 95% CI, −7.84 to 3.80; p = 0.52) and range of motion (MD, −6.96°; 95% CI, −16.23° to 2.31°; p = 0.14) were not significantly different between septic and aseptic revision TKAs. Conclusions: Despite the heterogeneity of prosthesis designs and surgical protocols used in septic and aseptic revision TKAs, the results of this systematic review suggest that 2-stage septic revision TKAs have poorer clinical outcomes and higher complication rates than aseptic revision TKAs do. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Eligibility Criteriamentioning

confidence: 99%

“…Along with the increasing number of TKAs, the number of revision TKAs is also rising 3,4 . The indications for revision TKA can be divided into septic and aseptic reasons 5-7 . Periprosthetic joint infections (PJIs) occur in <1% of all primary TKAs, but they are one of the main reasons for revision TKA (“septic revision”) 8 .…”

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confidence: 99%

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Kim,

Bae

2023

Journal of Bone and Joint Surgery

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“…TKA failure may occur due to various causes, the most common being periprosthetic loosening [ 13 , 14 ]. Precise detection of prosthetic loosening of TKA implants is challenging even for experienced clinicians and may not always be feasible, potentially delaying diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

et al. 2023

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(1) Background: The purpose of this study was to investigate whether the loosening of total knee arthroplasty (TKA) implants could be detected accurately on plain radiographs using a deep convolution neural network (CNN). (2) Methods: We analyzed data for 100 patients who underwent revision TKA due to prosthetic loosening at a single institution from 2012 to 2020. We extracted 100 patients who underwent primary TKA without loosening through a propensity score, matching for age, gender, body mass index, operation side, and American Society of Anesthesiologists class. Transfer learning was used to prepare a detection model using a pre-trained Visual Geometry Group (VGG) 19. For transfer learning, two methods were used. First, the fully connected layer was removed, and a new fully connected layer was added to construct a new model. The convolutional layer was frozen without training, and only the fully connected layer was trained (transfer learning model 1). Second, a new model was constructed by adding a fully connected layer and varying the range of freezing for the convolutional layer (transfer learning model 2). (3) Results: The transfer learning model 1 gradually increased in accuracy and ultimately reached 87.5%. After processing through the confusion matrix, the sensitivity was 90% and the specificity was 100%. Transfer learning model 2, which was trained on the convolutional layer, gradually increased in accuracy and ultimately reached 97.5%, which represented a better improvement than for model 1. Processing through the confusion matrix affirmed that the sensitivity was 100% and the specificity was 97.5%. (4) Conclusions: The CNN algorithm, through transfer learning, shows high accuracy for detecting the loosening of TKA implants on plain radiographs.

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“…In recent decades, the number of TKAs has steadily increased, and this upward trend is expected to continue [ 1 ]. However, with patients becoming younger, more active, yet also more obese, the prevalence of aseptic loosening has been increasing, raising concerns about the optimal fixation method in TKA [ 2 , 3 , 4 ]. Recently, the newer generation of cementless TKA, which incorporates an improved porous surface structure applied through three-dimensional printing technology and enhanced biologic fixation, is becoming increasingly popularized, and its utilization continues to grow [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study

Sohn

Cho²,

Oh³

et al. 2023

Medicina

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Background and Objectives: Recent advancements in three-dimensional printing technology have enhanced the biologic fixation of cementless total knee arthroplasty (TKA), therefore increasing the utilization of newer-generation cementless implants. However, the lack of sealing and tamponade effect of cement on the resected bone surface after cementless TKA raises concerns regarding the potential for greater blood loss compared to cemented TKA. The aim of this study was to (1) compare blood loss and transfusion rates between cementless and cemented TKAs and (2) identify the risk factor for higher blood loss in patients who underwent 1-week-interval staggered bilateral (SB) TKA. Materials and Methods: This retrospective, propensity-matched study included 54 cementless and 53 cemented SB TKAs performed by a single surgeon from 2019 to 2023 with a single implant that has similar design features in both cementless and cemented implants. All patients underwent 1-week-interval SB TKA and received the same patient blood management (PBM) and rehabilitation protocol. The estimated total blood loss (TBL), transfusion rate, and total hemoglobin drop were assessed. Patients were categorized according to TBL into average TBL and higher TBL groups. Univariate and multiple logistic regression analyses were performed to identify risk factors for higher blood loss. Results: There was no difference in TBL between cementless and cemented TKA groups (1233 ± 299 and 1282 ± 309 mL, respectively; p > 0.05). In addition, no between-group differences in the transfusion rate and mean total hemoglobin drop were observed. The logistic regression analyses revealed that whether TKA was cementless or cemented was not associated with higher blood loss; rather, the only identified risk factor was the pre-TKA patient blood volume (odd ratio 1.001, 95% confidence interval 1.000–1002, p = 0.026). Conclusions: Contemporary cementless fixation does not increase blood loss or transfusion rates compared to cemented fixation in patients undergoing 1-week-interval staggered bilateral TKA.

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Trend Shift in the Cause of Revision Total Knee Arthroplasty over 17 Years

Cited by 9 publications

References 26 publications

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study

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