AIM To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.METHODS We prospectively included 829 patie...AIM To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.METHODS We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty(TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born inthe study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as < 9 years, 9-12 years and > 12 years, respectively.RESULTS We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of < 9 years, 9-12 years and > 12 years, respectively. The mean preoperative(preOP) oxford knee score(OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS(18.6 vs 23.9, P < 0.001), higher pain levels(VAS 73.0 vs 58.7, P < 0.001), expected higher levels of post-OP pain(VAS 14.1 vs 6.1, P = 0.02) and of overall symptoms(VAS 16.6 vs 6.4, P = 0.006). Patients with > 12 years education had lower mean pre-OP OKS(21.5 vs 23.8 and 24.6, P < 0.001) and higher pre-OP VAS pain(65.4 vs 59.2 and 56.4, P < 0.001) compared to groups with shorter education. One year post-operative(post-OP) patients of minority ethnicity had lower mean OKS, higher pain and lower QoL. One year post-OP patients with > 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low(44.6%), and therefore post-OP results were not considered to be significant.CONCLUSION Minority ethnicity and the duration of education influ-ence preoperative disability and expectation in patients undergoing TKA. This should be taken into account when patients are advised pre-operatively.展开更多
AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retro...AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients operated on without a tourniquet. The duration of surgery was shorter and the OBL was less for the tourniquet group than the non-tourniquet group, whereas no significant difference was observed for the TBL. The TBL median was 859 mL(IQR: 383-1315) in the non-tourniquet group vs 737 mL(IQR: 331-1218) in the tourniquet group(P = 0.754). Within the 30-d follow-up period, 9 patients in the tourniquet group and 11 in the non-tourniquet group underwent a reamputation at the trans-femoral level. The use of a tourniquet showed no statistically significant association with the 30-d re-amputation at the femur level in the multiple logistic regression model(P = 0.78). The only variable with a significant association with re-amputation was age(OR = 1.07; P = 0.02).CONCLUSION The results indicate that tourniquets do not cause severe vascular damage with an increased postoperative bleeding or failure rate as the result.展开更多
AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,re...AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.展开更多
AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who ...AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA(UTKA) and 65 patients who had undergone simultaneous bilateral TKA(SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2(2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score(FJS) and Oxford Knee Score(OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- andpostoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant(CI =-0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6(SD = 9.0), and the mean OKS of the UTKA patients was 36.1(SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant(CI =-6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9(SD = 27.5), and the mean FJS of the UTKA patients was 57.5(SD = 28.8). CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.展开更多
BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel ...BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.METHODS A novel TKA system was introduced at our institution on 30th November 2015.Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons(25 TKAs/surgeon)were identified as the Introduction Group.Moreover,the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group.A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period.Demographics,surgery-related factors and alignment data were recorded,and intergroup differences compared.RESULTS Following introduction of the novel implant,Persona TKA was utilized in 69%(71%),53%(54%),and 45%(75%)of primary TKA procedures by the three surgeons,respectively(Follow-up Group).Mean surgery time was increased by 28%(P<0.0001)and mean intra-operative blood loss by 25%(P=0.002)in the Introduction Group,while only the mean surgery time was increased in the Follow-up Group by 18%(P<0.0001).Overall alignment was similar between the groups apart from femoral flexion(FF)and tibial slope(TS).The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction.These differences diminished one year after introduction of the new implant.Fewer outliers with respect to FF and TS were seen when using the novel TKA implant.Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.展开更多
基金Supported by the Danish Rheumatism Association,No.R111-A2587
文摘AIM To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.METHODS We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty(TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born inthe study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as < 9 years, 9-12 years and > 12 years, respectively.RESULTS We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of < 9 years, 9-12 years and > 12 years, respectively. The mean preoperative(preOP) oxford knee score(OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS(18.6 vs 23.9, P < 0.001), higher pain levels(VAS 73.0 vs 58.7, P < 0.001), expected higher levels of post-OP pain(VAS 14.1 vs 6.1, P = 0.02) and of overall symptoms(VAS 16.6 vs 6.4, P = 0.006). Patients with > 12 years education had lower mean pre-OP OKS(21.5 vs 23.8 and 24.6, P < 0.001) and higher pre-OP VAS pain(65.4 vs 59.2 and 56.4, P < 0.001) compared to groups with shorter education. One year post-operative(post-OP) patients of minority ethnicity had lower mean OKS, higher pain and lower QoL. One year post-OP patients with > 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low(44.6%), and therefore post-OP results were not considered to be significant.CONCLUSION Minority ethnicity and the duration of education influ-ence preoperative disability and expectation in patients undergoing TKA. This should be taken into account when patients are advised pre-operatively.
文摘AIM To investigate the total blood loss(TBL) and the safety with respect to the re-amputation rate after transtibial amputation(TTA) conducted with and without a tourniquet. METHODS The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittalflaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmH g above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss(OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL(6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 m L per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients operated on without a tourniquet. The duration of surgery was shorter and the OBL was less for the tourniquet group than the non-tourniquet group, whereas no significant difference was observed for the TBL. The TBL median was 859 mL(IQR: 383-1315) in the non-tourniquet group vs 737 mL(IQR: 331-1218) in the tourniquet group(P = 0.754). Within the 30-d follow-up period, 9 patients in the tourniquet group and 11 in the non-tourniquet group underwent a reamputation at the trans-femoral level. The use of a tourniquet showed no statistically significant association with the 30-d re-amputation at the femur level in the multiple logistic regression model(P = 0.78). The only variable with a significant association with re-amputation was age(OR = 1.07; P = 0.02).CONCLUSION The results indicate that tourniquets do not cause severe vascular damage with an increased postoperative bleeding or failure rate as the result.
文摘AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.
文摘AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA(UTKA) and 65 patients who had undergone simultaneous bilateral TKA(SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2(2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score(FJS) and Oxford Knee Score(OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- andpostoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant(CI =-0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6(SD = 9.0), and the mean OKS of the UTKA patients was 36.1(SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant(CI =-6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9(SD = 27.5), and the mean FJS of the UTKA patients was 57.5(SD = 28.8). CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.
文摘BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.METHODS A novel TKA system was introduced at our institution on 30th November 2015.Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons(25 TKAs/surgeon)were identified as the Introduction Group.Moreover,the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group.A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period.Demographics,surgery-related factors and alignment data were recorded,and intergroup differences compared.RESULTS Following introduction of the novel implant,Persona TKA was utilized in 69%(71%),53%(54%),and 45%(75%)of primary TKA procedures by the three surgeons,respectively(Follow-up Group).Mean surgery time was increased by 28%(P<0.0001)and mean intra-operative blood loss by 25%(P=0.002)in the Introduction Group,while only the mean surgery time was increased in the Follow-up Group by 18%(P<0.0001).Overall alignment was similar between the groups apart from femoral flexion(FF)and tibial slope(TS).The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction.These differences diminished one year after introduction of the new implant.Fewer outliers with respect to FF and TS were seen when using the novel TKA implant.Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.
