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Clinical Orthopaedics and Related... May 2013The use of total knee arthroplasty (TKA) has increased substantially in most Western countries. However, the trends in TKA use and changes in demographic characteristics... (Review)
Review
BACKGROUND
The use of total knee arthroplasty (TKA) has increased substantially in most Western countries. However, the trends in TKA use and changes in demographic characteristics of patients having TKA in Korea remain unclear.
QUESTIONS/PURPOSES
We documented the trends in TKA use and in the demographics of patients undergoing TKA in Korea over the past decade and determined whether current TKA use in Korea corresponds to worldwide trends.
METHODS
Using the Health Insurance Review and Assessment Service of Korea database, we analyzed TKA records (n = 398,218) from 2001 to 2010 in Korea. Trends in TKA use and demographics, including numbers and rates of primary and revision TKA, growth rate and the revision burden, and age- and sex-specific rates, were estimated. They were compared with nationwide TKA registry reports from other countries, and a systematic review was performed.
RESULTS
Over the past decade, the primary and revision TKA rates increased by 407% and 267%, respectively. However, the revision burden remained 2%. The highest proportion was observed in 65 to 74 years old and the greatest increase in 75 to 84 years old, but a decrease was observed in those 55 to 64 years old. Women consistently had a ninefold higher TKA rate. The primary TKA rate was comparable with that of other countries, but the revision burden remained lower. In addition, old and female patients comprised considerably higher proportions in Korea.
CONCLUSIONS
During the past decade, TKA use in Korea has markedly increased and caught up with the use levels of most developed Western countries. Trends toward consistent growth in elderly patients and higher rates in females were observed. Appropriate healthcare strategies reflecting these trends in demographics are urgently needed in Korea.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Asian People; Female; Humans; Male; Middle Aged; Postoperative Complications; Practice Patterns, Physicians'; Registries; Reoperation; Republic of Korea; Time Factors; Treatment Outcome
PubMed: 23054516
DOI: 10.1007/s11999-012-2622-y -
Journal of Orthopaedic Surgery and... Jun 2017Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty (TKA/THA) is an important and controversial topic. We conducted this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty (TKA/THA) is an important and controversial topic. We conducted this systematic review and meta-analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA.
METHODS
A comprehensive search was performed on PubMed, OVID, and Web of Science databases, and a systematic approach was carried out starting from the PRISMA recommendations. Relevant randomized controlled trials (RCTs) were selected. The risk of bias was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions version. Data were extracted and meta-analyzed or qualitatively synthesized for all the outcomes.
RESULTS
Data were extracted from 11 trials involving 774 procedures. Meta-analysis showed that high-dose systemic steroid (dexamethasone > 0.1 mg/kg) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain (within 24 h). In addition, systemic steroid is associated within faster functional rehabilitation and greater inflammation control. On the other hand, systemic steroid is associated with a higher level of postoperative serum glucose on the operation day. The complications between groups are similarly low.
CONCLUSIONS
Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain, high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA. The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control. More large, high-quality studies that investigate the safety and dose-response relationship are necessary.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Glucocorticoids; Humans; Pain, Postoperative; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic
PubMed: 28655354
DOI: 10.1186/s13018-017-0601-4 -
The Journal of Rheumatology Jul 2011To perform a systematic review of 30- and 90-day mortality rates in patients undergoing hip or knee arthroplasties. (Review)
Review
OBJECTIVE
To perform a systematic review of 30- and 90-day mortality rates in patients undergoing hip or knee arthroplasties.
METHODS
Five databases were searched for English-language studies of mortality in hip or knee arthroplasties and the following data were extracted: patient characteristics (age, sex, ethnicity), arthroplasty characteristics (unilateral vs bilateral, hip vs knee), system factors (hospital volume and surgeon volume), year of study, etc. Mortality rates were compared across variable categories; proportions were compared using relative risk ratios and 95% confidence intervals.
RESULTS
Out of 650 titles and abstracts, 80 studies qualified for analysis. Of these, 35%, 34%, and 31% of studies provided 30-, 90-, and > 90-day mortality rates. Overall 30-day mortality rates across all types of arthroplasties were 0.3%; 90-day, 0.7%. For those reports with specific rates, 30-day mortality was significantly higher in men than women [1.8% vs 0.4%, respectively; relative risk (RR) 3.93, 95% CI 3.30-4.68] and in bilateral versus unilateral procedures (0.5% vs 0.3%; RR 1.6, 95% CI 1.49-1.72), but no differences were noted by the underlying diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (0.4% vs 0.3%; RR 0.77, 95% CI 0.48-1.24). 90-day mortality showed nonsignificant trends favoring women, OA as the underlying diagnosis, and unilateral procedures.
CONCLUSION
Several demographic and surgical factors were associated with higher 30-day mortality rates following knee and hip arthroplasties. More studies are needed to examine the effect of body mass index, comorbidities, and other modifiable factors, in order to identify interventions to lower mortality rates following arthroplasty procedures.
Topics: Arthritis, Rheumatoid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Humans; Male; Osteoarthritis, Hip; Osteoarthritis, Knee; Postoperative Period; Survival Rate; Time Factors
PubMed: 21724724
DOI: 10.3899/jrheum.110280 -
BMC Musculoskeletal Disorders Aug 2016The latest generation of shoulder arthroplasty includes canal-sparing respectively stemless designs that have been developed to allow restoration of the glenohumeral... (Review)
Review
BACKGROUND
The latest generation of shoulder arthroplasty includes canal-sparing respectively stemless designs that have been developed to allow restoration of the glenohumeral center of rotation independently from the shaft, and to avoid stem-related complications. The stemless prosthesis design has also recently been introduced for use in reverse arthroplasty systems.
METHODS
We systematically reviewed the literature for studies of currently available canal-sparing respectively stemless shoulder arthroplasty systems. From the identified series, we recorded the indications, outcome measures, and humeral-sided complications.
RESULTS
We identified 11 studies of canal-sparing respectively stemless anatomic shoulder arthroplasty implants, published between 2010 and 2016. These studies included 929 cases, and had a mean follow-up of 26 months (range, 6 to 72 months). The rates of humeral component-related complications ranged between 0 and 7.9 %. The studies reported only a few isolated cases of complications of the humeral component. Some arthroplasty systems are associated with radiological changes, but without any clinical relevance.
CONCLUSIONS
All of the published studies of canal-sparing respectively stemless shoulder arthroplasty reported promising clinical and radiological outcomes in short to midterm follow-up. Long-term studies are needed to demonstrate the long-term value of these kind of implants.
Topics: Arthroplasty, Replacement; Humans; Humerus; Joint Prosthesis; Osteoarthritis; Postoperative Complications; Prosthesis Design; Radiography; Shoulder Joint; Treatment Outcome
PubMed: 27577859
DOI: 10.1186/s12891-016-1235-0 -
Clinical Orthopaedics and Related... Jul 2014Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent... (Review)
Review
BACKGROUND
Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies.
QUESTIONS/PURPOSES
We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis. Secondarily, we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries.
METHODS
We conducted a systematic review of English language studies published after 1996. Adverse events of interest included rates of early failure, time to revision, revision, reoperation, dislocation, infection/sepsis, femoral neck fracture, mortality, and postoperative component alignment. Revision rates were compared with those from four national joint replacement registries. Results were reported as adverse event rates per 1000 person-years stratified by device market status (in use and discontinued). Comparisons between event rates of metal-on-metal hip resurfacing and THA are made using a quasilikelihood generalized linear model. We identified 7421 abstracts, screened and reviewed 384 full-text articles, and included 236. The most common study designs were prospective cohort studies (46.6%; n = 110) and retrospective studies (36%; n = 85). Few randomized controlled trials were included (7.2%; n = 17).
RESULTS
The average time to revision was 3.0 years for metal-on-metal hip resurfacing (95% CI, 2.95-3.1) versus 7.8 for THA (95% CI, 7.2-8.3). For all devices, revisions and reoperations were more frequent with metal-on-metal hip resurfacing than THA based on point estimates and CIs: 10.7 (95% CI, 10.1-11.3) versus 7.1 (95% CI, 6.7-7.6; p = 0.068), and 7.9 (95% CI, 5.4-11.3) versus 1.8 (95% CI, 1.3-2.2; p = 0.084) per 1000 person-years, respectively. This difference was consistent with three of four national joint replacement registries, but overall national joint replacement registries revision rates were lower than those reported in the literature. Dislocations were more frequent with THA than metal-on-metal hip resurfacing: 4.4 (95% CI, 4.2-4.6) versus 0.9 (95% CI, 0.6-1.2; p = 0.008) per 1000 person-years, respectively. Adverse event rates change when discontinued devices were included.
CONCLUSIONS
Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing, except when discontinued devices are removed from the analyses. Results from the literature may be misleading without consistent definitions, standardized outcome metrics, and accounting for device market status. This is important when clinicians are assessing and communicating patient risk and when selecting which device is most appropriate for individual patients.
Topics: Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Chi-Square Distribution; Hip Joint; Hip Prosthesis; Humans; Likelihood Functions; Linear Models; Metal-on-Metal Joint Prostheses; Osteoarthritis, Hip; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation; Risk Factors; Surface Properties; Time Factors; Treatment Outcome
PubMed: 24700446
DOI: 10.1007/s11999-014-3556-3 -
International Journal of Surgery... Jun 2018Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher volume centers, and adoption of volume... (Review)
Review
INTRODUCTION
Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher volume centers, and adoption of volume standards. With limited literature investigating the impact of hospital and surgeon volume on the outcome of hip fracture repairs, we undertook a systematic review to solidify the findings and attempt to arrive at a definitive conclusion with respect to both factors.
MATERIALS AND METHODS
We performed a systematic review examining the association between surgeon and hospital volume and hip fracture outcomes. To be included in the review, the study population had to include patients undergoing any hip fracture repair such as hemiarthroplasty (HA), internal fixation (ORIF) and total hip arthroplasty (THA). A total of five studies investigating surgeon volume and twelve studies investigating hospital volume were included in the study. With the exception of one study investigating both surgeon and hospital volume, volume thresholds were defined for all studies.
RESULTS
Studies were variable in defining surgeon and hospital volume thresholds. Low surgeon volume was associated with a longer LOS and a higher risk of mortality, but results were contrasting with respect to postoperative complications. High volume hospitals fared better than low volume with respect to length of stay, postoperative complications and time to surgery.
CONCLUSIONS
Increasing hospital volume was a more stronger predictor of postoperative outcomes as compared to surgeon volume. However, there are still few researches with respect to surgeon volume and further studies may yield a more definitive answer to this question.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Female; Fracture Fixation, Internal; Hemiarthroplasty; Hip Fractures; Hospitals, High-Volume; Humans; Male; Middle Aged; Morbidity; Postoperative Complications; Postoperative Period; Risk Factors; Surgeons; Treatment Outcome
PubMed: 29102691
DOI: 10.1016/j.ijsu.2017.10.072 -
Annals of the Royal College of Surgeons... Jan 2015Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking. Currently in the UK, the two most frequently performed approaches to the hip are the posterior and the direct lateral.
METHODS
This systematic review was performed according to Cochrane guidelines following an extensive search for prospective controlled trials published in any language before January 2014. Of the 728 records identified from searches, 6 prospective studies (including 3 randomised controlled trials) involving 517 participants provided data towards this review.
FINDINGS
Compared with the lateral approach, the posterior approach conferred a significant reduction in the risk of Trendelenburg gait (odds ratio [OR]: 0.31, p=0.0002) and stem malposition (OR: 0.24, p=0.02), and a non-significant reduction in dislocation (OR: 0.37, p=0.16) and heterotopic ossification (OR: 0.41, p=0.13). Neither approach conferred a functional advantage. We draw attention to the paucity of evidence and the need for a further randomised trial.
Topics: Adult; Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Postoperative Complications; Treatment Outcome
PubMed: 25519259
DOI: 10.1308/003588414X13946184904008 -
The Bone & Joint Journal Jan 2018Reconstruction of the acetabulum after resection of a periacetabular malignancy is technically challenging and many different techniques have been used with varying... (Review)
Review
AIMS
Reconstruction of the acetabulum after resection of a periacetabular malignancy is technically challenging and many different techniques have been used with varying success. Our aim was to prepare a systematic review of the literature dealing with these techniques in order to clarify the management, the rate of complications and the outcomes.
PATIENTS AND METHODS
A search of PubMed and MEDLINE was conducted for English language articles published between January 1990 and February 2017 with combinations of key search terms to identify studies dealing with periacetabular resection with reconstruction in patients with a malignancy. Studies in English that reported radiographic or clinical outcomes were included. Data collected from each study included: the number and type of reconstructions, the pathological diagnosis of the lesions, the mean age and follow-up, gender distribution, implant survivorship, complications, functional outcome, and mortality. The results from individual studies were combined for the general analysis, and then grouped according to the type of reconstruction.
RESULTS
A total of 57 studies met the inclusion criteria and included 1700 patients. Most lesions were metastatic (41%), followed by chondrosarcoma (29%), osteosarcoma (10%), Ewing's sarcoma (7%), and multiple myeloma (2%). The techniques of reconstruction were divided into seven types for analysis: those involving a Harrington reconstruction, a saddle prosthesis, an allograft and allograft prosthesis composite, a pasteurised autograft, a porous tantalum implant, a custom-made prosthesis and a modular hemipelvic reconstruction. The rate of complications was 50%, with infection (14%) and instability (8%) being the most common. Mortality data were available for 1427 patients (84%); 50% had died of disease progression, 23% were alive with disease, and 27% had no evidence of disease at a mean follow-up of 3.4 years (0 to 34).
CONCLUSION
Both the rate of complications and mortality are high following resection of oncological periacetabular lesions and reconstruction. Many types of reconstruction have been used with unique challenges and complications for each technique. Newer prostheses, including custom-made prostheses and porous tantalum implants and augments, have shown promising early functional and radiographic outcomes. Cite this article: 2018;100-B(1 Supple A):22-30.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Bone Neoplasms; Humans; Multiple Myeloma; Postoperative Complications; Sarcoma; Treatment Outcome
PubMed: 29292336
DOI: 10.1302/0301-620X.100B1.BJJ-2017-0548.R1 -
BMC Musculoskeletal Disorders Apr 2023Mechanically aligned total knee arthroplasty (MATKA) is a well-established procedure. Kinematically aligned TKA (KATKA) has been proposed to restore and preserve... (Meta-Analysis)
Meta-Analysis
Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials.
BACKGROUND
Mechanically aligned total knee arthroplasty (MATKA) is a well-established procedure. Kinematically aligned TKA (KATKA) has been proposed to restore and preserve pre-arthritic knee anatomy. However, normal knee anatomy varies widely, and there have been concerns regarding restoring unusual anatomy. Accordingly, restricted KATKA (rKATKA) was introduced to reproduce constitutional knee anatomy within a safe range. This network meta-analysis (NMA) aimed to evaluate the clinical and radiological outcomes of the surgeries.
METHODS
We performed a database search on August 20, 2022, which included randomized controlled trials (RCTs) comparing any two of the three surgical TKA techniques for knee osteoarthritis. We conducted a random-effects NMA within the frequentist framework and evaluated confidence in each outcome using the Confidence in Network Meta-Analysis tool.
RESULTS
Ten RCTs with 1,008 knees and a median follow-up period of 1.5 years were included. The three methods might result in little to no difference in range of motion (ROM) between methods. In patient-reported outcome measures (PROMs), the KATKA might result in a slight improvement compared with the MATKA (standardized mean difference, 0.47; 95% confidence interval [CI], 0.16-0.78; very low confidence). There was little to no difference in revision risk between MATKA and KATKA. KATKA and rKATKA showed a slight valgus femoral component (mean difference [MD], -1.35; 95% CI, -1.95-[-0.75]; very low confidence; and MD, -1.72; 95% CI, -2.63-[-0.81]; very low confidence, respectively) and a slight varus tibial component (MD, 2.23; 95% CI, 1.22-3.24; very low confidence; and MD, 1.25; 95% CI, 0.01-2.49; very low confidence, respectively) compared with MATKA. Tibial component inclination and hip-knee-ankle angle might result in little to no difference between the three procedures.
CONCLUSIONS
KATKA and rKATKA showed similar ROM and PROMs and a slight variation in the coronal component alignment compared with MATKA. KATKA and rKATKA are acceptable methods in short- to mid-term follow-up periods. However, long-term clinical results in patients with severe varus deformity are still lacking. Surgeons should choose surgical procedures carefully. Further trials are warranted to evaluate the efficacy, safety, and subsequent revision risk.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Prosthesis; Network Meta-Analysis; Biomechanical Phenomena; Randomized Controlled Trials as Topic; Knee Joint; Osteoarthritis, Knee
PubMed: 37095485
DOI: 10.1186/s12891-023-06448-0 -
The Bone & Joint Journal Jul 2014In this systematic review, our aim was to explore whether or not patients are able to return to athletic activity following lower limb joint replacement. We also... (Review)
Review
In this systematic review, our aim was to explore whether or not patients are able to return to athletic activity following lower limb joint replacement. We also investigated any evidence as to whether participation in athletic activity post-joint replacement increases complications and reduces implant survival. A PubMed, Embase and Sports Discus search was performed using the MeSH terms 'Sport', 'Athletic', 'Athlete', 'Physical', 'Activity', 'Arthroplasty', 'Total Hip Replacement', 'Hip Resurfacing', 'Total Knee Replacement', 'Unicompartmental Knee Replacement' and 'Unicondylar Knee Replacement'. From this search, duplications were excluded, the remaining abstracts were reviewed and any unrelated to the search terms were excluded. The remaining abstracts had their full papers reviewed. Following joint replacement, participation in sporting activity is common principally determined by pre-operative patient activity levels, BMI and patient age. The type of joint replaced is of less significance. Total time spent performing activity does not change but tends to be at a lower intensity. There is little evidence in the literature of an association between high activity levels and early implant failure.
Topics: Age Factors; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Body Mass Index; Health Status Indicators; Humans; Patellofemoral Joint; Postoperative Period; Recovery of Function; Sports; Treatment Outcome
PubMed: 24986946
DOI: 10.1302/0301-620X.96B7.31585