Session 15: Knee Arthroplasty
18. November
09:00 - 10:00
Lokale: Vingsal 2
Chair: Andreas Kappel and Lasse E. Rasmussen
Anders Odgaard¹, Andreas Kappel², Frank Madsen³, Per Wagner Kristensen4, Snorre Stephensen5, Amir Pasha Attarzadeh6
¹ Department of Orthopaedic Surgery and Department of Clinical Medicine, Rigshospitalet – Copenhagen University Hospital, University of Copenhagen ² Department of Orthopaedic Surgery, Aalborg University Hospital ³ Department of Orthopaedic Surgery, Aarhus University Hospital 4 Department of Orthopaedic Surgery, Vejle Hospital, University of Southern Denmark, Vejle 5 5Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte 6 Department of Orthopaedic Surgery, Zealand University Hospital, Køge
Background: We previously reported 2-year results of an RCT of patellofemoral arthroplasty (PFA) vs. TKA for patellofemoral osteoarthritis. We found advantages of PFA for range of movement (ROM) and knee- related quality of life (QOL). Registers show increases in PFA revision rates from 2 to 6 years after surgery when TKA revision rates are decreasing, suggesting rapidly deteriorating knee function in PFA patients.
Aim: We aim to examine whether early advantages of PFA over TKA have deteriorated in our RCT and whether revision rates differ after 6 years.
Materials and Methods: Hundred patients were randomized to PFA or TKA between 2007 and 2014. Patients were seen for 5 follow-ups and completed 10 sets of questionnaires during the first 6 postop. years. The primary outcome was SF36 bodily pain. Other outcomes were reoperations, revisions, ROM, and PROs (SF36, OKS, and KOOS). Average PRO improvements over the 6 years were determined by the area under the curve divided by the observation time. PRO improvements at individual postop. times and ROM changes from baseline were compared using paired t-tests. Reoperation and revision rates were compared using competing risk analysis.
Results: PFA patients had a larger improvement in SF36 bodily pain during the first 6 years than TKA patients (35±19 vs. 23±17; mean diff. 12 [95% CI 4-20]; p=0.004). The same was true for SF36 physical functioning (p=0.008), KOOS symptoms (p=0.002), KOOS sport/rec. (p=0.048), and OKS (p=0.002). No PRO was in favor of TKA. At 6 years, only SF36 vitality differed between the groups, in favor of PFA (p=0.04). At 5 years, ROM had decreased less from baseline for PFA than TKA (-4°±14° versus -11°±13°; mean diff. 7° [95% CI 1°-13°]; p=0.02). Revision rates did not differ between the groups at 6 years with estimates of 0.10 and 0.04, respectively (p=0.24). Reoperation rates were also no different at 0.10 and 0.12, respectively (p=0.71).
Interpretation / Conclusion: The 2-year outcomes did not deteriorate from 2 to 6 years. PFA patients had better QOL throughout the postoperative years based on several PROs. When evaluated by the 6-year observations alone, we found no consistent difference for any PRO. Our findings cannot explain the high PFA revision rates observed in registers.
¹ Department of Orthopaedic Surgery and Department of Clinical Medicine, Rigshospitalet – Copenhagen University Hospital, University of Copenhagen ² Department of Orthopaedic Surgery, Aalborg University Hospital ³ Department of Orthopaedic Surgery, Aarhus University Hospital 4 Department of Orthopaedic Surgery, Vejle Hospital, University of Southern Denmark, Vejle 5 5Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte 6 Department of Orthopaedic Surgery, Zealand University Hospital, Køge
Background: We previously reported 2-year results of an RCT of patellofemoral arthroplasty (PFA) vs. TKA for patellofemoral osteoarthritis. We found advantages of PFA for range of movement (ROM) and knee- related quality of life (QOL). Registers show increases in PFA revision rates from 2 to 6 years after surgery when TKA revision rates are decreasing, suggesting rapidly deteriorating knee function in PFA patients.
Aim: We aim to examine whether early advantages of PFA over TKA have deteriorated in our RCT and whether revision rates differ after 6 years.
Materials and Methods: Hundred patients were randomized to PFA or TKA between 2007 and 2014. Patients were seen for 5 follow-ups and completed 10 sets of questionnaires during the first 6 postop. years. The primary outcome was SF36 bodily pain. Other outcomes were reoperations, revisions, ROM, and PROs (SF36, OKS, and KOOS). Average PRO improvements over the 6 years were determined by the area under the curve divided by the observation time. PRO improvements at individual postop. times and ROM changes from baseline were compared using paired t-tests. Reoperation and revision rates were compared using competing risk analysis.
Results: PFA patients had a larger improvement in SF36 bodily pain during the first 6 years than TKA patients (35±19 vs. 23±17; mean diff. 12 [95% CI 4-20]; p=0.004). The same was true for SF36 physical functioning (p=0.008), KOOS symptoms (p=0.002), KOOS sport/rec. (p=0.048), and OKS (p=0.002). No PRO was in favor of TKA. At 6 years, only SF36 vitality differed between the groups, in favor of PFA (p=0.04). At 5 years, ROM had decreased less from baseline for PFA than TKA (-4°±14° versus -11°±13°; mean diff. 7° [95% CI 1°-13°]; p=0.02). Revision rates did not differ between the groups at 6 years with estimates of 0.10 and 0.04, respectively (p=0.24). Reoperation rates were also no different at 0.10 and 0.12, respectively (p=0.71).
Interpretation / Conclusion: The 2-year outcomes did not deteriorate from 2 to 6 years. PFA patients had better QOL throughout the postoperative years based on several PROs. When evaluated by the 6-year observations alone, we found no consistent difference for any PRO. Our findings cannot explain the high PFA revision rates observed in registers.
Christian Bredgaard Jensen¹, Anders Troelsen¹, Christian Skovgaard Nielsen¹, Martin Lindberg-Larsen², Kirill Gromov¹
Dept. of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre¹; Dept. of Orthopaedic Surgery, Orthopaedic Research Unit (ORU), Odense University Hospital²
Background: Day case hip and knee arthroplasty is used increasingly in Danish hospitals and is proposed as a possible way to meet future demands for arthroplasty surgery. Previous studies have found day case hip and knee arthroplasty to be safe and feasible in selected patients. However, few studies compare day case patients to patients with an overnight stay in a larger patient population.
Aim: The aim of this study was to investigate differences in the 90-day readmission and complication rate between day case patients and patients with one overnight stay following THA/TKA/UKA.
Materials and Methods: Day case (dc) patients and patients with an overnight stay (on) following a primary unilateral THA/TKA/UKA between 2010-2020 were identified from the Danish National Patients Registry. Any overnight admission within 90 days of surgery was registered as a readmission. Complications were defined as overnight admissions due to diagnoses associated to complications after THA/TKA/UKA. Differences between groups were investigated using mixed effect models adjusted for patient characteristics, year of surgery and surgical centre as a random effect.
Results: We included 29,651 THAs (1,452 dcTHA and 28,203 onTHA), 15,251 TKAs (694 dcTKA and 14,559 onTKA), and 6,448 UKAs (1,534 dcUKA and 4,914 onUKA). The readmission rates of day case and overnight patients were as follows: dcTHA= 13.9% vs. onTHA=9.1% (odds-ratio(OR): 1.6 [95% confidence interval(CI): 1.3–2.0]), dcTKA= 10.1% vs. onTKA= 6.9% (OR: 1.6 [CI: 1.2–2.2]), dcUKA= 4.7% vs. onUKA = 5.2% (OR: 0.87 [CI: 0.65–1.2]). Complication rates were: dcTHA= 4.5% vs. onTHA= 3.4% (OR: 1.4 [CI: 1.1–1.8]), dcTKA= 2.3% vs. onTKA= 2.2% (OR: 1.0 [CI: 0.58–1.8]), dcUKA= 2.1% vs. onUKA= 1.7% (OR: 1.3 [CI: 0.85–2.0]).
Interpretation / Conclusion: DcTHA and dcTKA patients were more likely to be readmitted compared to overnight patients. DcTHA patients were also more likely to be readmitted due to arthroplasty complications compared to onTHA patients. DcUKA and onUKA patients had no significant differences in readmission or complications rates. This suggests that vigorous patient selection is important for day case THA and TKA to avoid increased readmission.
Dept. of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre¹; Dept. of Orthopaedic Surgery, Orthopaedic Research Unit (ORU), Odense University Hospital²
Background: Day case hip and knee arthroplasty is used increasingly in Danish hospitals and is proposed as a possible way to meet future demands for arthroplasty surgery. Previous studies have found day case hip and knee arthroplasty to be safe and feasible in selected patients. However, few studies compare day case patients to patients with an overnight stay in a larger patient population.
Aim: The aim of this study was to investigate differences in the 90-day readmission and complication rate between day case patients and patients with one overnight stay following THA/TKA/UKA.
Materials and Methods: Day case (dc) patients and patients with an overnight stay (on) following a primary unilateral THA/TKA/UKA between 2010-2020 were identified from the Danish National Patients Registry. Any overnight admission within 90 days of surgery was registered as a readmission. Complications were defined as overnight admissions due to diagnoses associated to complications after THA/TKA/UKA. Differences between groups were investigated using mixed effect models adjusted for patient characteristics, year of surgery and surgical centre as a random effect.
Results: We included 29,651 THAs (1,452 dcTHA and 28,203 onTHA), 15,251 TKAs (694 dcTKA and 14,559 onTKA), and 6,448 UKAs (1,534 dcUKA and 4,914 onUKA). The readmission rates of day case and overnight patients were as follows: dcTHA= 13.9% vs. onTHA=9.1% (odds-ratio(OR): 1.6 [95% confidence interval(CI): 1.3–2.0]), dcTKA= 10.1% vs. onTKA= 6.9% (OR: 1.6 [CI: 1.2–2.2]), dcUKA= 4.7% vs. onUKA = 5.2% (OR: 0.87 [CI: 0.65–1.2]). Complication rates were: dcTHA= 4.5% vs. onTHA= 3.4% (OR: 1.4 [CI: 1.1–1.8]), dcTKA= 2.3% vs. onTKA= 2.2% (OR: 1.0 [CI: 0.58–1.8]), dcUKA= 2.1% vs. onUKA= 1.7% (OR: 1.3 [CI: 0.85–2.0]).
Interpretation / Conclusion: DcTHA and dcTKA patients were more likely to be readmitted compared to overnight patients. DcTHA patients were also more likely to be readmitted due to arthroplasty complications compared to onTHA patients. DcUKA and onUKA patients had no significant differences in readmission or complications rates. This suggests that vigorous patient selection is important for day case THA and TKA to avoid increased readmission.
Kristine Arndt, Henrik Schrøder, Anders Troelsen, Martin Lindberg-Larsen
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark, Department of Orthopaedic Surgery, Naestved Hospital. Naestved, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark
Background: It is uncertain if patients undergoing revision knee arthroplasty for “pain without loosening” are relieved of pain.
Aim: This study aimed to compare pre- and postoperative analgesic consumption by patients undergoing revision for “pain without loosening” versus “aseptic loosening” and to determine predictors for postoperative long-term opioid use.
Materials and Methods: A retrospective nationwide study of 1,037 revsions for “pain without loosening” and 2,317 revisions for “aseptic loosening” during 1997- 2018 from the Danish Knee Arthroplasty Register. Analgesic use was defined by prescription reimbursement, and long-term opioid use by prescription reimbursement in four consecutive quarters.
Results: In the preoperative year, 37% and 29% of patients revised for “pain without loosening” and “aseptic loosening“ were opioid users compared to 32% and 30% in the postoperative year. Non-steroidal anti- inflammatory use was significantly lower postoperatively for both indications (35% vs 28% for “pain without loosening” and 33% vs 25% for “aseptic loosening”). Use of other analgesics was unchanged. Long-term opioid use increased postoperatively by 4% for patients with “pain without loosening” (p=0.029) and by 3% for “aseptic loosening” (p=0.003). New long- term opioid users (without preoperative long- term use) were 9% for “pain without loosening” and 8% for “aseptic loosening“. Predictors of new long-term opioid use were other opioid-requiring diagnoses or procedures within the first postoperative year, Charlson Comorbidity Index =3, and preoperative long-term NSAID use.
Interpretation / Conclusion: Opioid consumption decreased slightly after revision for “pain without loosening” but not for “aseptic loosening”. A large proportion of new long-term opioid users was generated postoperatively after revision for both indications.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark, Department of Orthopaedic Surgery, Naestved Hospital. Naestved, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark
Background: It is uncertain if patients undergoing revision knee arthroplasty for “pain without loosening” are relieved of pain.
Aim: This study aimed to compare pre- and postoperative analgesic consumption by patients undergoing revision for “pain without loosening” versus “aseptic loosening” and to determine predictors for postoperative long-term opioid use.
Materials and Methods: A retrospective nationwide study of 1,037 revsions for “pain without loosening” and 2,317 revisions for “aseptic loosening” during 1997- 2018 from the Danish Knee Arthroplasty Register. Analgesic use was defined by prescription reimbursement, and long-term opioid use by prescription reimbursement in four consecutive quarters.
Results: In the preoperative year, 37% and 29% of patients revised for “pain without loosening” and “aseptic loosening“ were opioid users compared to 32% and 30% in the postoperative year. Non-steroidal anti- inflammatory use was significantly lower postoperatively for both indications (35% vs 28% for “pain without loosening” and 33% vs 25% for “aseptic loosening”). Use of other analgesics was unchanged. Long-term opioid use increased postoperatively by 4% for patients with “pain without loosening” (p=0.029) and by 3% for “aseptic loosening” (p=0.003). New long- term opioid users (without preoperative long- term use) were 9% for “pain without loosening” and 8% for “aseptic loosening“. Predictors of new long-term opioid use were other opioid-requiring diagnoses or procedures within the first postoperative year, Charlson Comorbidity Index =3, and preoperative long-term NSAID use.
Interpretation / Conclusion: Opioid consumption decreased slightly after revision for “pain without loosening” but not for “aseptic loosening”. A large proportion of new long-term opioid users was generated postoperatively after revision for both indications.
Mette Garval¹ , Charlotte Runge¹ , Carsten Holm¹ , Lone Ramer Mikkelsen ¹ ², Asger Roer Pedersen ¹ ³, Trine Vestergaard¹, Søren Thorgaard Skou4 5
¹Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; ²Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; ³Research Unit, Hammel Neurorehabilitation and Research Centre; 4Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; 5The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Ringsted-Slagelse Hospital, Denmark
Background: Total knee arthroplasty (TKA) is considered a successful procedure and is frequently offered for end-stage knee osteoarthritis. However, approximately 20% of patients experience knee pain and up to 30% are lacking functional improvements in the long term.
Aim: Our aim was to identify baseline predictors of knee pain and function 12 months after TKA.
Materials and Methods: The study was a part of a large cohort study (SIlkeborg Knee replacement cohort Study (SIKS)) designed as a single-center cohort study with prospective data collection of 1.026 TKA patients between 2018 and 2020 at the Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark. Main outcome was Oxford Knee Score (OKS) measured at 12 months postoperatively. Potential predictors included age, sex, OKS, pain catastrophizing scale, EQ-5D-5L, previous surgery, body mass index, ASA classification, preoperative opioid consumption, living-, employment- and educational status, all obtained at baseline. Ordinal logistic regression models were used to identify predictors of OKS, categorized in intervals of 10 points.
Results: 915 patients completed 12 months' follow-up (89%). 784 patients' (88%) reached =30 points of OKS at follow-up, defined as the Patient Acceptable Symptom State (PASS). With higher baseline score, more patients reached the PASS. Patients with a baseline OKS between 20-29 and 30-39 had 1.6 (CI 1.1;2.2) and 2.5 (CI 1.6;4.0) higher odds of getting a better outcome of OKS, respectively, compared to patients with a baseline score between 10-19. Male patients had 1.5 (CI 1.1;2.0) higher odds of a better outcome of OKS, and patients, who had retired, had 2.3 (CI 1.2;4.2) higher odds of a better outcome compared to patients on social benefits.
Interpretation / Conclusion: Higher baseline pain and function, male sex and being retired were identified as predictors of getting a better pain and function outcome 12 months after TKA, and the odds of a better outcome increased significantly for every 10- point greater OKS at baseline.
¹Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; ²Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; ³Research Unit, Hammel Neurorehabilitation and Research Centre; 4Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; 5The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Ringsted-Slagelse Hospital, Denmark
Background: Total knee arthroplasty (TKA) is considered a successful procedure and is frequently offered for end-stage knee osteoarthritis. However, approximately 20% of patients experience knee pain and up to 30% are lacking functional improvements in the long term.
Aim: Our aim was to identify baseline predictors of knee pain and function 12 months after TKA.
Materials and Methods: The study was a part of a large cohort study (SIlkeborg Knee replacement cohort Study (SIKS)) designed as a single-center cohort study with prospective data collection of 1.026 TKA patients between 2018 and 2020 at the Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark. Main outcome was Oxford Knee Score (OKS) measured at 12 months postoperatively. Potential predictors included age, sex, OKS, pain catastrophizing scale, EQ-5D-5L, previous surgery, body mass index, ASA classification, preoperative opioid consumption, living-, employment- and educational status, all obtained at baseline. Ordinal logistic regression models were used to identify predictors of OKS, categorized in intervals of 10 points.
Results: 915 patients completed 12 months' follow-up (89%). 784 patients' (88%) reached =30 points of OKS at follow-up, defined as the Patient Acceptable Symptom State (PASS). With higher baseline score, more patients reached the PASS. Patients with a baseline OKS between 20-29 and 30-39 had 1.6 (CI 1.1;2.2) and 2.5 (CI 1.6;4.0) higher odds of getting a better outcome of OKS, respectively, compared to patients with a baseline score between 10-19. Male patients had 1.5 (CI 1.1;2.0) higher odds of a better outcome of OKS, and patients, who had retired, had 2.3 (CI 1.2;4.2) higher odds of a better outcome compared to patients on social benefits.
Interpretation / Conclusion: Higher baseline pain and function, male sex and being retired were identified as predictors of getting a better pain and function outcome 12 months after TKA, and the odds of a better outcome increased significantly for every 10- point greater OKS at baseline.
Anne Mette Schmidt¹, Mette Garval¹, Kirill Gromow³, Carsten Holm¹, Jens Rolighed Larsen ¹ 4, Morten Vase¹ , Lone Ramer Mikkelsen¹ 4, Louise Mortensen¹ 5 6, Søren Thorgaard Skou7 8
¹Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; ²University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg Regional Hospital, Denmark; ³Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; 4Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 5Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark6; Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark; 7Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; 8The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Ringsted-Slagelse Hospital, Denmark
Background: Despite increased attention and acceptance of fast-track procedures, there is a lack of studies of discharge on the day of surgery (DOS) following total knee arthroplasty (TKA).
Aim: The purpose of this study was to evaluate the feasibility of same day TKA surgery (SD-TKA), and to compare safety, and patient-reported outcomes (PROs) at 90-day follow-up between patients undergoing SD-TKA and patients undergoing standard TKA.
Materials and Methods: Patients were included from a prospective cohort study including 1026 consecutive patients who underwent TKA at the Elective Surgery Center, Silkeborg Regional Hospital, Denmark between February 2018 and March 2020. A SD-TKA group (n=101) was matched 1:1 to a standard TKA group (n=101) on sex, age, and American Society of Anesthesiologists (ASA) score. Feasibility (being discharged on the day of surgery (DOS)), safety (unplanned contacts and complications evaluated by telephone calls (2 weeks), outpatient visits (2 weeks), and readmissions (90 days)) were assessed. Further, Oxford Knee Score (OKS; 0-48) and pain at rest and activity measured with a Visual Analogue Scale (VAS; 0-100 mm) were reported (90 days).
Results: 89 of 101 (88 %) SD-TKA patients were discharged on DOS. We obtained complete data on follow-up on unplanned contacts and complications. The number of telephone calls (SD-TKA=83 and standard TKA=81) and outpatient visits (12 in both groups) were similar in the 2 groups. 3 patients were readmitted (SD-TKA=1 and standard TKA=2), only 1 of the readmissions (from the SD-TKA group) was related to TKA surgery. The 90- day follow-up rate for PROs was 87%. No differences were found between patients undergoing SD-TKA and patients undergoing standard TKA at 90-day follow-up in terms of OKS means (34 in both groups) or medians of VAS (pain in rest: SD-TKA=7 mm and standard TKA=8 mm; pain in activity: SD- TKA=17 mm and standard TKA=15 mm).
Interpretation / Conclusion: Our data suggest that the SD-TKA procedure is feasible in a selected group of patients. Further, our data suggest similar rates of unplanned contacts and complications, and similar PROs at 90-day follow-up when comparing a SD-TKA group and a standard TKA group.
¹Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; ²University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg Regional Hospital, Denmark; ³Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; 4Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 5Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark6; Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark; 7Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; 8The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Ringsted-Slagelse Hospital, Denmark
Background: Despite increased attention and acceptance of fast-track procedures, there is a lack of studies of discharge on the day of surgery (DOS) following total knee arthroplasty (TKA).
Aim: The purpose of this study was to evaluate the feasibility of same day TKA surgery (SD-TKA), and to compare safety, and patient-reported outcomes (PROs) at 90-day follow-up between patients undergoing SD-TKA and patients undergoing standard TKA.
Materials and Methods: Patients were included from a prospective cohort study including 1026 consecutive patients who underwent TKA at the Elective Surgery Center, Silkeborg Regional Hospital, Denmark between February 2018 and March 2020. A SD-TKA group (n=101) was matched 1:1 to a standard TKA group (n=101) on sex, age, and American Society of Anesthesiologists (ASA) score. Feasibility (being discharged on the day of surgery (DOS)), safety (unplanned contacts and complications evaluated by telephone calls (2 weeks), outpatient visits (2 weeks), and readmissions (90 days)) were assessed. Further, Oxford Knee Score (OKS; 0-48) and pain at rest and activity measured with a Visual Analogue Scale (VAS; 0-100 mm) were reported (90 days).
Results: 89 of 101 (88 %) SD-TKA patients were discharged on DOS. We obtained complete data on follow-up on unplanned contacts and complications. The number of telephone calls (SD-TKA=83 and standard TKA=81) and outpatient visits (12 in both groups) were similar in the 2 groups. 3 patients were readmitted (SD-TKA=1 and standard TKA=2), only 1 of the readmissions (from the SD-TKA group) was related to TKA surgery. The 90- day follow-up rate for PROs was 87%. No differences were found between patients undergoing SD-TKA and patients undergoing standard TKA at 90-day follow-up in terms of OKS means (34 in both groups) or medians of VAS (pain in rest: SD-TKA=7 mm and standard TKA=8 mm; pain in activity: SD- TKA=17 mm and standard TKA=15 mm).
Interpretation / Conclusion: Our data suggest that the SD-TKA procedure is feasible in a selected group of patients. Further, our data suggest similar rates of unplanned contacts and complications, and similar PROs at 90-day follow-up when comparing a SD-TKA group and a standard TKA group.
Stian Langgård Jørgensen, Signe Kierkegaarf, Per Aagaard, Marie Bagger Bohn, Inger Mechlenburg
Department of Occupational and Physical Therapy; Horsens Regional Hospital, Denmark; H-HIP, Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Department of Orthopedic Surgery, Aarhus University Hospital, Denmark, Department of Clinical Medicine, Aarhus University, Denmark
Background: Twenty percent of patients receiving total hip or knee replacement (TJR) report non-optimal postoperative outcome. Increasing preoperative lower-limb- strength prior to TJR may improve postoperative functional performance
Aim: To evaluate the effectiveness of preoperative resistance training in patients allocated to TJR surgery on selected post-operative outcomes, via a meta-analysis of studies using exercise modalities and loading intensities objectively known to promote gains in muscle size and strength in adults of young- to-old age.
Materials and Methods: Design: A systematic review and meta-analysis. Literature Search: Cochrane Central, MEDLINE, EMBASE, and PEDro were searched on August 4th 2021. Study Selection: Randomized Controlled Trials (RCTs) were included if (i) they compared preoperative lower-limb-exercises before TJR with standard care, (ii) explicitly reported the exercise intensity, and (iii) reported data on functional performance. Data Synthesis: This systematic review and meta-analysis is reported in accordance with the PRISMA reporting guidelines. A random effects model with an adjustment to the confidence interval was performed for pooling the data
Results: One thousand studies were identified. After applying exclusion criteria, five RCTs were located including 256 participants (mean age ranged from 61 to 72 years, 54% women). Moderate-to-large improvements in functional performance and maximal knee extensor strength were observed at three months after surgery along with small-to- moderate effects 12 months post-operatively. For patient-reported outcomes, small-to-moderate improvements were observed at three months post- operatively with no-to-small improvements at 12 months.
Interpretation / Conclusion: Prehabilitation efforts involving progressive resistance training provides an effective means to improve postoperative outcomes related to functional performance, knee extensor strength and patient-reported outcome in patients undergoing TJR. Due to large methodological diversity between studies, an optimal loading intensity remains unknown.
Department of Occupational and Physical Therapy; Horsens Regional Hospital, Denmark; H-HIP, Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Department of Orthopedic Surgery, Aarhus University Hospital, Denmark, Department of Clinical Medicine, Aarhus University, Denmark
Background: Twenty percent of patients receiving total hip or knee replacement (TJR) report non-optimal postoperative outcome. Increasing preoperative lower-limb- strength prior to TJR may improve postoperative functional performance
Aim: To evaluate the effectiveness of preoperative resistance training in patients allocated to TJR surgery on selected post-operative outcomes, via a meta-analysis of studies using exercise modalities and loading intensities objectively known to promote gains in muscle size and strength in adults of young- to-old age.
Materials and Methods: Design: A systematic review and meta-analysis. Literature Search: Cochrane Central, MEDLINE, EMBASE, and PEDro were searched on August 4th 2021. Study Selection: Randomized Controlled Trials (RCTs) were included if (i) they compared preoperative lower-limb-exercises before TJR with standard care, (ii) explicitly reported the exercise intensity, and (iii) reported data on functional performance. Data Synthesis: This systematic review and meta-analysis is reported in accordance with the PRISMA reporting guidelines. A random effects model with an adjustment to the confidence interval was performed for pooling the data
Results: One thousand studies were identified. After applying exclusion criteria, five RCTs were located including 256 participants (mean age ranged from 61 to 72 years, 54% women). Moderate-to-large improvements in functional performance and maximal knee extensor strength were observed at three months after surgery along with small-to- moderate effects 12 months post-operatively. For patient-reported outcomes, small-to-moderate improvements were observed at three months post- operatively with no-to-small improvements at 12 months.
Interpretation / Conclusion: Prehabilitation efforts involving progressive resistance training provides an effective means to improve postoperative outcomes related to functional performance, knee extensor strength and patient-reported outcome in patients undergoing TJR. Due to large methodological diversity between studies, an optimal loading intensity remains unknown.
Kristine B. Arndt¹, Claus Varnum², Martin Lindberg-Larsen¹, Christian B. Jensen³, Lasse E. Rasmussen²
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital¹; Department of Clinical Research, University of Southern Denmark, Denmark; Department of Orthopaedic Surgery, Lillebaelt Hospital – Vejle², Denmark; Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre³, Copenhagen University Hospital Hvidovre, Denmark.
Background: Limited nationwide data on the development of outpatient unicompartmental knee arthroplasty (UKA) practice and patient safety exist.
Aim: The primary objective of this study on patients receiving a medial or lateral UKA was to investigate 7-, 30- and 90-day readmission risk and 90-day mortality in outpatient vs inpatient surgeries. Secondary to investigate the nationwide development of outpatient UKA surgery in 2014-2018.
Materials and Methods: Included patients received a medial or lateral UKA in the period January 1, 2014 to December 31, 2018 in any Danish hospital. Data were collected from the Danish National Patient Register. The cohort consisted of 1,059 outpatient and 4,325 inpatient surgeries, hereof 5,182 medial and 202 lateral UKA. After propensity score matching (1:1) 1,057 patients were included in each group.
Results: We found a 7-day readmission risk of 1.5% vs 1.4% (p=0.8), 30-day readmission risk of 2.6% vs 3.2% (p=0.3), and 90-day readmission risk of 4.2% vs 4.8% (p=0.4) after outpatient vs inpatient UKA. Similar results were found after matching. We found no significant differences in 90-day mortality for the unmatched or matched cohorts. The amount of outpatient UKA surgeries in Denmark increased from 86 in 2014 to 214 in 2018.
Interpretation / Conclusion: Outpatient medial or lateral UKA seem to be as safe as inpatient UKA on a nationwide basis.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital¹; Department of Clinical Research, University of Southern Denmark, Denmark; Department of Orthopaedic Surgery, Lillebaelt Hospital – Vejle², Denmark; Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre³, Copenhagen University Hospital Hvidovre, Denmark.
Background: Limited nationwide data on the development of outpatient unicompartmental knee arthroplasty (UKA) practice and patient safety exist.
Aim: The primary objective of this study on patients receiving a medial or lateral UKA was to investigate 7-, 30- and 90-day readmission risk and 90-day mortality in outpatient vs inpatient surgeries. Secondary to investigate the nationwide development of outpatient UKA surgery in 2014-2018.
Materials and Methods: Included patients received a medial or lateral UKA in the period January 1, 2014 to December 31, 2018 in any Danish hospital. Data were collected from the Danish National Patient Register. The cohort consisted of 1,059 outpatient and 4,325 inpatient surgeries, hereof 5,182 medial and 202 lateral UKA. After propensity score matching (1:1) 1,057 patients were included in each group.
Results: We found a 7-day readmission risk of 1.5% vs 1.4% (p=0.8), 30-day readmission risk of 2.6% vs 3.2% (p=0.3), and 90-day readmission risk of 4.2% vs 4.8% (p=0.4) after outpatient vs inpatient UKA. Similar results were found after matching. We found no significant differences in 90-day mortality for the unmatched or matched cohorts. The amount of outpatient UKA surgeries in Denmark increased from 86 in 2014 to 214 in 2018.
Interpretation / Conclusion: Outpatient medial or lateral UKA seem to be as safe as inpatient UKA on a nationwide basis.