Abiram Bala1, Colin T Penrose2, Thorsten M Seyler3, Richard C Mather4, Samuel S Wellman5, Michael P Bolognesi6. 1. Duke University School of Medicine, Duke University Medical Center, Box 3269, Durham, NC 27710, United States. Electronic address: abirambala@gmail.com. 2. Duke University School of Medicine, Duke University Medical Center, Box 3269, Durham, NC 27710, United States. Electronic address: colin.penrose@dm.duke.edu. 3. Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: thorsten.seyler@dm.duke.edu. 4. Department of Orthopaedic Surgery, 4709 Creekstone Dr, Durham, NC 27703, United States. Electronic address: richard.mather@dm.duke.edu. 5. Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3447, Durham, NC 27710, United States. Electronic address: samuel.wellman@dm.duke.edu. 6. Division of Adult Reconstruction, Duke University Medical Center, Box 3269, Durham, NC 27710, United States; Total Joint Fellowship Department of Orthopaedic Surgery, Duke University Medical Center, Box 3269, Durham, NC 27710, United States. Electronic address: michael.bolognesi@dm.duke.edu.
Abstract
INTRODUCTION: Total Knee Arthroplasty (TKA) is an important treatment for posttraumatic arthritis (PTA), but evidence on outcomes is sparse. The purpose of this study was to evaluate the impact of PTA versus primary osteoarthritis (OA) on postoperative outcomes after TKA. METHODS: We queried the entire Medicare database from 2005 to 2012. International Classification of Diseases, 9th revision and Current Procedural Terminology codes were used to identify the procedure, indication, and complications. Patients with minimum two-years follow-up were selected. Odds ratios (ORs), confidence intervals, and p-values (p) were calculated. RESULTS: For PTA, 3509 patients had TKA. For OA, 257,611 patients with TKA served as controls. The average Charlson Comorbidity Index for both groups was five. PTA patients were younger; only eight out of 29 Elixhauser comorbidities were higher. PTA patients had higher incidence of periprosthetic infection (OR 1.72, p<0.001), cellulitis or seroma (OR 1.19, p<0.001), knee wound complications (OR 1.80, p<0.001), TKA revision (OR 1.23, p=0.01), and arthrotomy/incision and drainage (OR 1.55, p<0.001). Blood transfusion rate was lower in PTA patients. There were no significant differences in bleeding complications, prosthetic dislocation, broken prostheses, periprosthetic fracture, osteolysis and polywear, neurovascular injury, and extensor mechanism rupture. DISCUSSION AND CONCLUSION: This study represents, to our knowledge, TKA outcomes in the largest cohort of PTA patients to date. Our findings indicate that these patients are at higher risk for many, but not all, postoperative surgical complications despite being as healthy as patients receiving TKA for primary OA.
INTRODUCTION:Total Knee Arthroplasty (TKA) is an important treatment for posttraumatic arthritis (PTA), but evidence on outcomes is sparse. The purpose of this study was to evaluate the impact of PTA versus primary osteoarthritis (OA) on postoperative outcomes after TKA. METHODS: We queried the entire Medicare database from 2005 to 2012. International Classification of Diseases, 9th revision and Current Procedural Terminology codes were used to identify the procedure, indication, and complications. Patients with minimum two-years follow-up were selected. Odds ratios (ORs), confidence intervals, and p-values (p) were calculated. RESULTS: For PTA, 3509 patients had TKA. For OA, 257,611 patients with TKA served as controls. The average Charlson Comorbidity Index for both groups was five. PTA patients were younger; only eight out of 29 Elixhauser comorbidities were higher. PTA patients had higher incidence of periprosthetic infection (OR 1.72, p<0.001), cellulitis or seroma (OR 1.19, p<0.001), knee wound complications (OR 1.80, p<0.001), TKA revision (OR 1.23, p=0.01), and arthrotomy/incision and drainage (OR 1.55, p<0.001). Blood transfusion rate was lower in PTA patients. There were no significant differences in bleeding complications, prosthetic dislocation, broken prostheses, periprosthetic fracture, osteolysis and polywear, neurovascular injury, and extensor mechanism rupture. DISCUSSION AND CONCLUSION: This study represents, to our knowledge, TKA outcomes in the largest cohort of PTA patients to date. Our findings indicate that these patients are at higher risk for many, but not all, postoperative surgical complications despite being as healthy as patients receiving TKA for primary OA.
Authors: Fabricio Bolpato Loures; Wesley Correia; João Henrique Reis; Rodrigo Sattamini Pires E Albuquerque; Alan de Paula Mozela; Eduardo Branco de Souza; Phelippe Valente Maia; João Maurício Barretto Journal: Int Orthop Date: 2018-09-14 Impact factor: 3.075