Journal of Clinical Medicine

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12 pages, 2650 KiB

Open AccessArticle

Impact and Modification of the New PJI-TNM Classification for Periprosthetic Joint Infections

by Andre Lunz, Burkhard Lehner, Moritz N. Voss, Kevin Knappe, Sebastian Jaeger, Moritz M. Innmann, Tobias Renkawitz and Georg W. Omlor

J. Clin. Med. 2023, 12(4), 1262; https://doi.org/10.3390/jcm12041262 - 5 Feb 2023

Cited by 5 | Viewed by 2305

Abstract

The comprehensive “PJI-TNM classification” for the description of periprosthetic joint infections (PJI) was introduced in 2020. Its structure is based on the well-known oncological TNM classification to appreciate the complexity, severity, and diversity of PJIs. The main goal of this study is to [...] Read more.

The comprehensive “PJI-TNM classification” for the description of periprosthetic joint infections (PJI) was introduced in 2020. Its structure is based on the well-known oncological TNM classification to appreciate the complexity, severity, and diversity of PJIs. The main goal of this study is to implement the new PJI-TNM classification into the clinical setting to determine its therapeutic and prognostic value and suggest modifications to further improve the classification for clinical routine use. A retrospective cohort study was conducted at our institution between 2017 and 2020. A total of 80 consecutive patients treated with a two-stage revision for periprosthetic knee joint infection were included. We retrospectively assessed correlations between patients’ preoperative PJI-TNM classification and their therapy and outcome and identified several statistically significant correlations for both classifications, the original and our modified version. We have demonstrated that both classifications provide reliable predictions already at the time of diagnosis regarding the invasiveness of surgery (duration of surgery, blood and bone loss during surgery), likelihood of reimplantation, and patient mortality during the first 12 months after diagnosis. Orthopedic surgeons can use the classification system preoperatively as an objective and comprehensive tool for therapeutic decisions and patient information (informed consent). In the future, comparisons between different treatment options for truly similar preoperative baseline situations can be obtained for the first time. Clinicians and researchers should be familiar with the new PJI-TNM classification and start implementing it into their routine practice. Our adjusted and simplified version (“PJI-pTNM”) might be a more convenient alternative for the clinical setting. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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11 pages, 1983 KiB

Open AccessArticle

Physical Activity of Young Patients following Minimally Invasive Lateral Unicompartmental Knee Replacement

by Mustafa Hariri, Merlin Hagemann, Paul Mick, Julian Deisenhofer, Benjamin Panzram, Moritz Innmann, Tobias Reiner, Tobias Renkawitz and Tilman Walker

J. Clin. Med. 2023, 12(2), 635; https://doi.org/10.3390/jcm12020635 - 12 Jan 2023

Cited by 4 | Viewed by 1458

Abstract

Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this [...] Read more.

Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this study was to demonstrate return-to-activity rate and sporting activity of patients aged 60 years or younger following lateral UKR with a fixed-bearing (FB) prosthesis. Thirty-seven patients aged 60 years or younger after lateral FB-UKR were included. Sporting activities were assessed using the University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). Clinical outcome was measured using the Oxford Knee Score (OKS), range of motion (ROM) and visual analogue scale (VAS). The mean follow-up (FU) was 3.1 ± 1.5 years and the mean age at surgery was 52.8 ± 3.1 years. The return-to-activity rate was 87.5% and 49% of patients were highly active postoperatively as defined by an UCLA score of 7 or higher. All clinical parameters increased significantly postoperatively. We demonstrated a high return-to-activity rate with nearly half of the patients achieving high activity levels. Longer FU periods are necessary to evaluate the effect of activity on implant survival. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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9 pages, 626 KiB

Open AccessArticle

Trends in Computer-Assisted Surgery for Total Knee Arthroplasty in Germany: An Analysis Based on the Operative Procedure Classification System between 2010 to 2021

by Tizian Heinz, Annette Eidmann, Philip Anderson, Manuel Weißenberger, Axel Jakuscheit, Maximilian Rudert and Ioannis Stratos

J. Clin. Med. 2023, 12(2), 549; https://doi.org/10.3390/jcm12020549 - 9 Jan 2023

Cited by 6 | Viewed by 2169

Abstract

Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. [...] Read more.

Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (−3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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10 pages, 1134 KiB

Open AccessArticle

Resection of Infrapatellar Fat Pad during Total Knee Arthroplasty Has No Impact on Postoperative Function, Pain and Sonographic Appearance of Patellar Tendon

by Sławomir Michalak, Łukasz Łapaj, Arleta Witkowska-Łuczak, Paweł Chodór, Jan Zabrzyński and Jacek Kruczyński

J. Clin. Med. 2022, 11(24), 7339; https://doi.org/10.3390/jcm11247339 - 10 Dec 2022

Viewed by 1500

Abstract

Routine resection of the infrapatellar fat pad (IFP) during total knee arthroplasty (TKA) is controversial, as it may result in shortening of the patellar tendon (PT) and anterior knee pain. This prospective study examined whether IFP excision during TKA affects joint function, anterior [...] Read more.

Routine resection of the infrapatellar fat pad (IFP) during total knee arthroplasty (TKA) is controversial, as it may result in shortening of the patellar tendon (PT) and anterior knee pain. This prospective study examined whether IFP excision during TKA affects joint function, anterior knee pain, PT dimensions and sonographic structure. A total of 65 consecutive patients undergoing TKA for osteoarthritis were randomized into two groups: IFP was resected in one and retained in the other. Patients were examined preoperatively, at 6 weeks and 6 months postoperatively: pain (Numerical Rating Scale—NRS), range of motion (ROM) and knee function (Knee Injury and Osteoarthritis Outcome Score—KOOS score) were evaluated; sonographic examination determined the length, structure and vascularity of the PTs. In both groups there were postoperative improvements in NRS and KOOS scores, although IFP resection did not influence clinical outcomes or sonographic parameters. At 6 weeks and 6 months postoperatively for both groups there were no differences between NRS scores (Mann–Whitney test, p = 0.511 and p = 0.579), ROM scores (Mann–Whitney test, p = 0.331, p = 0.180) or all KOOS subscores. IFP excision had no effect on sonographic parameters. This study suggests that IFP resection during TKA does not influence postoperative functional outcomes, pain scores, patellar tendon length and thickness, or sonographic structure. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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12 pages, 3241 KiB

Open AccessArticle

Does Posterior Tibial Slope Influence Knee Kinematics in Medial Stabilized TKA?

by Leandra Bauer, Christoph Thorwächter, Arnd Steinbrück, Volkmar Jansson, Hannes Traxler, Zumreta Alic, Boris Michael Holzapfel and Matthias Woiczinski

J. Clin. Med. 2022, 11(22), 6875; https://doi.org/10.3390/jcm11226875 - 21 Nov 2022

Cited by 1 | Viewed by 2077

Abstract

Background: During total knee arthroplasty (TKA), one of the key alignment factors to pay attention to is the posterior tibial slope (PTS). The PTS clearly influences the kinematics of the knee joint but must be adapted to the coupling degree of the specific [...] Read more.

Background: During total knee arthroplasty (TKA), one of the key alignment factors to pay attention to is the posterior tibial slope (PTS). The PTS clearly influences the kinematics of the knee joint but must be adapted to the coupling degree of the specific TKA design. So far, there is hardly any literature including clear recommendations for how surgeons should choose the PTS in a medial stabilized (MS) TKA. The aim of the present study is to investigate the effects of different degrees of PTS on femorotibial kinematics in MS TKA. Materials and Methods: An MS TKA was performed in seven fresh-frozen human specimens successively with 0°, 3°, and 6° of PTS. After each modification, weight-bearing deep knee flexion (30–130°) was performed, and femorotibial kinematics were analyzed. Results: A lateral femoral rollback was observed for all three PTS modifications. With an increasing PTS, the tibia was shifted more anteriorly on the lateral side (0° PTS anterior tibial translation −9.09 (±9.19) mm, 3° PTS anterior tibial translation −11.03 (±6.72) mm, 6° PTS anterior tibial translation 11.86 (±9.35) mm). No difference in the tibial rotation was found for the different PTS variants. All PTS variants resulted in internal rotation of the tibia during flexion. With a 3° PTS, the design-specific medial rotation point was achieved more accurately. Conclusions: According to our findings, we recommend a PTS of 3° when implanting the MS prosthesis used in this study. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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12 pages, 1948 KiB

Open AccessArticle

Using the Phecode System to Identify the Preoperative Clinical Phenotypes Associated with Surgical Site Infection in Patients Undergoing Primary Total Knee Arthroplasty: The Sex Differences

by Ting-Yu Hung, Kuan-Lin Liu and Shu-Hui Wen

J. Clin. Med. 2022, 11(19), 5784; https://doi.org/10.3390/jcm11195784 - 29 Sep 2022

Cited by 1 | Viewed by 1306

Abstract

Sex-related differences among comorbid conditions associated with surgical site infection (SSI) after total knee arthroplasty (TKA) are unclear. This population-based cohort study used a novel approach with a Phecode system to evaluate preoperative clinical phenotypes (i.e., comorbid conditions) associated with SSI after TKA [...] Read more.

Sex-related differences among comorbid conditions associated with surgical site infection (SSI) after total knee arthroplasty (TKA) are unclear. This population-based cohort study used a novel approach with a Phecode system to evaluate preoperative clinical phenotypes (i.e., comorbid conditions) associated with SSI after TKA and delineate sex-related differences in phenotypes. Using the Taiwan National Health Insurance Research Database (2014–2018), 83,870 patients who underwent TKA were identified. Demographic and SSI data during the 90-day postoperative follow-up were obtained. Comorbidities identified by the International Classification of Diseases within 1 year before TKA were recorded and mapped into Phecodes representing phenotypes. The overall rate of 90-day SSI was 1.3%. In total, 1663 phenotypes were identified among 83,870 patients—1585 and 1458 phenotypes for female (n = 62,018) and male (n = 21,852) patients, respectively. According to multivariate logistic regression analysis, the SSI odds ratio significantly increased with the presence of each of the 16 phenotypes. Subgroup analysis revealed that the presence of 10 and 4 phenotypes significantly increased SSI risk in both sexes; only one phenotype was common to both sexes. Therefore, comorbid conditions and sex should be considered in preoperative SSI risk evaluation in patients undergoing primary TKA. These findings provide new perspectives on susceptibility, prevention, and treatment in these patients. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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9 pages, 3611 KiB

Open AccessArticle

Do Preoperative Vastus Medialis Volume and Quality Affect Functional Outcomes after Total Knee Arthroplasty?

by Ho Jung Jung, Min Wook Kang, Jong Hwa Lee and Joong Il Kim

J. Clin. Med. 2022, 11(13), 3618; https://doi.org/10.3390/jcm11133618 - 23 Jun 2022

Viewed by 1680

Abstract

Background: Vastus medialis function has been implicated in the development and progression of knee osteoarthritis; however, studies evaluating the influence of its preoperative volume and quality on functional outcomes following total knee arthroplasty (TKA) remain scarce. This study aimed to determine the association [...] Read more.

Background: Vastus medialis function has been implicated in the development and progression of knee osteoarthritis; however, studies evaluating the influence of its preoperative volume and quality on functional outcomes following total knee arthroplasty (TKA) remain scarce. This study aimed to determine the association between vastus medialis volume, quality, and clinical outcomes after TKA. Methods: Among the patients who underwent unilateral TKA, 92 who had undergone magnetic resonance imaging (MRI) before TKA were included. Preoperative vastus medialis volume and quality were assessed using the cross-sectional area (CSA) and fat infiltration ratio on MRI. Clinical outcomes were evaluated using the Knee Society knee score (KSKS) and Knee Society function score (KSFS) at baseline and 1 year after surgery. The relationships between preoperative CSA, fatty infiltration ratio, and clinical outcomes were analyzed using univariate and multivariate linear regression. Results: Only the fatty infiltration ratio was significantly associated with postoperative KSFS in the univariate linear regression analysis. In the multivariate linear regression analysis, age and fatty infiltration ratio were significantly associated with postoperative KSFS. Conclusions: Increased vastus medialis fat infiltration is associated with worse functional outcomes after TKA. Preserving vastus medialis quality could improve functional outcomes, and surgeons should encourage patients to perform quadriceps strengthening exercises before surgery. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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15 pages, 4083 KiB

Open AccessSystematic Review

Prevalence and Risk of Infection in Patients with Diabetes following Primary Total Knee Arthroplasty: A Global Systematic Review and Meta-Analysis of 120,754 Knees

by Mohd Aliff Ahmad, Shaifuzain Ab Rahman and Md Asiful Islam

J. Clin. Med. 2022, 11(13), 3752; https://doi.org/10.3390/jcm11133752 - 28 Jun 2022

Cited by 6 | Viewed by 1993

Abstract

Diabetes mellitus (DM) is a known risk factor for infection following total joint arthroplasty. This study looked at the prevalence and risk of infection in diabetic and non-diabetic patients who had primary total knee arthroplasty (TKA). PubMed, Scopus, Google Scholar, Web of Science, [...] Read more.

Diabetes mellitus (DM) is a known risk factor for infection following total joint arthroplasty. This study looked at the prevalence and risk of infection in diabetic and non-diabetic patients who had primary total knee arthroplasty (TKA). PubMed, Scopus, Google Scholar, Web of Science, and Science Direct electronic databases were searched for studies published up to 21 April 2022. To compare the risk of infection between diabetic and non-diabetic subjects, a pooled prevalence, and a risk ratio (RR) with 95% confidence intervals (CIs) were used. This research has been registered with PROSPERO (CRD42021244391). There were 119,244 participants from 18 studies, with a total of 120,754 knees (25,798 diabetic and 94,956 non-diabetic). We discovered that the risks of infection in diabetic patients were 1.84 times significantly higher than in non-diabetic patients. Infection was more common in diabetic patients (1.9%) than in non-diabetic patients (1.2%). In a subgroup analysis, the risks of developing deep surgical site infection (SSI) were 1.96 times higher in diabetic patients, but no significant difference when compared in superficial SSI. Prevalence of deep SSI was higher in diabetic (1.5%) than in non-diabetic (0.7%), but the prevalence of superficial SSI was lower in diabetic (1.4%) than in non-diabetic (2.1%). Consistent with previous research, we found diabetes is a risk factor for infection following primary TKA. However, the risk is much lower than previously published data, indicating that other factors play a larger role in infection. Full article

(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)

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