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Surgical Treatment of Joint Replacement

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 25304

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Prof. Dr. Rocco Papalia

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Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy
Interests: osteoarthritis; knee surgery; hip surgery; total hip reconstruction; regenerative medicine
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Vincenzo Denaro

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Orthopaedics and Traumatology Unit, Campus Bio-Medico University of Rome, 00128 Rome, Italy
Interests: spine surgery; cervical spondylosis; general orthopedics; joint arthroplasty
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Dr. Pier Francesco Indelli

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Orthopaedics and Traumatology, School of Medicine, Stanford University, Stanford, CA, USA
Interests: Total Knee Arthroplasty, Periprosthetic Joint Infections, Gait analysis
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Dr. Stefano Campi

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Orthopaedics and Traumatology Unit, Campus Bio-Medico University of Rome, 00128 Roma, Italy
Interests: knee arthroplasty; unicompartmental knee arthroplasty; unicompartmental implant design

Special Issue Information

Dear Colleagues,

The field of joint replacement is currently at a pathway of innovation, aiming to minimize the invasiveness and improve the clinical outcome through new technologies, new implant design, and new alignment conceptions. This process requires an iterative development of research studies and literature that is worth reading and studying to update the knowledge and improve the clinical practice of joint specialists. Similarly to fast-track procedures, the understanding of clinical factors that influence the outcome of patients undergoing joint arthroplasty makes a multidisciplinary approach mandatory in most cases. Many healthcare professionals are involved together with the orthopedic surgeon, including the internal medicine specialist, the gerontologist, the physiotherapists, and the nursing staff. This cooperation (co-management), either in the pre- or also in post-operative phases, yields to the optimization of the general health of the patient, better clinical and functional outcomes, and a lower complication rate. Moreover, implant design is developing through the minimization of bone loss and preservation of joint kinematic, achieving stabilization by design (i.e., medial pivot designs in the knee or dual mobility hip implants) and not by hardware (hinges and retentive components). This Special Issue is aimed at collecting the latest evidence and advances in joint replacement, gathering contributions by knee, hip, and shoulder surgeons and researchers. We particularly invite papers paying special attention to patient management and outcome optimization; surgical techniques to reduce invasiveness and surgical time; and implant design to improve kinematics and restore the native joint function.

Prof. Dr. Rocco Papalia
Prof. Vincenzo Denaro
Prof. Pier Francesco Indelli
Dr. Stefano Campi
Guest Editors

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Keywords

joint replacement
knee arthroplasty
hip arthroplasty
joint revision arthroplasty
periprosthetic infection

Published Papers (11 papers)

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Research

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9 pages, 510 KiB

Open AccessArticle

Length of Hospital Stay after Total Knee Arthroplasty: A Correlation Study on 1200 Patients

by Rocco Papalia, Guglielmo Torre, Anna Maria Alifano, Erika Albo, Giuseppe Francesco Papalia, Marco Bravi, Antonio De Vincentis, Emanuele Zappalà, Biagio Zampogna and Vincenzo Denaro

J. Clin. Med. 2022, 11(8), 2114; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11082114 - 11 Apr 2022

Cited by 5 | Viewed by 2288

Abstract

In countries with a high average population age, total knee arthroplasty is still carried out in an inpatient setting. The roadmap to performing major surgery on an outpatient basis passes through the understanding of those perioperative features that correlate with higher lengths of hospital stay (LOS). A retrospective database of 1200 patients was reviewed for retrieving preoperative and perioperative factors including anthropometric and demographic data, comorbidities, preoperative laboratory assessment, and surgical time. Considering the LOS as a discrete series, data were analyzed by means of logistic regression with multiple univariate and multivariate models. The results showed a median length of hospital stay of 3 (IQR 3, 4) days. According to multiple univariate analysis, arterial hypertension (p = 0.008), diabetes mellitus (p = 0.028), CCI score (p < 0.001), ASA score (p = 0.006), surgical time (p < 0.001) and intraoperative blood loss (p < 0.001) were significantly associated with the duration of hospital stay in days. Moreover, preoperative hemoglobin value was inversely correlated to the LOS (p = 0.008). Multivariate analysis showed a significant correlation between LOS and surgical time and intraoperative blood loss. Many factors influence the permanence of the inpatient and acting on those variables, by stabilizing comorbidities and optimizing laboratory values, may reduce the overall healthcare burden. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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10 pages, 761 KiB

Open AccessArticle

The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty

by Francesca Cannata, Alice Laudisio, Luca Ambrosio, Gianluca Vadalà, Fabrizio Russo, Biagio Zampogna, Nicola Napoli and Rocco Papalia

J. Clin. Med. 2021, 10(23), 5600; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10235600 - 28 Nov 2021

Cited by 6 | Viewed by 2349

Abstract

Overweight represents a major issue in contemporary orthopaedic practice. A higher body mass index (BMI) is associated with an increase of perioperative complications following several orthopaedic procedures, in particular total hip arthroplasty (THA). However, the influence of overweight on THA surgical time is controversial. In this study, we investigated the association between BMI and surgical time analyzing the role of patients’ comorbidities. We conducted a retrospective study on 748 patients undergoing THA at our institutions between 2017 and 2018. Information regarding medical diseases was investigated and the burden of comorbidity was quantified using the Charlson score (CCI). Surgical time and blood loss were also recorded. Median surgical time was 76.5 min. Patients with surgical time above the median had both a higher BMI (28.3 vs. 27.1 kg/m²; p = 0.002); and CCI (1 vs. 0; p = 0.016). According to linear regression, surgical time was associated with BMI in the unadjusted model (p < 0.0001), after adjusting for age and sex (p < 0.0001), and in the multivariable model (p = 0.005). Furthermore, BMI was associated with increased surgical time only in patients with a Charlson score above the median, but not in others. Obesity is associated with increased surgical time during THA, especially in pluricomorbid patients, with a higher risk of perioperative complications. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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12 pages, 557 KiB

Open AccessArticle

Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty—Our Experience on 743 Cases

by Rocco Papalia, Biagio Zampogna, Guglielmo Torre, Giuseppe Francesco Papalia, Ferruccio Vorini, Marco Bravi, Erika Albo, Antonio De Vincentis and Vincenzo Denaro

J. Clin. Med. 2021, 10(21), 5053; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10215053 - 28 Oct 2021

Cited by 10 | Viewed by 1760

Abstract

The aim of this retrospective investigation is to evaluate the correlation between several preoperative and perioperative factors and the length of hospital stay in patients that underwent elective total hip arthroplasty with overnight admission. Medical records of patients that underwent THA from the beginning of 2016 to the end of 2018 were retrospectively screened. Demographics, comorbidities, whole blood count, intraoperative details, and length of postoperative stay were retrieved. The association between clinical, laboratory and surgical factors and the length of hospital stay was explored by means of negative binomial and logistic regression models. The median length of postoperative hospital stay was four days (Inter Quartile Range, IQR 3, 5). After univariate regression a stepwise multivariate regression showed that operative time (p = 0.001), the preoperative serum creatinine (p < 0.001), the intraoperative blood loss (p = 0.04) and the use of an anterolateral approach (p < 0.001) were found to correlate significantly with the increase of the hospitalization length, while no significant correlation was found for all the other features. Multivariable model fitted through logistic regression (LOS below or over the median value of four days) had an Area Under the Curve (AUC) of 0.748. Our analysis suggests a significant role played by different preoperative and perioperative variables in influencing the length of hospital stay. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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9 pages, 850 KiB

Open AccessArticle

Weight Loss in Patients Waiting for Total Hip Arthroplasty: Fiber-Enriched High Carbohydrate Diet Improves Hip Function and Decreases Pain before Surgery

by Francesca Cannata, Alice Laudisio, Fabrizio Russo, Luca Ambrosio, Gianluca Vadalà, Marco Edoardo Cardinale, Chiara Bartolomei, Gabriella Iannone, Nicola Napoli and Rocco Papalia

J. Clin. Med. 2021, 10(18), 4203; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10184203 - 17 Sep 2021

Cited by 2 | Viewed by 1790

Abstract

The impact of obesity on clinical outcomes following joint replacement procedures is resounding. Therefore, multiple strategies to achieve a substantial weight loss before surgery are needed in obese patients. The aim of the study was to test the effect of a fiber-enriched high carbohydrate (FEHC) diet on the reduction in body weight and pain in elderly obese patients undergoing total hip arthroplasty (THA). Sixty-one candidates for THA were included in our study. Prior to the procedure, the participants have been randomly assigned to a 3-month diet intervention (FEHC diet or free diet). Anthropometric measures and food questionnaires were collected at the enrollment and after 3 months. The Oxford Hip Score (OHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario McMaster Universities OA Index (WOMAC) were administered at baseline and before surgery. A statistically significant variation of weight was found in the FEHC diet group (−3.7 kg, −4.4–−2.5) compared to the control group (−0.2 kg; −1.4–1.7; p < 0.0001), as well as significant improvements in the OHS (p < 0.0001), the HOOS (p < 0.0001) and the WOMAC (p < 0.0001) questionnaires. According to the results of the study, the FEHC diet in obese patients undergoing THA might help weight loss and improve related anthropometric parameters as well as hip function and pain. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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9 pages, 937 KiB

Open AccessArticle

Outcomes of Computer-Assisted Total Knee Arthroplasty Compared to Conventional TKA: A Bicentric Controlled Retrospective Clinical Study

by Biagio Zampogna, Stefano Campi, Guglielmo Torre, Eleonora Villari, Francesco Moncada, Aristide Perrino, Letterio Ciriaco, Marco Ferlazzo, Rocco Papalia and Vincenzo Denaro

J. Clin. Med. 2021, 10(15), 3352; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153352 - 29 Jul 2021

Cited by 3 | Viewed by 1760

Abstract

Despite the globally ascertained success of Total Knee Arthroplasty (TKA) procedure, 20% of patients are still unsatisfied with the surgery results. The purpose of the study is to identify the functional and radiological outcomes of the computer-assisted (CAS) TKA compared to the conventional technique. The clinical databases and medical records of both clinical sites were retrospectively analyzed, and then according to study time-lapse, inclusion, and exclusion criteria, eligible patients were retrieved and included. A total of 42 patients that underwent to CAS TKA (NAVI) and 61 patients that underwent to Conventional TKA (CONV) were included. The NAVI group reported a statistically significant higher surgical time. A lower intraoperative blood loss was found in the computer-assisted group, though this difference was not statistically significant. Implant survival analysis at two years did not show differences between groups during the follow-up period. At two years, follow-up postoperative intergroup analysis showed no statistically significant difference between groups. According to the radiologic analysis, the NAVI group showed comparable outcomes to the conventional group. The present study showed that there was no clinical and radiological difference between CAS arthroplasty and conventional technique. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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10 pages, 426 KiB

Open AccessArticle

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

by Lorenzo Rissolio, Luigi Sabatini, Salvatore Risitano, Alessandro Bistolfi, Umberto Galluzzo, Alessandro Massè and Pier Francesco Indelli

J. Clin. Med. 2021, 10(12), 2599; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10122599 - 12 Jun 2021

Cited by 7 | Viewed by 1968

Abstract

Total knee arthroplasty (TKA) is a successful and safe surgical procedure for treating osteoarthritic knees, but despite the overall good results, some patients remain dissatisfied. The aim of this study is to evaluate the influence of patient-related and surgery-related variables in a consecutive group of patients that underwent TKA. Individuals (n = 648) who had TKA performed between 01 January 2013 and 31 December 2017 were enrolled in the study. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint score (FJS-12) were collected at a mean follow-up of 4.79 years. Patient satisfaction was assessed with a questionnaire. Determinants of satisfaction (age, sex, smoking, presence of diabetes or cardiovascular disease, pain in other joints, preoperative arthritic stage) and components of satisfaction (slope variation, mechanical axis variation, outlier final alignment, surgeon experience) were examined to identify which variables correlated with positive outcome. Correlations with septic and mechanicals failures were also evaluated. Thirteen percent of patients were unsatisfied, despite good results in KOOS, WOMAC and FJS-12 tests. Female gender, low Kellgren–Lawrence grade and the presence of back pain and pain in other joints were factors associated with poor clinical results. Poorer clinical results were also reported in younger patients. Infection rate was correlated with active smoking and mechanical failure with an outlier final alignment. Comorbidities, smoking habits and high expectations have a big influence on TKA results and on final satisfaction after surgery. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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10 pages, 1412 KiB

Open AccessArticle

Fast-Track Programs in Total Hip and Knee Replacement at Swedish Hospitals—Influence on 2-Year Risk of Revision and Mortality

by Urban Berg, Annette W-Dahl, Anna Nilsdotter, Emma Nauclér, Martin Sundberg and Ola Rolfson

J. Clin. Med. 2021, 10(8), 1680; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081680 - 14 Apr 2021

Cited by 6 | Viewed by 1955

Abstract

Purpose: We aimed to study the influence of fast-track care programs in total hip and total knee replacements (THR and TKR) at Swedish hospitals on the risk of revision and mortality within 2 years after the operation. Methods: Data were collected from the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR), including 67,913 THR and 59,268 TKR operations from 2011 to 2015 on patients with osteoarthritis. Operations from 2011 to 2015 Revision and mortality in the fast-track group were compared with non-fast-track using Kaplan–Meier survival analysis and Cox regression analysis with adjustments. Results: The hazard ratio (HR) for revision within 2 years after THR with fast-track was 1.19 (CI: 1.03–1.39), indicating increased risk, whereas no increased risk was found in TKR (HR 0.91; CI: 0.79–1.06). The risk of death within 2 years was estimated with a HR of 0.85 (CI: 0.74–0.97) for TKR and 0.96 (CI: 0.85–1.09) for THR in fast-track hospitals compared to non-fast-track. Conclusions: Fast-track programs at Swedish hospitals were associated with an increased risk of revision in THR but not in TKR, while we found the mortality to be lower (TKR) or similar (THR) as compared to non-fast track. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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12 pages, 3163 KiB

Open AccessArticle

Medio-Lateral and Flexion-Extension Gap Imbalances in Mechanically Aligned Total Knee Arthroplasty Using Measured Resection Technique in Korean Patients: 3D Simulation

by Byung Woo Cho, Ji Hoon Nam, Yong Gon Koh, Kwan Kyu Park and Kyoung Tak Kang

J. Clin. Med. 2021, 10(4), 845; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10040845 - 18 Feb 2021

Cited by 1 | Viewed by 2288

Abstract

Background: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. Methods: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside’s line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). Results: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. Conclusions: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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Review

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11 pages, 821 KiB

Open AccessReview

Results of Simultaneous Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction: A Systematic Review

by Erika Albo, Stefano Campi, Biagio Zampogna, Guglielmo Torre, Giuseppe Francesco Papalia, Lorenzo Alirio Diaz Balzani, Anna Maria Alifano, Rocco Papalia and Vincenzo Denaro

J. Clin. Med. 2021, 10(19), 4290; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194290 - 22 Sep 2021

Cited by 3 | Viewed by 2212

Abstract

This systematic review aimed to investigate the clinical and functional outcomes and complication rate of simultaneous anterior cruciate ligament reconstruction (ACLR) and unicompartmental knee arthroplasty (UKA). A systematic search in PubMed–Medline, Cochrane Library, and Google Scholar was carried out to identify eligible randomized clinical trials, observational studies, or case series that reported on clinical and functional results of combined ACLR and UKA in adults with a unicompartmental knee osteoarthritis and ACL deficiency. Four retrospective studies and three prospective studies were included in this review. A total of 169 patients were included with a mean follow-up of 6.3 years. The Mean Oxford Knee Score improved from 29.4 to 43.9 at the final follow-up. All the other reported scores significantly improved after surgery. The overall revision rate was 3.5%. The MINORS score ranged from 8 to 14. Association analysis of MINORS score and year of publication, through Pearson’s coefficient, showed no significant association (p = −0.089). Simultaneous ACLR and UKA is a safe procedure with a significant postoperative improvement of functional and clinical outcomes for patients with ACL injury that complain of knee instability and isolated medial compartment pain. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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21 pages, 3209 KiB

Open AccessReview

Unicompartmental Knee Replacement in Obese Patients: A Systematic Review and Meta-Analysis

by Stefano Campi, Giuseppe Francesco Papalia, Carlo Esposito, Erika Albo, Francesca Cannata, Biagio Zampogna, Rocco Papalia and Vincenzo Denaro

J. Clin. Med. 2021, 10(16), 3594; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163594 - 15 Aug 2021

Cited by 8 | Viewed by 2709

Abstract

Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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12 pages, 446 KiB

Open AccessReview

Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review

by Marco Bravi, Fabio Santacaterina, Federica Bressi, Rocco Papalia, Stefano Campi, Silvia Sterzi and Sandra Miccinilli

J. Clin. Med. 2021, 10(16), 3470; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163470 - 05 Aug 2021

Cited by 10 | Viewed by 2784

Abstract

Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function. Full article

(This article belongs to the Special Issue Surgical Treatment of Joint Replacement)

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