PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-15 (15)
 

Clipboard (0)
None
Journals
Authors
more »
Year of Publication
Document Types
1.  Cerebrovascular Disease Is Associated with Outcomes after Total Knee Arthroplasty: A U.S. Total Joint Registry Study 
The Journal of arthroplasty  2013;29(1):10.1016/j.arth.2013.04.003.
We assessed the association of cerebrovascular disease with patient-reported outcomes (PROs) of moderate-severe activity limitation and moderate-severe pain at 2- and 5-years after primary total knee arthroplasty (TKA) using multivariable-adjusted logistic regression. 7,139 primary and 4,234 revision TKAs were included. Compared to the patients without cerebrovascular disease, those with cerebrovascular disease had a higher odds ratio (OR) of moderate-severe limitation at 2-years and 5-years, 1.32 (95% confidence interval [CI]: 1.02, 1.72; P=0.04) and 1.83 (95% CI: 1.32, 2.55; P<0.001). No significant associations were noted with moderate-severe pain at 2-years or 5-years. In conclusion, we found that cerebrovascular disease is independently associated with pain and function outcomes after primary TKA. This should be taken into consideration when discussing expected outcomes of TKA with patients.
doi:10.1016/j.arth.2013.04.003
PMCID: PMC3783649  PMID: 23664282
Pain; Activity limitation; cerebrovascular disease; Total knee replacement; arthroplasty; joint replacement; outcomes; Patient-Reported Outcomes; Activities of Daily Living; ADLs; Function; functional limitation
2.  Clinically important body weight gain following knee arthroplasty: A five-year comparative cohort study 
Arthritis care & research  2013;65(5):669-677.
Objective
The impact of knee arthroplasty on subsequent body weight gain has not been fully explored. Clinically important weight gain following knee arthroplasty would pose potentially important health risks.
Methods
We used one of the largest US-based knee arthroplasty registries and a population- based control sample from the same geographic region to determine whether knee arthroplasty increases risk of clinically important weight gain of 5% or more of baseline body weight over a 5-year postoperative period.
Results
Of the persons in the knee arthroplasty sample, 30.0% gained 5% or more of baseline body weight five years following surgery as compared to 19.7% of the control sample. The multivariable adjusted (age, sex, BMI, education, comorbidity and pre-surgical weight change) odds ratio was 1.6 (95% CI, 1.2, 2.2) in persons with knee arthroplasty as compared to the control sample. Additional arthroplasty procedures during the 5-year follow-up further increased risk for weight gain (OR=2.1, 95% CI, 1.4, 3.1) relative to the control sample. Specifically among patients with knee arthroplasty, younger patients and those who lost greater amounts of weight in the 5-year pre-operative period were at greater risk for clinically important weight gain.
Conclusions
Patients who undergo knee arthroplasty are at increased risk of clinically important weight gain following surgery. Future research should develop weight loss/maintenance interventions particularly for younger patients who have lost a substantial amount of weight prior to surgery as they are most at risk for substantial postsurgical weight gain.
doi:10.1002/acr.21880
PMCID: PMC4169302  PMID: 23203539
3.  Clinically important body weight gain following total hip arthroplasty: A cohort study with five-year follow-up 
Objective
Literature examining the effects of total hip arthroplasty (THA) on subsequent body weight gain is inconclusive. Determining the extent to which clinically relevant weight gain occurs following THA has important public health implications.
Design
We used multivariable logistic regression to compare data from one of the largest US-based THA registries to a population-based control sample from the same geographic region. We also identified factors that increased risk of clinically important weight gain specifically among persons undergoing THA. The outcome measure of interest was weight gain of ≥ 5% of body weight up to 5 years following surgery.
Results
The multivariable adjusted (age, sex, BMI, education, comorbidity and pre-surgical weight change) odds ratio for important weight gain was 1.7 (95% CI, 1.06, 2.6) for a person with THA as compared the control sample. Additional arthroplasty procedures during the 5-year follow-up further increased odds for important weight gain (OR=2.0, 95% CI, 1.4, 2.7) relative to the control sample. A patient with THA had increased risk of important post-surgical weight gain of 12% (OR=1.12; 95%CI,1.08, 1.16) for every kilogram of pre-operative weight loss.
Conclusions
While findings should be interpreted with caution because of missing follow-up weight data, patients with THA appear to be at increased risk of clinically important weight gain following surgery as compared to peers. Patients less than 60 years and who have lost a substantial amount of weight prior to surgery appear to be at particularly high risk of important postsurgical weight gain.
doi:10.1016/j.joca.2012.09.010
PMCID: PMC4169300  PMID: 23047011
knee; hip; arthroplasty; obesity
4.  Time trends in the Characteristics of Patients Undergoing Primary Total Knee Arthroplasty 
Arthritis care & research  2014;66(6):897-906.
Objective
To study the time-trends in socio-demographic and clinical characteristics of patients undergoing primary total knee arthroplasty (TKA).
Methods
We used the Mayo Clinic Total Joint Registry to examine the time-trends in patient demographics (body mass index [BMI], age), underlying diagnosis, medical (Deyo-Charlson index) and psychological comorbidity (anxiety, depression) and examination findings of primary TKA patients from 1993–2005. We used chi-square test and analysis of variance.
Results
7,229 patients constituted the primary TKA cohort; 55% were women. The mean age decreased by 1.3 years (69.3 to 68.0), BMI increased by 1.7 kg/m2 (30.1 to 31.8) and Deyo-Charlson index increased by 36% (1.1 to 1.5) over the 13-year study period (p<0.001 for all). Compared to 1993–95, significantly more patients (by 2–3 times) in 2002–05 had (p<0.001 for all): BMI ≥40, 4.8% vs. 10.6%; age <50, 2.9% vs. 5.2%; Deyo-Charlson index of ≥3, 12% vs. 22.3%; depression, 4.1% vs. 14.8%; anxiety, 4.1% vs. 8.9%; and a significantly fewer had an underlying diagnosis of rheumatoid/inflammatory arthritis, 6.4% vs. 1.5%. Compared to 1993–95, significant reductions were noted in 2002–05 for the physical examination findings of (p<0.001 for all): knee joint effusion, anterior-posterior knee instability, medial-lateral knee instability, moderate-severe knee synovitis, severe limp, fair or poor muscle strength and absent peripheral pulses.
Conclusions
In this large U.S. total joint registry study, we found significant time-trends in patient characteristics, diagnosis, comorbidity and knee/limb examination findings in primary TKA patients over 13-years. These secular trends should be taken into account when comparing outcomes over time and in policy-making decisions.
doi:10.1002/acr.22233
PMCID: PMC4151514  PMID: 24249702
Total knee replacement; time trends; arthroplasty; joint replacement; diagnosis; obesity; comorbidity; osteoarthritis
5.  Medical Comorbidity is Associated with Persistent Index Hip Pain after Primary THA 
Pain medicine (Malden, Mass.)  2013;14(8):10.1111/pme.12153.
Objective
To characterize whether medical comorbidity predicts persistent moderate-severe pain after total hip arthroplasty (THA)
Methods
We analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision THA between 1993–2005. Using multivariable-adjusted logistic regression analyses, we examined whether certain medical comorbidities were associated with persistent moderate-severe hip pain 2- or 5-years after primary or revision THA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented.
Results
The primary THA cohort consisted of 5,707 THAs and 3,289 THAs at 2- and 5-years, and revision THA, 2,687 and 1,627 THAs, respectively. In multivariable-adjusted logistic regression models, in the primary THA cohort, renal disease was associated with lower odds of moderate-severe hip pain (OR, 0.6; 95% CI, 0.3, 1.0) at 2-years. None of the comorbidities were significantly associated at 5-years. In the revision THA cohort, heart disease was significantly associated with higher risk (OR, 1.7; 95% CI, 1.1, 2.6) at 2-years and connective tissue disease with lower risk (OR, 0.5; 95% CI, 0.3, 0.9) of moderate-severe hip pain at 5-years follow-up.
Conclusion
This study identified new correlates of moderate-severe hip pain after primary or revision THA, a much-feared outcome of hip arthroplasty. Patients with these comorbidities should be informed regarding the increased risk or moderate-severe index hip pain, so that they can have a fully informed consent and realistic expectations.
doi:10.1111/pme.12153
PMCID: PMC3814009  PMID: 23742141
Pain; Function; functional limitation; Total hip replacement; primary; arthroplasty; joint replacement; outcomes; Patient-Reported Outcomes
6.  Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry 
Rheumatology (Oxford, England)  2013;52(6):1109-1118.
Objective. To characterize patient-level clinically meaningful improvements in pain and limitation of key activities of daily living (ADLs) after primary or revision total hip arthroplasty (THA).
Methods. We analysed prospectively collected data from the Mayo Clinic Total Joint Registry to study clinically meaningful improvements in index hip pain severity and limitation in seven key ADLs (walking, climbing stairs, putting on shoes/socks, picking up objects, getting in/out of car, rising from a chair and sitting), from preoperative to 2- and 5-year post-THA.
Results. The primary THA cohort consisted of 6168 responders preoperatively, 5707 at 2 years and 3289 at 5 years postoperatively. The revision THA cohort consisted of 2063 responders preoperatively, 2682 at 2 years and 1627 at 5 years postoperatively. In the primary THA cohort, clinically meaningful pain reduction to mild or no hip pain at 2 years was reported by 94% with moderate and 91% with severe preoperative pain; respective proportions were 91% and 89% at 5-year follow-up. For revision THA, respective proportions were 84% and 77% at 2 years and 80% and 78% at 5 years. In the primary THA cohort, up to 4% with moderate and 17% with severe preoperative ADL limitation reported severe limitation in the respective activity 2 years post-primary THA; at 5 years, the respective proportions were up to 7% and 20%. Respective proportions for revision THA were up to 10% and 26% at 2 years and 13% and 30% at 5 years.
Conclusions. These comprehensive data for patient-level clinically meaningful improvements in pain and seven key ADLs can help patients set realistic goals for improvement after THA.
doi:10.1093/rheumatology/kes416
PMCID: PMC3651614  PMID: 23382362
pain; activity limitation; activities of daily living; function; functional limitation; total hip replacement; arthroplasty; joint replacement; outcomes; patient-reported outcomes; primary; revision
7.  Better Functional and Similar Pain Outcomes in Osteoarthritis compared to Rheumatoid arthritis after primary total knee arthroplasty: A cohort study 
Arthritis care & research  2013;65(12):10.1002/acr.22090.
Objective
To determine the association of the underlying diagnosis with limitation in activities of daily living (ADLs) and pain in patients undergoing primary total knee arthroplasty (TKA).
Methods
Prospectively collected data from the Mayo Clinic Total Joint Registry were used to assess the association of diagnosis with moderate-severe limitation in activities of daily living (ADLs) and moderate-severe pain and at 2- and 5-years after primary TKA using multivariable-adjusted logistic regression analyses. We calculated odds ratios (OR) and 95% confidence intervals (CI).
Results
There were 7,139 primary TKAs at 2-years and 4,234 at 5-years. In multivariable-adjusted analyses, compared to rheumatoid arthritis (RA)/inflammatory arthritis, osteoarthritis (OA) was associated with significantly lower odds ratio (OR) [95% confidence interval (CI)] of moderate-severe ADL limitation with OR of 0.5 [95% CI: 0.3, 0.8] (p=0.004) at 2-years, and 0.5 [95% CI, 0.3, 0.9] (p=0.02) at 5-years. There was no significant association of diagnosis of OA with moderate-severe pain at 2-years with OR of 1.2 [0.5, 2.7] (p=0.68) or at 5-years with OR of 1.0 [0.3, 3.7] (p=1.0).
Conclusion
We found patients with OA who underwent primary TKA had better ADL outcomes compared to patients with RA/inflammatory arthritis at 2- and 5-years. On the other hand, the pain outcomes did not differ in OA vs. RA after primary TKA. This suggests discordant effect of underlying diagnosis on pain and function outcomes after TKA. These novel findings can be used to better inform both patients and surgeons about expected pain and function outcomes after primary TKA.
doi:10.1002/acr.22090
PMCID: PMC3855298  PMID: 23925956
Total knee replacement; arthroplasty; joint replacement; patient-reported outcomes; osteoarthritis; rheumatoid arthritis
8.  Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty 
Rheumatology (Oxford, England)  2013;52(5):916-923.
Objective. To study comorbidity correlates of moderate to severe pain after total knee arthroplasty (TKA).
Methods. We analysed prospectively collected Total Joint Registry data to examine whether medical (heart disease, peripheral vascular disease, renal disease, chronic obstructive pulmonary disease, diabetes and CTD) and psychological (anxiety and depression) comorbidity is associated with moderate to severe pain after primary or revision TKA. Multivariable-adjusted logistic regression simultaneously adjusted for all comorbidities, age, sex, BMI, underlying diagnosis, American Society of Anesthesiologist (ASA) class, distance from medical centre and implant fixation (only for primary TKA) was used to analyse primary and revision TKA separately.
Results. The primary TKA cohort consisted of 7139 and 4234 TKAs (response rates 65% and 57%) and the revision TKA cohort consisted of 1533 and 881 TKAs at 2 and 5 years (response rates 57% and 48%), respectively. In the primary TKA cohort, anxiety was associated with 1.4 higher odds (95% CI 1.0, 2.0) of moderate to severe index knee pain at 2 years; at 5 years, heart disease (OR 1.7; 95% CI 1.1, 2.6), depression (OR 1.7; 95% CI 1.1, 2.5) and anxiety (OR 1.9; 95% CI 1.2, 3.1) were significantly associated with moderate to severe pain. For revision TKA, CTD (OR 0.5; 95% CI 0.2, 0.9) and depression (OR 1.8; 95% CI 1.1, 3.1) were significantly associated with moderate to severe pain.
Conclusion. This study identified medical and psychological comorbidity risk factors for moderate to severe pain after primary and revision TKA. This information can be used to provide realistic outcome expectations for patients before undergoing primary or revision TKA.
doi:10.1093/rheumatology/kes402
PMCID: PMC3630396  PMID: 23325037
pain; function; functional limitation; total knee replacement; primary; arthroplasty; joint replacement; outcomes; patient-reported outcomes
9.  Predictors of Activity Limitation and Dependence on Walking Aids following Primary Total Hip Arthroplasty 
Journal of the American Geriatrics Society  2010;58(12):10.1111/j.1532-5415.2010.03182.x.
OBJECTIVES
To study function outcomes and their predictors after primary total hip arthroplasty (THA).
DESIGN
Prospective Cohort Study
SETTING
Single Institution
PARTICIPANTS
All patients who underwent primary THA at our institution between 1993 and 2005 and were alive at the time of follow-up.
MEASUREMENTS
Whether sex, age, body mass index (BMI), comorbidity, anxiety, and depression predict moderate to severe activity limitation (limitation in ≥3 activities) and complete dependence on waling aids 2 and 5 years after primary THA was examined. Multivariable logistic regression adjusted for operative diagnosis, American Society of Anesthesiologists score, implant type, and distance from medical center.
RESULTS
At 2 years, 30.3% of participants reported moderate to severe activity limitation; at 5 years, 35% of participants reported moderate to severe activity limitation. Significant predictors of moderate to severe activity limitations at 2-year follow-up were female sex (odds ratio (OR)=1.2, 95% confidence interval (CI)=1.1–1.4), aged 71 to 80 (OR=2.0, 95% CI=1.6–2.5), aged 80 and older (OR=4.5, 95% CI=3.4–6.0), depression (OR=2.1, 95% CI=1.6–2.7), and BMI greater than 30. At 5-year follow-up, significant predictors were aged 71 to 80 (OR=1.7, 95% CI=1.3–2.2), older than 80 (OR=4.3, 95% CI=2.8–6.6), depression (OR=2.3, 95% CI=1.6–3.4), and BMI greater than 30.Significant predictors of complete dependence on walking aids at 2 years were female sex (OR=2.0, 95% CI=1.4–2.7), aged 71 to 80 (OR=2.4, 95% CI=1.4–4.2), older than 80 (OR=11.4, 95% CI=6.0–21.9), higher Deyo-Charlson score (OR=1.5, 95% CI=(1.1–1.2) for 5-point increase, depression (OR=2.0, 95% CI=1.2–3.4), and BMI greater than 35. Each of these factors also significantly predicted complete dependence on walking at 5-year follow-up, with similar odds ratios, except that BMI 30–34.9 was not significantly associated.
CONCLUSION
Higher BMI, depression, older age, and female sex predict activity limitation and complete dependence on walking aids 2 and 5 years after primary THA.
doi:10.1111/j.1532-5415.2010.03182.x
PMCID: PMC3850176  PMID: 21143444
Primary Total Hip Arthroplasty; THA; Predictors; Activity Limitation; Function; walking aids
10.  Diabetes: A Risk Factor for Poor Functional Outcome after Total Knee Arthroplasty 
PLoS ONE  2013;8(11):e78991.
Background
To assess the association of diabetes with postoperative limitation of activities of daily living (ADLs) after primary total knee arthroplasty (TKA).
Methodology/Principal Findings
We used the prospectively collected data from the Mayo Clinic Total Joint Registry to assess the association of diabetes and diabetes with complications with moderate-severe ADL limitation 2- and 5-years after primary TKA. Multivariable logistic regression with general estimating equations adjusted for preoperative ADL limitation, comorbidity and demographic and clinical covariates. Odds ratio (OR) and 95% confidence interval (CI) are presented. 7,139 primary TKAs at 2-years and 4,234 at 5-years constituted the cohorts. In multivariable-adjusted analyses, diabetes was associated with higher odds of moderate-severe limitation at 2- and 5-years, 1.71 (95% CI: 1.26, 2.32; P = 0.001) and 1.66 (95% CI: 1.13, 2.46; P = 0.01). Respective ORs for patients with diabetes with complications were 2.73 (95% CI: 1.47, 5.07; P = 0.001) and 2.73 (95% CI: 1.21, 6.15; P = 0.016). Sensitivity analyses that adjusted for anxiety and depression or anxiety, depression and ipsilateral hip involvement showed minimal attenuation of magnitude of the association.
Conclusions/Significance
In this large study of patients who underwent primary TKA, diabetes as well as its severity were independently associated with poorer functional outcome. Given the increasing rates of both diabetes as well as arthroplasty, more insight is needed into disease-related and treatment-related factors that underlie this higher risk of ADL limitation in patients with diabetes. Poor functional outcomes may be preventable by modifying the control of diabetes and associated comorbidity in pre- and post-arthroplasty periods.
doi:10.1371/journal.pone.0078991
PMCID: PMC3827297  PMID: 24236080
11.  Total Knee Arthroplasty in Morbidly Obese Patients Treated with Bariatric Surgery: A Comparative Study 
The Journal of arthroplasty  2012;27(9):1696-1700.
Our objective was to compare outcomes (anesthesia time, total operative time, tourniquet time, duration of hospital stay, 90-day complication rate and transfusion rates) of patients with total knee arthroplasty (TKA) who underwent bariatric surgery before or after TKA. One-hundred-twenty-five patients were included: TKA before bariatric surgery (group 1; n=39); TKA within two years of bariatric surgery (group 2; n=25); and TKA more than 2 years after bariatric surgery (group 3; n=61). Patients with TKA more than 2 years after bariatric surgery had shorter anesthesia, total operative and tourniquet times than other groups; differences were significant between groups. Ninety-day complication and transfusion rates approached but did not meet statistical significance. Ninety-day complication rates and duration of hospital stay did not differ significantly between the three groups.
doi:10.1016/j.arth.2012.03.005
PMCID: PMC3413743  PMID: 22554730
Total knee arthroplasty; morbidly obese; bariatric surgery; outcomes
12.  Ninety-day Mortality in Patients Undergoing Elective Total Hip or Total Knee Arthroplasty 
The Journal of arthroplasty  2012;27(8):1417-1422.e1.
Using an institutional Joint Registry, we studied frequency, trends and predictors of mortality following elective total hip or knee arthroplasty (THA/TKA). Of the 12,727 and 12,484 patients who underwent THA and TKA respectively, all-cause mortality rates at 7-, 30- and 90-days were as follows: THA, 0.1%, 0.2% and 0.5%; TKA 0.1%. 0.2% and 0.4%, respectively. Statistically significant downward time-trend in 90-day mortality was noted after TKA (p=0.02), but not after THA (p=0.41). In multivariable-adjusted analyses of THA patients, older age, higher comorbidity index, and prior cardiac disease were significantly associated with higher 90-day mortality. In TKA patients, older age, male gender, ASA class of 3-4, and higher comorbidity index were associated with higher 90-day all-cause mortality. Optimization of disease management may reduce postoperative mortality after THA/TKA.
doi:10.1016/j.arth.2012.03.008
PMCID: PMC3413788  PMID: 22554727
13.  Cardiac and Thromboembolic Complications and Mortality in Patients Undergoing Total Hip and Total Knee Arthroplasty 
Annals of the Rheumatic Diseases  2011;70(12):2082-2088.
Objective
Study 90-day cardiac and thromboembolic complications and all-cause mortality following total hip or knee arthroplasty (THA/TKA).
Method
In a population-based cohort of all Olmsted County residents who underwent a THA or TKA between 1994 and 2008, we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis (DVT) or pulmonary embolism (PE)) and mortality.
Results
Among the Olmsted County THA and TKA cohorts, 90-day complication rates were as follows: cardiac, 15.8% and 6.9%; thromboembolic, 4.9% and 4.0%; and mortality, 0.7% and 0.4%, respectively. Unadjusted frequency of cardiac/thromboembolic events differed by history of prior respective event. In multivariable-adjusted logistic regression analyses, ASA class III–IV (OR, 6.1, 95% CI:1.6, 22.8) and higher Deyo-Charlson comorbidity score (OR, 1.2, 95% CI:1.0,1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known prior cardiac event. In those with known prior cardiac disease, ASA class III–IV (OR, 4.4, 95% CI:2.0, 9.9), male gender (OR, 0.5, 95% CI:0.3,0.9) and history of thromboembolic disease (OR, 3.2; 95% CI:1.4,7.0) were significantly associated with odds of cardiac complication 90-day post-THA. No significant predictors of thromboembolism were found in THA patients.
In TKA patients with no prior cardiac history, age >65 years (OR, 4.1, 95% CI:1.2, 14.0), and ASA class III–IV (OR, 2.8, 95% CI:1.1,6.8) and in TKA patients with known cardiac disease, ASA class III–IV (OR, 3.2, 95% CI:1.8,5.7) was significantly associated with odds of 90-day cardiac event. In TKA patients with no prior thromboembolic disease, male gender (OR, 0.5, 95% CI:0.2,0.9) and higher Charlson index (OR, 1.2, 95% CI:1.1,1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR, 1.1, 95% CI:1.1,1.4) was associated with odds of 90-day thromboembolic event.
Conclusion
Older age, higher comorbidity, higher ASA class and prior history of cardiac/thromboembolic disease was associated with an increased risk of 90-day cardiac and thromboembolic complications.
doi:10.1136/ard.2010.148726
PMCID: PMC3315837  PMID: 22021865
Cardiac; Thromboembolic; Total Hip Arthroplasty; Total Knee Arthroplasty; Mortality
14.  Peptic ulcer disease and Pulmonary disease are Associated with Risk of Periprosthetic Fracture after Primary Total Knee Arthroplasty 
Arthritis care & research  2011;63(10):1471-1476.
Objective
To assess the association of specific comorbidities with periprosthetic fractures after primary total knee replacement (TKA)
Methods
We used the prospectively collected data in the Mayo Clinic Total Joint Registry from 1989-2008 on all patients who had undergone primary TKA. The outcome of interest was postoperative periprosthetic fractures during the follow-up. Main predictors of interest were comorbidities grouped from the validated Deyo-Charlson index. Multivariable-adjusted Cox regression analyses adjusted for gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, operative diagnosis and implant fixation. Hazard ratios and 95% confidence intervals were calculated.
Results
We included 17,633 primary TKAs with a mean follow-up of 6.3 years. The mean age was 68 years, 55% were women and mean BMI was 31. There were 188 postoperative periprosthetic fractures on postoperative day one or later; 162 fractures (86%) occurred postoperative day 90 day or later. In multivariable analyses that simultaneously adjusted for all comorbidities and other variables (age, gender, BMI, ASA, operative diagnosis, cement status), two conditions were significantly associated with increased hazard of postoperative periprosthetic fractures: peptic ulcer disease, hazard ratio of 1.87 (95% confidence interval:1.28, 2.75; p=0.0014); and chronic obstructive pulmonary disease (COPD) hazard ratio of 1.62 (95% confidence interval:1.10, 2.40; p=0.02).
Conclusions
Peptic ulcer disease and COPD are associated with higher risk of periprosthetic fractures after primary TKA. This may be related to the disease or their treatments, which needs further study. Identification of specific risk factor may allow for implementation of intervention strategies to reduce this risk.
doi:10.1002/acr.20548
PMCID: PMC3183369  PMID: 21748860
Total knee arthroplasty; total knee replacement; periprosthetic fracture; predictors; risk factors; comorbidity; Primary TKA
15.  Higher Body Mass Index Is Not Associated with Worse Pain Outcomes After Primary or Revision Total Knee Arthroplasty (TKA) 
The Journal of arthroplasty  2010;26(3):366-374.e1.
We assessed whether higher Body Mass Index (BMI) is associated with higher risk of moderate-severe knee pain 2- and 5-years after primary or revision Total Knee Arthroplasty (TKA). We adjusted for gender, age, comorbidity, operative diagnosis and implant fixation in multivariable logistic regression. BMI (reference, <25 kg/m2) was not associated with moderate-severe knee pain at 2-years post-primary TKA (odds ratio (95% confidence interval): 25-29.9, 1.02 (0.75,1.39), p=0.90; 30-34.9, 0.93 (0.65,1.34), p=0.71; 35-39.9, 1.16 (0.77,1.74), p=0.47; ≥40, 1.09 (0.69,1.73), (all p-values ≥0.47). Similarly, BMI was not associated with moderate-severe pain at 5-year primary TKA and at 2- and 5-yr revision TKA follow-up. Lack of association of higher BMI with poor pain outcomes post-TKA implies that TKA should not be denied to obese patients for fear of suboptimal outcomes.
doi:10.1016/j.arth.2010.02.006
PMCID: PMC2930933  PMID: 20413245

Results 1-15 (15)