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J Knee Surg 2018; 31(10): 940-945
DOI: 10.1055/s-0038-1668580
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Operative Time, Length of Stay, Short-Term Readmission, and Complications after Hinged Primary Total Knee Arthroplasty: A Propensity Score Matched Analysis

Nipun Sodhi
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
,
Yatindra H. Patel
2   Department of Orthopaedic Surgery, University Hospitals, Cleveland, Ohio
,
Jaiben George
3   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Assem A. Sultan
3   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Hiba K. Anis
4   Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio
,
Jared M. Newman
5   Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
,
Thomas J. Kryzak
6   Department of Orthopaedics, Mid Coast Medical Group-Orthopaedics, Brunswick, Maine
,
Anton Khlopas
7   Department of Orthopaedics, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Joseph T. Moskal
8   Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
,
Michael A. Mont
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
› Author Affiliations
Further Information

Publication History

09 May 2018

19 July 2018

Publication Date:
29 August 2018 (online)

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Abstract

Despite the wide utilization of total knee arthroplasty (TKA), it can be technically challenging to perform in patients who have concomitant bone loss, ligamentous laxity, or high-grade deformity, whether in a revision situation or due to a primary pathology. Therefore, hinged knee prostheses have been developed to provide more stable fixation in these situations. The purpose of this study was to compare the short-term peri- and postoperative outcomes of patients undergoing primary TKA with and without hinged prosthesis. Specifically, we compared (1) mean operative times, (2) lengths of stay (LOS), (3) 30-day readmissions, and (4) complications. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify hinged TKAs and 99 procedures were included. They were matched in a 1:3 ratio to primary TKAs without a hinged prosthesis using propensity score matching. Operative time, LOS, discharge disposition, 30-day readmissions, and complications were compared. Adjusted odds ratios (OR) were also calculated. The operative time was significantly higher in hinged cohort compared with the nonhinged cohort (mean difference [MD] = 22 minutes; range, 10–34 minutes, p < 0.001). There were no significant differences between hinged and nonhinged TKAs with respect to LOS (MD= 0.61 days, range, –0.07–1.30 days, p = 0.080), discharge disposition (OR = 1.09, 95% confidence interval [CI], 0.66–1.84), readmissions (OR = 2.67, 95% CI, 0.84–8.24), and any complications (OR = 1.13, 95% CI, 0.55–2.19). Not surprisingly, primary TKAs with hinged prostheses had increased operative times, but had similar LOS, discharge dispositions, and 30-day rates of readmission and complications when compared with TKAs without a hinged prosthesis. One potential contributing factor to the increased operating time is that patients who receive a hinged implant tend to present with more severe deformities. It is reassuring to know that early outcomes were similar between both cohorts (although we await longer follow-up studies), and that hinged implants can be considered in these difficult to treat patients.

Keywords

hinged - total knee arthroplasty - outcomes - length of stay - readmissions
 

  • References

  • 1 Tateishi H. Indications for total knee arthroplasty and choice of prosthesis. J Japanese Med Assoc 2000; 123: 470-474
    PubMedGoogle Scholar
  • 2 Siqueira MB, Klika AK, Higuera CA, Barsoum WK. Modes of failure of total knee arthroplasty: registries and realities. J Knee Surg 2015; 28 (02) 127-138
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Jones GB. Total knee replacement-the Walldius hinge. Clin Orthop Relat Res 1973; (94) 50-57
    PubMedGoogle Scholar
  • 4 Habermann ET, Deutsch SD, Rovere GD. Knee arthroplasty with the use of the Walldius total knee prosthesis. Clin Orthop Relat Res 1973; (94) 72-84
    PubMedGoogle Scholar
  • 5 Karpinski MR, Grimer RJ. Hinged knee replacement in revision arthroplasty. Clin Orthop Relat Res 1987; (220) 185-191
    PubMedGoogle Scholar
  • 6 Barrack RL. Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 292-299
    PubMedGoogle Scholar
  • 7 Rickhuss PK, Gray AJ, Rowley DIA. A 5-10 year follow-up of the Sheehan total knee endoprosthesis in Tayside. J R Coll Surg Edinb 1994; 39 (05) 326-328
    PubMedGoogle Scholar
  • 8 Manning DW, Chiang PP, Freiberg AA. Hinge implants. In: Bono JV, Scott RD. , eds. Revision Total Knee Arthroplasty. New York, NY: Springer; 2005: 219-236
    CrossrefGoogle Scholar
  • 9 Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 2006; 443 (443) 266-272
    CrossrefPubMedGoogle Scholar
  • 10 Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH. The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty 2007; 22 (06) (Suppl. 02) 71-76
    CrossrefPubMedGoogle Scholar
  • 11 Goudie EB, Robinson C, Walmsley P, Brenkel I. Changing trends in total knee replacement. Eur J Orthop Surg Traumatol 2017; 27 (04) 539-544
    CrossrefPubMedGoogle Scholar
  • 12 Singh JA, Lewallen DG. Time trends in the characteristics of patients undergoing primary total knee arthroplasty. Arthritis Care Res (Hoboken) 2014; 66 (06) 897-906
    PubMedGoogle Scholar
  • 13 Iorio R, Robb WJ, Healy WL. , et al. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am 2008; 90 (07) 1598-1605
    CrossrefPubMedGoogle Scholar
  • 14 Oliveria SA, Felson DT, Cirillo PA, Reed JI, Walker AM. Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiology 1999; 10 (02) 161-166
    CrossrefPubMedGoogle Scholar
  • 15 Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1987; 30 (08) 914-918
    CrossrefPubMedGoogle Scholar
  • 16 Bradley BM, Griffiths SN, Stewart KJ, Higgins GA, Hockings M, Isaac DL. The effect of obesity and increasing age on operative time and length of stay in primary hip and knee arthroplasty. J Arthroplasty 2014; 29 (10) 1906-1910
    CrossrefPubMedGoogle Scholar
  • 17 Steckel H, Klinger HM, Baums MH, Schultz W. [Long-term results of the Blauth knee prosthesis--current status of hinged knee prostheses]. Z Orthop Ihre Grenzgeb 2005; 143 (01) 30-35
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Gehrke T, Kendoff D, Haasper C. The role of hinges in primary total knee replacement. Bone Joint J 2014; 96-B (11, Supple A): 93-95
    CrossrefPubMedGoogle Scholar
  • 19 Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am 2007; 89 (08) 1735-1741
    PubMedGoogle Scholar
  • 20 Birkmeyer JD, Shahian DM, Dimick JB. , et al. Blueprint for a new American College of Surgeons: National Surgical Quality Improvement Program. J Am Coll Surg 2008; 207 (05) 777-782
    CrossrefPubMedGoogle Scholar
  • 21 Molina CS, Thakore RV, Blumer A, Obremskey WT, Sethi MK. Use of the National Surgical Quality Improvement Program in orthopaedic surgery. Clin Orthop Relat Res 2015; 473 (05) 1574-1581
    CrossrefPubMedGoogle Scholar
  • 22 Dotson P. CPT® codes: what are they, why are they necessary, and how are they developed?. Adv Wound Care (New Rochelle) 2013; 2 (10) 583-587
    CrossrefPubMedGoogle Scholar
  • 23 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (07) 1487-1497
    PubMedGoogle Scholar
  • 24 Derman PB, Fabricant PD, David G. The role of overweight and obesity in relation to the more rapid growth of total knee arthroplasty volume compared with total hip arthroplasty volume. J Bone Joint Surg Am 2014; 96 (11) 922-928
    CrossrefPubMedGoogle Scholar
  • 25 Losina E, Katz JN. Total knee arthroplasty on the rise in younger patients: are we sure that past performance will guarantee future success?. Arthritis Rheum 2012; 64 (02) 339-341
    CrossrefPubMedGoogle Scholar
  • 26 Böhm P, Holy T. Is there a future for hinged prostheses in primary total knee arthroplasty? A 20-year survivorship analysis of the Blauth prosthesis. J Bone Joint Surg Br 1998; 80 (02) 302-309
    PubMedGoogle Scholar
  • 27 Petrou G, Petrou H, Tilkeridis C. , et al. Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up. J Bone Joint Surg Br 2004; 86 (06) 813-817
    CrossrefPubMedGoogle Scholar
  • 28 Bistolfi A, Lustig S, Rosso F, Dalmasso P, Crova M, Massazza G. Results with 98 Endo-Modell rotating hinge prostheses for primary knee arthroplasty. Orthopedics 2013; 36 (06) e746-e752
    CrossrefPubMedGoogle Scholar
  • 29 Martin JR, Beahrs TR, Stuhlman CR, Trousdale RT. Complex primary total knee arthroplasty: long-term outcomes. J Bone Joint Surg Am 2016; 98 (17) 1459-1470
    CrossrefPubMedGoogle Scholar