Development and Underlying Structure of a Second‐Generation Appropriateness Classification System for Total Knee Arthroplasty

2020 ◽  
Author(s):  
Antonio Escobar‐Martinez ◽  
Robert A. Perera ◽  
Daniel L. Riddle
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Classification System ◽  
Second Generation ◽  
Underlying Structure ◽  
Total Knee

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

2019 ◽  
Vol 33 (05) ◽  
pp. 513-524 ◽  
Author(s):  
Corey Scholes ◽  
Milad Ebrahimi ◽  
Nalan Ektas ◽  
John Ireland
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Second Generation ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Rotating Platform ◽  
Patient Reported ◽  
Total Knee

AbstractThere is a lack of clinical outcomes reported for the rotating bearing knee (RBK) total knee arthroplasty (TKA), which is a second-generation rotating platform knee, with purported benefits over earlier versions. The purpose of the study was to report the complications, short-term (minimum 1 year) patient-reported outcomes and long-term (up to 15 years) procedure survival in a consecutive series of patients receiving a rotating platform TKA (RBK) from an independent clinic. A retrospective analysis of a single-surgeon, private/public practice, with prospectively collected data in a subset of patients were performed. A total of 1,130 procedures (primary, revision from unicompartmental knee arthroplasty (UKA) to TKA) were crossmatched with manufacturer records. Clinical outcomes (complications, reoperations) were summarized and linked to patient-reported outcome measures (Eq. 5D, KSS-function, Oxford knee score [OKS]). OKS results were classified using minimally clinical important difference (MCID) and patient acceptable symptom state (PASS). PROMs were summarized and regression models used to determine relationships between patient factors and outcomes in this cohort. Cumulative percent revision was reported by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and compared between the senior author and national data using Kaplan–Meier survival analysis. We report a complication rate of 19.7% with the majority (> 60%) being thromboembolic events and complaints of stiffness. Significant improvements were observed in general health, knee pain, and function with > 89% exceeding the MCID for the OKS and > 65% exceeding the PASS for the OKS at an average follow-up of 3.2 years. We report a cumulative revision rate of 4.3% at 5 years and 4.8% at 14 years, with significantly lower revision rates in females and patients aged 55 to 64 years compared with AOANJRR data for fixed bearing designs. The RBK rotating platform TKA provides good functional outcomes, with relatively low revision and complications rates at up to 14 years follow-up. This design in conjunction with a gap balancing technique may be advantageous in certain patient subgroups.

scholarly journals Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Antonio Escobar ◽  
Amaia Bilbao ◽  
Maria L. Bertrand ◽  
Jesús Moreta ◽  
Miquel A. Froufe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Second Generation ◽  
Short Form ◽  
Critical Issue ◽  
Research Society ◽  
Public Hospitals ◽  
Preoperative Pain ◽  
Satisfaction Scale ◽  
Total Knee

Abstract Background To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA). Methods We applied the RAND/UCLA Appropriateness Method to derive our second-generation system and conducted a prospective study of patients diagnosed with knee osteoarthritis in eight public hospitals in Spain. Main outcome questionnaires were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form-12 (SF-12), and the Knee Society Score satisfaction scale (KSS), completed before and 6 months after TKA. Baseline, changes from baseline to 6 months (journey outcome), and 6-month scores (destination outcome) were compared according to appropriateness category. Percentage of patients attaining the minimal clinically important difference (MCID) and responders according to Outcome Measures in Rheumatology-Osteoarthritis Research Society (OMERACT-OARSI) criteria were also reported. Results A total of 282 patients completed baseline and 6-month questionnaires. Of these, 142 (50.4%) were classified as Appropriate, 90 (31.9%) as Uncertain, and 50 (17.7%) as Inappropriate. Patients classified as Appropriate had worse preoperative pain, function, and satisfaction (p < 0.001) and had greater improvements (i.e., journey scores) than those classified as Inappropriate (p < 0.001). At 6 months, destination scores for pain, function, or satisfaction were not significantly different across appropriateness categories. The percentage of patients meeting responder criteria (p < 0.001) and attaining MCID was statistically higher in Appropriate versus Inappropriate groups in pain (p = 0.04) and function (p = 0.004). Conclusions The validity of our second-generation appropriateness system was generally supported. The findings highlight a critical issue in TKA healthcare: whether TKA appropriateness should be driven by the extent of improvement, by patient final state, or by both.

Survival Analysis of a Second-Generation Contemporary Modular Total Knee Arthroplasty: A Large Multicenter 10-Year Study

2007 ◽  
Vol 22 (2) ◽  
pp. 314 ◽  
Author(s):  
Martin Roche ◽  
William Barrett ◽  
J. Bohannon Mason ◽  
Kent Boese ◽  
Wayne Goldstein ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Analysis ◽  
Knee Arthroplasty ◽  
Second Generation ◽  
Total Knee
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