Abstract
Introduction
The development of new prostheses with improved osseointegration, bone preservation, and reduced cost has renewed interest in uncemented total knee arthroplasty (UCTKA). In the current study, we aimed to: (1) assess demographic data of patients who were and were not readmitted and (2) identify patient-specific risk factors associated with readmission.
Methods
A retrospective query from the PearlDiver database was performed from January 1, 2015, to October 31, 2020. International Classification of Disease, Ninth Revision (ICD-9), ICD-10, or Current Procedural Terminology (CPT) coding was used to distinguish cohorts of patients who had osteoarthritis of the knee and underwent UCTKA. Patients readmitted within 90 days were classified as the study population, while those who were not readmitted were classified as control. A linear regression model was utilized to analyze readmission risk factors.
Results
The query yielded 14,575 patients, with 986 (6.8%) being readmitted. Patient demographics such as age (P < 0.0001), sex (P < 0.009), and comorbidity (P < 0.0001) were associated with annual 90-day readmission. Patient-specific risk factors associated with 90-day readmission following press-fit total knee arthroplasty were: arrhythmia (OR: 1.29, 95% CI: 1.11–1.49, P < 0.0005), coagulopathy (OR: 1.36, 95% CI: 1.13–1.63, P < 0.0007), fluid and electrolyte abnormalities (OR: 1.59, 95% CI: 1.38–1.84, P < 0.0001), iron deficiency anemia (OR: 1.49, 95% CI: 1.27–1.73, P < 0.0001), and obesity (OR: 1.37, 95% CI: 1.18–1.60, P < 0.0001).
Discussion
This study demonstrates that patients with comorbidities, such as fluid and electrolyte problems, iron deficiency anemia, and obesity, were at an increased risk of readmission after having an uncemented total knee replacement. The risks of readmission following an uncemented total knee arthroplasty can be discussed with patients who have certain comorbidities by arthroplasty surgeons.
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References
Hsu H, Siwiec RM (2018) Knee osteoarthritis
Deshpande BR, Katz JN, Solomon DH et al (2016) Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken) 68:1743–1750
Aprato A, Risitano S, Sabatini L et al (2016) Cementless total knee arthroplasty. Ann Transl Med 4:129
Manoli A III, Markel JF, Pizzimenti NM, Markel DC (2019) Early results of a modern uncemented total knee arthroplasty system. Orthopedics 42:355–360
Gwam CU, George NE, Etcheson JI et al (2019) Cementless versus cemented fixation in total knee arthroplasty: usage, costs, and complications during the inpatient period. J Knee Surg 32:1081–1087
Lehtonen EJ, Hess MC, McGwin G Jr et al (2018) Risk factors for early hospital readmission following total knee arthroplasty. Acta Ortop Bras 26:309–313
D’Apuzzo M, Westrich G, Hidaka C et al (2017) All-cause versus complication-specific readmission following total knee arthroplasty. J Bone Joint Surg Am 99:1093
Bovonratwet P, Shen TS, Ast MP et al (2020) Reasons and risk factors for 30-day readmission after outpatient total knee arthroplasty: a review of 3015 cases. J Arthroplasty 35:2451–2457
Siracuse BL, Ippolito JA, Gibson PD et al (2017) A preoperative scale for determining surgical readmission risk after total knee arthroplasty. JBJS 99:e112
Ali AM, Loeffler MD, Aylin P, Bottle A (2019) Predictors of 30-day readmission after total knee arthroplasty: analysis of 566,323 procedures in the United Kingdom. J Arthroplasty 34:242–248
Keeney JA, Nam D, Johnson SR et al (2015) The impact of risk reduction initiatives on readmission: THA and TKA readmission rates. J Arthroplasty 30:2057–2060
Ross TD, Dvorani E, Saskin R et al (2020) Temporal trends and predictors of thirty-day readmissions and emergency department visits following total knee arthroplasty in Ontario between 2003 and 2016. J Arthroplasty 35:364–370
Curtis GL, Jawad M, Samuel LT et al (2019) Incidence, causes, and timing of 30-day readmission following total knee arthroplasty. J Arthroplasty 34:2632–2636
Gold HT, Slover JD, Joo L et al (2016) Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplasty 31:2385–2388
Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R (2018) Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 11:63–73
Mesko NW, Bachmann KR, Kovacevic D et al (2014) Thirty-day readmission following total hip and knee arthroplasty–a preliminary single institution predictive model. J Arthroplasty 29:1532–1538
Hood M Jr, Dilley JE, Ziemba-Davis M, Meneghini RM (2021) Greater blood loss in contemporary cementless total knee arthroplasty than cemented total knee arthroplasty despite tranexamic acid use: a match-controlled retrospective study. J Knee Surg 34:351–356
Mercurio M, Gasparini G, Sanzo V et al (2022) Cemented total knee arthroplasty shows less blood loss but a higher rate of aseptic loosening compared with cementless fixation: an updated meta-analysis of comparative studies. J Arthroplasty 37:1879–1887
Liu Y, Zeng Y, Wu Y et al (2021) A comprehensive comparison between cementless and cemented fixation in the total knee arthroplasty: an updated systematic review and meta-analysis. J Orthop Surg Res 16:1–14
Pugely AJ, Callaghan JJ, Martin CT et al (2013) Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. J Arthroplasty 28:1499–1504
Rozell JC, Courtney PM, Dattilo JR et al (2016) Should all patients be included in alternative payment models for primary total hip arthroplasty and total knee arthroplasty? J Arthroplasty 31:45–49
Sher A, Keswani A, Yao D et al (2017) Predictors of same-day discharge in primary total joint arthroplasty patients and risk factors for post-discharge complications. J Arthroplasty 32:S150–S156
Yao D, Keswani A, Shah CK et al (2017) Home discharge after primary elective total joint arthroplasty: postdischarge complication timing and risk factor analysis. J Arthroplasty 32:375–380
Chung JJ, Dolan MT, Patetta MJ et al (2021) Abnormal coagulation as a risk factor for postoperative complications after primary and revision total hip and total knee arthroplasty. J Arthroplasty 36:3294–3299
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Chatad, D., Monas, A., Rodriguez, A.N. et al. Trends and risk factors for readmissions following press-fit total knee arthroplasty for the treatment of end-stage osteoarthritis of the knee: a five-year analysis. Eur J Orthop Surg Traumatol 33, 3495–3499 (2023). https://doi.org/10.1007/s00590-023-03578-y
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DOI: https://doi.org/10.1007/s00590-023-03578-y