Skip to main content

Advertisement

SpringerLink
Log in

Current Practice Trends in Knee Arthroplasty in India Among ISHKS Members: ISHKS Annual Meeting 2019

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Aim

To assess the current practice trends in knee arthroplasty in India among ISHKS members.

Methods

Literature review on 12 areas of key interest in total knee arthroplasty was conducted. Twenty-eight questions pertaining to these key areas in total knee arthroplasty surgery were presented to the delegates for a physical voting with audience response system (ARS) at ISHKS meeting, Bangalore, 2019. The members who could not attend the meeting voted by an online monkey survey. All questions were given three responses: a. Agree, b. Disagree, and c. Abstain.

Results

310 delegates participated and 295 voted in the physical meeting and 110 voted online. Consensus was reached for 28 statements representing five domains on the best practices. Overall, 92% of statements reached unanimous or strong consensus. The statements that achieved strong majority (> 90%) were the factors on pre-operative skin preparations, administration of antibiotics 30 min prior skin incision, and current practices of bilateral TKR. Furthermore, there was strong consensus approval on the role of aspirin for prophylaxis of DVT, lack of benefit on use of drain, considerations for pre-emptive analgesia, and neuraxial anesthesia. Finally, there were disparate views and weak consensus on use of laminar airflow theaters and use of surgical space suits, length of antibiotic administration postoperatively, and linking of DVT with PE and death.

Conclusion

This study gives the surgeon practice preferences in knee arthroplasty in India and assists in clinical decision-making for all healthcare professionals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Hooper, G. J., Rothwell, A. G., Frampton, C., & Wyatt, M. C. (2011). Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: The ten-year results of the New Zealand Joint Registry. Journal of Bone and Joint Surgery British, 93(1), 85–90. https://doi.org/10.1302/0301-620X.93B1.24862,PMID21196549

    Article  CAS  Google Scholar 

  2. Wang, Q., Xu, C., Goswami, K., Tan, T. L., & Parvizi, J. (2020). Association of laminar airflow during primary total joint arthroplasty with periprosthetic joint infection. JAMA Network Open, 3(10), e2021194. https://doi.org/10.1001/jamanetworkopen.2020.21194

    Article  PubMed  PubMed Central  Google Scholar 

  3. Parvizi, J., Cavanaugh, P. K., & Diaz-Ledezma, C. (2013). Periprosthetic knee infection: Ten strategies that work. Knee Surgery & Related Research, 25(4), 155–164. https://doi.org/10.5792/ksrr.2013.25.4.155,PMID24368992

    Article  Google Scholar 

  4. Tanner, J., Norrie, P., & Melen, K. (2011). Preoperative hair removal to reduce surgical site infection. Cochrane Database of Systematic Reviews, 11(11), CD004122. https://doi.org/10.1002/14651858.CD004122.pub4

    Article  Google Scholar 

  5. Cai, Y., Xu, K., Hou, W., Yang, Z., & Xu, P. (2017). Preoperative chlorhexidine reduces the incidence of surgical site infections in total knee and hip arthroplasty: A systematic review and meta-analysis. International Journal of Surgery, 39, 221–228. https://doi.org/10.1016/j.ijsu.2017.02.004

    Google Scholar 

  6. Dai. W., & Fang, F. (2022). Pre-Admission use of chlorhexidine-impregnated gauze for skin preparation reduces the incidence of peri-prosthetic joint infection after primary total knee arthroplasty: A prospective cohort with retrospective controls. Surgical Infections (Larchmt), 23(8), 717–721. https://doi.org/10.1089/sur.2022.177

    Article  Google Scholar 

  7. Illingworth, K. D., Mihalko, W. M., Parvizi, J., Sculco, T., McArthur, B., el Bitar, Y., et al. (2013). How to minimize infection and thereby maximize patient outcomes in total joint arthroplasty: A multicenter approach: AAOS exhibit selection. The Journal of Bone and Joint Surgery, 95(8), e50. https://doi.org/10.2106/JBJS.L.00596

    Article  PubMed  Google Scholar 

  8. American Academy of Orthopaedic Surgeons. Recommendations for the use of intravenous antibiotic prophylaxis information statement [internet]. IL: American Academy of Orthopaedic Surgeons; c2013 [cited Aug 10 2013]. Available from: http://www.aaos.org/about/papers/advistmt/1027.asp.

  9. McGrory, B., Weber, K., Lynott, J. A., Richmond, J. C., Davis, C. M., Yates, A., et al. (2016). The American academy of orthopaedic surgeons evidence-based clinical practice guideline on surgical management of osteoarthritis of the knee. Journal of Bone and Joint Surgery, 98(8), 688–692. https://doi.org/10.2106/JBJS.15.01311

    Article  Google Scholar 

  10. Fillingham, Y. A., Hannon, C. P., Kopp, S. L., Austin, M. S., Sershon, R. A., Stronach, B. M., et al. (2022). The efficacy and safety of regional nerve blocks in total knee arthroplasty: Systematic review and direct meta-analysis. Journal of Arthroplasty, 37(10), 1906-1921.e2. https://doi.org/10.1016/j.arth.2022.03.078,PMID36162923

    Article  PubMed  Google Scholar 

  11. Hannon, C. P., Keating, T. C., Lange, J. K., Ricciardi, B. F., Waddell, B. S., & Della Valle, C. J. (2019). Anesthesia and analgesia practices in total joint arthroplasty: A survey of the American Association of Hip and Knee Surgeons membership. Journal of Arthroplasty, 34(12), 2872-2877.e2. https://doi.org/10.1016/j.arth.2019.06.055,PMID31371038

    Article  PubMed  Google Scholar 

  12. Smith, A. F., Usmani, R. H., Wilson, K. D., Smith, L. S., & Malkani, A. L. (2021). Effect of tourniquet use on patient outcomes after cementless total knee arthroplasty: A randomized controlled trial. Journal of Arthroplasty, 36(7), 2331–2334. https://doi.org/10.1016/j.arth.2021.01.053,PMID33602588

    Article  PubMed  Google Scholar 

  13. Stronach, B. M., Jones, R. E., Meneghini, R. M., & Michael, M. (2021). Tourniquetless total knee arthroplasty: History, controversies, and technique. Journal of the American Academy of Orthopaedic Surgeons, 29(1), 17–23. https://doi.org/10.5435/JAAOS-D-20-00321

    Article  PubMed  Google Scholar 

  14. Agarwala, S., & Menon, A. (2020). Safety and efficacy of sequential simultaneous bilateral total knee arthroplasty: A single center retrospective cohort study. J Clin Orthop Trauma., 11(Suppl 4), S636–S644. https://doi.org/10.1016/j.jcot.2020.05.015,PMID32774041

    Article  PubMed  PubMed Central  Google Scholar 

  15. Putnis, S. E., Klasan, A., Redgment, J. D., Daniel, M. S., Parker, D. A., & Coolican, M. R. J. (2020). One-stage sequential bilateral total knee arthroplasty: An effective treatment for advanced bilateral knee osteoarthritis providing high patient satisfaction. Journal of Arthroplasty, 35(2), 401–406. https://doi.org/10.1016/j.arth.2019.09.032,PMID31635904

    Article  PubMed  Google Scholar 

  16. Benazzo, F., Perticarini, L., Jannelli, E., Ivone, A., Ghiara, M., & Rossi, S. M. P. (2020). Controversy: Supporting patellar resurfacing in total knee arthroplasty - do it. EFORT Open Rev., 5(11), 785–792. https://doi.org/10.1302/2058-5241.5.190075,PMID33312705

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chen, K., Dai, X., Li, L., Chen, Z., Cui, H., & Lv, S. (2021). Patellar resurfacing versus nonresurfacing in total knee arthroplasty: An updated meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 16(1), 83. https://doi.org/10.1186/s13018-020-02185-5,PMID33494774

    Article  PubMed  PubMed Central  Google Scholar 

  18. Longo, U. G., Ciuffreda, M., Mannering, N., D’Andrea, V., Cimmino, M., & Denaro, V. (2018). Patellar resurfacing in total knee arthroplasty: Systematic review and meta-analysis. Journal of Arthroplasty, 33(2), 620–632. https://doi.org/10.1016/j.arth.2017.08.041,PMID29032861

    Article  PubMed  Google Scholar 

  19. Deroche, E., Batailler, C., Swan, J., Sappey-Marinier, E., Neyret, P., Servien, E., & Lustig, S. (2021). No difference between resurfaced and non-resurfaced patellae with a modern prosthesis design: a prospective randomized study of 250 total knee arthroplasties. Knee Surgery, Sports Traumatology, Arthroscopy, 30(3) 1025–1038. https://doi.org/10.1007/s00167-021-06521-y

  20. Li, H. Q., Li, P. C., Wei, X. C., & Shi, J. J. (2022). Effectiveness of antibiotics loaded bone cement in primary total knee arthroplasty: A systematic review and meta-analysis. Orthopaedics and Traumatology: Surgery and Research, 108(5), 103295. https://doi.org/10.1016/j.otsr.2022.103295,PMID35552043

    Article  Google Scholar 

  21. Quinn, M., Bowe, A., Galvin, R., Dawson, P., & O’Byrne, J. (2015). The use of postoperative suction drainage in total knee arthroplasty: A systematic review. International Orthopaedics, 39(4), 653–658. https://doi.org/10.1007/s00264-014-2455-2,PMID25027980

    Article  PubMed  Google Scholar 

  22. Bawa, H., Weick, J. W., Dirschl, D. R., & Luu, H. H. (2018). Trends in deep vein thrombosis prophylaxis and deep vein thrombosis rates after total hip and knee arthroplasty. Journal of American Academy of Orthopaedic Surgeons, 26(19), 698–705. https://doi.org/10.5435/JAAOS-D-17-00235,PMID30153117

    Article  Google Scholar 

  23. Faour, M., Piuzzi, N. S., Brigati, D. P., Klika, A. K., Mont, M. A., Barsoum, W. K., et al. (2018). Low-dose aspirin is safe and effective for venous thromboembolism prophylaxis following total knee arthroplasty. Journal of Arthroplasty, 33(7S), S131–S135. https://doi.org/10.1016/j.arth.2018.03.001,PMID29656974

    Article  PubMed  Google Scholar 

  24. Cherian, N. J., Hanish, S. J., Ohnoutka, C. J., & Keeney, J. A. (2022). Blood transfusion can be avoided in single-anesthetic bilateral total knee arthroplasty. Journal of Arthroplasty, 37(10), 2020–2024. https://doi.org/10.1016/j.arth.2022.05.003,PMID35533821

    Article  PubMed  Google Scholar 

  25. Banerjee, S., Issa, K., Pivec, R., McElroy, M. J., Khanuja, H. S., Harwin, S. F., et al. (2013). Intraoperative pharmacotherapeutic blood management strategies in total knee arthroplasty. The Journal of Knee Surgery, 26(6), 379–385. https://doi.org/10.1055/s-0033-1353992,PMID23955184

    Article  PubMed  Google Scholar 

  26. Parvizi, J., Gehrke, T., & Chen, A. F. (2013). Proceedings of the international consensus on periprosthetic joint infection. The Bone and Joint Journal, 95-B(11), 1450–1452. https://doi.org/10.1302/0301-620X.95B11.33135

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge: Dr Ashok Shyam, Head of Academics, Sancheti Institute, Pune (for conducting the online survey). Dr Ritika Singh, Fellow in Joint Replacement, Ganga Hospital, Coimbatore (for helping in the preparation of this manuscript). The following surgeons actively participated in the literature review for the consensus meeting: Dr Chaitanya Waghchoure, MS Ortho, DNB Ortho Consultant Orthopaedic Surgeon, Inamdar hospital, Ruby Hall Clinic, Pune. Dr Yuvraj J Lakum MBBS, MS (Ortho), Consultant Joint Replacement Surgeon Ahmedabad Orthopedic Associates HCG Hospitals, Ahmedabad, Gujarat. Dr. Amish Kshatriya M.S., Arthroplasty Surgeon, Shalby Hospitals Ltd, Ahmedabad. Dr Ravi Shah, MS(Orth), DNB(Orth), FRCS (Ed), Consultant Arthroplasty & Trauma Surgeon, Saifee Hospital, Khar Hinduja Hospital, Mumbai. Dr Bharath L MBBS, MS(Ortho), D.Ortho, MRCS(Edin), Soundarapandian Bone and Joint Hospital, Chennai. Dr. Siddhart Yadav M.S. Senior Consultant, Apollo Hospital, Navi Mumbai. Dr. Vaibhav Bagaria, MBBS MS FCPS Dip SICOT, Director & Head: Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai. Dr. Shrinand Vaidya MS, FACS, Prof. and Unit Head, Consultant Joint Replacement Surgeon, Seth GS Medial College and KEM Hospital, Global, Breach Candy, Hinduja Health care, Jupiter Hospitals, Mumbai. Dr. Jigar Desai, M.S, Registrar. Dr Rajshekhar K. T. MBBS, MS, Joint replacement surgeon, HOSMAT. Bangalore. Dr Simon Thomas. DNB, Senior Consultant, Sant Parmanand Hospital, Delhi

Author information

Authors and Affiliations

  1. Consultant Knee Surgeon, Breach Candy Hospital, Hinduja Hospital, ACI Cumballa Hill Hospital, Mullaji Knee Clinic, Mumbai, India

    Arun Mullaji FRCS Ed, MCh Orth, MS Orth, DNB Orth, D Orth, MB

  2. Consultant Joint Replacement Surgery, Department of Orthopaedics, Ganga Hospital, Coimbatore, India

    Dhanasekara Raja Palanisami D Orth, DNB Orth, DTB

  3. Department of Orthopaedics, Shalby Hospital, Ahmedabad, Gujarat, 380015, India

    Pachore Javahir Anant MS Orth,

Authors
  1. Arun Mullaji FRCS Ed, MCh Orth, MS Orth, DNB Orth, D Orth, MB
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dhanasekara Raja Palanisami D Orth, DNB Orth, DTB
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pachore Javahir Anant MS Orth,
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dhanasekara Raja Palanisami D Orth, DNB Orth, DTB.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

For this type of study informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mullaji, A., Palanisami, D.R. & Anant, P.J. Current Practice Trends in Knee Arthroplasty in India Among ISHKS Members: ISHKS Annual Meeting 2019. JOIO 57, 1678–1688 (2023). https://doi.org/10.1007/s43465-023-00940-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-023-00940-4

Keywords

Search

Navigation