Factors associated with the incidence of revision total knee arthroplasty in Korea between 2007 and 2012: an analysis of the National Claim Registry

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Abstract Background The number of revision total knee arthroplasties (TKAs) in Asian countries is projected to increase with the rapid growth of primary TKA. We investigated the factors associated with the incidence of revision TKA using a nationally representative database. Methods Data collected by the Health Insurance Review Agency of Korea, from 260,068 TKA patients between 2007 and 2012, were used to estimate the incidence rate and cumulative incidence of revision TKA according to age, gender, and hospital TKA and prosthesis manufacturer volume. Age, hospital, and manufacturer volume were categorized into three groups. The incidence rates and cumulative incidences of revision TKA were computed by combining age and gender, and by combining hospital and prosthesis manufacturer volume. Results Incidence rates per 100,000 person-years were as follows: 1) by age: < 65 years, 447.2; 65–74 years, 363.7; ≥ 75 years, 270.9, 2) by gender: male, 537.8; female, 346.1; 3) by hospital volume (procedures/year): < 20, 536.9; 20–199, 432.3; ≥ 200, 300.1; and 4) by manufacturer volume (prostheses/year): < 1500, 772.3; 1500–3999, 453.9; ≥ 4000, 345.6. The revision TKA incidence rate in young males was significantly higher compared to that in elderly females. The difference in cumulative incidence, between hospitals with an annual volume of < 20 procedures and those with a volume of 20–199 procedures, was reduced for manufacturers with an annual volume of ≥ 4000. Similarly, the difference in cumulative incidence between manufacturers with an annual volume of <1500 prostheses and those with a volume of 1500–3999 prostheses was reduced in hospitals with an annual volume of ≥ 200. Conclusion Revision TKA incidence varied according to age, gender, and hospital and manufacturer volume. This data could inform clinical decisions and healthcare strategies

Assessment of a novel deep learning-based software developed for automatic feature extraction and grading of radiographic knee osteoarthritis

Background The Kellgren-Lawrence (KL) grading system is the most widely used method to classify the severity of osteoarthritis (OA) of the knee. However, due to ambiguity of terminology, the KL system showed inferior inter- and intra-observer reliability. For a more reliable evaluation, we recently developed novel deep learning (DL) software known as MediAI-OA to extract each radiographic feature of knee OA and to grade OA severity based on the KL system. Methods This research used data from the Osteoarthritis Initiative for training and validation of MediAI-OA. 44,193 radiographs and 810 radiographs were set as the training data and used as validation data, respectively. This AI model was developed to automatically quantify the degree of joint space narrowing (JSN) of medial and lateral tibiofemoral joint, to automatically detect osteophytes in four regions (medial distal femur, lateral distal femur, medial proximal tibia and lateral proximal tibia) of the knee joint, to classify the KL grade, and present the results of these three OA features together. The model was tested by using 400 test datasets, and the results were compared to the ground truth. The accuracy of the JSN quantification and osteophyte detection was evaluated. The KL grade classification performance was evaluated by precision, recall, F1 score, accuracy, and Cohen's kappa coefficient. In addition, we defined KL grade 2 or higher as clinically significant OA, and accuracy of OA diagnosis were obtained. Results The mean squared error of JSN rate quantification was 0.067 and average osteophyte detection accuracy of the MediAI-OA was 0.84. The accuracy of KL grading was 0.83, and the kappa coefficient between the AI model and ground truth was 0.768, which demonstrated substantial consistency. The OA diagnosis accuracy of this software was 0.92. Conclusions The novel DL software known as MediAI-OA demonstrated satisfactory performance comparable to that of experienced orthopedic surgeons and radiologists for analyzing features of knee OA, KL grading and OA diagnosis. Therefore, reliable KL grading can be performed and the burden of the radiologist can be reduced by using MediAI-OA

Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO

Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Background : We sought to determine (1) the success rate of debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) of the knee in patients with acute postsurgical infection and in those with acute hematogenous infection via a multicenter study, (2) the factors related to the failure of DAIR for overall acute PJI and acute hematogenous PJI via subgroup analysis, and (3) whether the PJI recurrence patterns differed between the two groups over time after DAIR. Methods : This retrospective multicenter study included 101 acute knee PJI. Acute postsurgical PJI was defined as PJI diagnosed < 3 months following initial knee arthroplasty surgery. DAIR was performed for 34 cases of acute postsurgical PJIs (postsurgical group) and 67 cases of acute hematogenous PJIs (hematogenous group). The success rates between groups were compared, and factors related to DAIR failure were analyzed. Results : The overall success rate of DAIR was 77%. The success rate tended to be higher in the postsurgical group than in the hematogenous group (p = 0.060). However, there was no significant factor related to DAIR failure in the subgroup analysis of acute hematogenous PJIs. In the postsurgical group, the recurrence of PJI occurred until 3 months, whereas in the hematogenous group, recurrence occurred for up to 2 years. Conclusions : The failure rate tended to be higher in the acute hematogenous PJI group than in the acute postsurgical PJI group. Since acute hematogenous infections may recur for a longer period than postsurgical infections, careful follow-up is required after DAIR

Posterior condylar offset changes and its effect on clinical outcomes after posterior-substituting, fixed-bearing total knee arthroplasty: anterior versus posterior referencing

Background We sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. We also assessed whether the PCO and PCOR changes, as well as patient factors were related to range of motion (ROM) in each referencing system. Methods This retrospective study included 130 consecutive patients (184 knees) with osteoarthritis who underwent primary posterior cruciate ligament (PCL)-substituting fixed-bearing TKA. The difference between preoperative and postoperative PCO and PCOR values were calculated. Clinical outcomes including ROM and Western Ontario and McMaster University (WOMAC) scores were evaluated. Furthermore, multiple linear regression analysis was performed to determine the factors related to postoperative ROM in each referencing system. Results The postoperative PCO was greater in the AR group (28.4 mm) than in the PR group (27.4 mm), whereas the PCO was more consistently preserved in the PR group. The mean postoperative ROM after TKA was greater in the AR group (129°) than in the PR group (122°), whereas improvement in WOMAC score did not differ between the two groups. Preoperative ROM was the only factor related to postoperative ROM in both groups. Conclusions There was no difference in postoperative PCO in AR and PR group and the PCO was not associated with postoperative ROM. PCO was more consistently preserved after surgery in the PR group. The postoperative PCO and PCOR changes did not affect the postoperative ROM. Furthermore, similar clinical outcomes were achieved in the AR and PR groups. Trial registration Retrospectively registered (Trial registration number: 06-2010-110).This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT (2017M3A9D8063538)

Elevated red cell distribution width is associated with advanced fibrosis in NAFLD

Background/AimsThe red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores.MethodsThis study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively.ResultsAfter adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61±0.41% (mean±SD), 12.70±0.70%, 12.77±0.62%, 12.87±0.82%, and 13.25±0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71±0.72%, 12.79±0.66%, and 13.23±1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and ≥2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of ≥1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score.ConclusionsElevated RDW is independently associated with advanced fibrosis in NAFLD