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The Bone & Joint Journal
Vol. 103-B, Issue 6 | Pages 1078 - 1087
1 Jun 2021
Awad ME Farley BJ Mostafa G Saleh KJ

Aims

It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs.

Methods

This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 339 - 339
1 Dec 2013
Hakki S Mihalko W Saleh KJ
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Introduction

The prevalence of reversing of extension coronal deformity during flexion and how that may change the routine algorithm of soft tissue balancing in total knee arthroplasty (TKA) has not been published. We name this phenomenon, the reversing coronal deformity (RCD). We observed 12% (45 patients) of coronal deformities consistently reverse in flexion in the osteoarthritic knees before surgery. We conclude that RCD phenomena need to be addressed in every TKA and collateral ligament release need to be modified or avoided; otherwise postoperative flexion instability may be inevitable. Femoral rotation adjustment with posterior capsule release has to be attempted first in RCD patients.

Method

We define RCD as the reversing of a coronal extension deformity of more than 2° while the knee reaches 90°of flexion. That is to say a 2° or more varus knee in extension becomes a 2° or more valgus at 90° of flexion or vice versa.

We retrospectively analyzed, in a multicenter study the alignment patterns of 387 (US = 270, UK = 117) consecutive computer navigated TKA subjects (June 2004–May 2008). 364/387 (US = 252, UK = 112) subjects were eligible for analysis (23 subjects had incomplete data: US = 18, UK = 5). The coronal deformity kinematics was observed during the range of motion and the range of medial /lateral deflections were analyzed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 116 - 116
1 Sep 2012
Kukkar N Beck RT Froelich JM Milbrandt JC Novicoff WM McLafferty RB Williams RG Saleh KJ
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Purpose

The patient-physician relationship is a complex interaction and the importance of effective communication is well documented. The importance and implications of effective physician-patient communication is highlighted by the implementation of Communication Skills as a core competency by ACGME. The purpose of this study was to evaluate anonymous surveys completed by orthopaedic clinic patients to assess their visit experiences and whether they would recommend their physician to a friend or family member.

Method

Data were collected from patients exiting SIUs Division of Orthopaedic Surgery outpatient clinics through the completion of an anonymous survey. The survey was distributed on a sample of days between 2002 and 2004 and again in 2009. Responders were asked to complete the survey and return it prior to leaving the office. Participating surgeons were aware of the project occurring but did not know the dates on which surveys would be collected from their clinic patients. All surveys were scanned for data entry and if there was any difficulty with the scanning process then the data was entered manually.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 587 - 588
1 Nov 2011
Froelich JM Novicoff WM Mihalko WM Saleh KJ
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Purpose: The purpose of this study was to examine the effects of baseline mental health on functional outcomes after primary knee arthroplasty by reviewing the data collected in a multi-center prospective observational cohort study. We hypothesized that those patients with lower baseline mental health status would demonstrate significantly worse outcomes vs. their counterparts with higher mental status following primary total knee arthroplasty.

Method: Data from a multi-center prospective cohort study of PS (posterior stabilizing implant) and CR (cruciate retaining implant) primary knee arthroplasty were compared to determine the relationship between baseline mental health status and functional outcomes post-surgery. Subjects were followed from the time of the index surgery to monitor outcomes and complications. Validated quality of life instruments, including SF-36, WOMAC, Knee Society Score, and an activity scale were used. The rates of improvement from 0 to 12 months were analyzed for this study.

Results: Baseline data was available for 436 subjects in the primary PS study and 493 subjects in the primary CR study. Patients improved significantly on all SF-36 and WOMAC components between baseline and 12 months post-surgery. Correlation and regression analysis between WOMAC and SF-36 showed that Global Health (GH), Mental Health (MH), and Mental Component Score (MCS) subscales on the SF-36 were significantly associated with positive post-operative changes in WOMAC scores.

Conclusion: This study examined the effects of baseline mental health on functional outcomes after primary knee arthroplasty and found that baseline mental health was a significant predictor of functional outcomes twelve months after surgery. This relationship between mental health and outcomes needs to be examined carefully to help surgeons better prepare their patients for surgery.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 24 - 24
1 Mar 2010
Saleh KJ Mihalko WM Brown TE Cui Q Novicoff W
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Purpose: Comorbidities in patients undergoing total joint arthroplasty continue to be a challenging problem. Retrospective studies have demonstrated that co-morbidities affect outcomes of revision total knee arthroplasty (RTKA). However, the relationship between the outcomes of RTKA and co-morbidities has not been well established. This prospective randomized study was undertaken to investigate these relationships.

Method: A prospective cohort study (the North America Knee Arthroplasty Revision Study) was conducted to examine factors that predict outcomes after RTKA. 308 subjects met inclusion/exclusion criteria. Subjects were followed from the time of the index surgery for a minimum of two years to monitor outcomes and complications. Validated quality of life instruments, including SF-36, WOMAC, Knee Society Score, and an activity scale were used. The rates of improvement from 0 to 12 and 12 to 24 months were analyzed.

Results: There were 145 males and 163 females. The mean age was 68.7 years. Mean time from primary procedure to RTKA was 7.9 years. Arthroplasty failure was classified as aseptic in 82% and septic in 18% of the cases. Hypertension was seen in 62.4%, back pain in 50%, heart disease in 25.9%, diabetes mellitus in 23.9%, gastric ulcers in 17.9%, and rheumatoid arthritis in 16.6%. Less frequent co-morbidities included anemia, cancer, kidney disease, lung disease and liver disease.

Conclusion: Analyses showed that the number of reported co-morbidities was the most significant predictor of outcomes, consistently forecasting poorer functional improvement on all measures. The results indicated that ultimate treatment of co-morbidities before and after surgery may improve outcomes of RTKA. Comorbidities in patients undergoing revision TKA can be a challenging problem. This study showed that the number of reported co-morbidities was the most significant predictor of poorer outcomes.