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      Challenges of traditional TKA

      Limiting long-term success

      Several patients remain unsatisfied after undergoing traditional Total Knee Arthroplasty (TKA)[1]. Identifying predictors and risk factors is crucial to increase patient satisfaction and to reduce costs. B. Braun aims to address all these pain points with Pheno4U® and holds the vision of revolutionizing the field of TKA.

      Chart of study results showing that 19% of patients remain dissatisfied after total knee replacement surgery.

      Indicators of dissatisfaction

      Three groups of dissatisfied patients

      Research shows that patients undergoing TKA who later become dissatisfied can be clustered into three groups. Some patients are dissatisfied within one year after implantation, while others become dissatisfied later or remain persistently unhappy. For example, patients suffering from depression are more likely to be dissatisfied within the first year, whereas patients with gastric ulceration are more likely to be persistently dissatisfied[2].

      Some leave while others stay

      Predictors of length of hospital stay

      Research indicates that factors such as functional status, pre-existing health limitations, and post-surgery complications are all linked to an extended hospital stay (over 24 hours) following TKA. It is crucial for both surgeons and patients to be aware of the risk factors of an extended stay when planning each individual patient path[3].

      Three icons are displayed, the first shows an elderly woman with a walking stick and underneath it says functional status. The second icon shows a briefcase with a cross in the middle, underneath it says pre-existing health conditions, the last icon shows a building, which also has a cross at the top, underneath it says post-surgery complications.
      Three icons are displayed, the first shows a cigarette with smoke at the end, with the word smoking underneath. The second icon shows a person with a big belly and a measuring tape, underneath it says BMI is greater than or equal to 30 kg/m2. The next icon shows a hand with a drop running from one finger, with diabetes written underneath.

      Feared complications

      Joint infections

      Periprosthetic joint infections are feared complications when it comes to joint replacement. The risk of developing such infections is influenced by several factors. Among these are smoking, BMI ≥ 30 kg/m2, diabetes, depression, steroid use, and frailty[4].

      What are the predictors?

      Postsurgical pain

      Several factors are associated with postsurgical pain after TKA. Among the strongest independent predictors of persistent pain after surgery are catastrophizing, mental health, preoperative knee pain, and pain at other sites[5].

      Three icons are displayed, the first icon shows a sign with an exclamation mark, underneath it says catastrophizing. The second icon shows a head shape with a heart at the back of the head and mental health underneath. The third icon shows a knee boil, with a lightning bolt and frame around it and the word preoperative knee pain underneath.

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      References

      1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res.2010;468(1):57-63. doi:10.1007/s11999-009-1119-9
      2. Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. The Bone & Joint Journal. 2018;100-B(2):161-169. doi:10.1302/0301-620X.100B2.BJJ-2017-1016.R1
      3. Johnson DJ, Castle JP, Hartwell MJ, D’Heurle AM, Manning DW. Risk Factors for Greater Than 24-Hour Length of Stay After Primary Total Knee Arthroplasty. The Journal of Arthroplasty. 2020;35(3):633-637. doi:10.1016/j.arth.2019.10.037
      4. Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD, Team I. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLOS ONE. 2016;11(3):e0150866. doi:10.1371/journal.pone.0150866
      5. Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. British Journal of Anaesthesia. 2015;114(4):551-561. doi:10.1093/bja/aeu441

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