ABSTRACT
AIM: To identify factors significant in influencing LOS following primary TKA in a UK specialist arthroplasty centre. METHOD: We retrospectively reviewed factors affecting LOS of 514 patients who underwent primary TKA in a single specialist arthroplasty centre in the UK over a one-year period. Surgical and patient factors that may influence LOS were recorded. RESULTS: The median LOS was 5days. 85% were discharged within 10days. Those staying longer were classified as long stay (up to 3months). The only surgical factor that influenced length of stay was postoperative blood transfusion (p<0.0001). Females stayed longer as did those who lived in more deprived areas. These factors did not remain significant in multivariate analysis. The other most significant predictors at multivariate analysis were pre-operative patient factors such as poor anaesthetic fitness (ASA3 and ASA4) (p=0.001), BMI=30-35 (p=0.04), BMI>35 (p=0.009) and age>80 (p=0.01). CONCLUSION: Length of stay is largely due to case mix and this should be considered when planning a local arthroplasty service. LEVEL OF EVIDENCE: 2-II.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Elective Surgical Procedures/methods , Length of Stay , Academic Medical Centers , Age Factors , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Blood Transfusion/statistics & numerical data , Cohort Studies , Elective Surgical Procedures/adverse effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis , Orthopedics , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Sex Factors , Time Factors , Treatment Outcome , United KingdomABSTRACT
PURPOSE: Disturbance in skin sensation is a recognised, often unpleasant consequence of knee replacement for many patients and may affect function especially kneeling. The aim of this study was to compare post-operative changes in skin sensation following total (TKA) and unicompartmental knee (UKA) arthroplasties using three different incision types and its effect on kneeling ability. METHODS: Skin sensation was recorded using a purpose-designed grid over the front of the knee in 72 patients (78 knees) following knee arthroplasty. Surface area of sensory change, length of incision, and kneeling ability were recorded and compared between three different types of incision; long antero-medial and midline for TKA, and short medial for UKA. RESULTS: The average length of the long antero-medial incision was 19 ± 5 cm with an average area of sensory alteration of 88 ± 56 cm(2). The average length of the midline incision was 18 ± 3 cm with an average area of sensory alteration of 57 ± 52 cm(2). The short medial incision used for UKA averaged 11 ± 3 cm in length with an average area of sensory alteration of 54 ± 45 cm(2). Long antero-medial produced a significantly greater area of sensory alteration than standard short medial (P = 0.017), but not the midline incision. There was a significant positive correlation of incision length with reduced sensation. Patients unable to kneel demonstrated a significantly larger area of hypersensitivity than patients who could kneel (P = 0.002). CONCLUSIONS: Increased length of incision results in a greater surface area of sensory change in the front of the knee. This finding was greatest in the long antero-medial incisions used in TKA. The inability to kneel following knee arthroplasty is associated with increased area of hypersensitivity of the anterior knee. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
