RESUMO
BACKGROUND: This study investigated the prevalence of adrenal insufficiency among patients admitted for total knee arthroplasty (TKA) due to osteoarthritis and identified factors contributing to adrenal insufficiency. METHODS: We divided the patients into two groups based on the results of preoperative standard-dose short synchronous stimulation tests: group 1 (adrenal insufficiency) and group 2 (normal adrenal function). We also assessed the prevalence of adrenal insufficiency and compared the numbers of patients who received oral steroids, the frequency of previous steroid injection use, and the frequency of systemic symptoms of steroid depletion such as fatigue and loss of appetite between the two groups. Multiple regression analysis was performed to identify factors related to adrenal insufficiency. RESULTS: The prevalence of adrenal insufficiency was 60.0% (120/200). Group 1 had higher numbers of previous steroid injections (12.8±10.2 vs. 6.8±7.9) and patients taking oral steroids (18/120 vs. 3/80) (p<0.001 and p=0.011, respectively). The frequency of systemic symptoms of steroid depletion, such as fatigue and loss of appetite, was also higher in group 1 (94/120 vs. 42/80, p<0.001). Recent steroid injections and loss of appetite were associated with adrenal insufficiency (p=0.002 and p=0.009, respectively). CONCLUSION: The results of this study revealed a high prevalence of adrenal insufficiency in Korean patients hospitalized for TKA due to end-stage osteoarthritis. Recent steroid injections were causally related to the development of adrenal insufficiency. Therefore, adrenal function should be assessed preoperatively to prevent postoperative complications related to adrenal insufficiency.
RESUMO
BACKGROUND: Varus deformity is common in osteoarthritic knee. The purpose of this study was to investigate the clinical and radiographic outcomes after cruciate-retaining (CR) total knee arthroplasty (TKA) for severely varus osteoarthritic knees and compare them to those of mildly to moderately deformed osteoarthritic knees. METHODS: Eight hundred ninety-four subjects were undergone CR TKA, 137 had severe varus deformity (group 1), and 757 had mild-to-moderate deformity (group 2) of the lower limb preoperatively. Pre- and postoperative outcomes were compared between two groups clinically and radiographically. RESULTS: Mean follow-up period was 54.7 ± 28.9 months. Mean age was 77.8 ± 6.7 years in group 1 and 74.5 ± 7.4 years in group 2 (p < 0.001). Preoperative hip-knee-ankle angle (HKAA) was - 17.7°±2.9° in group 1 and - 6.3° ± 5.1° in group 2 (p < 0.001). Preoperative range of motion (ROM) was 127.7° ± 15.2° in group 1 and 130.8 °± 9.6° in group 2 (p = 0.019). Preoperative Knee Society scores and WOMAC score were not significantly different between two groups. Postoperative HKAA was - 0.4° ± 2.3° in group 1 and 0.6 ° ± 2.0° in group 2 (p < 0.001). Postoperative ROM, Knee Society scores, and WOMAC score were not significantly different between two groups. CONCLUSIONS: CR TKA showed results in subjects with severe varus deformities comparable to those without severe varus deformities. Whether the degree of preoperative varus deformity of the lower limb should be considered when deciding to perform CR-type or PS-type TKA requires further discussion. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.
