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Title: Increased early mortality after total knee arthroplasty using conventional instrumentation compared with technology-assisted surgery: an analysis of linked national registry data.
Epworth Authors: de Steiger, Richard
Other Authors: Harris, Ian
Kirwan, David
Peng, Yi
Lewis, Peter
Graves, Stephen
Keywords: Total Knee Arthoplasty
Conventional Intramedullary Instrumentation
Technology-Assisted (Non-Intramedullary) Instrumentation
National Arthroplasty Registry
30 Day Mortality
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: May-2022
Publisher: BMJ
Citation: BMJ Open . 2022 May 31;12(5):e055859.
Abstract: Objectives: This study aims to compare early mortality after total knee arthroplasty (TKA) using conventional intramedullary instrumentation to TKA performed using technology-assisted (non-intramedullary) instrumentation. Design: Comparative observational study. Using data from a large national registry, the 30-day mortality after unilateral TKA performed for osteoarthritis was compared between procedures using conventional instrumentation and those using technology-assisted instrumentation. Firth logistic regression was used to calculate ORs, adjusting for age, sex, use of cement and procedure year for the whole period, and additionally adjusting for American Society of Anesthesiologists physical status classification system class and body mass index (BMI) for the period 2015 to 2019. This analysis was repeated for 7-day and 90-day mortality. Setting: National arthroplasty registry. Participants: People undergoing unilateral, elective TKA for osteoarthritis from 2003 to 2019 inclusive. Interventions: TKA performed using conventional intramedullary instrumentation or technology-assisted instrumentation. Main outcome measures: 30-day mortality (primary), and 7-day and 90-day mortality. Results: A total of 581 818 unilateral TKA procedures performed for osteoarthritis were included, of which 602 (0.10%) died within 30 days of surgery. The OR of death within 30 days following TKA performed with conventional instrumentation compared with technology-assisted instrumentation, adjusted for age, sex, cement use, procedure year, American Society of Anesthesiologists and BMI was 1.72 (95% CI, 1.23 to 2.41, p=0.001). The corresponding ORs for 7-day and 90-day mortality were 2.21 (96% CI, 1.34 to 3.66, p=0.002) and 1.35 (95% CI, 1.07 to 1.69, p=0.010), respectively. Conclusions: The use of conventional instrumentation during TKA is associated with higher odds of early postoperative death than when technology-assisted instrumentation is used. This difference may be explained by complications related to fat embolism secondary to intramedullary rods used in conventional instrumentation. Given the high number of TKA performed annually worldwide, increasing the use of technology-assisted instrumentation may reduce early post-operative mortality
DOI: 10.1136/bmjopen-2021-055859
PubMed URL:
ISSN: 2044-6055
Journal Title: BMJ Open
Type: Journal Article
Affiliated Organisations: School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Liverpool, New South Wales, Australia
Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
Insight Private Hospital, Albury, New South Wales, Australia.
Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Musculoskeletal

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