Download PDF
J Knee Surg 2019; 32(02): 165-170
DOI: 10.1055/s-0038-1636836
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

Jared M. Newman
1   Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
,
Assem A. Sultan
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Anton Khlopas
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Nipun Sodhi
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Mhamad Faour
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Nicolas S. Piuzzi
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Carlos A. Higuera
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Michael A. Mont
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

16 November 2017

28 January 2018

Publication Date:
07 March 2018 (online)

    Permissions and Reprints

Abstract

Due to the paucity of evidence, this study was conducted to evaluate: (1) unique characteristics of multiple sclerosis (MS) patients and (2) short-term clinical outcomes, of primary total knee arthroplasty (TKA) in patients with MS (MS-TKA) compared with matched non-MS patients. MS patients who underwent TKA were identified using the Nationwide Inpatient Sample (NIS) database. The study sample consisted of 10,884 patients with MS and 56,45,227 control cohort. Various patient factors were compared. To control for potential confounders, with the use of propensity scores, MS-TKA patients were matched (1:3) to non-MS-TKA patients and regression analyses were performed to compare perioperative complications, length of stay (LOS), and discharge dispositions. Patients with MS were younger, more likely to be females, on corticosteroids, and more likely to have muscle spasms and gait abnormalities. Annual frequency of TKAs in MS patients increased from 1.16/1,000 TKAs in 2002 to 2.48/1,000 TKAs in 2013 (p < 0.001). Compared with the matched cohort, MS patients had significantly greater odds for any medical complication (odds ratio [OR] = 1.26; 95% confidence interval [CI], 1.11–1.44), longer mean LOS (mean difference: 0.15; 95% CI, 0.09–0.22), and had a greater chance of being discharged to a care facility (OR = 2.17; 95% CI, 1.96–2.40). In this study, we identified specific characteristics of patients with MS who had TKA and analyzed and compared their short-term TKA outcomes to non-MS patients. It was demonstrated that more patients with MS are undergoing TKA, and these patients were at a higher risk of perioperative complications, had longer LOS, and were more likely to be discharged to a sub-acute or inpatient facility. Orthopaedic surgeons should be cognizant of the increased risks and provide proper counseling to MS patients who are candidates for TKA.

Keywords

multiple sclerosis - total knee arthroplasty - complications - lengths of stay - charges
 

  • References

  • 1 Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 2014; 96 (08) 624-630
    CrossrefPubMedGoogle Scholar
  • 2 Compston A, Coles A. Multiple sclerosis. Lancet 2008; 372 (9648): 1502-1517
    CrossrefPubMedGoogle Scholar
  • 3 Tullman MJ. Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis. Am J Manag Care 2013; 19 (2, Suppl): S15-S20
    PubMedGoogle Scholar
  • 4 Marrie RA. Environmental risk factors in multiple sclerosis aetiology. Lancet Neurol 2004; 3 (12) 709-718
    CrossrefPubMedGoogle Scholar
  • 5 Zwibel HL, Smrtka J. Improving quality of life in multiple sclerosis: an unmet need. Am J Manag Care 2011; 17 (May, Suppl 5 Improving): S139-S145
    PubMedGoogle Scholar
  • 6 Warren SA, Turpin KVL, Pohar SL, Jones A, Warren KG. Comorbidity and health-related quality of life in people with multiple sclerosis. Int J MS Care 2009; 11 (01) 6-16
    CrossrefPubMedGoogle Scholar
  • 7 Marrie RA, Hanwell H. General health issues in multiple sclerosis: comorbidities, secondary conditions, and health behaviors. Continuum (Minneap Minn) 2013; 19 (4 Multiple Sclerosis): 1046-1057
    PubMedGoogle Scholar
  • 8 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 9 Healy B, Liguori M. Predicting clinical course. In: Multiple Sclerosis: Diagnosis and Therapy. Wiley-Blackwell; 2012: 163-180
    Google Scholar
  • 10 Lublin FD, Reingold SC. ; National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Defining the clinical course of multiple sclerosis: results of an international survey. Neurology 1996; 46 (04) 907-911
    CrossrefPubMedGoogle Scholar
  • 11 Berger JR. Functional improvement and symptom management in multiple sclerosis: clinical efficacy of current therapies. Am J Manag Care 2011; 17 (May, Suppl 5 Improving): S146-S153
    PubMedGoogle Scholar
  • 12 Stazzone L, Brown B. Symptom management. In: Multiple Sclerosis: Diagnosis and Therapy. Wiley-Blackwell; 2012: 213-238
    Google Scholar
  • 13 Pidgeon TS, Ramirez JM, Schiller JR. Orthopaedic management of spasticity. R I Med J (2013) 2015; 98 (12) 26-31
    PubMedGoogle Scholar
  • 14 Glazer RM, Mooney V. Surgery of the extremities in patients with multiple sclerosis. Arch Phys Med Rehabil 1970; 51 (08) 493-500
    PubMedGoogle Scholar
  • 15 Hughes KE, Nickel D, Gurney-Dunlop T, Knox KB. Total knee arthroplasty in multiple sclerosis. Arthroplast Today 2016; 2 (03) 117-122
    PubMedGoogle Scholar
  • 16 Wissel J, Entner T. [Botulinum toxin treatment of hip adductor spasticity in multiple sclerosis]. Wien Klin Wochenschr 2001; 113 (Suppl. 04) 20-24
    PubMedGoogle Scholar
  • 17 Rao V, Targett JPG. Instability after total knee replacement with a mobile-bearing prosthesis in a patient with multiple sclerosis. J Bone Joint Surg Br 2003; 85 (05) 731-732
    PubMedGoogle Scholar
  • 18 Shannon FJ, Cogley D, Glynn M. Total knee replacement in patients with multiple sclerosis. Knee 2004; 11 (06) 485-487
    CrossrefPubMedGoogle Scholar
  • 19 Bron JL, Saouti R, De Gast A. Posterior knee dislocation after total knee arthroplasty in a patient with multiple sclerosis. A case report. Acta Orthop Belg 2007; 73 (01) 118-121
    PubMedGoogle Scholar
  • 20 Nationwide Inpatient Sample HCUP. . (NIS). Healthcare Cost and Utilization Project (HCUP). 2013. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp.2015
    PubMedGoogle Scholar
  • 21 Naziri Q, Boylan MR, Issa K, Jones LC, Khanuja HS, Mont MA. Does HIV infection increase the risk of perioperative complications after THA? A nationwide database study. Clin Orthop Relat Res 2015; 473 (02) 581-586
    CrossrefPubMedGoogle Scholar
  • 22 Newman JM, Schiltz NK, Mudd CD, Szubski CR, Klika AK, Barsoum WK. Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty. J Arthroplasty 2016; 31 (11) 2395-2401
    CrossrefPubMedGoogle Scholar
  • 23 Klika AK, Small TJ, Saleh A, Szubski CR, Chandran Pillai ALP, Barsoum WK. Primary total knee arthroplasty allogenic transfusion trends, length of stay, and complications: nationwide inpatient sample 2000-2009. J Arthroplasty 2014; 29 (11) 2070-2077
    CrossrefPubMedGoogle Scholar
  • 24 HCUP Comorbidity Software. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. 2002–2013. Available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp . Accessed September 4, 2015
    PubMedGoogle Scholar
  • 25 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
    CrossrefPubMedGoogle Scholar
  • 26 Goldenberg MM. Multiple sclerosis review. P&T 2012; 37 (03) 175-184
    PubMedGoogle Scholar
  • 27 Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Rev Neurol (Paris) 2016; 172 (01) 3-13
    CrossrefPubMedGoogle Scholar
  • 28 Crayton H, Heyman RA, Rossman HS. A multimodal approach to managing the symptoms of multiple sclerosis. Neurology 2004; 63 (11) (Suppl. 05) S12-S18
    PubMedGoogle Scholar
  • 29 Walther EU, Hohlfeld R. Multiple sclerosis: side effects of interferon beta therapy and their management. Neurology 1999; 53 (08) 1622-1627
    CrossrefPubMedGoogle Scholar
  • 30 Koudriavtseva T, Plantone D, Renna R, Mandoj C, Giannarelli D, Mainero C. Interferon-β therapy and risk of thrombocytopenia in multiple sclerosis patients. Neurol Sci 2015; 36 (12) 2263-2268
    CrossrefPubMedGoogle Scholar
  • 31 Gupta S, Goren A, Phillips AL, Stewart M. Self-reported burden among caregivers of patients with multiple sclerosis. Int J MS Care 2012; 14 (04) 179-187
    CrossrefPubMedGoogle Scholar
  • 32 Haselkorn JK, Balsdon Richer C, Fry Welch D. , et al; Multiple Sclerosis Council for Clinical Practice Guidelines. Overview of spasticity management in multiple sclerosis. Evidence-based management strategies for spasticity treatment in multiple sclerosis. J Spinal Cord Med 2005; 28 (02) 167-199
    PubMedGoogle Scholar
  • 33 Litwiller SE, Frohman EM, Zimmern PE. Multiple sclerosis and the urologist. J Urol 1999; 161 (03) 743-757
    CrossrefPubMedGoogle Scholar
  • 34 Belmont PJ, Goodman GP, Hamilton W, Waterman BR, Bader JO, Schoenfeld AJ. Morbidity and mortality in the thirty-day period following total hip arthroplasty: risk factors and incidence. J Arthroplasty 2014; 29 (10) 2025-2030
    CrossrefPubMedGoogle Scholar