Trends in Total Knee Replacement Surgery in Chile. How Are We Operating Them?

Abstract

Introduction Total knee replacement (TKR) significantly increased among the population in recent decades, and it shows great variation in its study and technique in different countries. There is no registered Chilean data to assess TKR implementation.

Objective To record the trends in TKR in different aspects within Chile and compare them with records from other countries.

Materials and Methods We conducted an email survey among knee surgeons in Chile considering four aspects: general features, preoperative study, surgical technique, and cementation technique. We excluded surveys not completed in full. The analyses included overall data and data per years of experience (YOEs), and we compared the results with those of international studies.

Results We obtained 87 complete surveys. Most respondents performed 25 to 50 TKRs each year (44%), with only 16% performing over 75 TKRs. Only 20% used the ambulatory modality, while 43% believed patients always require hospitalization (especially surgeons with more than 10 YOEs). Robotic systems were used by 18% of the surgeons, especially those with more than 10 YOEs; the most used systems were ROSA and CORI. In total 90% of the respondents believed TKR should be part of the Explicit Health Guarantees (Garantías Explícitas de Salud, GES, in Spanish) program, with no differences in terms of YOEs. A total of 81% used the posterior-stabilized (PS) system, 96% performed a medial parapatellar approach, 82% used an extramedullary tibial guide, 41% tended to replace the patella, and 35% did not use a tourniquet (none of the variables showed differences according to YOEs). Only 31% used vacuum cementation (with a higher frequency in the group with fewer than 10 YOEs), 95% placed cement on components and bone, 75% placed it in the keel, and 56% used finger packing (only 22% with a gun). The most common cementation sequence was tibia-femur-patella. In most aspects evaluated, we observed important differences compared with studies from other countries.

Conclusion There is a high variability in the performance of TKR in Chile, with different trends compared with those of other countries. Overall, there are no major differences in the surgical technique concerning YOEs, although there is variation in the cementation technique and the use of robotic systems.

Keywords

total knee replacement - national survey - surgical technique - cementation technique

Note

All authors have approved the present article.

Publication History

Received: 08 July 2023

Accepted: 01 April 2024

Article published online:
03 May 2024

• Referencias

• 1 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
• 2 Baker PN, Rushton S, Jameson SS, Reed M, Gregg P, Deehan DJ. Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: A cohort study from the National Joint Registry for England and Wales. Bone Joint J 2013; 95-B (10) 1359-1365
• 3 Barahona M, Martínez Á, Barahona M, Ramírez M, Barrientos C, Infante C. Impact of COVID-19 outbreak in knee arthroplasty in Chile: a cross-sectional, national registry-based analysis. Medwave 2022; 22 (04) e8731 . Spanish, English . PMID: 35580323
• 4 Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide, Australia: AOA; https://aoanjrr.sahmri.com/annual-reports-2022
• 5 The New Zealand Joint Registry. Annual Report. https://www.nzoa.org.nz/annual-reports
• 6 Norwegian Arthroplasty Register. Annual report of The Norwegian Arthroplasty Register, The Hip Fracture Register, Knee Ligament Register and Pediatric Hip Register of Norway. DOI:10.13140/RG.2.2.34266.26566
• 7 Swedish Knee Arthroplasty Register. https://registercentrum.blob.core.windows.net/sar/r/SAR-Annual-Report-2022_EN-HkgQE89Nus.pdf
• 8 American Joint Replacement Registry. Available at: http://www.ajrr.net/images/annual_reports/AJRR-2017-Annual-Report—Final.pdf?hsCtaTracking=61a2fedc-0f48-4241-a282-2bca6e4b68ad%7Ce4ed88d8-6b8e-4d0c-9a47-d1c169759e83
• 9 National Joint Registry for England. Wales, Northern Ireland and the Isle of Man. https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2019th%20Annual%20Report%202022.pdf
• 10 Figueroa D, Figueroa F, Calvo R, Vaisman A, Figueroa M, Putnis S. Trends in Total Knee Arthroplasty in a Developing Region: A Survey of Latin American Orthopaedic Surgeons. J Am Acad Orthop Surg 2020; 28 (05) 189-193
• 11 Barnes CL, Iorio R, Zhang X, Haas DA. An examination of the adoption of outpatient total knee arthroplasty since 2018. J Arthroplasty 2020; 35 (6S): S24-S27
• 12 Centers for Medicare & Medicaid Services. Total knee arthroplasty (TKA) removal from the Medicare Inpatient-Only (IPO) list and application of the 2-Midnight Rule. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19002.pdf . Accessed February 5, 2020
• 13 Numair J. Total knee arthroplasty with preservation of the posterior cruciate ligament: results after 7 years of follow-up. Total knee arthroplasty with preservation of the posterior cruciate ligament: results after 7 years of follow-up. Rev Chill Orthop Traumatol 1998; 39 (02) 32-43
• 14 Paulos J, Wagner E, Lisoni A. Total knee arthroplasty with posterior stabilized prosthesis: 10 years experience. Total knee arthroplasty with posterior stabilized prosthesis: 10 years experience. Rev Chill Orthop Traumatol 2001; 42 (01) 29-36
• 15 Berry DJ, Bozic KJ. Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty 2010; 25 (6, Suppl) 2-4
• 16 Martin JR, Archibeck MJ, Gililland JM. et al. Trends in Total Knee Arthroplasty Cementing Technique Among Arthroplasty Surgeons-A Survey of the American Association of Hip and Knee Surgeons Members. J Arthroplasty 2022; ••• : Epub ahead of print
• 17 Lutz MJ, Pincus PF, Whitehouse SL, Halliday BR. The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplasty. J Arthroplasty 2009; 24 (03) 461-467
• 18 Kopec M, Milbrandt JC, Duellman T, Mangan D, Allan DG. Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty. Can J Surg 2009; 52 (06) 490-494