TY - JOUR
T1 - Factors Affecting Longer Surgical Times in Total Knee Arthroplasty for Obese Patients-A Comparative Study between High- and Nonhigh-Volume Surgeons
AU - Harato, Kengo
AU - Kobayashi, Shu
AU - Nagashima, Masaki
AU - Hasegawa, Takayuki
AU - Tanikawa, Hidenori
AU - Maeno, Shinichi
AU - Nomoto, So
N1 - Publisher Copyright:
© 2018 Georg Thieme Verlag. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Obesity has a negative influence on surgical times in total knee arthroplasty (TKA). Our purpose in this multicenter study was to compare surgical times between high- (HV) and nonhigh-volume (NHV) surgeons and clarify the important factors affecting longer surgical times in primary TKA for obese patients. A total of 798 knees, average age 75.1 years, were enrolled. All TKAs were done using the same measured resection technique by 25 surgeons at 12 facilities and were divided into three groups based on body mass index (kg/m 2) of the patients (Group A: <24.9, Group B: 25-29.9, Group C: ≥30). Operative techniques including four surgical steps (surgical exposure, bone cutting, trial and fixation of the permanent component, and wound closure) were evaluated both in HV and NHV surgeons. In classifying surgeon volume, HV surgeons had performed >100 TKAs annually for many years, and other surgeons who had performed <100 TKAs annually were defined as NHV surgeons. Patient demographics, surgical details, and surgical times in each phase were compared using nonrepeated measures of analysis of variance and a post hoc Student-Newman-Keuls test. A total of 331, 327, 140 TKAs were allocated to Groups A, B, C, respectively. Regarding patient demographics, patients in Group C were younger and had the worst ranges of motion. The longest surgical time was observed in Group C of NHV surgeons (p < 0.05). Concerning each surgical phase, surgeons took much more time in surgical exposure and fixation of the permanent component for obese patients in NHV surgeons (p < 0.05). Our results suggest that younger age and lower range of motion were observed in obese patients, which led to longer surgical times. In addition, NHV surgeons took much time in surgical exposure and fixation of the permanent component for obese patients, while surgical time was similar among groups for HV surgeons.
AB - Obesity has a negative influence on surgical times in total knee arthroplasty (TKA). Our purpose in this multicenter study was to compare surgical times between high- (HV) and nonhigh-volume (NHV) surgeons and clarify the important factors affecting longer surgical times in primary TKA for obese patients. A total of 798 knees, average age 75.1 years, were enrolled. All TKAs were done using the same measured resection technique by 25 surgeons at 12 facilities and were divided into three groups based on body mass index (kg/m 2) of the patients (Group A: <24.9, Group B: 25-29.9, Group C: ≥30). Operative techniques including four surgical steps (surgical exposure, bone cutting, trial and fixation of the permanent component, and wound closure) were evaluated both in HV and NHV surgeons. In classifying surgeon volume, HV surgeons had performed >100 TKAs annually for many years, and other surgeons who had performed <100 TKAs annually were defined as NHV surgeons. Patient demographics, surgical details, and surgical times in each phase were compared using nonrepeated measures of analysis of variance and a post hoc Student-Newman-Keuls test. A total of 331, 327, 140 TKAs were allocated to Groups A, B, C, respectively. Regarding patient demographics, patients in Group C were younger and had the worst ranges of motion. The longest surgical time was observed in Group C of NHV surgeons (p < 0.05). Concerning each surgical phase, surgeons took much more time in surgical exposure and fixation of the permanent component for obese patients in NHV surgeons (p < 0.05). Our results suggest that younger age and lower range of motion were observed in obese patients, which led to longer surgical times. In addition, NHV surgeons took much time in surgical exposure and fixation of the permanent component for obese patients, while surgical time was similar among groups for HV surgeons.
KW - implant fixation
KW - obesity
KW - surgeon volume
KW - surgical exposure
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85038399619&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85038399619&partnerID=8YFLogxK
U2 - 10.1055/s-0037-1608879
DO - 10.1055/s-0037-1608879
M3 - Article
C2 - 29216673
AN - SCOPUS:85038399619
SN - 1538-8506
VL - 31
SP - 781
EP - 785
JO - Journal of Knee Surgery
JF - Journal of Knee Surgery
IS - 8
ER -