SKIN TEMPERATURE FOLLOWING TOTAL KNEE ARTHROPLASTY: A LONGITUDINAL OBSERVATIONAL STUDY
Notice bibliographique
Résumé
Total knee arthroplasty (TKA) is the most effective method of pain relief and increased functional status for end stage knee arthritis. Shared by both surgeons and patients, infection is one of the most feared complications. Due to this fear, patients constantly present to physicians complaining of increased temperature on the operated knee. This common clinical observation can be mistaken as a sign for infection leading to unnecessary investigations or the inappropriate use of antibiotics. We aimed to assess in patients undergoing unilateral, primary total knee arthroplasty, whether the temperature of the operated limb, compared to the non-operative limb, remains elevated up to one year post-operatively using a large prospective, longitudinal observational study design. A prospective longitudinal observational study performed in a single center clinical setting (Alberta Hip and Knee Clinic) with patients undergoing operations at three academic hospitals within Calgary, Alberta. These included the Peter Lougheed Center, Rockyview General Hospital and Foothills Medical Center. Fifteen arthroplasty-trained surgeons participated. Patients were Included if they were having an elective primary total knee arthroplasty. Exclusion criteria included patients who have undergone revision TKA, previous major infection, post-traumatic arthritis with previous hardware, previous major operation on the knee including high tibial osteotomy, open reduction internal fixation or major open ligamentous repair excluding arthroscopic ACL reconstruction. Skin temperatures were taken in 4 quadrants using infrared thermometer on the operated and non-operated knees pre-op, 2 weeks, 6 weeks, 3 months and at one year post-operatively. Subgroup analysis was performed in the patients deemed to have a superficial or deep infection. A total of 1094 patients were enrolled in the research study. 889 patients completed a minimum of 4 out of 5 follow-up appointments. Follow-up was impacted due to the COVID-19 pandemic. 864 patients had a normal post-operative course while 25 were deemed to have either superficial or deep infection. Within primary total knee patients, there was a statistically significant increase in skin temperature in the operated versus non-operated knee at every follow-up including the one year follow-up with p<0.001. However, the effect size was small at one-year follow-up with a mean difference in skin temperature of only 0.3oC. In the infected subgroup, there was also a statistically significant difference in skin temperature at 2, 6 and 12 weeks, with a greater difference in skin temperature between operated and non-operated knees (4.05 degrees versus 3.78 degrees in non-infected). However, there was little clinical difference (0.27 degrees) at two weeks between patients who were infected versus not infected. This study has a direct impact to improve the post-operative interaction between patients and surgeons. It is normal for skin temperature post TKA to increase initially and improve over time but can take up to a year before there is little clinical difference. Because of the small difference in the rise of skin temperature between those infected and not infected, there is little indication that skin temperature is a reliable indicator for infection.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».