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  1. Article ; Online: Does chronic kidney disease affect implant survival after primary hip and knee arthroplasty?

    Jämsä, Pyry / Reito, Aleksi / Oksala, Niku / Eskelinen, Antti / Jämsen, Esa

    The bone & joint journal

    2021  Volume 103-B, Issue 4, Page(s) 689–695

    Abstract: Aims: To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty.: Methods: This retrospective cohort study ... ...

    Abstract Aims: To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty.
    Methods: This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model.
    Results: There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered.
    Conclusion: We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article:
    MeSH term(s) Aged ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Prosthesis-Related Infections/epidemiology ; Renal Insufficiency, Chronic/complications ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2021-04-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2697156-2
    ISSN 2049-4408 ; 2049-4394
    ISSN (online) 2049-4408
    ISSN 2049-4394
    DOI 10.1302/0301-620X.103B4.BJJ-2020-0715.R2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: 3D laparoscopic prostatectomy: results of multicentre study.

    Haapiainen, Henry / Kaipia, Antti / Murtola, Teemu / Seikkula, Heikki / Seppänen, Marjo / Jämsä, Pyry / Raitanen, Mika

    Scandinavian journal of urology

    2022  Volume 56, Issue 3, Page(s) 176–181

    Abstract: Introduction: Three-dimensional laparoscopic prostatectomy (3D LRP) is a potentially cost-effective option for robot-assisted laparoscopic prostatectomy (RALP). Results for two-dimensional LRP and RALP are well documented; however, little has been ... ...

    Abstract Introduction: Three-dimensional laparoscopic prostatectomy (3D LRP) is a potentially cost-effective option for robot-assisted laparoscopic prostatectomy (RALP). Results for two-dimensional LRP and RALP are well documented; however, little has been published on the outcomes of 3D LRP. Our objective was to report the perioperative and short-term results of 3D LRP in a multicentre study.
    Materials and methods: In total, 496 unselected men with prostate cancer underwent 3D LRP by three surgeons between December 2013 and December 2018. Median age was 64 (43-76) years. Median prostate-specific antigen (PSA) was 7.9 (0.7-148) ng/ml. Preoperative and perioperative data and complications according to the Clavien-Dindo classification were collected. PSA and continence results were reported at 3 and 12 months postoperatively. Data were analysed with IBM SPSS statistics (25).
    Results: Pathological Gleason score was 6 in 29%, 7 in 55.4%, 8 in 9.1%, 9 in 5.2% and 10 in 1.2% of patients. Pathological tumour classification was T2c in 59.5%, T3a in 19.5% and T3b in 10.9% of cases. Positive surgical margins occurred in 27.2%. Lymphadenectomy was performed in 36.3%, with positive lymph nodes in 11.8%. Median operative time was 137 (78-334) min and median blood loss 200 (10-1100) ml. Clavien-Dindo IIIa and IIIb complications occurred in 6.9% and 1.6%, respectively. At 3 and 12 months postoperatively, 90.2% and 91.4% of patients, respectively, had PSA <0.2 ng/ml, while 77.1% and 87.7% of patients were completely dry or using a maximum of one pad daily.
    Conclusions: 3D LRP shows promising results, comparable to similar studies published on RALP.
    MeSH term(s) Adult ; Aged ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Prostate-Specific Antigen ; Prostatectomy/methods ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery ; Robotics/methods ; Treatment Outcome
    Chemical Substances Prostate-Specific Antigen (EC 3.4.21.77)
    Language English
    Publishing date 2022-05-28
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2701936-6
    ISSN 2168-1813 ; 2168-1805
    ISSN (online) 2168-1813
    ISSN 2168-1805
    DOI 10.1080/21681805.2022.2075458
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Do cobalt or chromium accumulate in metal-on-metal hip arthroplasty patients who have mild, moderate, or severe renal insufficiency?

    Manninen, Eveliina / Lainiala, Olli / Karsikas, Mari / Reito, Aleksi / Jämsä, Pyry / Eskelinen, Antti

    The bone & joint journal

    2021  Volume 103-B, Issue 7, Page(s) 1231–1237

    Abstract: Aims: To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasties and renal insufficiency, suggesting ... ...

    Abstract Aims: To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasties and renal insufficiency, suggesting that renal insufficiency could cause accumulation of Co and Cr in blood.
    Methods: Out of 2,520 patients with 3,013 MoM hip arthroplasties, we identified 1,244 patients with whole blood Co, Cr, and creatinine measured within no more than a one-year interval. We analyzed the correlation of blood metal ion levels and eGFR to identify a potential trend of accumulating Co or Cr with decreasing eGFR.
    Results: Of the 1,244 patients, 112 had normal renal function (eGFR > 90 ml/min/1.73 m
    Conclusion: As patients with MoM hip arthroplasties get older, the prevalence of renal insufficiency among them will increase, and orthopaedic surgeons will increasingly have to evaluate whether or not this affects patient follow-up. The USA Food and Drug Administration suggests that closer follow-up may be needed for MoM patients with renal insufficiency. We did not observe accumulation of blood Co or Cr in MoM hip arthroplasty patients with mild to severe renal insufficiency. Cite this article:
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/instrumentation ; Chromium/blood ; Cobalt/blood ; Creatinine/blood ; Cross-Sectional Studies ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Metal-on-Metal Joint Prostheses ; Middle Aged ; Retrospective Studies
    Chemical Substances Chromium (0R0008Q3JB) ; Cobalt (3G0H8C9362) ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2021-06-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2697156-2
    ISSN 2049-4408 ; 2049-4394
    ISSN (online) 2049-4408
    ISSN 2049-4394
    DOI 10.1302/0301-620X.103B7.BJJ-2020-0836.R2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Moderate to Severe Renal Insufficiency Is Associated With High Mortality After Hip and Knee Replacement.

    Jämsä, Pyry / Jämsen, Esa / Huhtala, Heini / Eskelinen, Antti / Oksala, Niku

    Clinical orthopaedics and related research

    2018  Volume 476, Issue 6, Page(s) 1284–1292

    Abstract: Background: In patients having elective hip or knee replacements, many comorbid conditions, including diabetes, cardiovascular disease, and congestive heart failure, are associated with postoperative mortality. Renal failure and a history of renal ... ...

    Abstract Background: In patients having elective hip or knee replacements, many comorbid conditions, including diabetes, cardiovascular disease, and congestive heart failure, are associated with postoperative mortality. Renal failure and a history of renal transplantation also increase mortality. However, the effect of different stages of chronic kidney disease on patients' prognoses is unclear.
    Questions/purposes: (1) What is the risk of postoperative mortality in different stages of chronic kidney disease after elective hip or knee replacement and does the risk increase with mild renal insufficiency? (2) How severe is the risk of death in patients with chronic kidney disease compared with other major medical comorbidities such as diabetes, cardiovascular disease, and congestive heart failure? (3) Are there risk factor combinations associated with especially poor survival?
    Methods: Using longitudinally maintained databases, the records of 18,575 patients (median age 69 years, 63% female, median body mass index 29 kg/m) undergoing elective hip and knee replacements from a single center between 2002 and 2011 were analyzed in this retrospective study. A total of 6519 (35%) patients had Stage I, 9917 (53%) Stage II, 2023 (11%) Stage III, 81 (0.4%) Stage IV, and 35 (0.2%) Stage V chronic kidney disease. Kaplan-Meier analysis was used to analyze mortality at different stages of the disease. Cox regression analysis was performed to compare the risk of death associated with the comorbid conditions of interest. Comorbid conditions with greatest risk for death (diabetes, coronary artery disease, and congestive heart failure) were combined separately with chronic kidney disease using logistic regression. According to data from the Finnish Population Register Centre, a total of 4055 deaths occurred in our patient cohort during the followup period. The median followup was 7.8 years (range, 0-14 years; interquartile range, 5.8-10.0 years).
    Results: The mean survival time was 13 years (95% confidence interval [CI], 12.5-12.7 years) in Stage I, 11 years (95% CI, 11.3-11.5 years) in Stage II, 9 years (95% CI, 9.2-9.7 years) in Stage III, 7 years (95% CI, 5.6-7.5 years) in Stage IV, and 6 years (95% CI, 4.9-8.0 years) in Stage V (p < 0.001). Compared with Stage I chronic kidney disease, the risk of death increased with every step of the disease (adjusted hazard ratio [HR], 1.9 [95% CI, 1.76-2.10]; HR, 3.8 [95% CI, 3.39-4.19]; and HR, 8.1 [95% CI, 6.33-10.31] in Stages II, III, and IV-V, respectively). Compared with congestive heart failure (HR, 2.11 [95% CI, 1.81-2.45], p < 0.001), coronary disease (HR, 1.54 [95% CI, 1.40-1.69], p < 0.001), diabetes (HR, 1.71 [95% CI, 1.54-1.90], p < 0.001), and hypertension (HR, 1.35 [95% CI, 1.26-1.45], p < 0.001), Stage III and Stage IV to V chronic kidney disease are associated with poorer survival. The combination of chronic kidney disease and diabetes (odds ratio [OR], 8.15 [95% CI, 4.9-13.51]) had a synergistic effect on the risk of death compared with chronic kidney disease (OR, 2.36 [95% CI, 1.70-3.28]) or diabetes alone (OR, 1.19 [95% CI, 0.70-2.03]) during the first postoperative year.
    Conclusions: All stages of chronic kidney disease have a harmful effect on long-term life expectancy in joint replacement recipients. The risk becomes clinically meaningful in the most severe forms of the disease, but also in moderate chronic kidney disease when it is accompanied by diabetes, coronary disease, or congestive heart failure. It should be recognized that these patients achieve fewer quality-adjusted life-years even if clinical outcomes were similar. The effect of chronic kidney disease on cost-effectiveness of hip and knee replacements should be investigated in future studies.
    Level of evidence: Level III, therapeutic study.
    MeSH term(s) Aged ; Arthroplasty, Replacement, Hip/mortality ; Arthroplasty, Replacement, Knee/mortality ; Comorbidity ; Databases, Factual ; Diabetes Complications/mortality ; Diabetes Complications/surgery ; Diabetes Mellitus/mortality ; Diabetes Mellitus/surgery ; Female ; Finland/epidemiology ; Heart Failure/mortality ; Heart Failure/surgery ; Humans ; Kaplan-Meier Estimate ; Longitudinal Studies ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Proportional Hazards Models ; Regression Analysis ; Renal Insufficiency/mortality ; Renal Insufficiency/surgery ; Renal Insufficiency, Chronic/mortality ; Renal Insufficiency, Chronic/surgery ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2018-05-31
    Publishing country United States
    Document type Evaluation Study ; Journal Article
    ZDB-ID 80301-7
    ISSN 1528-1132 ; 0009-921X
    ISSN (online) 1528-1132
    ISSN 0009-921X
    DOI 10.1007/s11999.0000000000000256
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Chronic Kidney Diseases Among Patients Undergoing Elective Arthroplasty: Risk Groups and the Value of Serum Creatinine.

    Jämsä, Pyry P / Oksala, Niku K J / Eskelinen, Antti P / Jämsen, Esa R

    The Journal of arthroplasty

    2017  Volume 33, Issue 1, Page(s) 230–234.e1

    Abstract: Background: In arthroplasty clinics, we tend to evaluate patient's kidney function looking at serum creatinine (SCr), while estimated glomerular filtration rate (eGFR) is recommended. We reported the prevalence of chronic kidney disease (CKD; eGFR <60 ... ...

    Abstract Background: In arthroplasty clinics, we tend to evaluate patient's kidney function looking at serum creatinine (SCr), while estimated glomerular filtration rate (eGFR) is recommended. We reported the prevalence of chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m
    Methods: Preoperative SCr values were used to calculate eGFR in 20,575 consecutive hip or knee arthroplasties.
    Results: Prevalence of CKD was 9%-12%. It was higher among older women, knee arthroplasty patients, and patients with hypertension, diabetes, or coronary disease. Using SCr instead of eGFR leads to missing CKD in up to 7% of the cases. In older women and older patients with body mass index <25 kg/m
    Conclusion: Use of eGFR instead of SCr to detect CKD more accurately is recommended.
    MeSH term(s) Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Creatinine/blood ; Elective Surgical Procedures ; Female ; Finland/epidemiology ; Glomerular Filtration Rate ; Humans ; Hypertension ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/epidemiology ; Risk Factors
    Chemical Substances Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2017-08-09
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632770-9
    ISSN 1532-8406 ; 0883-5403
    ISSN (online) 1532-8406
    ISSN 0883-5403
    DOI 10.1016/j.arth.2017.07.050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Risk factors associated with acute kidney injury in a cohort of 20,575 arthroplasty patients.

    Jämsä, Pyry / Jämsen, Esa / Lyytikäinen, Leo-Pekka / Kalliovalkama, Jarkko / Eskelinen, Antti / Oksala, Niku

    Acta orthopaedica

    2017  Volume 88, Issue 4, Page(s) 370–376

    Abstract: Background and purpose - Patients developing postoperative acute kidney injury (AKI) are at risk of higher morbidity and mortality. In arthroplasty patients, many pre- and perioperative factors are associated with AKI but some of the risk factors are ... ...

    Abstract Background and purpose - Patients developing postoperative acute kidney injury (AKI) are at risk of higher morbidity and mortality. In arthroplasty patients, many pre- and perioperative factors are associated with AKI but some of the risk factors are unclear. We report the incidence of postoperative AKI, the conditions associated with it, and survival rates in AKI patients. Patients and methods - We obtained data from 20,575 consecutive hip or knee arthroplasties. Postoperative AKI, occurring within 7 days after the operation, was defined using the risk, injury, failure, loss, and end-stage (RIFLE) criteria. We analyzed independent risk factors for AKI using binary logistic regression. In addition, we reviewed the records of AKI patients and performed a survival analysis. Results - The AKI incidence was 3.3 per 1,000 operations. We found preoperative estimated glomerular filtration rate, ASA classification, body mass index, and duration of operation to be independent risk factors for AKI. Infections, paralytic ileus, and cardiac causes were the predominant underlying conditions, whereas half of all AKI cases occurred without any clear underlying condition. Survival rates were lower in AKI patients. Interpretation - Supporting earlier results, existing renal insufficiency and patient-related characteristics were found to be associated with an increased risk of postoperative AKI. Furthermore, duration of operation was identified as an independent risk factor. We suggest careful renal monitoring postoperatively for patients with these risk factors.
    MeSH term(s) Acute Kidney Injury/etiology ; Acute Kidney Injury/mortality ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/mortality ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Knee/mortality ; Body Mass Index ; Female ; Glomerular Filtration Rate ; Humans ; Logistic Models ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Risk Factors ; Young Adult
    Language English
    Publishing date 2017-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2180677-9
    ISSN 1745-3682 ; 1745-3674
    ISSN (online) 1745-3682
    ISSN 1745-3674
    DOI 10.1080/17453674.2017.1301743
    Database MEDical Literature Analysis and Retrieval System OnLINE

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