Current Practice Trends in Knee Arthroplasty in India among ISHKS Members

Best clinical practices are followed, so that complications are minimized and recovery is enhanced. However, regional variations in clinical practice prevail due to the nature of pathology, availability of infrastructure, and individual surgeon preferences. Arun Mullaji et al conducted a study to assess the current practice trends in knee arthroplasty in India among ISHKS (Indian Society of Hip and Knee Surgeons) members. The study has been published in ‘Indian Journal of Orthopaedics.

Literature review on 12 areas of key interest in total knee arthroplasty was conducted. 28 questions pertaining to these key areas in total knee arthroplasty surgery were presented to the delegates for a physical voting with audience response system (ARS) at ISHKS meeting. The members who could not attend the meeting voted by an online via ‘monkey survey’. All questions were given three responses: a. Agree, b. Disagree, and c. Abstain.

Key findings of the study were:

• 310 delegates participated and 295 voted in the physical meeting and 110 voted online.

• Consensus was reached for 28 statements representing five domains on the best practices.

• Overall, 92% of statements reached unanimous or strong consensus.

• The statements that achieved strong majority (>90%) were the factors on pre-operative skin preparations, administration of antibiotics 30 min prior skin incision, and current practices of bilateral TKR.

 76% of panelists also have approved that it is not mandatory to perform arthroplasty surgery with the surgical team wearing body exhaust suits, whereas 22% of panelists have still supported their use.

 96% have given agreement that “Preoperative skin cleansing prior to arthroplasty surgery has a role to play in reducing SSI/PJI”

 82 percent of the panelists have approved that “Hair removal from the incision area can be done using clippers or depilatory creams, as close to the time of surgery and not in the operating theater”

 90% of the panelists have approved that Bilateral TKA may carry a slightly higher risk of complications and so careful patient selection is essential and that it should not be performed in patients with cardiopulmonary disease, advanced age, higher ASA grades, and significant medical co-morbidities.

• There was strong consensus approval on the role of aspirin for prophylaxis of DVT, lack of benefit on use of drain, considerations for pre-emptive analgesia, and neuraxial anesthesia.

• There were disparate views and weak consensus on use of laminar airflow theatres and use of surgical space suits, length of antibiotic administration postoperatively, and linking of DVT with PE and death.

The authors concluded – "This study gives the surgeon practice preferences in knee arthroplasty in India and assists in clinical decision making for all healthcare professionals."

Further reading:

Current Practice Trends in Knee Arthroplasty in India Among ISHKS Members: ISHKS Annual Meeting 2019

Arun Mullaji, Dhanasekara Raja Palanisami et al

Indian Journal of Orthopaedics (2023) 57:1678–1688

https://doi.org/10.1007/s43465-023-00940-4