Science.gov

Sample records for knee arthroplasty tka

  1. [PAIN MANAGEMENT IN PATIENTS OF RAPID RECOVERY (RR) PROGRAM IN TOTAL KNEE ARTHROPLASTY (TKA)].

    PubMed

    Marina Fernández, Rosa; Ginés Mateos, Gracia; Arco Pérez, Ma Carmen; Nuevo Gayoso, Montse; Faura Vendrell, Teresa

    2015-06-01

    Total knee arthroplasty (TKA) is a surgery consisting on the artificial joint replacement, due to a traumatic injury or a degenerative process or arthrosis. This surgery causes an important pain to patients, and sometimes affects negatively on their recovery. The choice of the prostheses will depend on the anatomical features of the patient and the surgeon criterion. The concept of a "rapid recovery surgery" was introduced in 1997 by Khelet and meant the beginning of the Fast Track model or the Rapid Recovery (RR) linked to an accelerated rehabilitation, an early discharge and the optimization of all the aspects of pre, intra and post-operative patient experience. Fast recovery is a surgical process which aims to achieve maximum autonomy of the patient through education, pain control and early mobilization. The key of the rapid recovery is to get the involvement of the patient thanks to the empowerment, which means a preoperative patient education that will help to reduce anxiety and it will make easier to engage in their own recovery. Furthermore the patient will take part of an effective post-operative physical therapy, using all the necessary tools to increase their ability to manage their own health problems. The empowerment of these patients is part of the Nursing Model in the Hospital Clinic de Barcelona (HCB), adopted by the Nursing Management in December of 2012. In Catalonia, until the start of the RR surgery, 14,132 interventions in 2008 where done by TKA conventional surgery, needing subsequent conventional hospitalization. This article describes the care and outcomes of nurse interventions, defined in the RR of TKA clinical way, which is focused on the pain's minimization and the impact on patients' mobilization. It was performed in a monographic unit from a tertiary-level hospital in Barcelona in 2013.

  2. A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA.

    PubMed

    Krackow, K A; Bayers-Thering, M; Phillips, M J; Bayers-Thering, M; Mihalko, W M

    1999-07-01

    Successful total knee arthroplasty (TKA) relies on proper positioning of prosthetic components to restore the mechanical axis of the lower extremity. This report presents and analyzes a new noninvasive method using the Optotrack (Northern Digital Inc, Ontario, Canada) to accurately determine the center of the femoral head. This method, together with direct digitization of the bony landmarks of the knee and ankle intraoperatively, permits placement of the lower extremity in proper alignment intraoperatively. It also permits the surgeon to follow all the angles of movement or rotation and all displacements that occur at each step of the operative procedure. knee intraoperatively via a customized Windows-based program. In addition to presenting our first case, which, importantly, represents the first computer-assisted TKA in a patient, we report on the accuracy and reproducibility of the technique for locating the center of the femoral head obtained during an extensive series of cadaver studies. Location of the femoral head, a major aspect of effecting neutral mechanical axis alignment, appears to be possible to within 2-4 mm, which corresponds to an angular accuracy of better than 1 degree. This method requires no computed tomography scans or other preliminary marker placement. The only basic requirement other than the instrumentation described is a freely mobile hip, which is generally present in TKA patients. PMID:10418867

  3. Anteroposterior Laxity After Bicruciate-Retaining Total Knee Arthroplasty Is Closer to the Native Knee Than ACL-Resecting TKA: A Biomechanical Cadaver Study.

    PubMed

    Halewood, Camilla; Traynor, Alison; Bellemans, Johan; Victor, Jan; Amis, Andrew A

    2015-12-01

    The purpose of this study was to examine whether a bicruciate retaining (BCR) TKA would yield anteroposterior (AP) laxity closer to the native knee than a posterior cruciate ligament retaining (CR) TKA. A BCR TKA was designed and compared to CR TKA and the native knee using cadaver specimens. AP laxity with the CR TKA was greater than the native knee (P=0.006) and BCR TKA (P=0.039), but no difference was found between the BCR TKA and the native knee. No significant differences were found in rotations between the prostheses and the native knee. BCR TKA was shown to be surgically feasible, reduced AP laxity versus CR TKA, and may improve knee stability without using conforming geometry in the implant design.

  4. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  5. Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial

    PubMed Central

    Rakel, Barbara; Zimmerman, M. Bridget; Geasland, Katharine; Embree, Jennie; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Herr, Keela; Walsh, Deirdre; Sluka, Kathleen A

    2014-01-01

    This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) have better function than participants receiving Placebo-TENS or Standard Care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses on 317 subjects after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) than Standard Care participants. TENS and Placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) than Standard Care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS. PMID:25270585

  6. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  7. Unicompartmental knee arthroplasty

    PubMed Central

    Murray, D. W.; Liddle, A. D.; Dodd, C. A. F.; Pandit, H.

    2015-01-01

    There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence, different people draw different conclusions and as a result, there is great variability in the usage of UKA. The revision rate of UKA is much higher than TKA and so some surgeons conclude that UKA should not be performed. Other surgeons believe that the main reason for the high revision rate is that UKA is easy to revise and, therefore, the threshold for revision is low. They also believe that UKA has many advantages over TKA such as a faster recovery, lower morbidity and mortality and better function. They therefore conclude that UKA should be undertaken whenever appropriate. The solution to this argument is to minimise the revision rate of UKA, thereby addressing the main disadvantage of UKA. The evidence suggests that this will be achieved if surgeons use UKA for at least 20% of their knee arthroplasties and use implants that are appropriate for these broad indications. Cite this article: Bone Joint J 2015;97-B(10 Suppl A):3–8. PMID:26430080

  8. Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty

    PubMed Central

    Boulezaz, Samuel; Gibon, Emmanuel; Loriaut, Philippe; Casabianca, Laurent; Rousseau, Romain; Dallaudiere, Benjamin; Pascal-Moussellard, Hugues

    2016-01-01

    This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification. PMID:27119034

  9. Stiffness after total knee arthroplasty.

    PubMed

    Manrique, Jorge; Gomez, Miguel M; Parvizi, Javad

    2015-04-01

    Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts patient function. Various risk factors for stiffness after TKA have been identified, including reduced preoperative knee range of motion, history of prior knee surgery, etiology of arthritis, incorrect positioning or oversizing of components, and incorrect gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis, complex regional pain syndrome, and heterotopic ossification, secondary gain issues have also been identified. Management of stiffness following TKA can be challenging. The condition needs to be assessed and treated in a staged manner. A nonsurgical approach is the first step. Manipulation under anesthesia may be considered within the first 3 months after the index TKA, if physical therapy fails to improve the range of motion. Beyond this point, consideration should be given to surgical intervention such as lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of stiffness is deemed to be surgical error, such as component malpositioning, revision arthroplasty is indicated. The purpose of this article is to evaluate the various aspects of management of stiffness after TKA.

  10. Robotic-assisted knee arthroplasty.

    PubMed

    Banerjee, Samik; Cherian, Jeffrey J; Elmallah, Randa K; Jauregui, Julio J; Pierce, Todd P; Mont, Michael A

    2015-01-01

    Robotics in total knee arthroplasty (TKA) has undergone vast improvements. Although some of the systems have fallen out of favor due to safety concerns, there has been recent increased interest for semi-active haptic robotic systems that provide intraoperative tactile feedback to the surgeon. The potential advantages include improvements in radiographic outcomes, reducing the incidence of mechanical axis malalignment of the lower extremity and better tissue balance. Proponents of robotic technology believe that these improvements may lead to superior functional outcomes and implant survivorship. We aim to discuss robotic technology development, outcomes of unicompartmental and total knee arthroplasty and the future outlook. Short-term follow-up studies on robotic-assisted knee arthroplasty suggest that, although some alignment objectives may have been achieved, more studies regarding functional outcomes are needed. Furthermore, studies evaluating the projected cost-benefit analyses of this new technology are needed before widespread adoption. Nevertheless, the short-term results warrant further evaluation. PMID:26365088

  11. Predictors of Satisfaction Following Total Knee Arthroplasty.

    PubMed

    Maratt, Joseph D; Lee, Yuo-yu; Lyman, Stephen; Westrich, Geoffrey H

    2015-07-01

    Despite the success of total knee arthroplasty (TKA), numerous studies report that nearly one in five patients who underwent TKA was unsatisfied with their outcome. The purpose of our study was to identify the preoperative factors predictive of satisfaction following well-performed TKA. Using improvement in patient-reported outcomes less than the minimally clinically important change as an indicator of dissatisfaction in a cohort of primary TKA patients, we found that patients with greater preoperative pain and disability with less severe degradation in health-related quality of life were more likely to be satisfied with the result of TKA. Balancing severity of symptoms and impact to quality of life is important when counseling patients considering TKA.

  12. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.

  13. Chronic Knee Dislocation After Total Knee Arthroplasty.

    PubMed

    Ross, John P; Brown, Nicholas M; Levine, Brett R

    2015-12-01

    Knee dislocation after total knee arthroplasty (TKA), although rare, is a dangerous injury that can lead to neurovascular compromise and permanent disability. Chronic dislocation after TKA is even less common and is defined as dislocation that is present for 4 weeks or more. There are few reports of its management. Chronic dislocation may be complicated further by concomitant extensor mechanism disruption, ligamentous instability, and/or capsular contracture. This article describes 3 cases of chronically dislocated TKAs and the challenges encountered in treating this difficult problem. A higher level of constraint was required to maintain knee stability, and an extensor mechanism allograft was needed in 2 of the 3 reported patients. The preferred technique at the authors' institution is a complete allograft composite, tensioned in full extension. In the setting of a chronically dislocated TKA, the authors now recommend revision surgery with an enhanced measure of constraint (constrained condylar device or hinged knee prosthesis), reconstruction of the extensor mechanism when necessary, and restoration of the joint while compensating for concomitant bony defects. Even when surgeons follow these principles, it is important to inform the patient that long-term outcomes will likely be inferior to those of revision surgery for other causes.

  14. Knee joint arthroplasty after tibial osteotomy

    PubMed Central

    Fosco, Matteo; Cenni, Elisabetta; Tigani, Domenico

    2009-01-01

    A total of 29 consecutive knee joint arthroplasties in 24 patients who underwent previous high tibial osteotomy (HTO) for medial unicompartment osteoarthritis of the knee and followed up for a mean of 97 months were compared with a control group of 28 patients with 29 primary total knee arthroplasty (TKA) without previous HTO. Results for the osteotomy group were satisfactory in 96.5% of cases. In one patient loosening of the implant occurred after 37 months, which required prosthesis revision. Three patients underwent a further operation of secondary patella resurfacing for patella pain. The group without osteotomy reported a similar percentage of satisfactory results. PMID:19882155

  15. Trends in total knee arthroplasty implant utilization.

    PubMed

    Nguyen, Long-Co L; Lehil, Mandeep S; Bozic, Kevin J

    2015-05-01

    The incidence of total knee arthroplasty (TKA) has increased alongside our knowledge of knee physiology, kinematics, and technology resulting in an evolution of TKA implants. This study examines the trends in TKA implant utilization. Data was extracted from The Orthopedic Research Network to evaluate trends in level of constraint, fixed vs. mobile bearing, fixation, and type of polyethylene in primary TKAs. In 2012, 88% used cemented femoral and tibial implants, and 96% involved patellar resurfacing. 38% of implants were cruciate retaining, 53% posterior stabilized or condylar stabilized, 3% constrained. 91% were fixed-bearing, 7% mobile-bearing. 52% of tibial inserts were HXLPE. TKA implant trends demonstrate a preference for cemented femoral and tibial components, patellar resurfacing, fixed-bearing constructs, metal-backed tibial components, patellar resurfacing, and increased usage of HXLPE liners. PMID:25613663

  16. Fungal prosthetic joint infection after total knee arthroplasty

    PubMed Central

    Reddy, Kankanala J; Shah, Jay D; Kale, Rohit V; Reddy, T Jayakrishna

    2013-01-01

    Fungal prosthetic joint infection after total knee arthroplasty (TKA) is a rare complication. Lacunae exist in the management of this complication. 62 year old lady presented with pain and swelling in left knee and was diagnosed as Candida tropicalis fungal infection after TKA. She underwent debridement, resection arthroplasty and antifungal plus antibiotic loaded cement spacer insertion, antifungal therapy with fluconazole followed by delayed revision TKA and further fluconazole therapy. Total duration of fluconazole therapy was 30 weeks. At 2 year followup, she has pain less range of motion of 10°-90° and there is no evidence of recurrence of infection. PMID:24133317

  17. Bilateral pseudogout 8 years after bilateral total knee arthroplasty.

    PubMed

    Levi, Gabriel S; Sadr, Kamran; Scuderi, Giles R

    2012-11-01

    This article presents the clinical features of crystal arthropathy after knee replacement. The current literature on pseudogout and gout after both total and partial knee replacement is summarized. A case of bilateral pseudogout 8 years after initial total knee arthroplasty (TKA) is used to highlight the clinical characteristics and treatment options for this underrecognized condition. Presentation mimicked a late septic joint arthroplasty with sudden onset of pain and effusion. The patient was treated successfully with an arthrotomy, debridement, synovectomy, polyethylene insert exchange, oral steroids, and nonsteroidal anti-inflammatories. There are no other reported cases of bilateral pseudogout after bilateral TKA.

  18. Revision of minimal resection resurfacing unicondylar knee arthroplasty to total knee arthroplasty: results compared with primary total knee arthroplasty.

    PubMed

    O'Donnell, Turlough M P; Abouazza, Omar; Neil, Michael J

    2013-01-01

    We compared a cohort of patients undergoing revision of a minimal resection resurfacing unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with a cohort of patients undergoing primary TKA. Both cohorts were matched in terms of age, sex, and body mass index. We collected data on preoperative and postoperative range of motion, International Knee Society scores, and radiologic data. We also collected data on the modes of failure of the primary UKA. There were 55 patients in each cohort. The average time the UKA was in place was 48.3 months. The average follow-up period from the time of revision was 39.2 months. The most common reason for revision was subsidence of the tibial base plate (58%). Forty percent of patients required particulate bone grafting for contained defects. Two patients required metal augments, and 1 required stems. There was no significant difference between the 2 groups in terms of range of motion, functional outcome, or radiologic outcomes. Revision of these types of implants to TKA is associated with similar results to primary TKA and is superior to revision of other forms of UKA.

  19. PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY – A SYSTEMATIC APPROACH

    PubMed Central

    Alves, Wilson Mello; Migon, Eduardo Zaniol; Zabeu, Jose Luis Amim

    2015-01-01

    Total knee arthroplasty (TKA) is known to be a successful procedure. The aging of the population and the growing demand for quality of life have greatly increased the indications for the procedure. Nonetheless, TKA presents some complications that still lack definitive resolution. Pain after TKA is caused by a myriad of reasons that need to be systematically studied in order to reach the correct diagnosis and treatment. History, physical examination, laboratory tests and imaging examinations must all be included in the workup and repeated until a plausible reason has been identified, since if pain is the only indication for TKA revision, the results may be catastrophic. PMID:27022583

  20. Fibrosis is a common outcome following total knee arthroplasty

    PubMed Central

    Abdul, Nicole; Dixon, David; Walker, Andrew; Horabin, Joanna; Smith, Nick; Weir, David J.; Brewster, Nigel T.; Deehan, David J.; Mann, Derek A.; Borthwick, Lee A.

    2015-01-01

    Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3–10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n = 30) or revision (n = 27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees. PMID:26553967

  1. Relationship between Improvements in Physical Measures and Patient Satisfaction in Rehabilitation after Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Nazzal, Mahmoud I.; Bashaireh, Khaldoon H.; Alomari, Mahmoud A.; Nazzal, Mohammad S.; Maayah, Mikhled F.; Mesmar, Mohammad

    2012-01-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per…

  2. Fixed flexion deformity and total knee arthroplasty.

    PubMed

    Su, E P

    2012-11-01

    Fixed flexion deformities are common in osteoarthritic knees that are indicated for total knee arthroplasty. The lack of full extension at the knee results in a greater force of quadriceps contracture and energy expenditure. It also results in slower walking velocity and abnormal gait mechanics, overloading the contralateral limb. Residual flexion contractures after TKA have been associated with poorer functional scores and outcomes. Although some flexion contractures may resolve with time after surgery, a substantial percentage will become permanent. Therefore, it is essential to correct fixed flexion deformities at the time of TKA, and be vigilant in the post-operative course to maintain the correction. Surgical techniques to address pre-operative flexion contractures include: adequate bone resection, ligament releases, removal of posterior osteophytes, and posterior capsular releases. Post-operatively, extension can be maintained with focused physiotherapy, a specially modified continuous passive motion machine, a contralateral heel lift, and splinting.

  3. Does Extended-Release Liposomal Bupivacaine Better Control Pain Than Bupivacaine After Total Knee Arthroplasty (TKA)? A Prospective, Randomized Clinical Trial.

    PubMed

    Schroer, William C; Diesfeld, Paul G; LeMarr, Angela R; Morton, Diane J; Reedy, Mary E

    2015-09-01

    Liposomal bupivacaine periarticular injection (PAI) offers sustained bupivacaine release after TKA, but few prospective independent studies exist. In this prospective, blinded study, liposomal bupivacaine was randomized against bupivacaine and incorporated into a comprehensive multimodal pain management protocol. 111 primary TKAs were randomized to receive PAI: 58 patients received 266 mg (20cc) liposomal bupivacaine mixed with 75 mg (30cc) 0.25% bupivacaine, and 53 patients received 150 mg (60cc) 0.25% bupivacaine. Visual analog pain scores and narcotic use were determined. No pain score differences occurred between study and control patients: Day 1: 4.5/4.6 (P=0.73); Day 2: 4.4/4.8 (P=0.27); or Day 3: 3.5/3.7 (P=0.58). Narcotic use was similar during hospitalization, 51.8/54.2 (P=0.34). The study medication costs $285, and the control medication costs $2.80. This finding does not justify the routine use of liposomal bupivacaine.

  4. Painful knee arthroplasty: definition and overview

    PubMed Central

    Carulli, Christian; Villano, Marco; Bucciarelli, Giovanni; Martini, Caterina; Innocenti, Massimo

    2011-01-01

    Summary Total Knee Arthroplasty (TKA) is one of the most successful procedures in Orthopaedic Surgery, with good clinical results and high survival rate in more than 90% of the cases at long-term follow-up. Since the increase of population’s mean age, worsening of articular degenerative alterations, and articular sequelae related to previous fractures, there is a persistent growing of the number of knee arthroplasties in every country each year, with expected increase of complications rates. Painful TKA is considered an unusual complication, but several reports focus on this challenging clinical issue. Common causes of painful TKA may be divided as early or late, and in referred, periarticular or intra-articular. Among the early, we recall implant instability (related to surgical and technical mistakes) and problems of extensor mechanism (patella not resurfaced, malalignment of femoral, tibial, or patellar component, tendons failure or degeneration). Late causes of painful TKA are almost related to aseptic loosening and infection, but also, even if unusual, reflex sympathetic dystrophy, synovitis, and hypersensitivity to metal implants are represented. Hypersensitivity to metal is a clinical issue with significative increase, but to date without a specific characterization. The Authors report about incidence, clinical features, and diagnostic pathways of hypersensitivity to metal implants, focusing on the prevention of this challenging problem. PMID:22461811

  5. Subacute pain after total knee arthroplasty.

    PubMed

    Sauter, Axel; Breivik, Harald

    2014-06-01

    Acute pain during and immediately after total knee arthroplasty (TKA) can be well controlled by spinal anesthesia, local infiltration analgesia, and peripheral nerve blocks; this enables early or fast-track rehabilitation. However, about half of patients have clinically significant pain in the following weeks. Active movements and rehabilitation of joint function, muscle strength, and ability to maintain balance and prevent falls all become more difficult when the joint is painful on movement. Intensive analgesic and antihyperalgesic treatment during the first few weeks after TKA surgery may reduce the risk of chronic pain after this operation, which is itself intended to remove the patient's chronic osteoarthritis pain. Spinal cord stimulation may be an effective option for patients with mainly neuropathic pain after TKA surgery.

  6. Patient Satisfaction after Total Knee Arthroplasty

    PubMed Central

    Choi, Young-Joon

    2016-01-01

    Total knee arthroplasty (TKA) is one of the most successful and effective surgical options to reduce pain and restore function for patients with severe osteoarthritis. The purpose of this article was to review and summarize the recent literatures regarding patient satisfaction after TKA and to analyze the various factors associated with patient dissatisfaction after TKA. Patient satisfaction is one of the many patient-reported outcome measures (PROMs). Patient satisfaction can be evaluated from two categories, determinants of satisfaction and components of satisfaction. The former have been described as all of the patient-related factors including age, gender, personality, patient expectations, medical and psychiatric comorbidity, patient's diagnosis leading to TKA and severity of arthropathy. The latter are all of the processes and technical aspects of TKA, ranging from the anesthetic and surgical factors, type of implants and postoperative rehabilitations. The surgeon- and patient-reported outcomes have been shown to be disparate occasionally. Among various factors that contribute to patient satisfaction, some factors can be managed by the surgeon, which should be improved through continuous research. Furthermore, extensive discussion and explanation before surgery will reduce patient dissatisfaction after TKA. PMID:26955608

  7. Knee arthroplasty rating.

    PubMed

    Binazzi, R; Soudry, M; Mestriner, L A; Insall, J N

    1992-06-01

    A number of rating systems used to evaluate the results of total knee arthroplasty exist. Many of these systems are based on different concepts, and might be expected to give divergent results. To see if this was so, the authors examined a consecutive series of 235 posterior stabilized knee arthroplasties recording the results according to five rating systems: HSS (The Hospital for Special Surgery), Brigham, Freeman, BOA (British Orthopaedic Association), and the VENN diagram. In spite of their apparent differences, all point systems and the BOA gave almost identical results, while the VENN diagram proved to be the most stringent. The authors suggest that any of the current point systems may be used to "score" arthroplasties, but the results should also be rated with the VENN diagram in order to see the quality of the arthroplasty and a comparison between the different series.

  8. Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients: a survey of the AAHKS membership.

    PubMed

    Mesko, J W; Brand, R A; Iorio, R; Gradisar, I; Heekin, R; Leighton, R; Thornberry, R

    2001-09-01

    The American Association of Hip and Knee Surgeons (AAHKS) distributed a survey to its members exploring practice patterns implemented to prevent venous thromboembolic disease (VTED) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Of 720 (33%) members, 236 responded. Prophylaxis was prescribed for 100% of patients during the course of hospitalization for THA and TKA. Warfarin was the commonest pharmacologic treatment used for THA (66%) and TKA (59%) patients. Low-molecular-weight heparin was used in 16% of THA patients and 18% of TKA patients. The most commonly employed mechanical modality was pneumatic devices in THA (51%) and TKA (50%). Universal acceptance of the need for prophylaxis administration for patients undergoing THA and TKA is shown. The method and duration remain highly variable; although the survey illustrates such variation, it suggests there is no one best method of prophylaxis.

  9. Dislocation after total knee arthroplasty.

    PubMed

    Wazir, N N; Shan, Y; Mukundala, V V; Gunalan, R

    2007-05-01

    Two cases of dislocation of total knee arthroplasty presented to us within the same week. The first patient is a 71-year-old woman who underwent bilateral primary total knee arthroplasty. The left knee dislocated three weeks after the surgery. Due to failure of conservative measures, she underwent revision total knee arthroplasty. The other patient is a 72-year-old woman presenting ten years after primary total knee arthroplasty, with a traumatic dislocation of the knee joint. She was treated as an outpatient with closed manipulative reduction.

  10. Surgical approaches for total knee arthroplasty.

    PubMed

    Vaishya, Raju; Vijay, Vipul; Demesugh, Daniel Mue; Agarwal, Amit Kumar

    2016-01-01

    There are various surgical approaches to the knee joint and its surrounding structures and such approaches are generally designed to allow the best access to an area of pathology whilst safeguarding important surrounding structures. Controversy currently surrounds the optimal surgical approach for total knee arthroplasty (TKA). The medial parapatellar arthrotomy, or anteromedial approach, has been the most used and has been regarded as the standard approach for exposure of the knee joint. It provides extensive exposure and is useful for open anterior cruciate ligament reconstruction, total knee replacement, and fixation of intra-articular fractures. Because this approach has been implicated in compromise of the patellar circulation, some authors have advocated the subvastus, midvastus, and trivector approaches for exposure of the knee joint. While these approaches expose the knee from the medial side, the anterolateral approach exposes the knee joint from the lateral side. With careful planning and arthrotomy selection, the anterior aspect of the joint can be adequately exposed for TKA in different clinical scenarios. PMID:27182142

  11. Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

    PubMed Central

    Lum, Z. C.; Lombardi, A. V.; Hurst, J. M.; Morris, M. J.; Adams, J. B.; Berend, K. R.

    2016-01-01

    Aims Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts. Patients and Methods A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed. Results The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively). Conclusion We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28–33. PMID:27694513

  12. Results of sleeves in revision total knee arthroplasty: an editorial comment on recently published in the Journal of Arthroplasty

    PubMed Central

    Jiang, Chao

    2015-01-01

    The paper entitled “Direct, cementless, metaphyseal fixation in knee revision arthroplasty with sleeves-short-term results” published in the Journal of Arthroplasty to analyze the short- and mid-term results in revision total knee arthroplasty (TKA) in a largest series so far. This article shown that cementless metaphyseal fixation with sleeves is a promising option for revision TKA implant fixation. The clinical outcomes regarding the range of motion and the KSS are also promising. Based on this article and related literatures about sleeves, we assess the short to mid-term outcomes and the clinical perspectives in revision TKAs. PMID:26697477

  13. Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision

    PubMed Central

    Toliopoulos, Panagiota; LeBlanc, Marc-Andre; Hutt, Jonathan; Lavigne, Martin; Desmeules, Francois; Vendittoli, Pascal-Andre

    2016-01-01

    Objectives: The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA. Methods: Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files. Results: The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded. Conclusion: Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted. PMID:27563365

  14. Computer-Navigated Total Knee Arthroplasty Utilization.

    PubMed

    Bala, Abiram; Penrose, Colin Thomas; Seyler, Thorsten Markus; Mather, Richard Chad; Wellman, Samuel Secord; Bolognesi, Michael Paul

    2016-07-01

    Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs and operative time, we hypothesized that the utilization rate of CN-TKA would be decreasing relative to standard TKA in the Medicare population given the current health care economic environment. We queried 1,914,514 primary TKAs performed in the entire Medicare database from 2005 to 2012. Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify and separate CN-TKAs. Utilization of TKA was compared by year, gender, and region. Average change in cases per year and compound annual growth rate (CAGR) were used to evaluate trends in utilization of the procedure. We identified 30,773 CN-TKAs performed over this time period. There was an increase in utilization of CN-TKA per year from 984 to 5,352 (average = 572/year, R (2) = 0.85, CAGR = 23.58%) from 2005 to 2012. In contrast, there was a slight decrease in overall TKA utilization from 264,345 to 230,654 (average = 4297/year, R (2) = 0.74, CAGR = - 1.69%). When comparing proportion of CN-TKA to all TKAs, there was an increase from 0.37 to 2.32% (average 0.26%/year, R (2) = 0.88, CAGR = 25.70%). CN-TKA growth in males and females was comparable at 24.42 and 23.11%, respectively. The South region had the highest growth rate at 28.76%, whereas the Midwest had the lowest growth rate at 15.51%. The Midwest was the only region that peaked (2008) with a slow decline in utilization until 2012. Despite increased costs with unclear clinical benefit, CN-TKA is increasing in utilization among Medicare patients. Reasons could include patient preference, advertising, proper of coding the procedure, and increased publicly available information about

  15. Fracture of the Tibial Baseplate in Bicompartmental Knee Arthroplasty.

    PubMed

    Stuyts, Bart; Vandenberghe, Melanie; Van der Bracht, Hans; Fortems, Yves; Van den Eeden, Elke; Cuypers, Luc

    2015-01-01

    Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis. PMID:26843998

  16. Fracture of the Tibial Baseplate in Bicompartmental Knee Arthroplasty

    PubMed Central

    Stuyts, Bart; Vandenberghe, Melanie; Van der Bracht, Hans; Fortems, Yves; Van den Eeden, Elke; Cuypers, Luc

    2015-01-01

    Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis. PMID:26843998

  17. Translational and rotational knee joint stability in anterior and posterior cruciate-retaining knee arthroplasty.

    PubMed

    Lo, JiaHsuan; Müller, Otto; Dilger, Torsten; Wülker, Nikolaus; Wünschel, Markus

    2011-12-01

    This study investigated passive translational and rotational stability properties of the intact knee joint, after bicruciate-retaining bi-compartmental knee arthroplasty (BKA) and after posterior cruciate retaining total knee arthroplasty (TKA). Fourteen human cadaveric knee specimens were used in this study, and a robotic manipulator with six-axis force/torque sensor was used to test the joint laxity in anterior-posterior translation, valgus-varus, and internal-external rotation. The results show the knee joint stability after bicruciate-retaining BKA is similar to that of the native knee. On the other hand, the PCL-retaining TKA results in inferior joint stability in valgus, varus, external rotation, anterior and, surprisingly, posterior directions. Our findings suggest that, provided functional ligamentous structures, bicruciate-retaining BKA is a biomechanically attractive treatment for joint degenerative disease.

  18. Rotational stability of a posterior stabilized total knee arthroplasty.

    PubMed

    Whiteside, L A; Amador, D D

    1989-05-01

    The effect of the posterior stabilizing mechanism on rotational stability in total knee arthroplasty (TKA) was investigated in six cadaver knees using a special knee-testing device. The device evaluated varus-valgus, rotational, and anteroposterior (AP) stability in the normal knee compared to a posterior stabilized TKA with either a rotationally constrained or an unconstrained articular surface. None of the stability parameters was significantly different from normal in either configuration of the tibial surface, but the constrained surface did decrease rotational deflection compared to the rotationally unconstrained surfaces. These findings show that rotational constraint in a posterior stabilized TKA is not necessary to achieve rotational stability as long as varus-valgus stability is achieved by appropriately tensioning the collateral ligaments. PMID:2706852

  19. Knee-Extension Training with a Single-Joint Hybrid Assistive Limb during the Early Postoperative Period after Total Knee Arthroplasty in a Patient with Osteoarthritis

    PubMed Central

    Sugaya, Hisashi; Kubota, Shigeki; Onishi, Mio; Kanamori, Akihiro; Sankai, Yoshiyuki; Yamazaki, Masashi

    2016-01-01

    The knee range of motion is an important outcome of total knee arthroplasty (TKA). According to previous studies, the knee range of motion temporarily decreases for approximately 1 month after TKA due to postoperative pain and quadriceps dysfunction following surgical invasion into the knee extensor mechanism. We describe our experience with a knee-extension training program based on a single-joint hybrid assistive limb (HAL-SJ, Cyberdyne Inc., Tsukuba, Japan) during the acute recovery phase after TKA. HAL-SJ is a wearable robot suit that facilitates the voluntary control of knee joint motion. A 76-year-old man underwent HAL-SJ-based knee-extension training, which enabled him to perform knee function training during the acute phase after TKA without causing increased pain. Thus, he regained the ability to fully extend his knee postoperatively. HAL-SJ-based knee-extension training can be used as a novel post-TKA rehabilitation modality. PMID:27774330

  20. A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

    PubMed Central

    van Jonbergen, Hans-Peter W.; Barnaart, Alexander F.W.; Verheyen, Cees C.P.M.

    2010-01-01

    Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty. PMID:21228917

  1. Metaphyseal bone loss in revision knee arthroplasty.

    PubMed

    Ponzio, Danielle Y; Austin, Matthew S

    2015-12-01

    The etiology of bone loss encountered during revision total knee arthroplasty (TKA) is often multifactorial and can include stress shielding, osteolysis, osteonecrosis, infection, mechanical loss due to a grossly loose implant, and iatrogenic loss at the time of implant resection. Selection of the reconstructive technique(s) to manage bone deficiency is determined by the location and magnitude of bone loss, ligament integrity, surgeon experience, and patient factors including the potential for additional revision, functional demand, and comorbidities. Smaller, contained defects are reliably managed with bone graft, cement augmented with screw fixation, or modular augments. Large metaphyseal defects require more extensive reconstruction such as impaction bone grafting with or without mesh augmentation, prosthetic augmentation, use of bulk structural allografts, or use of metaphyseal cones or sleeves. While each technique has advantages and disadvantages, the most optimal method for reconstruction of large metaphyseal bone defects during revision TKA is not clearly established. PMID:26362647

  2. Blood Management Strategies in Total Knee Arthroplasty

    PubMed Central

    Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-01-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

  3. Blood Management Strategies in Total Knee Arthroplasty

    PubMed Central

    Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-01-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  4. Blood Management Strategies in Total Knee Arthroplasty.

    PubMed

    Liu, David; Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-09-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  5. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty.

    PubMed

    Morishita, Masayuki; Ishida, Kazunari; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Kurosaka, Masahiro; Tsumura, Nobuhiro

    2014-12-01

    This randomized controlled study was conducted to assess the effects of platelet-rich plasma (PRP) on outcomes of total knee arthroplasty (TKA). Forty patients who underwent unilateral TKA were evaluated prospectively; 20 received intraoperative PRP and 20 served as control subjects. The results showed no significant differences in reduction of bleeding, range of motion, swelling around the knee joint, muscle power recovery, pain, Knee Society Scores, and Knee Injury and Osteoarthritis Outcome Score between the 2 groups. Additionally, no distinct clinical characteristics were found in patients who received intraoperative PRP. Therefore, we conclude that intraoperative PRP does not improve outcomes of TKA.

  6. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

    PubMed

    Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L

    2011-08-01

    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.

  7. Anterior knee pain following primary total knee arthroplasty.

    PubMed

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-11-18

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  8. Anterior knee pain following primary total knee arthroplasty

    PubMed Central

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-01-01

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  9. The effect of total knee arthroplasty on knee joint kinematics and kinetics during gait.

    PubMed

    Hatfield, Gillian L; Hubley-Kozey, Cheryl L; Astephen Wilson, Janie L; Dunbar, Michael J

    2011-02-01

    This study determined how total knee arthroplasty (TKA) altered knee motion and loading during gait. Three-dimensional kinematic and kinetic gait patterns of 42 patients with severe knee osteoarthritis were collected 1 week prior and 1-year post-TKA. Principal component analysis extracted major patterns of variability in the gait waveforms. Overall and midstance knee adduction moment magnitude decreased. Overall knee flexion angle magnitude increased due to an increase during swing. Increases in the early stance knee flexion moment and late stance knee extension moment were found, indicating improved impact attenuation and function. A decrease in the early stance knee external rotation moment indicated alteration in the typical rotation mechanism. Most changes moved toward an asymptomatic pattern and would be considered improvements in motion, function, and loading.

  10. Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity

    PubMed Central

    Gupta, Ryan; Phan, Duy; Schwarzkopf, Ran

    2015-01-01

    Patient: Female, 70 Final Diagnosis: Metal hypersensitivity Symptoms: Joint pain • swelling • instability Medication: — Clinical Procedure: Revision total knee arthroplasty Specialty: Orthopedics and Traumatology Objective: Unusual clinical course Background: Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure. Case Report: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure. Conclusions: This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery. PMID:26278890

  11. The effect of modern total knee arthroplasty on muscle balance at the knee.

    PubMed

    Buford, William L; Ivey, F; Loveland, Dustin M; Flowers, Christopher W

    2009-01-01

    Total Knee Arthroplasty (TKA) may affect the muscles operating at the flexion/extension (FE) or internal /external rotation (IE) axes. This study tested the hypothesis that a modern posterior stabilizing TKA will change the mechanical balance of the knee joint by altering the moment arms of muscles acting about two separate axes of rotation. Moment arms were determined for the normal knee, the knee after resection of the Anterior Cruciate Ligament (the ACL - knee) and the knee after a PCL-sacrificing TKA. Five fresh cadaver hemi pelvis specimens were used with 5 posterior stabilizing prostheses (a single model available from one manufacturer). Moment arms for the individual muscle tendons were multiplied by the muscle's tension fraction (fractional physiological cross-sectional area [PCSA]) to estimate its potential for moment production relative to the other muscles at the knee, and this value was labeled as the muscle's moment potential. Unlike earlier studies that looked at TKA across many manufacturers' types, this study concluded that there were no significant differences in muscle balance when comparing the intact knee and the posterior stabilized TKA.

  12. Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners.

    PubMed

    Van Manen, Mike D; Nace, James; Mont, Michael A

    2012-11-01

    Osteoarthritis (OA) of the knee, one of the most common causes of disability, continues to increase in prevalence as the older adult and obese populations grow. Often, the general practitioner is the first to evaluate a patient with a painful knee that has arthritis. Evidence-based evaluation and treatment guidelines recommend the use of nonoperative treatments before surgical treatment options such as total knee arthroplasty (TKA) are considered. Understanding available nonoperative treatment options is critical for physicians who first encounter patients with OA of the knee. The authors provide an overview of nonoperative treatment options for patients with OA, including weight loss, aerobic exercise, osteopathic manipulative treatment, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. The authors also discuss operative treatment options to be considered before TKA and review indications for TKA when other treatment options have been exhausted.

  13. Similar outcome for total knee arthroplasty after previous high tibial osteotomy and for total knee arthroplasty as the first measure.

    PubMed

    W-Dahl, Annette; Robertsson, Otto

    2016-08-01

    Background and purpose - Patients having a total knee arthroplasty (TKA) after a previous high tibial osteotomy (HTO) constitute a minor group among those undergoing primary TKA for knee osteoarthritis (OA). There have been few reports on whether such patients differ pre- and postoperatively from those who undergo TKA as the first measure. We evaluated patient characteristics, knee-related pain, function, quality of life, and general health before and 1 year after TKA surgery in these 2 groups of patients. Patients and methods - We included 119 HTOs that were operated on for knee OA in the Skåne region, Sweden, in the period1998-2007 and that had been converted to a TKA during 2009-2013 (the C group). We also included 5,013 primary TKAs performed for knee OA in the same region, during the same period, and in patients of the same age range (42-82 years) (the P group). The patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-VAS preoperatively and 1 year after the TKA surgery, when they were also asked about their satisfaction with the surgery. Case-mix variables available were Charnley category, American Society of Anesthesiologists (ASA) classification, sex, age, and body mass index (BMI). Results - Most of the HTOs were performed using open-wedge osteotomy with external fixation (81 of 119). Compared to the P group, the patients in the C group were more often men, were younger, and were healthier (according to the ASA classification). With respect to pre- and postoperative knee-related pain, function, quality of life, and general health, the 2 groups had similar mean values without any statistically significant differences. A similar proportion of patients in the 2 groups were satisfied with the surgery 1 year postoperatively (82% vs. 80%). Interpretation - Our findings indicate that HTO is a reasonable alternative for delaying TKA surgery in younger and/or physically active OA patients. PMID:27339330

  14. Short term outcomes of revision total knee arthroplasty.

    PubMed

    Dieterich, James D; Fields, Adam C; Moucha, Calin S

    2014-11-01

    Few studies have assessed postoperative complications in revision total knee arthroplasty (rTKA). The aim of this study was to assess which preoperative factors are associated with postoperative complications in rTKA. Using the National Surgical Quality Improvement (NSQIP) database, we identified patients undergoing rTKA from 2010 to 2012. Patient demographics, comorbidities, and complications within thirty days of surgery were analyzed. A total of 3421 patients underwent rTKA. After adjusted analysis, dialysis (P = 0.016) was associated with minor complications. Male gender (P = 0.03), older age (P = 0.029), ASA class >2 (P = 0.017), wound class >2 (P < 0.0001), emergency operation (P = 0.038), and pulmonary comorbidity (P = 0.047) were associated with major complications.

  15. The potential of accelerometers in the evaluation of stability of total knee arthroplasty.

    PubMed

    Khan, Humera; Walker, Peter S; Zuckerman, Joseph D; Slover, James; Jaffe, Fredrick; Karia, Raj J; Kim, Joo H

    2013-03-01

    An accelerometer attached to the anterior proximal tibia was investigated as an evaluation of knee stability of Total Knee Arthroplasty (TKA) patients while performing daily activities. Acceleration data of 38 TKA knees with a minimum follow up of 6months were compared with 34 control knees. The activities performed were: walking three steps forward and coming to a sudden stop; turning in the direction of non-tested knee; sit-to-stand; and stepping up and down from a 7 inch step. The acceleration results showed significant differences between TKA and controls while stepping down and while turning in the non-tested knee direction. The higher accelerations with the TKA group may have represented an objective measure of stability, even if this was not directly discernible to the patient. PMID:23122873

  16. Patellofemoral resurfacing at total knee arthroplasty.

    PubMed

    Harwin, S F; Stein, A J; Stern, R E

    1994-10-01

    A retrospective review of 268 primary total knee arthroplasties (TKAs) with a mean follow-up of four years is presented. The patellae were resurfaced in all cases. There were six complications (2.2%) referable to the patellofemoral articulation: three subluxations, one patellar fracture, one loosening of a metal-backed patellar component, and one patellar tendon avulsion. Successful patellofemoral resurfacing (PFR) can be accomplished with minimal complications if the following technical considerations are met: 5-7 degrees of valgus alignment; medial placement of the patellar component; taking care not to increase either the AP diameter of the knee or the thickness of the patella; avoiding internal rotation of either the tibial or femoral components and proper soft tissue balancing. A thorough review of patellofemoral complications after TKA is presented, and technical considerations relevant to the successful performance of PFR are discussed.

  17. Total knee arthroplasty using subvastus approach in stiff knee: A retrospective analysis of 110 cases

    PubMed Central

    Shah, Nilen A; Patil, Hitendra Gulabrao; Vaishnav, Vinod O; Savale, Abhijit

    2016-01-01

    Background: Subvastus approach used in total knee arthroplasty (TKA) is known to produce an earlier recovery but is not commonly utilized for TKA when the preoperative range of motion (ROM) of the knee is limited. Subvastus approach is known for its ability to give earlier recovery due to less postoperative pain and early mobilization (due to rapid quadriceps recovery). Subvastus approach is considered as a relative contraindication for TKA in knees with limited ROM due to difficulty in exposure which can increase risk of complications such as patellar tendon avulsion or medial collateral injury. Short stature and obesity are also relative contraindications. Tarabichi successfully used subvastus approach in knees with limited preoperative ROM. However, there are no large series in literature with the experience of the subvatus approach in knees with limited preoperative ROM. We are presenting our experience of the subvastus approach for TKA in knees with limited ROM. Materials and Methods: We conducted retrospective analysis of patients with limited preoperative ROM (flexion ≤90°) of the knee who underwent TKA using subvastus approach and presenting the 2 years results. There were a total 84 patients (110 knees) with mean age 64 (range 49–79 years) years. The mean preoperative flexion was 72° (range 40°–90°) with a total ROM of 64° (range 36°–90°). Results: Postoperatively knee flexion improved by mean 38° (P < 0.05) which was significant as assed by Student's t- test. The mean knee society score improved from 36 (range 20–60) to 80 (range 70–90) postoperatively (P < 0.05). There was one case of partial avulsion of patellar tendon from the tibial tubercle. Conclusions: We concluded that satisfactory results of TKA can be obtained in knees with limited preoperative ROM using subvastus approach maintaining the advantages of early mobilization. PMID:27053806

  18. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty.

    PubMed

    Arnold, John B; Mackintosh, Shylie; Olds, Timothy S; Jones, Sara; Thewlis, Dominic

    2015-12-01

    Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity.

  19. Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty.

    PubMed

    Hamilton, William G; Reeves, James D; Fricka, Kevin B; Goyal, Nitin; Engh, Gerard A; Parks, Nancy L

    2015-01-01

    The purpose of this study was to determine the rate of thromboembolic and bleeding complications when using mechanical prophylaxis with preoperative risk stratification following total knee arthroplasty (TKA). Between 1994 and 2007, 4037 TKAs were performed on 3144 patients at our institution. Mechanical VTE prophylaxis was used for standard risk patients, which included AV impulse foot pumps, thigh high stockings, and early mobilization. Chemoprophylaxis was only given to patients who were at increased thromboembolic risk. The incidence of DVT identified by ultrasound following TKA was 2.1%. A retrospective review showed 1 patient had a fatal pulmonary embolism, and 5 patients had bleeding complications in the knee. We conclude that mechanical thromboembolic prophylaxis using risk stratification is safe and effective following TKA.

  20. The femoral sulcus in total knee arthroplasty.

    PubMed

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  1. The difficult primary total knee arthroplasty: a review.

    PubMed

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.

  2. Mechanoreceptors found in a posterior cruciate ligament from a well-functioning total knee arthroplasty retrieval.

    PubMed

    Mihalko, William M; Creek, Aaron T; Mary, Michelle N; Williams, John L; Komatsu, David E

    2011-04-01

    Histologic analysis of the posterior cruciate ligament has been reported in the normal and osteoarthritic knee but not after cruciate-retaining (CR) total knee arthroplasty (TKA). Retention of the posterior cruciate ligament during TKA has been debated as to whether it is beneficial in stability and function. If the presence of mechanoreceptors is shown to be maintained in CR TKA, then there may be an argument for retention. This case report used a retrieval of a well-functioning TKA specimen that had a CR TKA. To prove the presence of mechanoreceptors within the ligament, immunohistochemistry techniques using S100 protein and neurofilament protein were used. This specimen had pacini and lamellar type of mechanoreceptors present on immunohistochemistry analysis. The presence or retention of mechanoreceptors and innervations of the ligament may indicate an advantage when retained during TKA.

  3. Can technology improve alignment during knee arthroplasty.

    PubMed

    Thienpont, Emmanuel; Fennema, Peter; Price, Andrew

    2013-09-01

    Component malalignment remains a concern in total knee arthroplasty (TKA); therefore, a series of technologies have been developed to improve alignment. The authors conducted a systematic review to compare computer-assisted navigation with conventional instrumentation, and assess the current evidence for patient-matched instrumentation and robot-assisted implantation. An extensive search of the PubMed database for relevant meta-analyses, systematic reviews and original articles was performed, with each study scrutinised by two reviewers. Data on study characteristics and outcomes were extracted from each study and compared. In total 30 studies were included: 10 meta-analyses comparing computer-assisted navigation and conventional instrumentation, 13 studies examining patient-matched instrumentation, and seven investigating robot-assisted implantation. Computer-assisted navigation showed significant and reproducible improvements in mechanical alignment over conventional instrumentation. Patient-matched instrumentation appeared to achieve a high degree of mechanical alignment, although the majority of studies were of poor quality. The data for robot-assisted surgery was less indicative. Computer-assisted navigation improves alignment during TKA over conventional instrumentation. For patient-matched instrumentation and robot-assisted implantation, alignment benefits have not been reliably demonstrated. For all three technologies, clinical benefits cannot currently be assumed, and further studies are required. Although current technologies to improve alignment during TKA appear to result in intra-operative benefits, their clinical impact remains unclear, and surgeons should take this into account when considering their adoption.

  4. Lifetime medical costs of knee osteoarthritis management in the United States: Impact of extending indications for total knee arthroplasty

    PubMed Central

    Losina, Elena; Paltiel, A. David; Weinstein, Alexander M.; Yelin, Edward; Hunter, David J.; Chen, Stephanie P.; Klara, Kristina; Suter, Lisa G.; Solomon, Daniel H.; Burbine, Sara A.; Walensky, Rochelle P.; Katz, Jeffrey N.

    2015-01-01

    Objective The impact of increasing utilization of total knee arthroplasty (TKA) on lifetime costs in persons with knee OA is under-studied. Methods We used the Osteoarthritis Policy Model to estimate total lifetime costs and TKA utilization under a range of TKA eligibility criteria among US persons with symptomatic knee OA. Current TKA utilization was estimated from the Multicenter Osteoarthritis Study and calibrated to Health Care Utilization Project (HCUP) data. OA treatment efficacy and toxicity were drawn from published literature. Costs in 2013 USD were derived from Medicare reimbursement schedules and Red Book Online®. Time costs were derived from published literature and the US Bureau of Labor Statistics. Results Estimated average discounted (3%/year) lifetime costs for persons diagnosed with knee OA were $140,300. Direct medical costs were $129,600, with $12,400 (10%) attributable to knee OA over 28 years. OA patients spent, on average, 13 (SD 10) years waiting for TKA after failing non-surgical regimens. Under current TKA eligibility criteria, 54% of knee OA patients underwent TKA over their lifetimes. Estimated OA-related discounted lifetime direct medical costs ranged from $12,400 (54% TKA uptake) when TKA eligibility was limited to K-L 3 or 4 to $16,000 (70% TKA uptake) when eligibility was expanded to include symptomatic OA with a lesser degree of structural damage. Conclusion Due to low efficacy of non-surgical regimens, knee OA treatment-attributable costs are low, representing a small portion of all costs for OA patients. Expanding TKA eligibility increases OA-related costs substantially for a population, underscoring the need for more effective non-operative therapies. PMID:25048053

  5. Cost-effectiveness of Total Knee Arthroplasty in the United States

    PubMed Central

    Losina, Elena; Walensky, Rochelle P.; Kessler, Courtenay L.; Emrani, Parastu S.; Reichmann, William M.; Wright, Elizabeth A.; Holt, Holly L.; Solomon, Daniel H.; Yelin, Edward; Paltiel, A. David; Katz, Jeffrey N.

    2009-01-01

    Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters’ influences on cost-effectiveness. Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers. PMID:19546411

  6. History of previous knee surgery does not affect the clinical outcomes of primary total knee arthroplasty in an Asian population

    PubMed Central

    Loh, Bryan; Chong, Hwei Chi; Tan, Andrew Hwee Chye

    2016-01-01

    Background Patients with a history of previous knee surgeries, such as anterior cruciate ligament reconstruction (ACLR) and high tibial osteotomy (HTO), often have a higher likelihood of requiring a subsequent total knee arthroplasty (TKA). However, there is relatively limited data, especially in the Asian population, on how previous knee surgery could affect the clinical outcomes of TKA. Therefore, this study aims to evaluate the impact of previous knee surgeries on the clinical outcomes of future TKA. Methods We reviewed the prospectively-collected data of 303 patients who underwent TKA by a single surgeon from a total joint registry of a tertiary hospital over a period of 5 years. Those with a history of previous knee surgery were identified. The SF-36 Health Survey, Oxford Knee Score (OKS) and Knee Society Score (KSS) were used to evaluate clinical outcomes pre-operatively, at 6 months and 2 years. Results Previous knee surgery did not have a significant impact on the patients’ pre-operative baseline clinical scores and body mass index (BMI). Patients with a history of knee surgery undergo TKA at a significantly younger age (mean of 6.6 years younger). On follow-up, patients with a history of knee surgery have similar post-operative outcome scores as those without previous knee surgery. Also, a high proportion of these patients are satisfied with their post-operative results and feel that their expectations have been met. Conclusions Patients with previous knee surgery had TKA at a significantly younger age than those without. But these patients have similar clinical and quality of life outcomes after TKA. In addition, a high proportion of these patients are satisfied with the results of surgery and feel that their expectations of TKA are met. This is important for clinicians when counselling patients pre-operatively.

  7. History of previous knee surgery does not affect the clinical outcomes of primary total knee arthroplasty in an Asian population

    PubMed Central

    Loh, Bryan; Chong, Hwei Chi; Tan, Andrew Hwee Chye

    2016-01-01

    Background Patients with a history of previous knee surgeries, such as anterior cruciate ligament reconstruction (ACLR) and high tibial osteotomy (HTO), often have a higher likelihood of requiring a subsequent total knee arthroplasty (TKA). However, there is relatively limited data, especially in the Asian population, on how previous knee surgery could affect the clinical outcomes of TKA. Therefore, this study aims to evaluate the impact of previous knee surgeries on the clinical outcomes of future TKA. Methods We reviewed the prospectively-collected data of 303 patients who underwent TKA by a single surgeon from a total joint registry of a tertiary hospital over a period of 5 years. Those with a history of previous knee surgery were identified. The SF-36 Health Survey, Oxford Knee Score (OKS) and Knee Society Score (KSS) were used to evaluate clinical outcomes pre-operatively, at 6 months and 2 years. Results Previous knee surgery did not have a significant impact on the patients’ pre-operative baseline clinical scores and body mass index (BMI). Patients with a history of knee surgery undergo TKA at a significantly younger age (mean of 6.6 years younger). On follow-up, patients with a history of knee surgery have similar post-operative outcome scores as those without previous knee surgery. Also, a high proportion of these patients are satisfied with their post-operative results and feel that their expectations have been met. Conclusions Patients with previous knee surgery had TKA at a significantly younger age than those without. But these patients have similar clinical and quality of life outcomes after TKA. In addition, a high proportion of these patients are satisfied with the results of surgery and feel that their expectations of TKA are met. This is important for clinicians when counselling patients pre-operatively. PMID:27668223

  8. Effect of Rotational Component Alignment on Clinical Outcome 5 to 7 Years After TKA With the Columbus Knee System.

    PubMed

    Thielemann, Friedrich W; Konstantinids, Lukas; Herget, Georg W; Knothe, Dagmar; Helwig, Peter; Sudkamp, Norbert P; Hauschild, Oliver

    2016-05-01

    The aim of the study was to examine the effects of rotational component alignment on outcome after total knee arthroplasty (TKA) with a minimum follow-up of 5 years. For this study, 96 patients were available for follow-up at a mean of 5.7 years after TKA. Computed tomography scans were available in 55 patients. Outcome (Oxford Knee Score [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], 36-item Short Form Health Survey) was correlated with postoperative femoral and tibial component malrotation or femorotibial rotational alignment mismatch. Results showed that femoral or tibial component malrotation or femorotibial mismatch were present in 15.5%, 38.2%, and 29.1% of patients, respectively. Although femoral componoent malrotation was associated with significantly poorer, KSS and KOOS scores, outcome was comparable for patients with or without tibial component malrotation or femorotibial mismatch. In conclusion, both internal and external rotational femoral malalignment exceeding 3° is associated with significantly poorer subjective and objective outcome 5 to 7 years after TKA. Tibial component malrotation and femorotibial mismatch were more common, but did not significantly compromise outcome. [Orthopedics. 2016; 39(3):S50-S55.].

  9. Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

    PubMed Central

    Lee, Ju Hong

    2015-01-01

    Background We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. Methods We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. Results The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups

  10. Overview of Total Knee Arthroplasty and Modern Pain Control Strategies.

    PubMed

    Lavie, Lacey Giambelluca; Fox, M Patricia; Dasa, Vinod

    2016-11-01

    Perioperative pain management of total knee arthroplasty (TKA) remains a challenge for physicians and anesthesiologists. Reducing postoperative pain is an essential component of patient satisfaction, functional outcomes, and hospital length of stay. Multimodal pain management regimens have been demonstrated to be superior to monotherapy in achieving adequate pain control, as well as an effective method of limiting side effects of analgesics. In the present investigation, we present literature published over the last year relating to new advancements in perioperative pain management for TKA. While it is widely accepted that methods including peripheral nerve blocks and local anesthetic injections are essential to pain protocols, there is still conflicting evidence over what modalities provide superior relief. The incorporation of cryoneurolysis preoperatively is a new modality which has been incorporated and has been shown to improve pain control in patients undergoing TKA.

  11. Predicting poor physical performance after total knee arthroplasty.

    PubMed

    Bade, Michael J; Wolfe, Pamela; Zeni, Joseph A; Stevens-Lapsley, Jennifer E; Snyder-Mackler, Lynn

    2012-11-01

    The purpose of this study was to develop a preliminary decision algorithm predicting functional performance outcomes to aid in the decision of when to undergo total knee arthroplasty (TKA). One hundred and nineteen patients undergoing primary unilateral TKA were evaluated before and 6 months after TKA. A regression tree analysis using a recursive partitioning function was performed with the Timed Up and Go (TUG) time, Six-Minute Walk (6MW) distance, and Stair Climbing Test (SCT) time as measured 6 months after TKA as the primary outcomes. Preoperative measures of functional performance, joint performance, anthropometrics, demographics, and self-reported status were evaluated as predictors of the primary outcomes 6 months after surgery. Individuals taking ≥10.1 s on the TUG and aged 72 years or older before surgery had the poorest performance on the TUG 6 months after surgery. Individuals walking <314 meters on the 6MW before surgery had the poorest performance on the 6MW test 6 months after surgery. Individuals taking ≥17 s to complete the SCT and scoring <40 on the SF-36 mental component score before surgery had the poorest performance on the SCT 6 months after surgery. Poorer performance preoperatively on the 6MW, SCT, and TUG, was related to poorer performance in the same measure after TKA. Age and decreased mental health were secondary predictors of poorer performance at 6 months on the TUG and SCT, respectively. These measures may help further develop models predicting thresholds for poor outcomes after TKA.

  12. Predicting Poor Physical Performance after Total Knee Arthroplasty

    PubMed Central

    Bade, Michael J; Wolfe, Pamela; Zeni, Joseph A; Stevens-Lapsley, Jennifer E.; Snyder-Mackler, Lynn

    2012-01-01

    The purpose of this study was to develop a preliminary decision algorithm predicting functional performance outcomes to aid in the decision of when to undergo total knee arthroplasty (TKA). One hundred nineteen patients undergoing primary unilateral TKA were evaluated before and 6 months after TKA. A regression tree analysis using a recursive partitioning function was performed with the Timed Up and Go (TUG) time, Six-Minute Walk (6MW) distance, and Stair Climbing Test (SCT) time as measured 6 months after TKA as the primary outcomes. Preoperative measures of functional performance, joint performance, anthropometrics, demographics, and self reported status were evaluated as predictors of the primary outcomes 6 months after surgery. Individuals taking ≥ 10.1 seconds on the TUG and aged 72 years or older before surgery had the poorest performance on the TUG 6 months after surgery. Individuals walking < 314 meters on the 6MW before surgery had the poorest performance on the 6MW test 6 months after surgery. Individuals taking ≥ 17 seconds to complete the SCT and scoring < 40 on the SF-36 mental component score before surgery had the poorest performance on the SCT 6 months after surgery. Poorer performance preoperatively on the 6MW, SCT, and TUG, was related to poorer performance in the same measure after TKA. Age and decreased mental health were secondary predictors of poorer performance at 6 months on the TUG and SCT, respectively. These measures may help further develop models predicting thresholds for poor outcomes after TKA. PMID:22539338

  13. Extensor tendon ruptures after total knee arthroplasty.

    PubMed

    Bonnin, M; Lustig, S; Huten, D

    2016-02-01

    Extensor tendon rupture is a rare but serious complication after total knee arthroplasty (TKA) that impairs active knee extension, thereby severely affecting knee function. Surgery is usually required. Surgical options range from simple suturing to allograft reconstruction of the entire extensor mechanism and include intermediate methods such as reconstruction using neighbouring tendons or muscles, synthetic ligament implantation, and partial allograft repair. Simple suturing carries a high failure rate and should therefore be routinely combined with tissue augmentation using a neighbouring tendon or a synthetic ligament. After allograft reconstruction, outcomes are variable and long-term complications common. Salvage procedures for managing the most severe cases after allograft failure involve reconstruction using gastrocnemius or vastus flaps. Regardless of the technique used, suturing must be performed under tension, with the knee fully extended, and rehabilitation must be conducted with great caution. Weaknesses of available case-series studies include small sample sizes, heterogeneity, and inadequate follow-up duration. All treatment options are associated with substantial failure rates. The patient should be informed of this fact and plans made for a salvage option. Here, the main techniques and their outcomes are discussed, and a therapeutic strategy is suggested.

  14. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific.

    PubMed

    Astephen Wilson, Janie L; Dunbar, Michael J; Hubley-Kozey, Cheryl L

    2015-01-01

    The future of total knee arthroplasty (TKA) surgery will involve planning that incorporates more patient-specific characteristics. Despite known biological, morphological, and functional differences between men and women, there has been little investigation into knee joint biomechanical and neuromuscular differences between men and women with osteoarthritis, and none that have examined sex-specific biomechanical and neuromuscular responses to TKA surgery. The objective of this study was to examine sex-associated differences in knee kinematics, kinetics and neuromuscular patterns during gait before and after TKA. Fifty-two patients with end-stage knee OA (28 women, 24 men) underwent gait and neuromuscular analysis within the week prior to and one year after surgery. A number of sex-specific differences were identified which suggest a different manifestation of end-stage knee OA between the sexes.

  15. Early PROMs following total knee arthroplasty--functional outcome dependent on patella resurfacing.

    PubMed

    Baker, Paul N; Petheram, Timothy; Dowen, Daniel; Jameson, Simon S; Avery, Peter J; Reed, Mike R; Deehan, David J

    2014-02-01

    Patella resurfacing during primary total knee arthroplasty (TKA) remains controversial. Variation in published results for patella resurfacing may potentially be explained by differences in design between TKA brands. We interrogated NJR-PROMs data to ascertain whether there is an early functional benefit to resurfacing the patella, both overall and for each of the five most popular primary knee designs through use of the Oxford Knee Score. A total of 8103 resurfaced TKAs and 15,290 nonresurfaced TKAs were studied. There was a large variation in the proportion of knees undergoing patella resurfacing by brand (Nexgen=16% versus Triathlon=52%). Patellar resurfacing did not significantly influence the magnitude of improvement in overall knee function or anterior knee-specific function irrespective of TKA brand or for cruciate retaining versus sacrificing designs.

  16. Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis

    PubMed Central

    Wang, Ying; Bian, Yanyan; Feng, Bin; Weng, Xisheng

    2016-01-01

    Introduction Although being debated for many years, the superiority of posterior cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior-stabilized (PS) TKA remains controversial. We compare the knee scores, post-operative knee range of motion (ROM), radiological outcomes about knee kinematic and complications between CR TKA and PS TKA. Methods Literature published up to August 2015 was searched in PubMed, Embase and Cochrane databases, and meta-analysis was performed using the software, Review Manager version 5.3. Results Totally 14 random control trials (RCTs) on this topic were included for the analysis, which showed that PS and CR TKA had no significant difference in Knee Society knee Score (KSS), pain score (KSPS), Hospital for Special Surgery score (HSS), kinematic characteristics including postoperative component alignment, tibial posterior slope and joint line, and complication rate. However, PS TKA is superior to CR TKA regarding post-operative knee range of motion (ROM) [Random Effect model (RE), Mean Difference (MD) = -7.07, 95% Confidential Interval (CI) -10.50 to -3.65, p<0.0001], improvement of ROM (Fixed Effect model (FE), MD = -5.66, 95% CI -10.79 to -0.53, p = 0.03) and femoral-tibial angle [FE, MD = 0.85, 95% CI 0.46 to 1.25, p<0.0001]. Conclusions There are no clinically relevant differences between CR and PS TKA in terms of clinical, functional, radiological outcome, and complications, while PS TKA is superior to CR TKA in respects of ROM, while whether this superiority matters or not in clinical practice still needs further investigation and longer follow-up. PMID:26824368

  17. Dislocation following total knee arthroplasty: A report of six cases

    PubMed Central

    Villanueva, Manuel; Ríos-Luna, Antonio; Pereiro, Javier; Fahandez-Saddi, Homid; Pérez-Caballer, Antonio

    2010-01-01

    Background: Dislocation following total knee arthroplasty (TKA) is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4), an inadequate selection of implants (n=1), malrotation of components (n=1) leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC). The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR) TKA designs: four were revised to a posterior stabilized (PS) TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory. PMID:20924487

  18. Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation

    PubMed Central

    2014-01-01

    Background Intercondylar femoral bone removal during posterior stabilized (PS) total knee arthroplasty (TKA) makes many cruciate substituting implant designs less appealing than cruciate retaining implants. Bone stock conservation is considered fundamental in the prevision of future revision surgeries. The purpose of this study was to compare the quantity of intercondylar bone removable during PS housing preparation using three contemporary PS TKA instrumentations. Method We compared different box cutting jigs which were utilized for the PS housing of three popular PS knee prostheses. The bone removal area from every PS box cutting jig was three-dimensionally measured. Results Independently from the implant size, the cutting jig for a specific PS TKA always resected significantly less bone than the others: this difference was statistically significant, especially for small- to medium-sized total knee femoral components. Conclusion This study does not establish a clinical relevance of removing more or less bone at primary TKA, but suggests that if a PS design is indicated, it is preferable to select a model which possibly resects less distal femoral bone. PMID:25037275

  19. Patient-reported outcome measures after total knee arthroplasty

    PubMed Central

    Ramkumar, P. N.; Harris, J. D.; Noble, P. C.

    2015-01-01

    Objectives A lack of connection between surgeons and patients in evaluating the outcome of total knee arthroplasty (TKA) has led to the search for the ideal patient-reported outcome measure (PROM) to evaluate these procedures. We hypothesised that the desired psychometric properties of the ideal outcome tool have not been uniformly addressed in studies describing TKA PROMS. Methods A systematic review was conducted investigating one or more facets of patient-reported scores for measuring primary TKA outcome. Studies were analysed by study design, subject demographics, surgical technique, and follow-up adequacy, with the ‘gold standard’ of psychometric properties being systematic development, validity, reliability, and responsiveness. Results A total of 38 articles reported outcomes from 47 different PROMS to 85 541 subjects at 26.3 months (standard deviation 30.8) post-operatively. Of the 38, eight developed new scores, 20 evaluated existing scores, and ten were cross-cultural adaptation of existing scores. Only six of 38 surveyed studies acknowledged all ‘gold standard’ psychometric properties. The most commonly studied PROMS were the Oxford Knee Score, New Knee Society Score, Osteoarthritis Outcome Score, and Western Ontario and McMaster Universities Osteoarthritis Index. Conclusions A single, validated, reliable, and responsive PROM addressing TKA patients’ priorities has not yet been identified. Moreover, a clear definition of a successful procedure remains elusive. Cite this article: Bone Joint Res 2015;4:120–127 PMID:26220999

  20. Patellar malalignment treatment in total knee arthroplasty

    PubMed Central

    Gasparini, Giorgio; Familiari, Filippo; Ranuccio, Francesco

    2013-01-01

    Summary The patella, with or without resurfacing, plays a fundamental role in the success of a total knee arthroplasty (TKA). Patellofemoral joint complications are due to problems related to the patient, to the surgical technique, or to the design of the components. Patellar tracking is influenced by several factors: a severe preoperative valgus, the presence of pre-existing patellofemoral dysplasia, the design of the femoral component, the surgical approach, the Q angle, the mechanical alignment of the limb, the tightness of the lateral retinaculum, the positioning of the patellar component in the proximal-distal and medial-lateral directions, the patella height, the patella (native or resurfaced) thickness, the size of the femoral and the tibial components, and the alignment and rotation of the components. Several factors are crucial to prevent patellar maltracking in TKA: the use of an anatomical femoral component, a meticulous surgical technique, careful dynamic intraoperative assessment of patellar tracking, and, if necessary, the achievement of an adequate lateral release. PMID:25606506

  1. Full versus surface tibial baseplate cementation in total knee arthroplasty.

    PubMed

    Galasso, Olimpio; Jenny, Jean-Yves; Saragaglia, Dominique; Miehlke, Rolf K

    2013-02-01

    The use of a keel in the tibial component during modern primary total knee arthroplasty (TKA) has become common, and its cementation may affect the future performance of the prosthesis. Although proponents of cementing the entire tibial component argue that this technique provides better initial fixation and may prevent aseptic loosening, reasons exist to apply cement only to the tibial baseplate. In this study, 232 patients who underwent TKA using full or surface cementation of the tibial baseplate were evaluated at an average 5.6-year follow-up to assess survivorship and clinical results. The cumulative survival rate at 8 years was 97.1%. With revision of either component for any reason considered the endpoint, no significant difference was noted between full and surface cemented groups. Knee Society Score, range of motion, and femoro-tibial mechanical angle significantly increased postoperatively. Multivariate analysis revealed that good preoperative range of motion and Knee Society Scores were related to good postoperative range of motion and Knee Society Scores. Follow-up length was a negative predictor of postoperative Knee Society Score. The use of full or surface cementation of the baseplate was unrelated to the postoperative clinical outcomes. Clinical outcomes did not differ according to the tibial component cementation technique. The results of this study suggest that cementing the keel of the tibial component during primary TKA has no advantage for patients. Longer-term follow-up and proper patient randomization are required to confirm these findings.

  2. Clinical evaluation of 292 Genesis II posterior stabilized high-flexion total knee arthroplasty: range of motion and predictors.

    PubMed

    Fuchs, Mathijs C H W; Janssen, Rob P A

    2015-01-01

    The primary aim of the study was to evaluate the range of motion and complications after Genesis II total knee arthroplasty with high-flexion tibia insert (TKA-HF). Furthermore, difference in knee flexion between high flexion and standard inserts was compared. The hypothesis was that knee flexion is better after high-flexion TKA. A total of 292 TKA-HF were retrospectively reviewed. Mean follow-up was 24.3 months. The range of motion was compared between TKA-HF (high-flexion group) and a comparable cohort of 86 Genesis II TKA with a standard tibia insert (control group). Surgeries were performed by one experienced knee orthopedic surgeon. Knee flexion in the high-flexion group increased from 114.8° preoperatively to 118.0° postoperatively (P < 0.01). Knee extension in the high-flexion group increased from -4.5° preoperatively to -0.4° after surgery (P < 0.01). Mean knee flexion was 5.52° (± 1.46°) better in the high-flexion group compared with the control group (P < 0.01). Preoperative range of motion, body mass index, diabetes mellitus and patellofemoral pain significantly influenced range of motion. Few complications occurred after TKA-HF. The Genesis II TKA-HF showed good short-term results with limited complications. Knee flexion after Genesis II TKA-HF was better compared with a standard tibia insert.

  3. Muscle force steadiness in older adults before and after total knee arthroplasty.

    PubMed

    Smith, Jessica W; Marcus, Robin L; Peters, Christopher L; Pelt, Christopher E; Tracy, Brian L; LaStayo, Paul C

    2014-06-01

    The ability to control submaximal muscle forces has been shown to be associated with age-related decreases in physical function, such as increased tendency to fall. This study compared quadriceps muscle force steadiness (MFS) in individuals with knee OA before and after total knee arthroplasty (TKA) to an age-matched group of controls. Lower extremity MFS was measured in 13 subjects with knee OA before and at six months after TKA (TKA-GROUP) and compared to an age-matched control group (CONTROL-GROUP). MFS was significantly more impaired in the TKA-GROUP at the pre-operative, but not post-operative visit, and significantly improved between the pre-operative and post-operative visits. Further research is warranted to evaluate the relation between this MFS measurement and physical functional performance in those at high risk for falling.

  4. New approach for the rehabilitation of patients following total knee arthroplasty

    PubMed Central

    Elbaz, Avi; Debbi, Eytan M.; Segal, Ganit; Mor, Amit; Bar-Ziv, Yaron; Velkes, Steven; Benkovich, Vadim; Shasha, Nadav; Shoham-Blonder, Ronit; Debi, Ronen

    2014-01-01

    Purpose To investigate the effect of a biomechanical therapy on gait, function and clinical condition in patients following total knee arthroplasty (TKA). Methods Seventeen TKA patients participated in the study. Patients received a biomechanical therapy AposTherapy). Patients underwent a gait test, clinical examination and an assessment of pain, function and quality of life (QOL). Patients were examined again at one, three and six month follow-ups. Results A significant improvement over time was found in most gait measurements. Significant improvements were also found in pain, function and QOL. Conclusions The examined biomechanical therapy may help in the rehabilitation process following TKA. PMID:25104889

  5. Acute hypotension after total knee arthroplasty and its nursing strategy

    PubMed Central

    Zhang, Yu-Mei; He, Jie; Zhou, Chang; Li, Yu; Yi, De-Kun; Zhang, Xia

    2015-01-01

    Objective: To determine the factors affecting postoperative acute hypotension after total knee arthroplasty (TKA) and provide a basis for guiding the clinical prevention. Methods: Between May 2001 and May 2013, a total of 495 patients undergoing routine TKA were analyzed retrospectively. Independent risk factors related to postoperative acute hypotension after TKA were determined by univariate and multivariate analysis. Results: Of the 495 patients undergoing TKA, 61 (12.32%) developed postoperative acute hypotension after surgery. Univariate analysis showed that preoperative Neu, time of surgery, time of anesthesia, pressure of tourniquet, time of using tourniquet, preoperative hypertension, age and type of surgery were significant influencing factors, whereas by multivariate analysis, only age, pressure of tourniquet and type of surgery were significant influencing factors. Conclusion: Factors those were associated with a significantly increased postoperative acute hypotension after TKA included age, pressure of tourniquet and type of surgery. Achieving a good preoperative and postoperative evaluation and monitoring vital signs and disease change contribute to the detection, intervention and salvage for the acute hypotension. PMID:26550351

  6. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up.

  7. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up. PMID:26043046

  8. Gonyautoxins: First evidence in pain management in total knee arthroplasty.

    PubMed

    Hinzpeter, Jaime; Barrientos, Cristián; Zamorano, Álvaro; Martinez, Álvaro; Palet, Miguel; Wulf, Rodrigo; Barahona, Maximiliano; Sepúlveda, Joaquín M; Guerra, Matias; Bustamante, Tamara; Del Campo, Miguel; Tapia, Eric; Lagos, Nestor

    2016-09-01

    Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids. PMID:27317871

  9. Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy

    PubMed Central

    Song, Sang Jun; Kim, Kang Il; Lee, Chung Hwan

    2016-01-01

    Clinical results of high tibial osteotomy (HTO) deteriorate over time despite the initial satisfactory results. Several knees may require a conversion to total knee arthroplasty (TKA) because of failure such as the progression of degenerative osteoarthritis and the loss of the correction angle. It is important to know the long-term survival rate and common reason of failure in HTO to inform patients of postoperative expectations before surgery and to prevent surgical errors during surgery. In addition, it has been reported that clinical and radiological results, revision rate, and complication rate were poorer than those in patients without a previous HTO. There are few review articles that describe why conversion TKA after HTO is surgically difficult and the results are poor. Surgeons have to avoid the various complications and surgical errors in this specific situation. We would like to present the considering factors and technical difficulties during conversion TKA after HTO with a review of the literature. We could conclude through the review that the correction of deformity, lower amount of tibial bone resection, and sufficient polyethylene insert thickness, restoration of the joint line height, and adequate ligament balancing can be helpful in overcoming the technical challenges encountered during TKA following HTO. PMID:27274465

  10. Gonyautoxins: First evidence in pain management in total knee arthroplasty.

    PubMed

    Hinzpeter, Jaime; Barrientos, Cristián; Zamorano, Álvaro; Martinez, Álvaro; Palet, Miguel; Wulf, Rodrigo; Barahona, Maximiliano; Sepúlveda, Joaquín M; Guerra, Matias; Bustamante, Tamara; Del Campo, Miguel; Tapia, Eric; Lagos, Nestor

    2016-09-01

    Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids.

  11. Kinematics and Mechanical Properties of Knees following Patellar Replacing and Patellar Retaining Total Knee Arthroplasty

    PubMed Central

    Huang, Rongying; Liu, Yanqiang; Zhu, Jun

    2015-01-01

    Knee injury is a common medical issue. A full understanding of the kinematics and mechanical properties of knees following total knee arthroplasty (TKA) repair utilizing patellar replacement (only the base of the patella is replaced) versus patellar retaining surgical techniques is still lacking. In the current paper, we investigated magnetic resonance (MR) imaging data from knees repaired by these two methods and evaluated total knee models created using imaging reconstruction technology that simulated gait conditions. Results revealed that patellar replacement had little influence on tibiofemoral kinematics, although the tibia-surface equivalent stress increased slightly. By contrast, patellar replacement had a significant influence on the patellofemoral joint; patellar internal rotation, external rotation, and medial-lateral translation were all increased. Moreover, the stress distribution on patellar prostheses was altered, resulting in an increased surface maximal equivalent stress on the corresponding area. Moreover, during the gait cycle, we found that the area with maximal equivalent stress shifted its position. Finally, the patellofemoral joint showed decreased motion stability. From the view of kinematics and mechanics, this paper suggests that patella should be retained during TKA if it is possible. The present study presented approaches and technologies for evaluating kinematics and mechanical properties of total knee joint after TKA under gait loads. PMID:27057134

  12. Polyethylene Wear in Knee Arthroplasty.

    PubMed

    Chakravarty, Rajit; Elmallah, Randa D K; Cherian, Jeffrey Jai; Kurtz, Steven M; Mont, Michael A

    2015-10-01

    Polyethylene (PE) wear and osteolysis are common causes for late revisions of knee arthroplasties. Several implant and surgical factors have been implicated in contributing to the development of wear, such as type of bearing surface used, inaccurate articular geometry, and poor knee kinematics. In addition, patient-related factors, such as younger age and higher activity levels, may also contribute to wear. Our purpose was to evaluate and compare the effect of these variables on wear rates following knee arthroplasty. Recently, technological advancements have been aimed at reducing the incidence of wear by improving the PE manufacturing process, creating implants that minimize contact stresses, and refining our surgical techniques. Furthermore, the development of newer highly cross-linked PEs (HXLPEs) and the introduction of additives, such as vitamin E, to the PEs may improve overall implant survivorship. As a result, with the advent of newer implant and PE designs, wear is no longer the most common cause of early failure, though it remains an important factor in limiting long-term implant survivorship. However, there are a few clinical studies evaluating the long-term outcomes of newer HXLPEs and implant designs, with further evaluations necessary to determine the best implant-PE combination for improved knee arthroplasty survivorship. PMID:26030263

  13. Deep venous thrombosis was not detected after total knee arthroplasty in Japanese patients with haemophilia.

    PubMed

    Takedani, H; Ohnuma, K; Hirose, J

    2015-09-01

    Combined thrombo-prophylaxis with mechanical and pharmacological methods is recommended in patients undergoing total knee or hip arthroplasty. As patients with 'untreated inherited bleeding disorders such as haemophilia' are at risk of bleeding, no prophylaxis has been prescribed for these patients. However, a retrospective study reported subclinical deep venous thrombosis (DVT) in 10% of patients with haemophilia undergoing major orthopaedic surgery. In this study, we aimed to evaluate the risk of DVT after total knee arthroplasty (TKA). We examined 38 TKA in 33 Japanese patients with haemophilia using ultrasonography. We did not detect DVT. The risk of DVT in patients with haemophilia after TKA may be lower than that in the general population. However, as patients with haemophilia progress in age, venous thromboembolism should be considered as a potential problem.

  14. Comparison of pain perception between open and minimally invasive surgery in total knee arthroplasty

    PubMed Central

    Moretti, Biagio; Vitale, Elsa; Esposito, Antonio; Colella, Antonio; Cassano, Maria; Notarnicola, Angela

    2010-01-01

    Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed to patient dissatisfaction after TKA. After a computerized search of the Medline and Embase databases, we considered articles from January 1st, 1997 to October 31st, 2009 that underlined the impact on patient pain perception of either standard open total knee arthroplasty or minimally invasive total knee arthroplasty. We included articles that used the visual analog scale (VAS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Knee Score, Hospital for Special Surgery Score (HSS), Oxford Knee Score (OKS) as postoperative pain indicators, and we included studies with a minimum follow-up period of two months. We excluded studies that monitored only functional postoperative knee activities. It was shown that TKA with the open technique was a better treatment for knees with a positive effect on pain and function than the minimally invasive technique. PMID:21042568

  15. Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty.

    PubMed

    Daniilidis, Kiriakos; Skwara, Adrian; Vieth, Volker; Fuchs-Winkelmann, Susanne; Heindel, Walter; Stückmann, Volker; Tibesku, Carsten O

    2012-08-01

    The use of highly conforming polyethylene inlays in total knee arthroplasty (TKA) provides improved anteroposterior stability. The aim of this fluoroscopic study was to investigate the in vivo kinematics during unloaded and loaded active extension with a highly conforming inlay and a flat inlay after cruciate retaining (CR) total knee arthroplasty (TKA). Thirty one patients (50 knees) received a fixed-bearing cruciate retaining total knee arthroplasty (Genesis II, Smith & Nephew, Schenefeld, Germany) for primary knee osteoarthritis. Twenty two of them received a flat polyethylene inlay (PE), nine a deep dished PE and 19 were in the control group (physiological knees). The mean age at the time of surgery was 62 years. Dynamic examination with fluoroscopy was performed to assess the "patella tendon angle" in relation to the knee flexion angle (measure of anteroposterior translation) and the "kinematic index" (measure of reproducibility). Fluoroscopy was performed under active extension and flexion, during unloaded movement, and under full weight bearing, simulated by step climbing. No significant difference was observed between both types of polyethylene inlay designs and the physiological knee during unloaded movement. Anteroposterior (AP) instability was found during weight-bearing movement. The deep-dish inlay resulted in lower AP translation and a non-physiological rollback. Neither inlay types could restore physiological kinematics of the knee. Despite the fact that deep dished inlays reduce the AP translation, centralisation of contact pressure results in non-physiological rollback. The influence of kinematic pattern variability on clinical results warrants further investigation.

  16. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    PubMed Central

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  17. Low-grade infection after a total knee arthroplasty caused by Actinomyces naeslundii.

    PubMed

    Hedke, J; Skripitz, R; Ellenrieder, M; Frickmann, H; Köller, T; Podbielski, A; Mittelmeier, W

    2012-08-01

    Here, we present a case of an 85-year-old woman with a low-grade-infection caused by Actinomyces naeslundii after total-knee arthroplasty (TKA) followed by septic loosening. Actinomyces naeslundii was cultured from a tissue sample from the knee joint capsule/synovial tissue obtained after the initial TKA. A review of the literature revealed two cases of periprosthetic infection and another three cases of arthritis due to Actinomyces naeslundii. So far, no standard treatment for periprosthetic infections caused by Actinomyces species has been established.

  18. Hydrotherapy after total knee arthroplasty. A follow-up study.

    PubMed

    Giaquinto, S; Ciotola, E; Dall'Armi, V; Margutti, F

    2010-01-01

    The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population.

  19. Rotational alignment of the tibial component in total knee arthroplasty

    PubMed Central

    Graceffa, Angelo; Marcucci, Massimiliano; Baldini, Andrea

    2016-01-01

    Many surgical techniques, correlated to different anatomical landmarks, have been proposed to allow a satisfactory rotational alignment of the tibial component in primary total knee arthroplasty (TKA). Unfortunately, an accurate landmark has not yet been established although many computer models using CT reconstructions and standard radiologic studies have been performed. In this review article, the authors propose a new anatomical rotational reference for a correct positioning of the tibial component during primary TKA; the authors compared the results of their studies with the current literature on rotational alignment references and previously proposed surgical techniques. The authors also analyzed the correlation between classic and newer tibial baseplate designs and different tibial rotational landmarks. PMID:26855939

  20. Multi-Joint Compensatory Effects of Unilateral Total Knee Arthroplasty During High-Demand Tasks.

    PubMed

    Gaffney, Brecca M; Harris, Michael D; Davidson, Bradley S; Stevens-Lapsley, Jennifer E; Christiansen, Cory L; Shelburne, Kevin B

    2016-08-01

    Patients with total knee arthroplasty (TKA) demonstrate quadriceps weakness and functional limitations 1 year after surgery during daily tasks such as walking and stair climbing. Most biomechanical analyses of patients after TKA focus on quadriceps function and rarely investigate other lower-extremity muscles or high-demand ambulatory activities of daily living. The purpose of this investigation was to quantify lower-extremity muscle forces in patients with unilateral TKA during high-demand tasks of pivoting and descending stairs. Five patients with unilateral TKA and five age and sex-matched controls performed three bilateral high-demand tasks: (1) step down from an 8-inch platform, (2) inside pivot: 90° direction change toward planted limb, and (3) outside pivot: 90° direction change away from planted limb. Subject-specific musculoskeletal simulations were created in OpenSim to determine joint angles, moments, and lower-extremity muscle forces. The results indicate that patients with TKA adopt compensatory strategies at both the hip and knee. Patients with TKA demonstrated increased hip external rotation, decreased knee flexion, decreased quadriceps force, and decreased hip abductor force in all three tasks. These strategies are likely a result of quadriceps avoidance, which may stem from instability after TKA or a habitual strategy developed during the late stages of osteoarthritis.

  1. Tranexamic Acid Decreases Incidence of Blood Transfusion in Simultaneous Bilateral Total Knee Arthroplasty.

    PubMed

    Bagsby, Deren T; Samujh, Christopher A; Vissing, Jacqueline L; Empson, Janene A; Pomeroy, Donald L; Malkani, Arthur L

    2015-12-01

    Blood management for simultaneous bilateral total knee arthroplasty (TKA) patients is more challenging than in unilateral arthroplasty. We examined if administration of tranexamic acid (TXA) to patients undergoing simultaneous bilateral TKA would reduce blood loss and decrease allogeneic blood transfusion requirements. A retrospective review of 103 patients, 57 in the control and 46 in the TXA group, was performed. There was higher postoperative day 1 hemoglobin in patients receiving TXA (2.95±1.33 versus 4.33±1.19, P<0.0001). There was also a decrease in the transfusion incidence with administration of TXA (17.4% versus 57.9%, P<0.0001). In conclusion, we have shown that TXA is an effective tool in reducing the transfusion rates by almost 70% in simultaneous bilateral total knee arthroplasty.

  2. Patient function after a posterior stabilizing total knee arthroplasty: cam-post engagement and knee kinematics.

    PubMed

    Suggs, Jeremy F; Hanson, George R; Park, Sang Eun; Moynihan, Angela L; Li, Guoan

    2008-03-01

    Even though posterior substituting total knee arthroplasty has been widely used in surgery, how the cam-post mechanism (posterior substituting mechanism) affects knee joint kinematics and function in patients is not known. The objective of the present study was to investigate posterior femoral translation, internal tibial rotation, tibiofemoral contact, and cam-post engagement of total knee arthroplasty patients during in vivo weight-bearing flexion. Twenty-four knees with a PS TKA were investigated while performing a single leg weight-bearing lunge from full extension to maximum flexion as images were recorded using a dual fluoroscopic system. The in vivo knee position at each targeted flexion angle was reproduced using 3D TKA models and the fluoroscopic images. The kinematics of the knee was measured from the series of the total knee arthroplasty models. The cam-post engagement was determined when the surface model of the femoral cam overlapped with that of the tibial post. The mean maximum flexion angle for all the subjects was 112.5 +/- 13.1 degrees . The mean flexion angle where cam-post engagement was observed was 91.1 +/- 10.9 degrees . The femur moved anteriorly from 0 degrees to 30 degrees and posteriorly through the rest of the flexion range. The internal tibial rotation increased approximately 6 degrees from full extension to 90 degrees of flexion and decreased slightly with further flexion. Both the medial and lateral contact point moved posteriorly from 0 degrees to 30 degrees , remained relatively constant from 30 degrees to 90 degrees , and then moved further posterior from 90 degrees to maximum flexion. The in vivo cam-post engagement corresponded to increased posterior translation and reduced internal tibial rotation at high flexion of the posterior substituting total knee arthroplasty. The initial cam-post engagement was also mildly correlated with the maximum flexion angle of the knee (R = 0.51, p = 0.019). A later cam-post engagement might

  3. MEDIUM-TERM ASSESSMENT OF TOTAL KNEE ARTHROPLASTY WITH IMPLANT MADE IN BRAZIL

    PubMed Central

    Barretto, João Maurício; Malta, Márcio; e Albuquerque, Rodrigo Pires; de Assis, Daniel Pinho; Campos, André Siqueira

    2015-01-01

    Objective: This study assessed 47 patients who underwent total knee arthroplasty (TKA) with implants manufactured in Brazil, with a mean follow-up of five years. Methods: This was a retrospective study at Santa Casa de Misericordia Hospital in Rio de Janeiro, from January 1993 to December 2002. The sample comprised 47 patients (44 females and three males) who underwent TKA, totaling 58 knees. The patients’ ages ranged from 46 to 83 years. A diagnosis of osteoarthritis or rheumatic disease was confirmed in all the patients. Results: In this investigation, all the patients underwent cemented TKA with preservation of the posterior cruciate ligament. The length of follow-up ranged from 5 to 17 years. The functional assessment criterion used was the one of the Hospital for Special Surgery (HSS), and this yielded an average of 87 points after the operation. The radiographic criterion used was the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. We had three cases with a radiolucent line without implant loosening, which were asymptomatic from a clinical standpoint. Conclusion: The total knee arthroplasty procedures using an implant made in Brazil were performed by a trained and experienced team. To date, over the clinical follow-up on these patients with knee osteoarthritis or rheumatoid arthritis, the results have been seen to be satisfactory. PMID:27027051

  4. HIGH TIBIAL OSTEOTOMY VERSUS UNICOMPARTMENTAL KNEE ARTHROPLASTY FOR MEDIAL COMPARTMENT ARTHROSIS OF THE KNEE: A REVIEW OF THE LITERATURE

    PubMed Central

    Dettoni, Federico; Bonasia, Davide Edoardo; Castoldi, Filippo; Bruzzone, Matteo; Blonna, Davide; Rossi, Roberto

    2010-01-01

    This review examined the literature regarding high tibial osteotomy (HTO) and imicompartmental knee arthroplasty (UKA), focusing on indications, survivorship and functional outcomes of the two procedures, as well as revision to total knee arthroplasty (TKA) after failed HTO or UKA. HTO and UKA share the same indications in selected cases of medial unicompartmental knee arthrosis. These indications include patients who are: 1) 55 to 65 years old; 2) moderately active; 3) non-obese; 4) have mild varus malalignment; 5) no joint instability; 6) good range of motion; and 7) moderate unicompartmental arthrosis. Few studies are available in the literature comparing the outcomes of HTO and UKA. Those few studies show slightly better results for UKA in terms of survivorship and functional outcome. Nevertheless, the differences are not remarkable, the study methods are not homogeneous and most of the papers report on closing wedge HTOs. For these reasons, no definitive conclusions can be drawn. TKA represents the revision option for both treatments and yields satisfactory functional outcomes and survivorship. Whether revision HTO and UKA-to-TKA perform any worse than primary TKA is still controversial. With the correct indications, both treatments produce durable and predictable outcomes in the treatment of medial unicompartmental arthrosis of the knee. There is no evidence of superior results of one treatment over the other. PMID:21045985

  5. NAVIGATION IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    da Mota e Albuquerque, Roberto Freire

    2015-01-01

    Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references. Since the first systems, which were basically used to control the alignment of bone cutting referenced to the mechanical axis of the lower limb, many other surgical steps have been incorporated, such as component rotation, ligament balancing and arranging the symmetry of flexion and extension spaces, among others. Its efficacy as a precision tool with an effective capacity for promoting better alignment of the lower-limb axis has been widely proven in the literature, but the real value of optimized alignment and the impact of navigation on clinical results and the longevity of arthroplasty have yet to be established. PMID:27026979

  6. Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty?

    PubMed

    Kim, Dong-Kyoon; Seo, Min-Chul; Song, Sang-Joon; Kim, Kang-Il

    2015-12-01

    Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients.

  7. Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty?

    PubMed Central

    Kim, Dong-Kyoon; Seo, Min-Chul; Song, Sang-Joon

    2015-01-01

    Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients. PMID:26675374

  8. Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing

    PubMed Central

    Ali, Abdulemir; Lindstrand, Anders; Nilsdotter, Anna; Sundberg, Martin

    2016-01-01

    Background and purpose Knee pain after total knee arthroplasty (TKA) is not uncommon. Patellar retention in TKA is one cause of postoperative knee pain, and may lead to secondary addition of a patellar component. Patellar resurfacing in TKA is controversial. Its use ranges from 2% to 90% worldwide. In this randomized study, we compared the outcome after patellar resurfacing and after no resurfacing. Patients and methods We performed a prospective, randomized study of 74 patients with primary osteoarthritis who underwent a Triathlon CR TKA. The patients were randomized to either patellar resurfacing or no resurfacing. They filled out the VAS pain score and KOOS questionnaires preoperatively, and VAS pain, KOOS, and patient satisfaction 3, 12, and 72 months postoperatively. Physical performance tests were performed preoperatively and 3 months postoperatively. Results We found similar scores for VAS pain, patient satisfaction, and KOOS 5 subscales at 3, 12, and 72 months postoperatively in the 2 groups. Physical performance tests 3 months postoperatively were also similar in the 2 groups. No secondary resurfacing was performed in the group with no resurfacing during the first 72 months Interpretation Patellar resurfacing in primary Triathlon CR TKA is of no advantage regarding pain, physical performance, KOOS 5 subscales, or patient satisfaction compared to no resurfacing. None of the patients were reoperated with secondary addition of a patellar component within 6 years. According to these results, routine patellar resurfacing in primary Triathlon TKA appears to be unnecessary. PMID:27212102

  9. Patient-Specific Instrumentation in Total Knee Arthroplasty: What Is the Evidence?

    PubMed

    Szczech, Bartlomiej; McDermott, James D; Issa, Kimona; Rifai, Aiman; Festa, Anthony; Matarese, William A; McInerney, Vincent K

    2016-05-01

    With a steady increase in the demand for primary and revision total knee arthroplasty (TKA), any potential reduction in the number of failures can be a topic of significant clinical importance. Patient-specific instrumentation (PSI) is introduced to potentially achieve more reproducible alignment with reduced outliers by creating more accurate and patient-specific femoral and tibial cuts based on neutral mechanical axis. However, there is no widely accepted consensus on the efficacy and indication of using PSI in TKA. The purpose of this review was to assess the current literature on patient-specific TKA and its effect on perioperative outcomes, including templating and preoperative planning, mechanical alignment, clinical outcomes, perioperative blood loss, and economic evaluations. Based on the current literature, more prospective studies are necessary to evaluate the routine use of PSI in TKA.

  10. Modern abbreviated computer navigation of the femur reduces blood loss in total knee arthroplasty.

    PubMed

    Licini, David J; Meneghini, R Michael

    2015-10-01

    Computer assisted surgery (CAS) optimizes component position in total knee arthroplasty (TKA), yet effects specifically on blood loss are less known. This study purpose was to determine whether a modern abbreviated CAS protocol would reduce blood loss in TKA compared to conventional instrumentation. One hundred consecutive TKAs were retrospectively reviewed comparing abbreviated CAS versus conventional IM instrumentation. Blood loss was determined using drain output, change in hemoglobin, and calculated blood loss. The CAS group demonstrated less hourly drain output (P=0.02), hemoglobin change (P=0.001), and estimated blood loss (P=0.001) versus conventional instrumentation. With proven advantages of accurate component placement and improved functional outcome after TKA, CAS provides additional value by reducing blood loss in TKA.

  11. Obese patients undergoing total knee arthroplasty have distinct preoperative characteristics: an institutional study of 4718 patients.

    PubMed

    Vulcano, Ettore; Lee, Yuo-Yu; Yamany, Tarek; Lyman, Stephen; Valle, Alejandro González Della

    2013-08-01

    Obesity affects a disproportionate proportion of total knee arthroplasty (TKA) patients. Our study explores pre-operative characteristics between obese and non-obese patients undergoing TKA surgery. A cohort of 4718 osteoarthritic patients, undergoing primary TKA, was studied. Patients were stratified according to BMI classes. Each class was compared in terms of age, race, gender, level of education, insurance status, pre-operative WOMAC, SF-36, and Elixhauser comorbidities. There was a positive relationship between BMI and female gender, non-white race, Medicaid, private insurance, and self-pay. A negative relationship was observed between BMI and age, Medicare, WOMAC and SF-36. Obese TKA candidates differ from their non-obese counterparts in a number of demographic, socioeconomic, and clinical characteristics. PMID:23523207

  12. Patient-specific versus conventional instrumentation for total knee arthroplasty: peri-operative and cost differences.

    PubMed

    DeHaan, Alexander M; Adams, Jacob R; DeHart, Matthew L; Huff, Thomas W

    2014-11-01

    The role of patient-specific instrumentation in total knee arthroplasty (TKA) is yet to be clearly defined. Current evidence evaluating peri-operative and cost differences against conventional TKA is unclear. We reviewed 356 TKAs between July 2008 and April 2013; 306 TKAs used patient-specific instrumentation while 50 had conventional instrumentation. The patient-specific instrumentation cohort averaged 20.4 min less surgical time (P < 0.01) and had a 42% decrease in operating room turnover time (P = 0.022). At our institution, the money saved through increased operating room efficiency offset the cost of the custom cutting blocks and pre-operative advanced imaging. Routine use of patient-specific TKA can be performed with less surgical time, no increase in peri-operative morbidity, and at no increased cost when compared to conventional TKA.

  13. Patient-specific instrumentation does not improve alignment in total knee arthroplasty.

    PubMed

    Russell, Robert; Brown, Timothy; Huo, Michael; Jones, Richard

    2014-12-01

    Patient-specific instrumentation (PSI) was developed to improve the accuracy of component positioning in total knee arthroplasty (TKA). A meta-analysis of level I and level II studies was performed to determine if PSI improves the mechanical alignment of the leg compared with conventional instrumentation (CI) in TKA. Seven studies met inclusion criteria evaluating 559 patients undergoing TKA. Mean coronal alignment was within 1 degree of neutral mechanical alignment in both groups (PSI, 0.78 degrees; CI, 0.81 degrees). There were fewer outliers in the PSI group (21.1%) than in the CI group (23.2%), but this was not statistically significant (p = 0.59). On the basis of the data from this analysis, PSI does not significantly improve the postoperative mechanical alignment of the limb after TKA. Moreover, PSI does not decrease the number of outliers compared with CI.

  14. Is Single-Radius Design Better for Quadriceps Recovery in Total Knee Arthroplasty?

    PubMed Central

    Kim, Duk-Hyun; Kim, Dong-Kyoon; Lee, Sang-Hak; Bae, Dae-Kyung

    2015-01-01

    Purpose Although single-radius (SR) designs have a theoretical advantage in quadriceps recovery following total knee arthroplasty (TKA), there has been a paucity of objective evaluation studies. Materials and Methods One hundred and twenty minimally invasive TKAs were prospectively randomized by a single surgeon into 2 groups: SR design TKA group and multi-radius design TKA group. Quadriceps force and power were assessed using a dynamometer, and clinical data were investigated preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. Results There were no differences between two groups in quadriceps recovery and clinical results throughout the follow-up period. Furthermore, the proportion of patients whose postoperative quadriceps force and power reached preoperative level was similar in both groups. Conclusions Femoral component design itself would not significantly influence quadriceps recovery after TKA. PMID:26676282

  15. Total knee arthroplasty with concurrent femoral and tibial osteotomies in osteogenesis imperfecta.

    PubMed

    Wagner, Russell; Luedke, Colten

    2014-01-01

    Three total knee arthroplasties (TKA) with concurrent femoral and/or tibial osteotomies in 2 patients with osteogenesis imperfecta were performed from 2004 to 2009. The 2 patients were followed for a mean of 6 years. One patient with concurrent TKA, and femoral and tibial osteotomies developed a nonunion of the tibial site that responded to open reduction and internal fixation with iliac crest bone graft. The second patient underwent right TKA with bi-level tibial osteotomies, which healed uneventfully, allowing pain free, unassisted ambulation. The same patient then elected to undergo left TKA with bi-level tibial osteotomies. Intraoperatively he sustained a minor tibial plateau fracture requiring the use of a stemmed component and postoperatively, he developed a nonunion at the proximal site and valgus malunion of the distal site. Revision of fixation was performed at both osteotomy sites, and both healed within 3 months. Both patients are now pain free and ambulate without assistance.

  16. Failure of aseptic revision total knee arthroplasties

    PubMed Central

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-01-01

    Background and purpose In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. Method This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. Results 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). Interpretation In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties. PMID:25267502

  17. Clinical and Biomechanical Evaluations of Staged Bilateral Total Knee Arthroplasty Patients with Two Different Implant Designs

    PubMed Central

    Renaud, Alexandre; Fuentes, Alexandre; Hagemeister, Nicola; Lavigne, Martin; Vendittoli, Pascal-André

    2016-01-01

    Background: Various implants of total knee arthroplasty (TKA) are used in clinical practice and each presents specific design characteristics. No implant managed this day to reproduce perfectly the biomechanics of the natural knee during gait. Objectives: We therefore asked whether (1) differences in tridimensional (3D) kinematic data during gait could be observed in two different designs of TKA on the same patients, (2) if those gait kinematic data are comparable with those of asymptomatic knees and (3) if difference in clinical subjective scores can be observed between the two TKA designs on the same patient. Methods: We performed knee kinematic analysis on 15 patients (30 TKAs) with two different TKA implant designs (Nexgen, Zimmer and Triathlon, Stryker) on each knee and on 25 asymptomatic subjects (35 knees). Clinical evaluation included range of motion, weight bearing radiographs, questionnaire of joint perception, KOOS, WOMAC and SF-12. Results: Comparison between TKAs and asymptomatic knees revealed that asymptomatic knees had significantly less knee flexion at initial contact (p < 0.04) and more flexion for most of the swing phase (p between 0.004 and 0.04). Asymptomatic knees also had less varus at loading response, during stance phase and during most of the swing phase (p between 0.001 - 0.05). Transverse plane analysis showed a tendency for asymptomatic knees to be more in internal rotation during stance phase (p 0.02 - 0.04). Comparing both TKA designs, NexgenTM implant had significantly more flexion at the end of swing phase (p = 0.04) compared to knees with the TriathlonTM implant. In frontal plane, from initial contact to maximum mid stance angle and between the mean mid stance angle and initial contact NexgenTM TKA had significantly more adduction (varus, p =0.02 – 0.03). Clinical scores of both TKAs did not have significant difference. Conclusions: TKA with the tested implants did not reproduce natural knee kinematics during gait. In our cohort

  18. Asymmetry of the leg alignment affects trunk bending in the coronal plane after unilateral total knee arthroplasty.

    PubMed

    Harato, Kengo; Yoshida, Hiroki; Otani, Toshiro

    2013-08-01

    Unilateral total knee arthroplasty (TKA) would produce asymmetric changes of lower extremity in patients with bilateral varus deformity. Our purpose was to investigate whether asymmetry of the leg alignment would affect trunk bending in the coronal plane after unilateral TKA. Twenty patients (mean 76 years old) with bilateral end-stage knee osteoarthritis (OA) participated. Spine images during relaxed standing were obtained on pre- and postoperative day 21. As a result, the shoulder tilted more to the TKA side and the pelvis inclined more to the contralateral OA side. These results suggested that the trunk would bend away from the contralateral OA side after unilateral TKA in patients with bilateral end-stage knee OA and varus deformity. Asymmetry of the leg alignment led to asymmetric trunk bending.

  19. All-polyethylene and metal-backed tibial components in total knee arthroplasty: a matched pair analysis of functional outcome.

    PubMed

    Najibi, Soheil; Iorio, Richard; Surdam, Jonathan W; Whang, William; Appleby, David; Healy, William L

    2003-10-01

    A group of 98 patients who had primary unilateral total knee arthroplasty (TKA) with cemented, posterior-stabilized knee implants for osteoarthritis were matched for age, diagnosis, weight, body mass index, and presence of comorbid conditions. The patients were followed up with clinical, radiographic, and outcome measures including SF-36 scales and patient outcome questionnaires. Forty-nine patients had all-polyethylene tibial implants (APT), and 49 patents had metal backed tibial implants (MBT) with similar knee implant design and articular geometry. There is no difference among these patient cohorts in the clinical performance or functional outcome of TKA using APT or MBT components in primary TKA at intermediate term follow-up. In consideration of concerns about polyethylene wear, osteolysis, and cost associated with MBT components, these findings may present an opportunity for quality improvement and cost savings with increased utilization of APT in TKA operations. PMID:14560404

  20. Which patients do not return to work after total knee arthroplasty?

    PubMed

    Kuijer, P Paul F M; Kievit, Arthur J; Pahlplatz, Thijs M J; Hooiveld, Truus; Hoozemans, Marco J M; Blankevoort, Leendert; Schafroth, Matthias U; van Geenen, Rutger C I; Frings-Dresen, Monique H W

    2016-09-01

    Total knee arthroplasty (TKA) is increasingly being performed among working patients suffering from knee osteoarthritis. Two out of ten patients do not return to work (RTW) after TKA. Little evidence is available about these patients to guide clinicians. Therefore, this study investigates patients' characteristics associated with no RTW. A multicenter retrospective cohort study was performed among working patients having undergone a primary TKA during 2005-2010. The following preoperative characteristics were assessed: age at surgery, sex, comorbidity, body mass index (BMI), preoperative sick-leave duration, patient-reported work-relatedness of knee symptoms, and physical job demands. In addition, the Knee injury and Osteoarthritis Outcome Scores (KOOS) after TKA were assessed. Backward stepwise logistic regression analyses were performed to predict no RTW. Seven hundred and sixty-four patients were approached, and 558 patients (73 %) responded. One hundred and sixty-seven met the inclusion criteria and 46 did not RTW. A preoperative sick-leave duration >2 weeks (OR 12.5, 90 % CI 5.0-31.5) was most strongly associated with no RTW. Other associations found were: female sex (OR 3.2, 90 % CI 1.3-8.2), BMI ≥ 30 (OR 2.8, 90 % CI 1.1-7.1), patient-reported work-relatedness of knee symptoms (OR 5.3, 90 % CI 2.0-14.1), and a physically knee-demanding job (OR 3.3, 90 % CI 1.2-8.9). Age and KOOS were not associated with no RTW. Especially obese female workers, with a preoperative sick-leave duration >2 weeks, who perform knee-demanding work and indicate that their knee symptoms are work-related have a high chance for no RTW after TKA. These results stress the importance of a more timely referral for work-directed care of patients at risk for no RTW after TKA. PMID:27342661

  1. Which patients do not return to work after total knee arthroplasty?

    PubMed

    Kuijer, P Paul F M; Kievit, Arthur J; Pahlplatz, Thijs M J; Hooiveld, Truus; Hoozemans, Marco J M; Blankevoort, Leendert; Schafroth, Matthias U; van Geenen, Rutger C I; Frings-Dresen, Monique H W

    2016-09-01

    Total knee arthroplasty (TKA) is increasingly being performed among working patients suffering from knee osteoarthritis. Two out of ten patients do not return to work (RTW) after TKA. Little evidence is available about these patients to guide clinicians. Therefore, this study investigates patients' characteristics associated with no RTW. A multicenter retrospective cohort study was performed among working patients having undergone a primary TKA during 2005-2010. The following preoperative characteristics were assessed: age at surgery, sex, comorbidity, body mass index (BMI), preoperative sick-leave duration, patient-reported work-relatedness of knee symptoms, and physical job demands. In addition, the Knee injury and Osteoarthritis Outcome Scores (KOOS) after TKA were assessed. Backward stepwise logistic regression analyses were performed to predict no RTW. Seven hundred and sixty-four patients were approached, and 558 patients (73 %) responded. One hundred and sixty-seven met the inclusion criteria and 46 did not RTW. A preoperative sick-leave duration >2 weeks (OR 12.5, 90 % CI 5.0-31.5) was most strongly associated with no RTW. Other associations found were: female sex (OR 3.2, 90 % CI 1.3-8.2), BMI ≥ 30 (OR 2.8, 90 % CI 1.1-7.1), patient-reported work-relatedness of knee symptoms (OR 5.3, 90 % CI 2.0-14.1), and a physically knee-demanding job (OR 3.3, 90 % CI 1.2-8.9). Age and KOOS were not associated with no RTW. Especially obese female workers, with a preoperative sick-leave duration >2 weeks, who perform knee-demanding work and indicate that their knee symptoms are work-related have a high chance for no RTW after TKA. These results stress the importance of a more timely referral for work-directed care of patients at risk for no RTW after TKA.

  2. Tibiofemoral alignment in posterior stabilized total knee arthroplasty: Static alignment does not predict dynamic tibial plateau loading.

    PubMed

    Miller, Emily J; Pagnano, Mark W; Kaufman, Kenton R

    2014-08-01

    For total knee arthroplasty (TKA), neutral mechanical alignment produces balanced static knee loading. Dynamically, knee loading is affected by more than limb static alignment. We compared static and dynamic knee loading following TKA. Fifteen TKA patients were evaluated pre-operatively and 2 months and 2 years post-operatively. Tibiofemoral angles and medial tibial plateau loading were calculated. Pre-operatively, static medial load was greater for varus than valgus knees. Post-operatively, no relationship existed between tibiofemoral angle and static medial plateau load. Pre-operatively and post-operatively, dynamic medial load was not dependent on tibiofemoral angle. While all patients achieved equal static plateau load distributions at 2 years, only 47% had dynamic medial load distributions of 50 ± 10%. Static tibiofemoral alignment alone does not predict dynamic tibial loading.

  3. Load transfer characteristics of a noncemented total knee arthroplasty.

    PubMed

    Whiteside, L A; Pafford, J

    1989-02-01

    This study evaluated load transfer characteristics of femoral and tibial components of a total knee prosthesis that was designed to achieve distal femoral and proximal tibial compressive load-bearing. Strain gauge readings were highest on the cortex of the tibial metaphyseal flare. Roentgenograms of 110 patients with noncemented total knee arthroplasty (TKA) with follow-up periods of 12-24 months were evaluated. Cancellous bone hypertrophy bridging from the undersurface of the tibial component to the metaphyseal cortical bone was noted on all roentgenograms at six months, suggesting stress transfer through cancellous bone to this area. Anterolateral sinking was noted in six of the first 46 patients but was not seen again in the series after a design change was made to more rigidly fix the stem in the bone of the upper tibia. Roentgenograms of the femoral components demonstrated distal bone hypertrophy suggesting compressive load bearing. None of the femoral components migrated or sank. PMID:2912617

  4. Bibliometric Analysis of Orthopedic Literature on Total Knee Arthroplasty in Asian Countries: A 10-year Analysis

    PubMed Central

    Eom, Sang Hwa; Bamne, Ankur B.; Chowdhry, Madhav; Chae, Ihn Seok

    2015-01-01

    Purpose We aimed to determine the quantity and quality of research output of selected Asian countries in the field of total knee arthroplasty (TKA) in the last 10 years. Materials and Methods Top 15 Asian countries were selected according to their gross domestic product. The Science Citation Index Expanded database was used to search for the literature published between 2004 and 2013 using "Total Knee Arthroplasty". The numbers of articles, journals and citations and the contribution of each country were analyzed. The articles were classified according to the type of study and the relative proportion of each type was analyzed. Results Asian surgeons have increasingly contributed to orthopedic literature on TKA for the past 10 years, but the dominant contribution came from only a few countries. The total number of articles published by Asian countries increased by 261%, with Japan producing most of the studies and China showing the maximum growth rate. The majority of studies were published in low impact factor journals. Korea published the highest proportion of articles in high impact factor journals. Clinical papers were most frequent. Conclusions Our identification of research productivity pertaining to TKA among Asian countries gives a unique insight into the level of academic research in the field of TKA in these countries. There is a need to improve the quality of research to enhance the publishing power in high impact journals as well as the need for more basic research and epidemiological studies considering the unique differences among Asian patients undergoing TKA. PMID:26389067

  5. Extensor Mechanism Disruption after Total Knee Arthroplasty: A Case Series and Review of Literature

    PubMed Central

    Vaishya, Raju; Vijay, Vipul

    2016-01-01

    Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare but devastating complication. These patients may require revision of the implants, but even then, it may not be possible to restore the normal function of the knee after the disruption. The patterns of extensor mechanism disruption can broadly be classified into three types: suprapatellar (quadriceps tendon rupture), transpatellar (patellar fracture), or infrapatellar (patellar tendon rupture). Infrapatellar tendon ruptures are the worst injuries, as they carry maximum morbidity and are challenging to manage. The disruption of the extensor mechanism may occur either intra-operatively or in the immediate postoperative period due to an injury. The treatment of extensor mechanism complications after TKA may include either nonsurgical management or surgical intervention in the form of primary repair or reconstruction with autogenous, allogeneic, or synthetic substitutes. We have provided an algorithm for the management of extensor mechanism disruption after TKA. PMID:27004156

  6. Intra-Articular Giant Heterotopic Ossification following Total Knee Arthroplasty for Charcot Arthropathy

    PubMed Central

    Tsuge, Shintaro; Aoki, Yasuchika; Sonobe, Masato; Shibata, Yoshifumi; Sasaki, Yu; Nakagawa, Koichi

    2013-01-01

    Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy. PMID:24151574

  7. Manipulation under Anesthesia for Stiffness after Total Knee Arthroplasty

    PubMed Central

    Yoo, Ju-Hyung; Oh, Jin-Cheol; Park, Sang-Hoon

    2015-01-01

    Purpose This study evaluated the incidence of manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty (TKA) and the degree of joint motion recovery after MUA. Materials and Methods A total of 4,449 TKAs (2,973 patients) were performed between March 2000 and August 2014. Cases that underwent MUA for stiffness after TKA were reviewed. TKAs were performed using the conventional procedure in 329 cases and using the minimally invasive procedure in 4,120 cases. The preoperative range of joint motion, timing of manipulation, diagnosis and the range of joint motion before and after MUA were retrospectively investigated. Results MUA was carried out in 22 cases (16 patients), resulting in the incidence of 0.5%. The incidence after the conventional procedure was 1.2% and 0.4% after the minimally invasive procedure. In the manipulated knees, the preoperative range of motion (ROM) was 102.5°±26.7°, and the preoperative diagnosis was osteoarthritis in 19 cases, rheumatoid arthritis in two, and infection sequela in one. MUA was performed 4.7±3.0 weeks after TKA. The average ROM was 64.5°±13.5° before manipulation. At an average of 64.3±41.3 months after manipulation, the ROM was recovered to 113.4°±31.2°, which was an additional 49.9° improvement in flexion. Conclusions The satisfactory recovery of joint movement was achieved when MUA for stiffness was performed relatively early after TKA. PMID:26676186

  8. Effects of Tourniquet Release on Total Knee Arthroplasty.

    PubMed

    Tie, Kai; Hu, Dongcai; Qi, Yongjian; Wang, Hua; Chen, Liaobin

    2016-07-01

    This study investigated the clinical outcomes of early and late tourniquet release (tourniquet release after cementing the prosthesis vs tourniquet release after wound closure and pressure dressing) in total knee arthroplasty (TKA). The study was conducted by searching PubMed, Embase, Web of Science, and Cochrane Central databases for articles on randomized controlled trials comparing early and late tourniquet release in primary TKA that were published from 1966 to March 2015. Relevant data were extracted, and the Physiotherapy Evidence Database (PEDro) Scale was used to assess the methodologic quality. Stata software (StatCorp, College Station, Texas) was used to perform a meta-analysis. Sixteen articles were included with a total of 1073 patients and 1097 knees. For blood loss, there were no significant differences between the 2 groups in calculated blood loss, decrease in hemoglobin level, drop in hematocrit level, and measured postoperative blood loss, although total measured blood loss and postoperative blood transfusion rate were significantly higher in the early tourniquet release group than in the late tourniquet release group. No statistical differences were found for operative time and incidence of deep venous thrombosis (DVT) between the 2 groups. Wound complication rate in the early tourniquet release group was significantly lower than in the late tourniquet release group. Primary TKA with early tourniquet release is similar to TKA with late tourniquet release regarding perioperative blood loss, operative time, and incidence of DVT. Early tourniquet release reduced the incidence of wound complications compared with late tourniquet release. [Orthopedics. 2016; 39(4):e642-e650.]. PMID:27286051

  9. Anatomic variations should be considered in total knee arthroplasty.

    PubMed

    Nagamine, R; Miura, H; Bravo, C V; Urabe, K; Matsuda, S; Miyanishi, K; Hirata, G; Iwamoto, Y

    2000-01-01

    The effect of anatomic variations on the operative techniques used in total knee arthroplasty (TKA) was assessed. In 133 Japanese patients with medial osteoarthritis (OA), six parameters were measured on anteroposterior radiographs of the lower extremities taken with the patients in the supine position. The results showed that the characteristics of the knees were bowing of the femoral shaft and proximal tibia vara, with lateral offset of the tibial shaft with respect to the center of the tibial plateau. The angle between a perpendicular to the mechanical axis and the tangent to the distal femoral condyles can be used in determining the external rotation of the femoral component. This angle was more than 3 degrees in 20% of the patients. The femoral component should therefore be externally rotated more than 3 degrees relative to the posterior condylar line in such patients. Because the center of the tibial plateau is located medial to the central line of the tibial shaft in knees with medial OA, the central point of the tibial articular surface should not be used for alignment of the tibial component. The medial offset stem of the tibial component may impinge against the medial wall. Anatomic variations should be evaluated before TKA is attempted. PMID:10982663

  10. Contact stresses with an unresurfaced patella in total knee arthroplasty: the effect of femoral component design.

    PubMed

    Matsuda, S; Ishinishi, T; Whiteside, L A

    2000-03-01

    Compressive contact stresses between the patella and the anterior femur were measured with a digital electronic sensor before and after total knee arthroplasty (TKA) in 10 cadaver knee specimens. Contact stresses were measured first in normal knees, then after TKA with the Insall-Burstein Total Condylar, Miller Galante II, Ortholoc II, Porous Coated Anatomic, and Profix knee prostheses implanted without resurfacing the patella. The Insall-Burstein, Miller-Galante II, and Ortholoc II prostheses had significantly higher contact stresses than the normal knee throughout the flexion arc. The Porous Coated Anatomic, which has a smooth patellar groove, maintained contact area as in the normal knee and did not have significantly higher contact stresses at flexion angles <90 degrees. At flexion angles > or =105 degrees, patellofemoral contact occurred in two small areas as the patella encountered the intercondylar notch in all components except the Profix. The Profix maintained full contact and low compressive stresses throughout the full flexion arc because of its posteriorly extended patellar groove. Design features of the patellofemoral portion of TKA components are important factors that affect contact stresses in the patellofemoral joint. These features likely will affect the clinical results of TKA with an unresurfaced patella. PMID:10741365

  11. The role of the popliteus tendon in total knee arthroplasty: a cadaveric study

    PubMed Central

    COTTINO, UMBERTO; BRUZZONE, MATTEO; ROSSO, FEDERICA; DETTONI, FEDERICO; BONASIA, DAVIDE EDOARDO; ROSSI, ROBERTO

    2015-01-01

    Purpose this study was conducted to investigate the influence of the popliteus tendon (PT) on the static stability of total knee arthroplasty (TKA). Methods twenty knees were used. In 10 right knees, a cruciate-retaining (CR) TKA trial prosthesis was implanted; in the other ten knees (left knees), the posterior cruciate ligament was cut and a posterior substitution (PS) TKA trial prosthesis was implanted. Lamina spreaders were set at 100 N of tension, one on the medial and one on the lateral articular space. Gaps were then measured with a caliper before and after PT sectioning. Results the correlation between femoral dimensions and popliteus insertion distance from articular surfaces was measured with the Pearson correlation index and considered significant. In the CR-TKA group, medial and lateral gap measurements showed a significant increase after PT sectioning both in flexion and in extension. In the PS-TKA group, lateral gap measurements showed a significant increase after PT sectioning both in flexion and in extension, while the medial gap measurements increased significantly only in flexion. Conclusions PT sectioning destabilized both the lateral and the medial aspects of the knee. A greater effect was observed in the lateral compartment. The most statistically reliable effect was observed with the knee in flexion. In addition, we observed that preserving the PCL does not prevent lateral gap opening after PT sectioning. Clinical relevance PT should always be preserved when performing a TKA, because its resection can affect gap balancing, in flexion and in extension. Type of study controlled laboratory study. PMID:26151034

  12. MR Imaging of Knee Arthroplasty Implants

    PubMed Central

    Fritz, Jan; Lurie, Brett

    2015-01-01

    Primary total knee arthroplasty is a highly effective treatment that relieves pain and improves joint function in a large percentage of patients. Despite an initially satisfactory surgical outcome, pain, dysfunction, and implant failure can occur over time. Identifying the etiology of complications is vital for appropriate management and proper timing of revision. Due to the increasing number of knee arthroplasties performed and decreasing patient age at implantation, there is a demand for accurate diagnosis to determine appropriate treatment of symptomatic joints following knee arthroplasty, and for monitoring of patients at risk. Magnetic resonance (MR) imaging allows for comprehensive imaging evaluation of the tissues surrounding knee arthroplasty implants with metallic components, including the polyethylene components. Optimized conventional and advanced pulse sequences can result in substantial metallic artifact reduction and afford improved visualization of bone, implant-tissue interfaces, and periprosthetic soft tissue for the diagnosis of arthroplasty-related complications. In this review article, we discuss strategies for MR imaging around knee arthroplasty implants and illustrate the imaging appearances of common modes of failure, including aseptic loosening, polyethylene wear–induced synovitis and osteolysis, periprosthetic joint infections, fracture, patellar clunk syndrome, recurrent hemarthrosis, arthrofibrosis, component malalignment, extensor mechanism injury, and instability. A systematic approach is provided for evaluation of MR imaging of knee implants. MR imaging with optimized conventional pulse sequences and advanced metal artifact reduction techniques can contribute important information for diagnosis, prognosis, risk stratification, and surgical planning. ©RSNA, 2015 PMID:26295591

  13. Deep vein thrombosis after total knee arthroplasty in asian patients without prophylactic anticoagulation.

    PubMed

    Chung, Lien-Hsiang; Chen, Wei-Ming; Chen, Cheng-Fong; Chen, Tain-Hsiung; Liu, Chien-Lin

    2011-01-01

    Deep vein thrombosis (DVT) is an important complication following total knee arthroplasty (TKA). However, the incidence of DVT is generally underestimated due to subclinical or minor symptoms and signs. In Western countries, prophylactic agents against DVT are administered routinely after TKA. However, in Asia, no regular prophylaxis is generally given to patients undergoing TKA. This article presents a prospective study evaluating the incidence of DVT in 724 consecutive Taiwanese patients who underwent TKA without prophylactic anticoagulation therapy. Of these, 328 patients (45.3%) showed positive Homan's sign with calf swelling >3 cm. Ultrasonographic examination revealed the overall incidence of DVT to be 8.6% (62/724). The incidence of DVT was significantly higher in women (P=.035), in patients who underwent bilateral TKA (P=.002), and in patients with a body mass index ≥30 kg/m(2) (P=.026). The incidence of DVT appeared to be increased in patients with higher tourniquet time; however, the difference was not statistically significant. In all of the suspected cases of DVT, the symptoms subsided after the administration of enoxaparin with uneventful follow-up. No patient developed pulmonary embolism. Our results showed a relatively high incidence of DVT in an Asian population following TKA. We therefore consider that following TKA, prophylactic anticoagulation therapy should be administered to high-risk patients.

  14. Tranexamic Acid Administration in Total Knee Arthroplasty Without Tourniquet

    PubMed Central

    Bohler, Iain R M; Howse, Louise; Baird, Andrew; Giles, Nigel

    2016-01-01

    Objective: There are multiple documented advantages of undertaking total knee arthroplasty (TKA) without tourniquet, however, increased rates of blood loss and transfusion are often cited as contraindications to this approach. The aim of this study was to examine the effect of intra-operative TA administration on blood loss and transfusion rates in TKA without pneumatic tourniquet, using Rivaroxaban as thrombo-embolic prophylaxis. Method: 120 patients split into two continuous data sets, (A+B), underwent TKA without application of above knee tourniquet, receiving a post-operative dose of oral Rivaroxaban within 8 hours. Group B patients received an intra-operative dose of 1 gram of Tranexamic Acid intravenously before the first cut, whilst those in group A did not. Haemoglobin and Haematocrit levels were recorded peri-operatively. A revised Gross formula was used to calculate blood loss. Four patients were excluded from the study for incomplete data. Result: 58 patients (M34F24) in Group A, average age 6, had a mean Haemoglobin drop of 33gram/litre, Haematocrit drop of 0.097litre/litre (9.7%), with an average calculated blood loss of 1393 ml. 58 (M34, F24) patients in group B, average age 67, had a Haemoglobin drop of 25.2gram/litre, Haematocrit drop of 0.076litre/litre (7.6%) with an average calculated blood loss of1079 ml. Thus Group A patients were seen to sustain significantly more blood loss without TA administration, with a 29.1% larger calculated blood loss, a 25.5% larger drop in Haemoglobin and a 27.6% larger fall in Haematocrit. Transfusion rate was 5.2%(3 patients) per group. Conclusion: TA was shown to be effective in reducing blood loss in TKA without tourniquet using Rivaroxaban. Transfusion rates of 5.2% across both groups is close to 1/10th of the transfusion rate reported for major studies of TKA using Rivaroxaban with tourniquet application, and 1/8th of the transfusion rate in studies of TKA with administration of TA and use of tourniquet.

  15. Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

    PubMed Central

    Cline, Joseph T.; Alentorn-Geli, Eduard; Choi, J. H. James; Stuart, Joseph J.; Kruger, Terry; Moorman III, Claude T.

    2015-01-01

    Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA). In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction) can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA. PMID:26881160

  16. The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy

    PubMed Central

    Badawy, Mona; Fenstad, Anne M; Indrekvam, Kari; Havelin, Leif I; Furnes, Ove

    2015-01-01

    Background and purpose — Previous studies have found different outcomes after revision of knee arthroplasties performed after high tibial osteotomy (HTO). We evaluated the risk of revision of total knee arthroplasty with or without previous HTO in a large registry material. Patients and methods — 31,077 primary TKAs were compared with 1,399 TKAs after HTO, using Kaplan-Meier 10-year survival percentages and adjusted Cox regression analysis. Results — The adjusted survival analyses showed similar survival in the 2 groups. The Kaplan-Meier 10-year survival was 93.8% in the primary TKA group and 92.6% in the TKA-post-HTO group. Adjusted RR was 0.97 (95% CI: 0.77–1.21; p = 0.8). Interpretation — In this registry-based study, previous high tibial osteotomy did not appear to compromise the results regarding risk of revision after total knee arthroplasty compared to primary knee arthroplasty. PMID:26058747

  17. Radiological Stability after Revision of Infected Total Knee Arthroplasty Using Modular Metal Augments

    PubMed Central

    Lee, Kyung-Jae; Cho, Chul-Hyun; Son, Eun-Seok; Jung, Jae-Won

    2016-01-01

    Purpose To evaluate the radiological stability according to the number of modular augments after revision of infected total knee arthroplasty (TKA). Materials and Methods Between February 2006 and September 2013, 37 patients (39 knees) followed ≥2 years after revision of infected TKA using modular metal augments for bone defects were reviewed retrospectively. We divided the patients into 3 groups according to the number of augments into group A (≤2 augments, 14 knees), group B (3–4 augments, 18 knees), and group C (5≥ augments, 7 knees) and evaluated the width of radiolucent zones around the implant at the last follow-up. Results There were 3 Anderson Orthopedic Research Institute type I, 33 type II, and 3 type III bone defects. The mean number of radiolucent zones of group A was 3 and the sum of width averaged 4.4 mm. In group B, the values were 4.8 and 6.2 mm, respectively. In group C, the values were 8.1 and 12.9 mm, respectively. The differences between the three groups were statistically significant. Conclusions In revision TKA with modular metal augmentation caused by infected TKA, increased modularity can result in radiological instability. PMID:26955613

  18. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis.

    PubMed

    Swank, Ann M; Kachelman, Joseph B; Bibeau, Wendy; Quesada, Peter M; Nyland, John; Malkani, Arthur; Topp, Robert V

    2011-02-01

    Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject's TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p < 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA.

  19. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer.

    PubMed

    Tomite, Takenori; Saito, Hidetomo; Aizawa, Toshiaki; Kijima, Hiroaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. PMID:27648328

  20. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

    PubMed Central

    Saito, Hidetomo; Aizawa, Toshiaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. PMID:27648328

  1. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

    PubMed Central

    Saito, Hidetomo; Aizawa, Toshiaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning.

  2. Analgesic Techniques in Hip and Knee Arthroplasty: From the Daily Practice to Evidence-Based Medicine

    PubMed Central

    Anastase, Denisa Madalina; Cionac Florescu, Simona; Munteanu, Ana Maria; Ursu, Traian; Stoica, Cristian Ioan

    2014-01-01

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II–IV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice. PMID:25484894

  3. Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

    PubMed Central

    Harman, Melinda K.; Bonin, Stephanie J.; Leslie, Chris J.; Banks, Scott A.; Hodge, W. Andrew

    2014-01-01

    Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ≥120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL. PMID:25374697

  4. Is hydroxyapatite a reliable fixation option in unicompartmental knee arthroplasty? A 5- to 13-year experience with the hydroxyapatite-coated unix prosthesis.

    PubMed

    Epinette, Jean-Alain; Manley, Michael T

    2008-10-01

    Hydroxyapatite-coated unicompartmental knee arthroplasty (UKA) is a debatable approach to unicompartmental knee arthritis because UKA isoften viewed as a short-term solution, at best, fora condition that will eventually require a total knee arthroplasty (TKA). Unicompartmental knee arthroplasty is a more technically demanding procedure than TKA, and appropriate patient selection, careful surgical technique, and correct choice of implant geometry are all critical components to its success. A fundamental issue surrounding UKA is whether hydroxyapatite-coated unicompartmental components can provide a long-term solution to unicondylar arthritis. We address this issue in the current study, which is based on a prospective series of 125 hydroxyapatite-coated Unix knee prostheses implanted consecutively between 1994 and 2002, with a 5-year minimum follow-up and a 13-year maximum follow-up. The results of our study indicate that uncemented hydroxyapatite-coated UKA can be successful in the long term.

  5. Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach

    PubMed Central

    Dabboussi, Naji; Sakr, Mazen; Girard, Julien; Fakih, Riad

    2012-01-01

    Background: Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation. Aim: Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA). Materials and Methods: During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group). Results: Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion. Conclusion: This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach. PMID:22408753

  6. Frequent Dental Scaling Is Associated with a Reduced Risk of Periprosthetic Infection following Total Knee Arthroplasty: A Nationwide Population-Based Nested Case-Control Study

    PubMed Central

    Tai, Ta-Wei; Lin, Tzu-Chieh; Ho, Chia-Jung; Kao Yang, Yea-Huei; Yang, Chyun-Yu

    2016-01-01

    Oral bacteremia has been presumed to be an important risk factor for total knee arthroplasty (TKA) infection. We aimed to investigate whether dental scaling could reduce the risk of TKA infection. A nested case-control study was conducted to compare 1,291 TKA patients who underwent resection arthroplasty for infected TKA and 5,004 matched controls without infection in the TKA cohort of Taiwan’s National Health Insurance Research Database (NHIRD). The frequency of dental scaling was analyzed. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. The percentage of patients who received dental scaling was higher in the control group than in the TKA infection group. The risk for TKA infection was 20% lower for patients who received dental scaling at least once within a 3-year period than for patients who never received dental scaling. Moreover, the risk of TKA infection was reduced by 31% among patients who underwent more frequent dental scaling (5–6 times within 3 years). Frequent and regular dental scaling is associated with a reduced risk of TKA infection. PMID:27336912

  7. Frequent Dental Scaling Is Associated with a Reduced Risk of Periprosthetic Infection following Total Knee Arthroplasty: A Nationwide Population-Based Nested Case-Control Study.

    PubMed

    Tai, Ta-Wei; Lin, Tzu-Chieh; Ho, Chia-Jung; Kao Yang, Yea-Huei; Yang, Chyun-Yu

    2016-01-01

    Oral bacteremia has been presumed to be an important risk factor for total knee arthroplasty (TKA) infection. We aimed to investigate whether dental scaling could reduce the risk of TKA infection. A nested case-control study was conducted to compare 1,291 TKA patients who underwent resection arthroplasty for infected TKA and 5,004 matched controls without infection in the TKA cohort of Taiwan's National Health Insurance Research Database (NHIRD). The frequency of dental scaling was analyzed. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. The percentage of patients who received dental scaling was higher in the control group than in the TKA infection group. The risk for TKA infection was 20% lower for patients who received dental scaling at least once within a 3-year period than for patients who never received dental scaling. Moreover, the risk of TKA infection was reduced by 31% among patients who underwent more frequent dental scaling (5-6 times within 3 years). Frequent and regular dental scaling is associated with a reduced risk of TKA infection. PMID:27336912

  8. Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients.

    PubMed

    Bohm, Eric R; Molodianovitsh, Katy; Dragan, Alina; Zhu, Naisu; Webster, Greg; Masri, Bas; Schemitsch, Emil; Dunbar, Michael

    2016-07-01

    Background and purpose - There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods - Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006-2007 to 2012-2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results - Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation - We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design. PMID:27167849

  9. Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients

    PubMed Central

    Molodianovitsh, Katy; Dragan, Alina; Zhu, Naisu; Webster, Greg; Masri, Bas; Schemitsch, Emil; Dunbar, Michael

    2016-01-01

    Background and purpose — There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods — Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006–2007 to 2012–2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results — Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation — We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design. PMID:27167849

  10. The constraints on day-case total knee arthroplasty: the fastest fast track.

    PubMed

    Thienpont, E; Lavand'homme, P; Kehlet, H

    2015-10-01

    Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case TKA. These constraints may be social, linked to patient's comorbidities, or due to surgery-related adverse events (e.g. pain, post-operative nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and multimodal opioid-sparing analgesia, day-case TKA might be achievable in a limited group of patients. The younger, male patient without comorbidities and with an excellent social network around him might be a candidate. Demographic changes, effective recovery programmes and less invasive surgical techniques such as unicondylar knee arthroplasty, may increase the size of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced against any increase in morbidity and mortality and the cost of advanced follow-up at a distance with new technology. These factors need to be evaluated before adopting this ultimate 'fast-track' approach. PMID:26430085

  11. A clinical study of the rotational alignment of the femoral component in total knee arthroplasty

    PubMed Central

    Ding, Liangjia; Liu, Xiaomin; Liu, Changlu; Liu, Yingli

    2015-01-01

    [Purpose] The reasons for femorotibial rotational malalignment after total knee arthroplasty (TKA) were analyzed to provide evidence for clinical knee joint surgery and to reduce complications. [Subjects and Methods] Ninety knees of 60 patients were selected and randomly divided into two groups (n=30). For one group, rotational alignment of the femoral component was determined by the transepicondylar axis and TKA was performed. For the other group, rotational alignment of the femoral component was conducted through 3° external rotation of the posterior femoral condyles. Knee joint specimens were operated with TKA and various biomechanical indices were measured. [Results] The femoral epicondylar axis was a constant, reliable reference for femoral component rotational alignment. When the femoral component was rotated by 0° versus the epicondylar axis, the peak contact pressure on the patellofemoral joint was optimal. When the femoral component was arranged in parallel with Whiteside’s line, the peak contact pressure on the patellofemoral joint varied largely. The patellofemoral contact areas of the two groups were similar. [Conclusion] Axial rotational alignment of the femoral component influenced the contact pressure of patellofemoral joints in TKA more significantly than external rotation of the femoral condyles. It is more reliable to use the femoral epicondylar axis as the reference for the rotational alignment of the femoral component. PMID:26311929

  12. Tantalum cones and bone defects in revision total knee arthroplasty.

    PubMed

    Boureau, F; Putman, S; Arnould, A; Dereudre, G; Migaud, H; Pasquier, G

    2015-04-01

    Management of bone loss is a major challenge in revision total knee arthroplasty (TKA). The development of preformed porous tantalum cones offers new possibilities, because they seem to have biological and mechanical qualities that facilitate osseointegration. Compared to the original procedure, when metaphyseal bone defects are too severe, a single tantalum cone may not be enough and we have developed a technique that could extend the indications for this cone in these cases. We used 2 cones to fill femoral bone defects in 7 patients. There were no complications due to wear of the tantalum cones. Radiological follow-up did show any migration or loosening. The short-term results confirm the interest of porous tantalum cones and suggest that they can be an alternative to allografts or megaprostheses in case of massive bone defects.

  13. Mobile bearing and fixed bearing total knee arthroplasty.

    PubMed

    Capella, Marcello; Dolfin, Marco; Saccia, Francesco

    2016-04-01

    The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience. PMID:27162777

  14. Mobile bearing and fixed bearing total knee arthroplasty

    PubMed Central

    Dolfin, Marco; Saccia, Francesco

    2016-01-01

    The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience. PMID:27162777

  15. Are static and dynamic kinematics comparable after total knee arthroplasty?

    PubMed

    Saevarsson, Stefan K; Romeo, Carolina I; Anglin, Carolyn

    2013-04-01

    Knee kinematics provide information about how the femoral, tibial and patellar bones or prosthetic components move relative to each other. Accurate knowledge of kinematics is valuable for implant design, comparisons between designs or surgical techniques, and to identify differences between patients with good and poor outcomes. Both static and dynamic imaging techniques have been used to evaluate kinematics. In general, static imaging is used to capture better quality images or to capture views that cannot be acquired by dynamic imaging, whereas dynamic imaging is used to capture real-life movements. How well static kinematics represent dynamic kinematics is subject to frequent debate and has not been adequately addressed, especially after total knee arthroplasty (TKA). We compared the static and dynamic weightbearing kinematics of 10 female subjects after TKA. Using the same clinical scanner for both methods, static images were taken using our standard protocol, sequential-biplane radiographs at multiple flexion angles, as well as with dynamic video fluoroscopy during a step up activity. The static method can reliably measure all 12 degrees of freedom (DOF) after TKA, however only seven were compared due to the poorer out-of-plane reliability in the single-plane dynamic imaging. No differences were found between the static and dynamic kinematics for nine out of ten subjects. For one subject, however, a difference of 5-8° in internal/external tibial rotation was found. The research question, study purpose and the advantages and disadvantages of each method need to be considered when determining which imaging method to use.

  16. Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review

    PubMed Central

    Saleh, Hesham; Yu, Stephen; Vigdorchik, Jonathan; Schwarzkopf, Ran

    2016-01-01

    AIM To review and report functional outcomes, complications, and survivorship associated with total knee arthroplasty (TKA) in the treatment of post-traumatic arthritis (PTA). METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for English-language clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles. We extracted data on patients’ demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text. RESULTS Sixteen studies, four prospective and ten retrospective, examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion (ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear. CONCLUSION Although associated with higher complication rates, TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.

  17. Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review

    PubMed Central

    Saleh, Hesham; Yu, Stephen; Vigdorchik, Jonathan; Schwarzkopf, Ran

    2016-01-01

    AIM To review and report functional outcomes, complications, and survivorship associated with total knee arthroplasty (TKA) in the treatment of post-traumatic arthritis (PTA). METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for English-language clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles. We extracted data on patients’ demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text. RESULTS Sixteen studies, four prospective and ten retrospective, examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion (ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear. CONCLUSION Although associated with higher complication rates, TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes. PMID:27672572

  18. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty.

    PubMed

    Bagsby, Deren T; Ireland, Phillip H; Meneghini, R Michael

    2014-08-01

    The purpose of this study was to compare a novel liposomal bupivacaine to traditional peri-articular injection (PAI) in a multi-modal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared 85 consecutive patients undergoing TKA with a traditional PAI of ropivacaine, epinephrine and morphine to 65 patients with a liposomal bupivacaine PAI. After the initial 24h, inpatient self-reported pain scores were higher in the liposomal bupivacaine group compared to the traditional PAI group (P = 0.04) and a smaller percentage (16.9%) of patients in the liposomal bupivacaine group rated their pain as "mild" compared to the traditional group (47.6%). Liposomal bupivacaine PAI provided inferior pain control compared to the less expensive traditional PAI in a multi-modal pain control program in patients undergoing TKA.

  19. Incidence of clinically significant venous thromboembolic events in Asian patients undergoing total knee arthroplasty without anticoagulation.

    PubMed

    Bin Abd Razak, Hamid Rahmatullah; Soon, Ang Teng; Dhanaraj, Ian Dominic; Tan, Andrew Hwee Chye

    2012-06-01

    This study aimed to evaluate the incidence of clinically significant venous thromboembolic events (VTE) in Asian patients undergoing total knee arthroplasty (TKA) without anticoagulation. All patients who underwent TKA by a single surgeon from 2006 to 2010 in Singapore General Hospital were reviewed. Only symptomatic patients were referred for ultrasonography. Of the 531 patients reviewed, 3 patients developed symptoms of deep vein thrombosis with subsequent ultrasonographic confirmation, whereas 1 patient developed fatal pulmonary embolism without any clinical or radiologic evidence of deep vein thrombosis. Hence, the incidence of clinically significant VTE was 0.75%. Given the low incidence of clinically significant VTE, there is a need to review the current practice of routine chemoprophylaxis in Asian patients undergoing TKA.

  20. Specialized instruments and modular implants for minimally invasive total knee arthroplasty.

    PubMed

    Coon, Thomas M

    2006-07-01

    To optimize the benefits potentially achievable with minimally invasive surgery (MIS) total knee arthroplasty (TKA), the surgeon must operate through a smaller incision without compromising the surgical result. Initial efforts in this regard centered on using miniaturized instruments and ancillary navigational instruments to compensate for reduced visualization. With the advent of the quadriceps-sparing approach came the side-cutting tool, which had additional applications in other MIS TKA approaches. Innovation has occurred not only in MIS TKA instrumentation but also in components, such as MIS precoated stemmed tibial implants. MIS implants are now available in modular components that can be assembled in vivo with specialized insertion and locking tools. Although clinical experience is still limited, initial experience with new instrumentation and components for MIS seems promising, and technological development continues.

  1. Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-month postoperative comparison

    PubMed Central

    2013-01-01

    Background The recovery of gait ability is one of the primary goals for patients following total arthroplasty of lower-limb joints. The aim of this study was to objectively compare gait differences of patients after unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA) and total ankle arthroplasty (TAA) with a group of healthy controls. Methods A total of 26 TAA, 26 TKA and 26 THA patients with a mean (± SD) age of 64 (± 9) years were evaluated six months after surgery and compared with 26 matched healthy controls. Subjects were asked to walk at self-selected normal and fast speeds on a validated pressure mat. The following spatiotemporal gait parameters were measured: walking velocity, cadence, single-limb support (SLS) time, double-limb support (DLS) time, stance time, step length and step width. Results TAA and TKA patients walked slower than controls at normal (p<0.05) and fast speeds (p<0.01). The involved side of TAA and TKA patients showed shorter SLS compared to controls at both normal and fast speeds (p<0.01). Regardless of walking speed, the uninvolved side of TAA and TKA patients demonstrated longer stance time and shorter step length than controls (p<0.01). TAA patients showed shorter SLS of the involved side, longer stance time and shorter step length of the uninvolved side compared to the contralateral side at both normal and fast speeds (p<0.001). Conclusions Gait disability after unilateral lower-limb joint arthroplasty was more marked for distal than for proximal joints at six months after surgery, with a proximal-to-distal progression in the impairment (TAA>TKA>THA). THA patients demonstrated no gait differences compared with controls. In contrast, TAA and TKA patients still demonstrated gait differences compared to controls, with slower walking velocity and reduced SLS in the involved limb. In addition, TAA patients presented marked side-to-side asymmetries in gait characteristics. PMID:23731906

  2. Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty

    PubMed Central

    Leitner, Lukas; Musser, Ewald; Kastner, Norbert; Friesenbichler, Jörg; Hirzberger, Daniela; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time. In a multivariate logistic regression analysis the independent influences of PAT, demographic parameters, ASA score > 2, and duration of the operation on RCC demand following TKA were analyzed. Patients with PAT were significantly older, more often had an ASA > 2 at surgery, needed a higher number of RCCs units and more frequently and had lower perioperative hemoglobin levels. Multivariate logistic regression revealed PAT was an independent predictor for RCC requirement. PAT patients are more likely to require RCC following TKA and should be accurately monitored with respect to postoperative blood loss. PMID:27488941

  3. Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty.

    PubMed

    Leitner, Lukas; Musser, Ewald; Kastner, Norbert; Friesenbichler, Jörg; Hirzberger, Daniela; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time. In a multivariate logistic regression analysis the independent influences of PAT, demographic parameters, ASA score > 2, and duration of the operation on RCC demand following TKA were analyzed. Patients with PAT were significantly older, more often had an ASA > 2 at surgery, needed a higher number of RCCs units and more frequently and had lower perioperative hemoglobin levels. Multivariate logistic regression revealed PAT was an independent predictor for RCC requirement. PAT patients are more likely to require RCC following TKA and should be accurately monitored with respect to postoperative blood loss. PMID:27488941

  4. Patellar resurfacing in total knee arthroplasty: functional outcome differs with different outcome scores

    PubMed Central

    Aunan, Eirik; Næss, Grethe; Clarke-Jenssen, John; Sandvik, Leiv; Kibsgård, Thomas Johan

    2016-01-01

    Background and purpose — Recent research on outcomes after total knee arthroplasty (TKA) has raised the question of the ability of traditional outcome measures to distinguish between treatments. We compared functional outcomes in patients undergoing TKA with and without patellar resurfacing, using the knee injury and osteoarthritis outcome score (KOOS) as the primary outcome and 3 traditional outcome measures as secondary outcomes. Patients and methods — 129 knees in 115 patients (mean age 70 (42–82) years; 67 female) were evaluated in this single-center, randomized, double-blind study. Data were recorded preoperatively, at 1 year, and at 3 years, and were assessed using repeated-measures mixed models. Results — The mean subscores for the KOOS after surgery were statistically significantly in favor of patellar resurfacing: sport/recreation, knee-related quality of life, pain, and symptoms. No statistically significant differences between the groups were observed with the Knee Society clinical rating system, with the Oxford knee score, and with visual analog scale (VAS) for patient satisfaction. Interpretation — In the present study, the KOOS—but no other outcome measure used—indicated that patellar resurfacing may be beneficial in TKA. PMID:26540368

  5. Posterior femoral translation in medial pivot total knee arthroplasty of posterior cruciate ligament retaining type

    PubMed Central

    Cho, Su Hyun; Cho, Hyung Lae; Lee, Soo Ho; Jin, Hong Ki

    2013-01-01

    Purpose To report clinical results and demonstrate posterior femoral translation (PFT) in medial pivot total knee arthroplasty (TKA) of posterior cruciate ligament (PCL) retaining type. Materials and methods A prospective study was performed upon thirty consecutive subjects who were operated on with medial pivot TKA of PCL retaining type between March 2009 and March 2010 and had been followed up for at least 2 years. Clinically, the knee society knee score and function score were used. In full extension and active flexion lateral radiograph, anteroposterior (AP) condylar position and magnitude of PFT was determined. Results At last follow-up, the mean knee society knee score and function score improved significantly compared to preoperative scores. The AP condylar positions were consistently posterior to midline throughout the entire range of flexion. The PFTs averaged 0.31 (±0.12) of half length of tibial base plate and were greater in higher flexion cases (r = 0.56, p = 0.0012). There were no cases having either component migration or radiolucent line wider than 2 mm except for one case showing instability related to trauma. Conclusions In medial pivot TKA of PCL retaining type, clinical outcomes were satisfactory and posterior femoral translations were consistently observed during progressive flexions of knees at two- to three-year follow-up. PMID:24403754

  6. VALUE OF PREOPERATIVE RADIOGRAPHIC EVALUATIONS ON KNEE BONE DEFECTS FOR REVISION ARTHROPLASTY

    PubMed Central

    Iamaguchi, Mauricio Masasi; Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Tirico, Luiz Eduardo Passarelli; Pecora, Jose Ricardo; Camanho, Gilberto Luis

    2015-01-01

    Objective: To evaluate the value of preoperative radiographic evaluations for total knee arthroplasty (TKA) revision. Methods: Thirty-one knees that were operated between 2006 and 2008, in a consecutive series of cases of TKA revision surgery were analyzed retrospectively. The following criteria were evaluated: number of wedges or structured bone grafts used for filling the bone defects; locations of the wedges and bone grafts used; and mean thickness of the polyethylene used. The AORI classification was previously established based on preoperative radiographs, using preestablished criteria. After the analysis, the knees were divided into four groups (I, IIA, IIB and III). Results: The mean number of wedges or grafts used in each knee progressively increased among the groups (group I: 1.33; group IIA: 2; group IIB: 4.33; and group III: 4.83) (P = 0.0012). The commonest locations were medial in the tibia and posteromedial in the femur. There were no statistically significant differences in the thickness of the polyethylene used. Conclusion: The AORI classification for bone defects in the knee, based on preoperative radiographs, showed a correlation with increasing need to use wedges and/or structured grafts in TKA revisions. However, up to 46% of the knees in groups I and IIA presented bone defects of up to 5 mm that were not diagnosed by means of preoperative radiographs. PMID:27047889

  7. Total knee arthroplasty in patient with paraplegia after spinal cord injury.

    PubMed

    Zietek, P; Dobiecki, K

    2015-01-01

    The clinical management of paraplegic patients is more complex than in able-bodied subjects. Spinal cord injury (SCI) affects younger, active people more often than the elderly during high-energy fall or traffic accidents. In order to return to work after suffering an SCI, patients need to regain their functional independence, especially their ability to drive. The literature lacks strong evidence addressing the surgical solutions in severe knee arthrosis in paralyzed patients after SCI. We present a favourable outcome of total knee arthroplasty (TKA) of a stiff knee in extension in a man with T12 grade C paraplegia after SCI. We describe an effective rehabilitation protocol after knee arthroplasty in patient with damage to the spinal cord. Several factors should be taken into account before performing surgery: 1. ability of regaining some of spinal cord locomotor function through intensive gait rehabilitation in SCI patients, 2. presence of muscle imbalance and knee contractures combined with a risk of bone fracture resulting from intensive postoperative rehabilitation, 3. the impaired microvasculature of the skin and subcutaneous tissues and increased risk of occlusion occurrence of the capillaries and small vessels of the leg, 4. higher prevalence of secondary infections via urinary entry sites in patients after SCI, 5. patient's strong determination and willingness to undergo the arthroplasty procedure. TKA might be considered in selected paralyzed patients after SCI, especially in those with severe arthrosis as well as significant knee contractures. Our study reveals the advantage of performing TKA in improving functional state in patients with cord injury. PMID:25748667

  8. Gait comparison of unicompartmental and total knee arthroplasties with healthy controls

    PubMed Central

    Jones, G. G.; Kotti, M.; Wiik, A. V.; Collins, R.; Brevadt, M. J.; Strachan, R. K.; Cobb, J. P.

    2016-01-01

    Aims To compare the gait of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) patients with healthy controls, using a machine-learning approach. Patients and Methods 145 participants (121 healthy controls, 12 patients with cruciate-retaining TKA, and 12 with mobile-bearing medial UKA) were recruited. The TKA and UKA patients were a minimum of 12 months post-operative, and matched for pattern and severity of arthrosis, age, and body mass index. Participants walked on an instrumented treadmill until their maximum walking speed was reached. Temporospatial gait parameters, and vertical ground reaction force data, were captured at each speed. Oxford knee scores (OKS) were also collected. An ensemble of trees algorithm was used to analyse the data: 27 gait variables were used to train classification trees for each speed, with a binary output prediction of whether these variables were derived from a UKA or TKA patient. Healthy control gait data was then tested by the decision trees at each speed and a final classification (UKA or TKA) reached for each subject in a majority voting manner over all gait cycles and speeds. Top walking speed was also recorded. Results 92% of the healthy controls were classified by the decision tree as a UKA, 5% as a TKA, and 3% were unclassified. There was no significant difference in OKS between the UKA and TKA patients (p = 0.077). Top walking speed in TKA patients (1.6 m/s; 1.3 to 2.1) was significantly lower than that of both the UKA group (2.2 m/s; 1.8 to 2.7) and healthy controls (2.2 m/s; 1.5 to 2.7; p < 0.001). Conclusion UKA results in a more physiological gait compared with TKA, and a higher top walking speed. This difference in function was not detected by the OKS. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):16–21. PMID:27694511

  9. Stance time variability during stair stepping before and after total knee arthroplasty: A pilot study.

    PubMed

    Smith, Jessica W; Marcus, Robin L; Tracy, Brian L; Foreman, K Bo; Christensen, Jesse C; LaStayo, Paul C

    2016-02-01

    The main objectives of this pilot study were to: (1) investigate stance time variability (STV) during stair stepping in older adults with osteoarthritis (OA) before and after total knee arthroplasty (TKA), and compare to an age- and sex-matched group of healthy controls with native knees and (2) evaluate the relationship between quadriceps strength and STV during stair stepping before and after TKA. A prospective, observational, pilot study was carried out on 13 individuals (15% male, mean age 62.71±6.84years) before and after TKA using an instrumented stairway, patient-reported outcomes, timed stair stepping test, and quadriceps strength measures. At 6-months post-operatively, STV during stair descent was significantly greater in the TKA-GROUP compared to the CONTROL-GROUP, but was not significantly different at 12-months compared to controls. There were no significant differences in STV for stair ascent between the pre- and post-operative visits, or compared to controls. There was a trend toward significance for the relationship between quadriceps strength and STV during stair ascent (P=0.059) and descent (P=0.073). Variability during stair stepping may provide an important, short-term rehabilitation target for individuals following TKA and may represent another parameter to predict declines in functional mobility.

  10. No clinical benefit of gender-specific total knee arthroplasty

    PubMed Central

    Zhu, Chen; Wang, Jiaxing; Cheng, Mengqi; Peng, Xiaochun; Wang, Qi; Zhang, Xianlong

    2014-01-01

    Background and purpose There is no consensus regarding the clinical relevance of gender-specific prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-specific prostheses and standard unisex prostheses in female patients. Methods We used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-specific prostheses with standard unisex prostheses in female patients who underwent primary TKAs. Results 6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-specific group. Interpretation Gender-specific prostheses do not appear to confer any benefit in terms of clinician- and patient-reported outcomes for the female knee. PMID:24954488

  11. Bilateral Spontaneous Midsubstance Patellar Tendon Rupture after Bilateral Total Knee Arthroplasty

    PubMed Central

    Rajani, Amyn; Dash, Kumar Kaushik; Mahajan, Neetin P; Kumar, Ritesh

    2016-01-01

    Introduction: Patellar tendon rupture can occur due to multiple causes ranging from inflammatory pathologies to episodes of trauma. Extensor mechanism rupture is a rare complication of total knee arthroplasty (TKA). In most of these cases, the failure occurs as avulsion of patellar tendon from tibial tuberosity. We report a rare case with bilateral mid-substance patellar tendon rupture one month after bilateral total knee arthroplasty. Case Presentation: A 69-year-old male was operated for bilateral grade 4 osteoarthritis. On day 30 post-operative, he sustained bilateral patellar tendon rupture while getting up from toilet. He had a history of multiple steroid injections in the knee, which could have affected the tendon. The other etiologies could be inherent weakness of tendon due to diabetes and old age and micro-trauma/stretch associated with sudden correction of previous deformity by TKA. The management in our case was done by primary repair along with augmentation by autologous semitendinosus graft and suture anchor. Conclusion: The operating surgeon must be aware of the possibility of patellar tendon rupture following total knee arthroplasty. This will help the surgeon in early recognition and preparedness to handle such complications, should they arise. Surgeons may consider advising caution to both patient and rehabilitation team in cases with old age, chronic diabetes mellitus, and with a history of steroid injections. PMID:27703942

  12. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

    PubMed Central

    Cook, Jon R; Warren, Meghan; Ganley, Kathleen J; Prefontaine, Paul; Wylie, Jack W

    2008-01-01

    Background Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°), but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period. Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe

  13. Estimating patient-specific soft-tissue properties in a TKA knee.

    PubMed

    Ewing, Joseph A; Kaufman, Michelle K; Hutter, Erin E; Granger, Jeffrey F; Beal, Matthew D; Piazza, Stephen J; Siston, Robert A

    2016-03-01

    Surgical technique is one factor that has been identified as critical to success of total knee arthroplasty. Researchers have shown that computer simulations can aid in determining how decisions in the operating room generally affect post-operative outcomes. However, to use simulations to make clinically relevant predictions about knee forces and motions for a specific total knee patient, patient-specific models are needed. This study introduces a methodology for estimating knee soft-tissue properties of an individual total knee patient. A custom surgical navigation system and stability device were used to measure the force-displacement relationship of the knee. Soft-tissue properties were estimated using a parameter optimization that matched simulated tibiofemoral kinematics with experimental tibiofemoral kinematics. Simulations using optimized ligament properties had an average root mean square error of 3.5° across all tests while simulations using generic ligament properties taken from literature had an average root mean square error of 8.4°. Specimens showed large variability among ligament properties regardless of similarities in prosthetic component alignment and measured knee laxity. These results demonstrate the importance of soft-tissue properties in determining knee stability, and suggest that to make clinically relevant predictions of post-operative knee motions and forces using computer simulations, patient-specific soft-tissue properties are needed. PMID:26291455

  14. Flexion-extension gap in cruciate-retaining versus posterior-stabilized total knee arthroplasty: a cadaveric study.

    PubMed

    Matthews, Joshua; Chong, Alexander; McQueen, David; O'Guinn, Justin; Wooley, Paul

    2014-05-01

    We re-examined experimental model results using half-body specimens with intact extensor mechanisms and navigation to evaluate cruciate-retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA) component gaps through an entire range of motion. Six sequential testing regimens were conducted with the knee intact, with a CR TKA in place, and with a PS TKA in place, with and without 22 N traction in place at each stage. Each of 10 knees was taken through six full ranges of motion from 0° to 120° at every stage using a navigated knee system to record component gapping. No significant difference was found between loaded and unloaded component gaps, and no significant differences were found in component gapping between CR and PS TKAs throughout a full range of motion. Flexion-extension gap measurements were significantly different from previously published data (at 90° flexion). No difference was found in kinematics when comparing CR and PS TKA component designs. Our results suggest that intact extensor mechanisms may be required to perform proper kinematic studies of TKA. Our findings provide evidence that the extensor mechanism may play a major role in the flexion-extension gaps in cadaveric knees.

  15. Use of antibiotic-loaded cement in total knee arthroplasty

    PubMed Central

    Hinarejos, Pedro; Guirro, Pau; Puig-Verdie, Lluis; Torres-Claramunt, Raul; Leal-Blanquet, Joan; Sanchez-Soler, Juan; Monllau, Joan Carles

    2015-01-01

    Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement (ALBC) is helpful when treating an infection in total knee arthroplasty (TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in the literature, its pros and cons. Many authors have recommended the use of ALBC also in primary TKA for infection prophylaxis, but the evidence based on data from National Registries, randomized clinical trials and meta-analysis suggest a protective effect of ALBC against infection when used in hips, but not (or only mild) in knees. A possible explanation to this finding is that the duration and quantity of locally elevated antibiotic levels after surgery are smaller in TKA, due to the smaller amount of cement used for fixation in TKA-only a layer in the bone surface. There are some concerns about the routine use of ALBC in primary TKA as prophylaxis against infection: Firstly, there is a risk of hypersensivity or toxicity even when the chance is highly improbable. Secondly, there is a reduction in the mechanical properties of the cement, but this can be probably neglected if the antibiotic is used in low doses, not more than 1 g per 40 g cement package. Another significant concern is the increased economic cost, which could be overlooked if there were enough savings in treating fewer prosthetic infections. Finally, there is also a risk of selection of antibiotic-resistant strains of bacteria and this could be the main concern. If used, the choice of the antibiotic mixed in ALBC should consider microbiological aspects (broad antimicrobial spectrum and low rate of resistant bacteria), physical and chemical aspects (thermal stability, high water solubility), pharmacological

  16. Total knee arthroplasty in valgus knees using minimally invasive medial-subvastus approach

    PubMed Central

    Shah, Nilen Amulak; Jain, Nimesh Prakash

    2016-01-01

    Background: An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications. Materials and Methods: We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24–84 months). Results: The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°–35°) to 5° (range 3°–9°) valgus (P < 0.001). Conclusions: Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications. PMID:26955174

  17. Early follow-up after primary total knee and total hip arthroplasty with rapid recovery : Focus groups.

    PubMed

    van Egmond, Jeroen C; Verburg, Hennie; Vehmeijer, Stephan B W; Mathijssen, Nina M C

    2015-09-01

    Rapid recovery protocols reduce the length of hospital stay after Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). However, little is known about the early postoperative phase. The purpose of this study was to examine which problems patients encountered during the first six weeks after primary TKA or THA surgery with rapid recovery. We invited twenty patients for a focus group meeting which discussed various subjects regarding the first six weeks after hospital discharge. The focus group meetings were analysed qualitatively. Patients were mostly satisfied by the short length of hospital stay. Patients who lived alone needs more care and would like to stay longer in the hospital. After THA surgery all patients complained of inability to sleep. More patients experienced pain after TKA surgery compared to THA surgery. All patients had various experiences regarding physical therapy therefore an evidence based rehabilitation protocol might be needed.

  18. Stress fracture of the first metatarsal after total knee arthroplasty: two case reports using gait analysis.

    PubMed

    Harato, Kengo; Ozaki, Masahiro; Sakurai, Aiko; Kudo, Yutaka; Otani, Toshiro

    2014-01-01

    Stress fractures after total knee arthroplasty (TKA) occur mainly in patients with considerable deformity of the knee. In addition, the majority of these fractures after TKA involve the hip joint. We present two cases of stress fractures of the first metatarsal after TKA in patients with severe varus deformity. Correction of leg alignment and pain reduction obtained by TKA lead to stress fracture of the bone. Gait analysis was carried out for both cases in order to clarify the gait characteristics of the stress fracture. As a result, side-to-side differences of the distance between first metatarsal and foot center of pressure in the coronal plane were observed using gait analysis in these patients. Fortunately, conservative treatment was successful for these patients. Stress fractures should be considered when a patient who had a considerable severe deformity of the knee preoperatively complains of foot pain on the affected side. Contrary to stress fractures at the hip joint, patients with the fracture of the first metatarsal can be treated without surgery.

  19. Metal-backed versus all-polyethylene tibial components in primary total knee arthroplasty

    PubMed Central

    2011-01-01

    Background and purpose The choice of either all-polyethylene (AP) tibial components or metal-backed (MB) tibial components in total knee arthroplasty (TKA) remains controversial. We therefore performed a meta-analysis and systematic review of randomized controlled trials that have evaluated MB and AP tibial components in primary TKA. Methods The search strategy included a computerized literature search (Medline, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials) and a manual search of major orthopedic journals. A meta-analysis and systematic review of randomized or quasi-randomized trials that compared the performance of tibial components in primary TKA was performed using a fixed or random effects model. We assessed the methodological quality of studies using Detsky quality scale. Results 9 randomized controlled trials (RCTs) published between 2000 and 2009 met the inclusion quality standards for the systematic review. The mean standardized Detsky score was 14 (SD 3). We found that the frequency of radiolucent lines in the MB group was significantly higher than that in the AP group. There were no statistically significant differences between the MB and AP tibial components regarding component positioning, knee score, knee range of motion, quality of life, and postoperative complications. Interpretation Based on evidence obtained from this study, the AP tibial component was comparable with or better than the MB tibial component in TKA. However, high-quality RCTs are required to validate the results. PMID:21895503

  20. EFFECT OF TRANEXAMIC ACID ON BLEEDING CONTROL IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    SADIGURSKY, DAVID; ANDION, DANIEL; BOUREAU, PÉRICLES; FERREIRA, MARIA CORDULINA; CARNEIRO, ROGÉRIO JAMIL FERNANDES; COLAVOLPE, PAULO OLIVEIRA

    2016-01-01

    ABSTRACT Objectives: To analyze the effectiveness of intravenous (IV) tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA). Method: The population sample was composed of patients with a diagnosis of primary knee osteoarthritis. The patients undergoing TKA were divided in two groups. Group A: comprised patients who used IV TA and B group, formed by patients who did not use TA in the intra or post-operative period. For descriptive analysis, quantitative variables were represented by mean and standard deviations when their distribution was normal and interquartile ranges and medians for non-normal variables. Results: The mean age of patients was 68 years old, most of them were female and with involvement of the left knee. Postoperatively patients who had used IV TA showed less bleeding rate and less hemoglobin rate reduction. Conclusion: The use of IV TA in TKA reduces blood loss in peri- and postoperative periods. Regarding total blood loss reduction, hemoglobin rate and need for blood transfusions, IV TA should be used routinely during TKA since it has been shown to be safe with no increase in side effects as thromboembolic events. Level of Evidence III. Retrospective Comparative Study. PMID:27217813

  1. Femoral nerve block for patient undergoing total knee arthroplasty

    PubMed Central

    Heo, Bong Ha; Lee, Hyeon Jung; Lee, Hyung Gon; Kim, Man Young; Park, Keun Suk; Choi, Jeong Il; Yoon, Myung Ha; Kim, Woong Mo

    2016-01-01

    Abstract Background: The existence of peripheral opioid receptors and its effectiveness in peripheral nerve block remain controversial. The aim of this prospective, randomized, double-blinded study was to examine the analgesic effects of adding fentanyl to ropivacaine for continuous femoral nerve block (CFNB) using patient-controlled analgesia after total knee arthroplasty (TKA). Methods: The patients were divided into 2 groups, each with n = 40 in ropivacaine (R) group and n = 42 in R with fentanyl (R + F) group. After operation, the patients in each group received R + F and R alone via a femoral nerve catheter, respectively. We assessed the visual analog scale (VAS) pain immediately before administration (baseline) and at 15, 30, and 60 minutes on postanesthesia care unit (PACU), and resting and ambulatory VAS score up to 24 hours. Results: Overall, the average VAS scores in the R + F group were slightly lower than those of the R group. However, the VAS score differences between groups were not statistically significant, except for 30 minutes (P = 0.009) in PACU. R group showed higher supplemental analgesics consumption in average compared with R + F group, but not significant. Conclusion: Additional fentanyl did not show prominent enhancement of analgesic effect in the field of CFNB after TKA. PMID:27603376

  2. Relationship between improvements in physical measures and patient satisfaction in rehabilitation after total knee arthroplasty.

    PubMed

    Nazzal, Mahmoud I; Bashaireh, Khaldoon H; Alomari, Mahmoud A; Nazzal, Mohammad S; Maayah, Mikhled F; Mesmar, Mohammad

    2012-06-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per week. Pain scores, number of steps climbed (STp), and maximum walked distance (MWD) were determined before the operation and 3 months after cessation of the rehabilitation program. In addition, knee-flexion range of motion (ROM) was measured before the surgery and immediately, 2 weeks and 3 months after the surgery. Pain decreased whereas MWD and STp increased at 3 months postoperation. In addition, the magnitude of improvement in STp correlated positively with the magnitude of change in MWD and pain. There was a significant increase in knee-flexion ROM at 2 weeks and 3 months postoperation compared with preoperation. The patient age also correlated positively with the magnitude of improvement in knee-flexion ROM after 2 weeks and 3 months of therapy. Improvements in MWD and STp were greater and pain was less, among the satisfied patients compared with unsatisfied ones. The results of this study further confirm the importance of therapy for osteoarthritis patients after TKA. In addition, as older patients are less conditioned, they seem to be more inclined to improvement in functionality with rehabilitation. Satisfied patients seem to achieve larger improvements in functional capacity and pain measures.

  3. Total knee arthroplasty using cementless keels and cemented tibial trays: 10-year results

    PubMed Central

    Kolisek, Frank R.; Mont, Michael A.; Seyler, Thorsten M.; Marker, David R.; Jessup, Nenette M.; Siddiqui, Junaed A.; Monesmith, Eric

    2008-01-01

    The problem of early mechanical stability of cemented and cementless keels of the tibial component in total knee arthroplasty (TKA) is controversial. The purpose of this study was to assess clinical and radiographic outcomes of a cohort of 51 TKAs using a cemented platform with cementless keel fixation. At a mean follow-up of 10.4 years (range, 7 to 14 years), the mean Knee Society Score (KSS) was 93 points (range, 59 to 100 points), and the mean functional score was 73 points (range, 0 to 100 points). Only one patient demonstrated progressive tibial radiolucencies at 13.1 years follow-up, which resolved with a revision with an exchange of components. The results of this study suggest that a proximally cemented tibial tray with a press-fit keel TKA provides excellent mean 10-year outcomes. PMID:18185931

  4. Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty

    PubMed Central

    Sloan, Jeffrey

    2010-01-01

    The objective of this study was to compare comorbidity, functional ability, and health care utilization in veterans with total knee arthroplasty (TKA) or total hip arthroplasty (THA) versus matched control populations. A cohort of veterans using Veterans Affairs (VA) healthcare system reported limitations in six activities of daily living (ADLs; bathing, dressing, eating, walking, transferring, and using the toilet), demographics, and physician-diagnosed comorbidity. VA databases provided healthcare utilization and International Classification of Diseases-9/Common procedure terminology codes for TKA/THA. Patients were classified as: (1) primary TKA; (2) primary THA; (3) combination group (≤1 procedure); and (4) control veteran population (no THA/TKA). Multivariable regression analyses compared the risk or counts of ADL limitation and in-/out-patient visits. After multivariable adjustment, TKA, THA or combination groups had significantly higher prevalence of the following compared to veteran controls: arthritis, diabetes, or heart disease (p<0.0001 each), severe (≥3) ADL limitation (33%, 42%, 42% vs. 24%; p<0.0001), and annual hospitalization rate (24%, 19%, 26% vs. 16%, p<0.0001). Annual outpatient surgery visits were more (2.5, 2.3, 2.3 vs. 2, p=0.01) and risk of any mental health outpatient visit was lower (12%, 11%, 12% vs. 18%, p=0.0039). All ADLs, except eating, were significantly more limited in arthroplasty groups (p= 0.0009). Severe ADL limitation was more prevalent in veterans with arthroplasty than in two age-matched US cohorts: 13.4 times in ≥65 years; and 1.2-, 1.6-, and 4-fold in ≥85, 75–84, and 65–74 years. Poorer function and higher comorbidity and utilization in veterans with TKA/THA suggest that this group is appropriate for interventions targeted at improving function and decreasing utilization. PMID:19517157

  5. Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty.

    PubMed

    Singh, Jasvinder A; Sloan, Jeffrey

    2009-09-01

    The objective of this study was to compare comorbidity, functional ability, and health care utilization in veterans with total knee arthroplasty (TKA) or total hip arthroplasty (THA) versus matched control populations. A cohort of veterans using Veterans Affairs (VA) healthcare system reported limitations in six activities of daily living (ADLs; bathing, dressing, eating, walking, transferring, and using the toilet), demographics, and physician-diagnosed comorbidity. VA databases provided healthcare utilization and International Classification of Diseases-9/Common procedure terminology codes for TKA/THA. Patients were classified as: (1) primary TKA; (2) primary THA; (3) combination group (>or=1 procedure); and (4) control veteran population (no THA/TKA). Multivariable regression analyses compared the risk or counts of ADL limitation and in-/out-patient visits. After multivariable adjustment, TKA, THA or combination groups had significantly higher prevalence of the following compared to veteran controls: arthritis, diabetes, or heart disease (p < 0.0001 each), severe (>or=3) ADL limitation (33%, 42%, 42% vs. 24%; p < 0.0001), and annual hospitalization rate (24%, 19%, 26% vs. 16%, p < 0.0001). Annual outpatient surgery visits were more (2.5, 2.3, 2.3 vs. 2, p = 0.01) and risk of any mental health outpatient visit was lower (12%, 11%, 12% vs. 18%, p = 0.0039). All ADLs, except eating, were significantly more limited in arthroplasty groups (p arthroplasty than in two age-matched US cohorts: 13.4 times in >or=65 years; and 1.2-, 1.6-, and 4-fold in >or=85, 75-84, and 65-74 years. Poorer function and higher comorbidity and utilization in veterans with TKA/THA suggest that this group is appropriate for interventions targeted at improving function and decreasing utilization.

  6. Proximal tibial fracture following total knee arthroplasty.

    PubMed

    Krause, Heike; Dunleavy, Kim

    2011-09-01

    The patient was a 74-year-old man, with a history of total knee arthoplasty 14 years earlier, after having sustained a pathological fracture of the proximal diaphysis of the left tibia following a fall. Given the unstable nature of the fracture and the severe osteolysis noted below the total knee arthroplasty, surgical management 1 day after the fall entailed packing cancellous bone graft into the defect and realigning the fracture. PMID:21885911

  7. [Rehabilitation after total knee arthroplasty of hip and knee].

    PubMed

    Jansen, E; Brienza, S; Gierasimowicz-Fontana, A; Matos, C; Reynders-Frederix-Dobre, C; HateM, S M

    2015-09-01

    Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome.

  8. [Rehabilitation after total knee arthroplasty of hip and knee].

    PubMed

    Jansen, E; Brienza, S; Gierasimowicz-Fontana, A; Matos, C; Reynders-Frederix-Dobre, C; HateM, S M

    2015-09-01

    Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome. PMID:26591319

  9. Preoperative Periarticular Knee Bone Mineral Density in Osteoarthritic Patients Undergoing TKA

    PubMed Central

    Ishii, Yoshinori; Noguchi, Hideo; Sato, Junko; Todoroki, Koji; Ezawa, Nobukazu; Toyabe, Shin-ichi

    2016-01-01

    Background: Preoperative periarticular bone quality is affected by joint loading. The purpose of this study was to determine the periarticular bone mineral density of the knee joint of patients undergoing total knee arthroplasty, and whether the location of the load-bearing axis correlates with the measured bone mineral density. Materials and Methods: The bone mineral densities of the medial and lateral femoral condyles and the medial and lateral tibial condyles were analyzed in consecutive 116 osteoarthritic patients (130 knees) by dual energy x-ray absorptiometry. Results: The median bone mineral density values in the condyles were 1.138 in femoral medial, 0.767 in femoral lateral, 1.056 in tibial medial, and 0.714 in tibial lateral. The medial condyles showed significantly higher bone mineral densities than the lateral condyles in both the femur and tibia. In addition, the femoral medial showed significantly higher bone mineral density levels than the tibial medial, and the femoral lateral condyle had higher bone mineral density levels than the tibial lateral. The bone mineral density Medial/Lateral ratio was significantly negatively correlated with the location (tibial medial edge 0%, lateral edge 100%) of the load-bearing axis in the femur and tibia. Conclusion: Preoperative bone mineral density values may provide against the changes in bone mineral density after total knee arthroplasty by reflecting the correlation with joint loading axis. These results help explain why total knee arthroplasty has such good long-term clinical outcomes with a low frequency of component loosening and periarticular fractures despite a high degree of postoperative bone loss. PMID:27583058

  10. Does prosthesis design affect the need for secondary resurfacing in total knee arthroplasty?

    PubMed Central

    Rotigliano, Niccolò; Hirschmann, Michael T.

    2016-01-01

    Aims and Objectives: The purpose of this retrospective consecutive study was to compare the rate of secondary resurfacing in consecutive series of five different TKA systems. It was our hypothesis that different brands of TKA show different rates of secondary resurfacing. Materials and Methods: A retrospective study was performed on data from patients who underwent TKA without primary patellar resurfacing from 2004 to 2012 in an university affiliated hospital. The study cohort included 784 patients (m:f=302:482, mean age at surgery±SD 71±10) operated with TKA during this period. Five different cruciate-retaining TKA systems were used in consecutives series. These were the following: A) Triathlon, Stryker, Switzerland (n=296), B) PFC Sigma, DepuySynthes, Switzerland (n=215), C) LCS, DepuySynthes, Switzerland (n=80), D) Balansys, Mathys, Bettlach, Switzerland (n=129), E) Duracon, Stryker, Switzerland (n=64). Data was retrospectively obtained from our different hospital archives. Patients demographics, age at surgery, type of total knee arthroplasty were noted. In addition, the data were screened for a secondary resurfacing in each patient. On anterior-posterior, lateral and skyline view radiographs different measurements were performed. TKA component position was assessed on radiographs with respect to "The knee society total knee arthroplasty roentgenographic evaluation and scoring system (TKA-RESS). Pearson Chi square test was used to compare differences between groups (p<0.05). There was no significant difference between the groups in terms of age, gender, and radiological outcomes. Results: Twenty-six of 784 patients (3.3%) underwent secondary resurfacing due to patellofemoral pain during follow-up. In group A four of 296 patients (1.4%), in group B fifteen of 215 patients (7%), in group C four of 80 patients (5%), in group D two of 129 patients (1.6%), in group E one of 64 patients (1.6%) underwent secondary patellar resurfacing during follow-up. There was a

  11. Risk Adjustment for Medicare Total Knee Arthroplasty Bundled Payments.

    PubMed

    Clement, R Carter; Derman, Peter B; Kheir, Michael M; Soo, Adrianne E; Flynn, David N; Levin, L Scott; Fleisher, Lee

    2016-09-01

    The use of bundled payments is growing because of their potential to align providers and hospitals on the goal of cost reduction. However, such gain sharing could incentivize providers to "cherry-pick" more profitable patients. Risk adjustment can prevent this unintended consequence, yet most bundling programs include minimal adjustment techniques. This study was conducted to determine how bundled payments for total knee arthroplasty (TKA) should be adjusted for risk. The authors collected financial data for all Medicare patients (age≥65 years) undergoing primary unilateral TKA at an academic center over a period of 2 years (n=941). Multivariate regression was performed to assess the effect of patient factors on the costs of acute inpatient care, including unplanned 30-day readmissions. This analysis mirrors a bundling model used in the Medicare Bundled Payments for Care Improvement initiative. Increased age, American Society of Anesthesiologists (ASA) class, and the presence of a Medicare Major Complications/Comorbid Conditions (MCC) modifier (typically representing major complications) were associated with increased costs (regression coefficients, $57 per year; $729 per ASA class beyond I; and $3122 for patients meeting MCC criteria; P=.003, P=.001, and P<.001, respectively). Differences in costs were not associated with body mass index, sex, or race. If the results are generalizable, Medicare bundled payments for TKA encompassing acute inpatient care should be adjusted upward by the stated amounts for older patients, those with elevated ASA class, and patients meeting MCC criteria. This is likely an underestimate for many bundling models, including the Comprehensive Care for Joint Replacement program, incorporating varying degrees of postacute care. Failure to adjust for factors that affect costs may create adverse incentives, creating barriers to care for certain patient populations. [Orthopedics. 2016; 39(5):e911-e916.]. PMID:27359282

  12. Deep venous thrombosis after total hip or knee arthroplasty in a "low-risk" Chinese population.

    PubMed

    Ko, P S; Chan, W F; Siu, T H; Khoo, J; Wu, W C; Lam, J J

    2003-02-01

    Scarcely any information has been published on deep vein thrombosis (DVT) in Chinese patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, generally, no prophylaxis is given to patients who do not have conventional high-risk factors because they are believed to be at "low risk." We performed a prospective study on 80 such "low risk" patients undergoing THA or TKA (58 TKA and 22 THA) without prophylaxis and performed duplex ultrasonography on both lower limbs 6 to 8 days after surgery. A total of 22 patients (27.5%) showed ultrasonographic evidence of DVT. Eighteen (31%) TKAs and 4 (18.1%) THAs were complicated by DVT. Three patients showed bilateral involvement, all of whom underwent TKA. Two patients had symptomatic pulmonary embolism. The sensitivity and positive predictive value of the clinical examination was 27.2% and 31.6%, respectively. This study showed that patients who are labeled "low risk" for DVT actually had a significant risk and suggests that the current practice of providing prophylaxis to only patients deemed at "high risk" should be revised.

  13. Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression

    PubMed Central

    Yılmaz, Barış; Kömür, Baran; Aktaş, Erdem; Sonnur Yılmaz, Firdes; Çopuroğlu, Cem; Özcan, Mert; Çiftdemir, Mert; Çopuroğlu, Elif

    2015-01-01

    Purpose: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. Methods: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records. Results: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. Conclusion: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression. PMID:26664498

  14. Computer-assisted navigation in knee arthroplasty: a critical appraisal.

    PubMed

    Venkatesan, Muralidharan; Mahadevan, Devendra; Ashford, Robert U

    2013-10-01

    The purpose of this review was to appraise the use of computer-assisted navigation in total knee arthroplasty and to assess whether this technology has improved clinical outcomes. Studies were identified through searches in MEDLINE, Embase, and PubMed. Numerous studies have shown improved leg and component alignment using navigation systems. However, the better alignment achieved in navigated knee arthroplasty has not been shown to lead to better clinical outcomes. Navigated knee arthroplasty had lower calculated blood loss and lower incidence of fat embolism compared with conventional knee arthroplasty using intramedullary jigs. It may be most valued when dealing with complex knee deformities, revision surgery, or minimally invasive surgery. Navigated knee arthroplasty, however, is only cost-effective in centers with a high volume of joint replacements. Overall, computer-assisted navigated knee arthroplasty provides some advantages over conventional surgery, but its clinical benefits to date are unclear and remain to be defined on a larger scale.

  15. Direct Repair without Augmentation of Patellar Tendon Avulsion following TKA

    PubMed Central

    Kumar, Nishikant; Yadav, Chandrashekhar; Kumar, Ashok

    2015-01-01

    Complications involving the extensor mechanism after TKA are potentially disastrous. We are reporting a case of patellar tendon rupture from tibial tuberosity following total knee arthroplasty. We managed it by direct repair with fiberwire using Krackow suture technique without augmentation. Our long term result has been very encouraging. Our method is a safe and better method of management of patellar tendon avulsion following TKA when it happens without any tissue loss. PMID:25632362

  16. Unexpected wear of an unicompartimental knee arthroplasty in oxidized zirconium.

    PubMed

    Luyet, Anais; Fischer, Jean-François; Jolles, Brigitte M; Lunebourg, Alexandre

    2015-12-01

    Unicompartimental knee arthroplasty is a successful procedure for the treatment of localized osteoarthritis to one compartment of the knee with good long-term results. However, several modes of failure of unicompartimental knee arthroplasty have been described, namely aseptic or septic loosening, progression of disease, wear, and instability. Metallosis after unicompartimental knee arthroplasty is rarely reported and is most often related with polyethylene wear or break. We report on a case of rapid failure of unicompartimental knee arthroplasty in oxidized zirconium associated with metallosis secondary to the dislocation of the polyethylene.

  17. Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

    PubMed Central

    Seol, Young-Jun; Seon, Jong-Keun; Lee, Seung-Hun; Jin, Cheng; Prakash, Jatin; Park, Yong-Jin

    2016-01-01

    Purpose Total knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA. Materials and Methods A total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups. Results The mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 24 hours postoperatively. The mean units of transfusion were smaller in the tranexamic acid group (0.76 units) than in the control group (1.28 units). Conclusions Our data suggest that intravenous injection of tranexamic acid decreases the total blood loss and transfusion after TKA. PMID:27595071

  18. Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

    PubMed Central

    Seol, Young-Jun; Seon, Jong-Keun; Lee, Seung-Hun; Jin, Cheng; Prakash, Jatin; Park, Yong-Jin

    2016-01-01

    Purpose Total knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA. Materials and Methods A total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups. Results The mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 24 hours postoperatively. The mean units of transfusion were smaller in the tranexamic acid group (0.76 units) than in the control group (1.28 units). Conclusions Our data suggest that intravenous injection of tranexamic acid decreases the total blood loss and transfusion after TKA.

  19. Topical versus systemic tranexamic acid after total knee and hip arthroplasty

    PubMed Central

    Chen, Yongcai; Chen, Zhuo; Cui, Shuo; Li, Zhiyang; Yuan, Zhengjiang

    2016-01-01

    Abstract Background: Tranexamic acid (TXA) is an antifibrinolytic drug widely used to reduce blood loss during joint replacements, including total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, there is no final consensus regarding the composition of an optimal administration of TXA regime between topical and systemic (intravenous). The purpose of our study was to compare the efficacy of topical and intravenous (IV) regimen of TXA during TKA and THA. Methods: Five relevant electronic online databases, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Chinese Biomedical Database were systematically searched in November 2015. Randomized controlled trials (RCTs) that compared topical with intravenous TXA in patients with TKA or THA were included. The search terms included “topical,” “intravenous,” “tranexamic acid,” “knee arthroplasty” and “hip arthroplasty.” Two reviewers independently extracted data and assessed the risk of bias and study quality. Data were analyzed with Review Manager 5.3 software. Grades of Recommendation Assessment, Development and Evaluation (GRADE) were used to assess the quality of evidence. Results: Sixteen RCTs with 1250 patients undergoing TKA and 4 RCTs involving 550 patients undergoing THA were included. There were no significant differences in total blood loss (mean difference [MD]TKA = −28.72 mL, 95% confidence interval [CI] −195.97 to 138.54 mL, P = 0.74; MDTHA = 14.03 mL, 95% CI −35.53 to 63.59 mL; P = 0.78), total drain out (MDTKA = −3.09 mL, 95% CI −39.05 to 32.88 mL; P = 0.87; MDTHA −31.00 mL, 95% CI −66.56 to 4.66 mL; P = 0.09), and transfusion rates (ORTKA = 0.90, 95% CI 0.58–1.40, P = 0.64; ORTHA = 1.19, 95% CI 0.67–2.09; P = 0.63) between topical and intravenous (IV) TXA. Conclusions: The current evidence suggested that topical TXA was equally effective and safe compared with intravenous TXA in reducing blood loss

  20. Bilateral Total Knee Arthroplasty in a 15 Year Old With Skeletal Dysplasia and Open Physes.

    PubMed

    Ho, Jason C; Siqueira, Marcelo B P; Jacob, Paul; Goodwin, Ryan C; Barsoum, Wael K

    2016-05-01

    There are limited reports of total knee arthroplasty (TKA) in the pediatric population. The use of constrained, stemmed components is particularly unusual in the setting of open physes due to concerns with growth arrest and implant survivorship. The current authors describe a 15-year-old boy with open growth plates and an epiphyseal dysplasia-like condition affecting the knees bilaterally. He had no other significant medical or orthopedic conditions and his genetic workup was negative. He had severe knee pain and a bilateral 40° valgus with severe lateral compartment arthritis. Conservative treatment provided no symptom relief, and the patient had been wheelchair bound for 18 months prior to presentation. Treatment with simultaneous bilateral TKA using cemented, stemmed, and constrained components was undertaken. There were no intraoperative complications, and his final follow-up was at 5.6 years postoperatively. Radiographic evaluation at follow-up showed that components were well placed with no loosening. The patient had pain-free motion and a perfect Knee injury and Osteoarthritis Outcome Score. Based on the review of the literature and the outcomes of this case, the authors believe simultaneous bilateral TKA using cemented, stemmed, and constrained components is a reasonable option for joint reconstruction in the pediatric patient with open physes who also has significant arthritis and deformity not of oncologic origin. [Orthopedics. 2016; 39(3):e549-e552.]. PMID:27045485

  1. Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs.

    PubMed

    Ploegmakers, M J M; Ginsel, B; Meijerink, H J; de Rooy, J W; de Waal Malefijt, M C; Verdonschot, N; Banks, S A

    2010-06-01

    The aim of this study was to investigate anteroposterior instability in the CKS and the PFC total knee arthroplasty (TKA) designs. Physical examinations, including VAS, IKS and WOMAC were performed in combination with a detailed fluoroscopic measurement technique for three-dimensional kinematic assessment of TKA design function. Anteroposterior instability rated with the IKS was not significantly different (p=0.34), but patients with a CKS design showed more limitations according to the WOMAC joint stiffness total score, and for items regarding higher flexion activities in the WOMAC score for knee disability. Kinematic analyses showed that the CKS design tended to have more anterior sliding of the femur on the tibia during mid- and deep flexion activities. The sliding distance was larger at the medial than at the lateral side. This phenomenon has also been described for posterior cruciate ligament deficient knees. Furthermore, the CKS design showed a significantly lower range of tibial rotation (p<0.05) from maximum extension to maximum flexion during deep knee bend activities. Kinematic differences can be ascribed to posterior cruciate ligament deficiency/laxity or differences in TKA designs.

  2. Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty

    PubMed Central

    Ali, Abdulemir; Sundberg, Martin; Hansson, Ulrik; Malmvik, Johan; Flivik, Gunnar

    2015-01-01

    Background and purpose Local infiltration analgesia (LIA) is well established for effective postoperative pain relief in total knee arthroplasty (TKA). To prolong the effect of LIA, infusion pumps with local intraarticular analgesia can be used. We evaluated the effect of such an infusion pump for the first 48 h postoperatively regarding pain, knee function, length of stay (LOS) in hospital, and complications. Patients and methods 200 patients received peroperative LIA and a continuous intraarticular elastomeric infusion pump set at 2 mL/h. The patients were randomized either to ropivacaine (7.5 mg/mL) or to NaCl (9 mg/mL) in the pump. Visual analog scale (VAS) pain (0–100 mm), analgesic consumption, side effects of medicine, range of motion (ROM), leg-raising ability, LOS, and complications during the first 3 months were recorded. Results On the first postoperative day, the ropivacaine group had lower VAS pain (33 vs. 40 at 12 noon and 36 vs. 43 at 8 p.m.; p = 0.02 and 0.03, respectively), but after that all recorded variables were similar between the groups. During the first 3 months, the ropivacaine group had a greater number of superficial and deep surgical wound infections (11 patients vs. 2 patients, p = 0.02). There were no other statistically significant differences between the groups. Interpretation Continuous intraarticular analgesia (CIAA) with ropivacaine after TKA has no relevant clinical effect on VAS pain and does not affect LOS, analgesic consumption, ROM, or leg-raising ability. There may, however, be a higher risk of wound-healing complications including deep infections. PMID:25428755

  3. Diagnosis and Management of Extra-articular Causes of Pain After Total Knee Arthroplasty.

    PubMed

    Manning, Blaine T; Lewis, Natasha; Tzeng, Tony H; Saleh, Jamal K; Potty, Anish G R; Dennis, Douglas A; Mihalko, William M; Goodman, Stuart B; Saleh, Khaled J

    2015-01-01

    Postoperative pain, which has been attributed to poor outcomes after total knee arthroplasty (TKA), remains problematic for many patients. Although the source of TKA pain can often be delineated, establishing a precise diagnosis can be challenging. It is often classified as intra-articular or extra-articular pain, depending on etiology. After intra-articular causes, such as instability, aseptic loosening, infection, or osteolysis, have been ruled out, extra-articular sources of pain should be considered. Physical examination of the other joints may reveal sources of localized knee pain, including diseases of the spine, hip, foot, and ankle. Additional extra-articular pathologies that have potential to instigate pain after TKA include vascular pathologies, tendinitis, bursitis, and iliotibial band friction syndrome. Patients with medical comorbidities, such as metabolic bone disease and psychological illness, may also experience prolonged postoperative pain. By better understanding the diagnosis and treatment options for extra-articular causes of pain after TKA, orthopaedic surgeons may better treat patients with this potentially debilitating complication. PMID:25745922

  4. The Impact of Personality Traits on the Outcome of Total Knee Arthroplasty

    PubMed Central

    Giurea, A.; Fraberger, G.; Kolbitsch, P.; Lass, R.; Schneider, E.; Kubista, B.; Windhager, R.

    2016-01-01

    Ten to twenty percent of patients with total knee arthroplasty (TKA) are dissatisfied with their clinical outcome. Aim of this study was to investigate the impact of personality traits on the subjective outcome of TKA. We investigated 80 patients with 86 computer navigated TKAs. We asked for patients satisfaction and divided patients into two groups (satisfied or dissatisfied). 12 personality traits were tested by the Freiburg Personality Inventory (FPI-R). Postoperative examination included Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Visual Analogue Scale (VAS). Radiologic investigation was done in all patients. 84% of our patients were satisfied, while 16% were not satisfied. The FPI-R showed statistical significant influence of four personality traits on patient satisfaction: life satisfaction (p = 0.006), performance orientation (p = 0.015), somatic distress (p = 0.001), and emotional stability (p = 0.002). All clinical scores (VAS, WOMAC, and KSS) showed significantly better results in the satisfied patient. Radiological examination showed optimal alignment of all TKAs. There were no complications requiring revision surgery. The results of our study show that personality traits may influence patients satisfaction and clinical outcome after TKA. Therefore patients personality traits may be a useful predictive factor for postoperative satisfaction after TKA. PMID:26989686

  5. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011

    PubMed Central

    Nazem, Khalilolah; Motififard, Mehdi; Yousefian, Mehdi

    2016-01-01

    Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients. Materials and Methods: This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation. Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year. Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations.

  6. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011

    PubMed Central

    Nazem, Khalilolah; Motififard, Mehdi; Yousefian, Mehdi

    2016-01-01

    Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients. Materials and Methods: This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation. Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year. Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations. PMID:27656617

  7. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    PubMed Central

    Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash

    2014-01-01

    An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty. PMID:24944978

  8. Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis.

    PubMed

    Moon, Young-Wan; Kim, Hyun-Jung; Ahn, Hyeong-Sik; Lee, Dae-Hee

    2016-01-01

    This meta-analysis was performed to analyze serial changes in thigh muscles, including quadriceps and hamstring muscles, from before to one year after total knee arthroplasty (TKA). All studies sequentially comparing isokinetic quadriceps and hamstring muscle strengths between the TKA side and the contralateral uninjured limb were included in this meta-analysis. Five studies with 7 cohorts were included in this meta-analysis. The mean differences in the strengths of quadriceps and hamstring muscles between the TKA and uninjured sides were greatest three months after surgery (26.8 N∙m, 12.8 N∙m, P<0.001), but were similar to preoperative level at six months (18.4 N∙m, 7.4 N∙m P<0.001) and were maintained for up to one year (15.9 N∙m, 4.1 N∙m P<0.001). The pooled mean differences in changes in quadriceps and hamstring strengths relative to preoperative levels were 9.2 N∙m and 4.9 N∙m, respectively, three months postoperatively (P = 0.041), but were no longer significant after six months and one year. During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.

  9. Minimally invasive knee arthroplasty: An overview

    PubMed Central

    Tria, Alfred J; Scuderi, Giles R

    2015-01-01

    Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended. The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient. The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques. The surgeries are easier with smaller instruments but can be performed with standard ones. The techniques are accurate and do lead to a more rapid recovery, with less pain, less blood loss, and greater motion if they are appropriately performed. PMID:26601062

  10. How human gait responds to muscle impairment in total knee arthroplasty patients: Muscular compensations and articular perturbations.

    PubMed

    Ardestani, Marzieh M; Moazen, Mehran

    2016-06-14

    Post-surgical muscle weakness is prevalent among patients who undergo total knee arthroplasty (TKA). We conducted a probabilistic multi-body dynamics (MBD) to determine whether and to what extent habitual gait patterns of TKA patients may accommodate strength deficits in lower extremity muscles. We analyzed muscular and articular compensations in response to various muscle impairments, and the minimum muscle strength requirements needed to preserve TKA gait patterns in its habitual status. Muscle weakness was simulated by reducing the strength parameter of muscle models in MBD analysis. Using impaired models, muscle and joint forces were calculated and compared versus those from baseline gait i.e. TKA habitual gait before simulating muscle weakness. Comparisons were conducted using a relatively new statistical approach for the evaluation of gait waveforms, i.e. Spatial Parameter Mapping (SPM). Principal component analysis was then conducted on the MBD results to quantify the sensitivity of every joint force component to individual muscle impairment. The results of this study contain clinically important, although preliminary, suggestions. Our findings suggested that: (1) hip flexor and ankle plantar flexor muscles compensated for hip extensor weakness; (2) hip extensor, hip adductor and ankle plantar flexor muscles compensated for hip flexor weakness; (3) hip and knee flexor muscles responded to hip abductor weakness; (4) knee flexor and hip abductor balanced hip adductor impairment; and (5) knee extensor and knee flexor weakness were compensated by hip extensor and hip flexor muscles. Future clinical studies are required to validate the results of this computational study. PMID:27063251

  11. The Quality of Life (QOL) after Total Knee Arthroplasties among Saudi Arabians: A Pilot Study

    PubMed Central

    Al-Omran, Abdallah S.

    2014-01-01

    Background and Objective: Total knee arthroplasty (TKA) is commonly performed in Saudi Arabia but there is very limited published data on outcome and quality of life (QOL) post Knee arthroplasty. To assess the QOL post TKA we performed this retrospective study. Methods: Total Knee arthroplasty was started in mid- 2000’s at the university hospital. Fifty–two patients of TKA who came for follow up during the study period were asked to fill a pre-determined questionnaire and clinical examination, were included in the study. Patients were assessed and at 2 parameters pre and postoperative time-points, for pain [1-9], walking [1-9] and asked whether they would recommend the procedure to their relatives and friends, and finally whether they were satisfied with the outcome. Results: We interviewed 52 patients (9 males and 43 females), mean age of 64.75 ± 7.90 years. Twenty (34.50%) had bilateral TKR, and the rest single sided. The preoperative night pain was 7.72 ± 2.03 compared to postoperative 1.92 ± 1.41 (P<0.001 (5.80 and < 6.47) and pain at walking was 8.39 ± 0.77 versus 2.39 ± 2.05 (P<0.001(5.40 and < 6.55). The overall satisfaction 93% (8.37 ± 1.32) and QOL as assessed preoperatively was 3.60 ± 2.15 and postoperatively was 8.41  ±  1.27 (P<0.001 (4.81and 4.13). Fifty-one (98.07%) patients indicated that they will recommend the procedure to others. Conclusions: The overall satisfaction and improvement of QOL in male patients was 93.77% and female patients 92.77% and all patients indicated that they will recommend others to undergo the similar procedure to improve their QOL. PMID:25324701

  12. Evaluation of a subject-specific musculoskeletal modelling framework for load prediction in total knee arthroplasty.

    PubMed

    Chen, Zhenxian; Zhang, Zhifeng; Wang, Ling; Li, Dichen; Zhang, Yuanzhi; Jin, Zhongmin

    2016-08-01

    Musculoskeletal (MSK) multibody dynamics (MBD) models have been used to predict in vivo biomechanics in total knee arthroplasty (TKA). However, a full lower limb MSK MBD modelling approach for TKA that combines subject-specific skeletal and prosthetic knee geometry has not yet been applied and evaluated over a range of patients. This study evaluated a subject-specific MSK MBD modelling framework for TKA using force-dependent kinematics (FDK) and applied it to predict knee contact forces during gait trials for three patients implanted with instrumented prosthetic knees. The prediction accuracy was quantified in terms of the mean absolute deviation (MAD), root mean square error (RMSE), Pearson correlation coefficient (ρ), and Sprague and Geers metrics of magnitude (M), phase (P) and combined error (C). Generally good agreements were found between the predictions and the experimental measurements from all patients for the medial contact forces (150 N < MAD <178 N, 174 N < RMSE < 224 N, 0.87 < ρ < 0.95, -0.04 < M < 0.20, 0.06 < P < 0.09, 0.08 < C < 0.22) and the lateral contact force (113 N < MAD <195 N, 131 N < RMSE < 240 N, 0.41 < ρ < 0.82, -0.25 < M < 0.34, 0.08 < P < 0.22, 0.13 < C < 0.36). The results suggest that the subject-specific MSK MBD modelling framework for TKA using FDK has potential as a powerful tool for investigating the functional outcomes of knee implants.

  13. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients.

    PubMed

    Berend, Keith R; Lombardi, Adolph V; Mallory, Thomas H

    2004-01-01

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most successful procedures performed in terms of quality-of-life years gained. The long-term goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. The short-term goals, however, have become the target of aggressive peri-operative programs that aim to speed recovery, reduce morbidity and complications, and create a program of efficiency while maintaining the highest level of patient care. The concept of rapid recovery is built upon the burgeoning interest in less-invasive and small-incision surgeries for (THA and TKA). However, the incision size does not appear to be the most critical aspect of the program. This article outlines the specific elements of the rapid-recovery program for lower-extremity arthroplasty patients, including pre-operative patient education, peri-operative nutrition, vitamin and herbal medication supplementation, preemptive analgesia, and post-operative rehabilitation. A holistic peri-operative, rapid-recovery program has lead to a significantly decreased hospital length of stay and significantly lower hospital readmission rates in patients who undergo primary THAs and TKAs. Combining these results with minimally invasive techniques and instrumentation should make recovery even faster.

  14. Knee arthroplasty in Denmark, Norway and Sweden

    PubMed Central

    Bizjajeva, Svetlana; Fenstad, Anne Marie; Furnes, Ove; Lidgren, Lars; Mehnert, Frank; Odgaard, Anders; Pedersen, Alma Becic; Havelin, Leif Ivar

    2010-01-01

    Background and purpose The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ. Methods We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997–2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced. Results The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital—less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3–1.6) and 1.6 (CI: 1.4–1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4–2.0) and 1.5 (CI: 1.3–1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9–1.7) and 1.3 (CI: 1.0–1.7). Interpretation We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies. PMID:20180723

  15. Traditions and myths in hip and knee arthroplasty

    PubMed Central

    Husted, Henrik; Gromov, Kirill; Malchau, Henrik; Freiberg, Andrew; Gebuhr, Peter; Troelsen, Anders

    2014-01-01

    Background and purpose — Traditions are passed on from experienced surgeons to younger fellows and become “the right way to do it”. Traditions associated with arthroplasty surgery may, however, not be evidence-based and may be potentially deleterious to both patients and society, increasing morbidity and mortality, slowing early functional recovery, and increasing cost. Methods — We identified selected traditions and performed a literature search using relevant search criteria (June 2014). We present a narrative review grading the studies according to evidence, and we suggest some lines of future research. Results — We present traditions and evaluate them against the published evidence. Preoperative removal of hair, urine testing for bacteria, use of plastic adhesive drapes intraoperatively, and prewarming of the operation room should be abandoned—as should use of a tourniquet, a space suit, a urinary catheter, and closure of the knee in extension. The safety and efficacy of tranexamic acid is supported by meta-analyses. Postoperatively, there is no evidence to support postponement of showering or postponement of changing of dressings to after 48 h. There is no evidence to recommend routine dental antibiotic prophylaxis, continuous passive motion (CPM), the use of compression stockings, cooling for pain control or reduction of swelling, flexion of at least 90 degrees as a discharge criterion following TKA, or having restrictions after THA. We present evidence supporting the use of NSAIDs, early mobilization, allowing early travel, and a low hemoglobin trigger for transfusion. Interpretation — Revision of traditions and myths surrounding hip and knee arthroplasty towards more contemporary evidence-based principles can be expected to improve early functional recovery, thus reducing morbidity, mortality, and costs. PMID:25285615

  16. Surgical waste audit of 5 total knee arthroplasties

    PubMed Central

    Stall, Nathan M.; Kagoma, Yoan K.; Bondy, Jennifer N.; Naudie, Douglas

    2013-01-01

    Background Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution’s ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. Methods We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008–2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. Results The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008–2009 was 407 889 kg by weight and 15 272 m3 by volume. Conclusion Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level of evidence Level IV, case series. PMID:23351497

  17. Limited femoral navigation versus conventional intramedullary femoral jig based instrumentation for achieving optimal restoration of mechanical axis post total knee arthroplasty: a prospective comparative study of 200 knees.

    PubMed

    Shah, Nilen A; Patil, Hitendra G; Dhawale, Amol S; Khedkar, Bipin M

    2015-04-01

    A prospective comparative study was conducted to compare the mechanical axis post total knee arthroplasty (TKA) between two groups: In the first group of 100 knees (ASM group) Articular Surface Mounted navigation system was used to guide the distal femoral cut. In the second group of 100 knees (JIG group) conventional intramedullary femoral jig was used. The postoperative mechanical axis of the leg was within 3° of neutral alignment in 90% of the TKA in the ASM group (mean 178.12°) as compared to 74% in the JIG group (mean 177.02°). This difference was statistically significant (P<0.05). The data presented show that the use of limited femoral navigation leads to more accurate restoration of mechanical axis alignment when compared to conventional intramedullary femoral jigs.

  18. Effect of Preoperative Vitamin D Levels on Functional Performance after Total Knee Arthroplasty

    PubMed Central

    Patil, Aniket Machindra; Maniar, Adit Rajesh; Gangaraju, Bharat; Singh, Jaivardhan

    2016-01-01

    Background Low vitamin D levels affects muscle function. Vitamin D and calcium deficiency cause osteomalacic myopathy and poor functional recovery after hip fractures. The relationship of vitamin D and functional performance after total knee arthroplasty (TKA) is not previously reported. Methods Influence of vitamin D on functional performance before and after TKA was reviewed retrospectively in 120 patients. Of these, 64 had vitamin D deficiency (25-hydroxy vitamin D < 30 ng/mL) preoperatively. All 120 patients received vitamin D oral supplementation postoperatively. Functional parameters including Western Ontario and McMaster Osteoarthritis Index (WOMAC), Short-Form Health Survey questionnaire, and Knee Society Score were assessed pre- and postoperatively at 3 months. Results Preoperative function was significantly lower in osteoarthritic patients with vitamin D deficiency (WOMAC score; p = 0.040), but at 3 months all functional scores were similar. Conclusions We concluded that vitamin D deficiency has a negative effect on function in knee osteoarthritic patients. However, postoperative vitamin D supplementation can lead to functional recovery in these patients. Thus, TKA should not be delayed in vitamin D deficient patients; rather supplementation in the postoperative period is preferable to achieve comparable functional outcome at 3 months to patients with vitamin D sufficiency. PMID:27247739

  19. Accuracy of implant positioning for minimally invasive total knee arthroplasty in patients with severe varus deformity.

    PubMed

    Niki, Yasuo; Matsumoto, Hideo; Otani, Toshiro; Enomoto, Hiroyuki; Toyama, Yoshiaki; Suda, Yasunori

    2010-04-01

    Minimally invasive surgery (MIS) in total knee arthroplasty (TKA) reportedly yields decreased patient morbidity and a rapid return of function, but how much deformity can be accepted for MIS-TKA remains unclear. This study investigated 238 knees from 218 consecutive patients who underwent MIS-TKA. Patients were divided into groups with tibiofemoral mechanical axis (TFM) 195 degrees or greater and TFM less than 195 degrees, then clinical and radiographic results were compared. Similar improvements in knee score at 3 months postoperatively were obtained in the both groups, whereas radiographic accuracy of the coronal alignment in the TFM >or=195 degrees group was inferior to that in TFM <195 degrees group. Postoperative TFM was significantly worsened in patients with lateral bowing angle of the femoral shaft (LBFS) 4 degrees or greater, and 53% of patients in the TFM >or=195 degrees group displayed LBFS 4 degrees or greater, explaining the inferior radiographic accuracy in this group compared with the TFM <195 degrees group. These results indicate that use of MIS techniques decreases radiographic accuracy, particularly in patients with severe genu varum and increased LBFS. PMID:20347714

  20. Snapping Pes Syndrome after Unicompartmental Knee Arthroplasty

    PubMed Central

    Taketomi, Shuji; Yamagami, Ryota; Tahara, Keitaro; Tanaka, Sakae

    2016-01-01

    Snapping pes syndrome is defined as a snapping sensation in the medial knee caused by pes anserinus and rarely occurs. Snapping pes syndrome after unicompartmental knee arthroplasty (UKA) has not been reported yet. We experienced two cases with this syndrome after UKA. Conservative treatment was effective in one case, while surgical excision of the gracilis tendon was necessary to relieve painful snapping in the other case. The main cause of the first case might be posteromedial overhang of the tibial tray that reached up to 5 mm. The probable cause of the second case was posteromedial overhang of the mobile bearing. PMID:27274476

  1. Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty

    PubMed Central

    Hamilton, T. W.; Pandit, H. G.; Lombardi, A. V.; Adams, J. B.; Oosthuizen, C. R.; Clavé, A.; Dodd, C. A. F.; Berend, K. R.; Murray, D. W.

    2016-01-01

    Aims An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre. Patients and Methods Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature. Results The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100). Conclusion The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):3–10. PMID:27694509

  2. The value of indium 111 leukocyte scanning in the evaluation of painful or infected total knee arthroplasties

    SciTech Connect

    Rand, J.A.; Brown, M.L. )

    1990-10-01

    Evaluation of painful total knee arthroplasties (TKAs) for infection can be difficult. Indium 111 ({sup 111}In) leukocyte bone scanning provides a minimally invasive technique for evaluation of possible infection. Thirty-eight patients with a painful TKA who had surgical exploration after {sup 111}In leukocyte scanning were reviewed. The scan had an accuracy of 84%, a sensitivity of 83%, and a specificity of 85%. The {sup 111}In leukocyte scans must be interpreted in conjunction with the clinical evaluation of the patient because they are less accurate for study of TKAs than of total hip arthroplasties.

  3. Perioperative Complications in Patients with Inflammatory Arthropathy Undergoing Total Knee Arthroplasty.

    PubMed

    Schnaser, Erik A; Browne, James A; Padgett, Douglas E; Figgie, Mark P; D'Apuzzo, Michele R

    2015-09-01

    Little data exists comparing acute post-operative outcomes in patients with different types of inflammatory arthritis (IA) after undergoing a total knee arthroplasty (TKA). Our objectives were to compare perioperative complications and determine the most common complications between the different IA subtypes compared with patients with osteoarthritis undergoing primary TKA. We found significant differences when comparing complications within the different subtypes of IA. RA patients, despite having a greater number of comorbidities had a reduced rate of medical complications postoperatively compared to the OA cohort. All of the inflammatory subtypes had a higher rate of orthopedic complications postoperatively compared to the OA group except for patients with AS. However, ankylosing spondylitis had the highest mortality rate as well as medical complication rate among the subtypes. PMID:26111792

  4. IN VIVO OXIDATION CONTRIBUTES TO DELAMINATION BUT NOT PITTING IN POLYETHYLENE COMPONENTS FOR TOTAL KNEE ARTHROPLASTY

    PubMed Central

    Medel, Francisco J.; Kurtz, Steven M.; Sharkey, Peter; Parvizi, Javad; Klein, Gregg; Hartzband, Mark; Kraay, Matthew; Rimnac, Clare M.

    2010-01-01

    The aim of this study was to better understand how in vivo oxidation contributes to fatigue damage in total knee arthroplasty (TKA). 119 tibial inserts were consecutively collected after revision surgery. Of the 119 polyethylene retrievals, 29 were gamma sterilized in air (historical), while the remaining 90 were gamma sterilized in nitrogen (conventional). Surface damage assessment and characterization of oxidation were performed on all the retrievals. Delamination was significantly more prevalent and extensive in the longer-term, highly oxidized, historical tibial inserts. Pitting damage, in contrast, appeared to be equally prevalent between both retrieval groups, and was not correlated with in vivo oxidation. Our findings support our hypothesis that in vivo oxidation is a contributing factor to delamination, but not pitting, in TKA. Despite the lower oxidation displayed by conventional retrievals, this study provides strong evidence that delamination secondary to in vivo oxidation may occur during the second decade of implantation. PMID:20875942

  5. Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers.

    PubMed

    Best, Matthew J; Buller, Leonard T; Klika, Alison K; Barsoum, Wael K

    2015-07-01

    The influence of drug misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent primary THA or TKA between 1990 and 2007. Patients were divided into two groups: 1) those with a diagnosis of drug misuse (cannabis, opioids, cocaine, amphetamines, sedatives, inhalants or mixed combinations) (n=13,163) and 2) those with no diagnosis of misuse (n=8,366,327). Patients with a diagnosis of drug misuse had longer hospital stays (P<0.001), nearly eight times the odds of leaving against medical advice (P<0.001) and five times the mortality rate (P<0.001). Drug misuse was associated with higher odds (P<0.001) of complications including postoperative infection, anemia, convulsions, osteomyelitis, and blood transfusion. PMID:25765129

  6. [Sport activity after hip and knee arthroplasty].

    PubMed

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them. PMID:24416822

  7. [Sport activity after hip and knee arthroplasty].

    PubMed

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.

  8. Biofeedback to Promote Movement Symmetry After Total Knee Arthroplasty: A Feasibility Study

    PubMed Central

    ZENI, JOSEPH; ABUJABER, SUMAYAH; FLOWERS, PORTIA; POZZI, FEDERICO; SNYDER-MACKLER, LYNN

    2014-01-01

    STUDY DESIGN Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point. OBJECTIVES To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA). BACKGROUND TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes. METHODS Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining. RESULTS Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol. CONCLUSION Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared

  9. Unicondylar knee arthroplasty: a cementless perspective

    PubMed Central

    Forsythe, Michael E.; Englund, Roy E.; Leighton, Ross K.

    2000-01-01

    Objective To compare the results of cementless unicondylar knee arthroplasty (UKA) with those already reported in a similar study on cemented UKA. Design A case-series cross-sectional study. Setting The Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax. Patients Fifty-one patients who underwent a total of 57 UKAs between May 1989 and May 1997. Inclusion criteria were osteoarthritis involving the predominantly the medial compartment of the knee, relative sparing of the other compartments, less than 15° of varus, minimal knee instability, and attendance at the postoperative clinical visit. Intervention Cementless UKA. Main outcome measures Clinical parameters that included pain, range of motion and the Knee Society Clinical Knee Score. Roentgenographic parameters that included α, β, γ and σ angles and the presence of periprosthetic radiolucency or loose beads. Results Age, weight, gender and follow-up interval did not significantly affect the clinical results in terms of pain, range of motion or knee score. Knees with more than 1 mm of radiolucency had significantly lower knee scores than those with no radiolucency. Knees that radiologically had loose beads also had significantly lower knee scores. The clinical outcomes of cementless UKA were comparable to those already reported on cemented UKA. Cementless femurs had less radiolucency than the cemented femurs, whereas cementless tibias had more radiolucency than their cemented counterparts. Conclusions Cementless UKA seems to be as efficacious as cemented UKA. However, there is some concern about the amount of radiolucency in the cementless tibial components. A randomized clinical trial comparing both cementless and cemented tibial components with a cementless femur (hybrid knee) is needed to further assess this controversial issue in UKA. PMID:11129829

  10. CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY

    PubMed Central

    Mittag, Falk; Leichtle, Carmen Ina; Schlumberger, Michael; Leichtle, Ulf Gunther; Wünschel, Markus

    2016-01-01

    ABSTRACT Objective: Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection. Methods: We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. Results: There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Conclusion: Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study. PMID:26997914

  11. Safety of desirudin in thrombosis prevention after total knee arthroplasty: the DESIR-ABLE study.

    PubMed

    Jove, Maurice; Maslanka, Marc; Minkowitz, Harold S; Jaffer, Amir K

    2014-01-01

    Desirudin, administered 30 minutes before total hip arthroplasty is superior to enoxaparin in preventing proximal deep vein thrombosis (DVT) and pulmonary embolism (PE) with similar bleeding. The purpose of this study was to determine the safety of desirudin in patients undergoing elective total knee arthroplasty (TKA) when the first dose of desirudin was administered the evening after surgery. This is a case series of patients undergoing TKA who received desirudin 15 mg every 12 hours subcutaneously for an average of 5 days with the first dose administered postoperatively. The primary endpoint was major bleeding; secondary endpoints included wound outcomes (oozing and infection) and new symptomatic DVT or PE. Desirudin has a favorable safety profile when administered postoperatively in patients undergoing TKA with no reports of major bleeding, wound ooze, or infection. No patients experienced symptomatic DVT, but 2 patients had PE detected by computed tomography after experiencing atypical symptoms. The safety profile of desirudin is improved when administered postoperatively. Bleeding and wound outcomes seem to occur less frequently than historical desirudin and enoxaparin controls.

  12. Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty.

    PubMed

    Pan, Liying; Hou, Dong; Liang, Wei; Fei, Jiali; Hong, Zongyuan

    2015-01-01

    The aim of this study was to estimate the effects of pressurized salt ice packs (PIP) with water ice packs (WIP) which are used to relieve pain and decrease swelling on patients following total knee arthroplasty (TKA). Sixty-nine patients undergoing primary unilateral TKA were randomly divided into two groups (PIP group and WIP group). We used a visual analog scale (VAS) to score knee pain and the score was recorded. The knee bilateral girth, the slipping times of the ice pack, and the times of wound dressing or bed moist were recorded during cryotherapy. The scores of pain between the two groups were significant difference in 12 h, 24 h, 48 h and 72 h after TKA (P < 0.05). No significant difference was found for the girth measurements of the operative knee on the two levels in 12 h, 24 h and 72 h, respectively. However, there was statistically difference for girth measurements between the two groups in 48 h after TKA (P < 0.05). PIP is a cheap, safe and simple method, which is more effective than WIP on reducing pain and swelling degree of patients. Thus, PIP is recommended in clinical nursing work. PMID:26770417

  13. A comprehensive analysis of Medicare trends in utilization and hospital economics for total knee and hip arthroplasty from 2005 to 2011.

    PubMed

    Nwachukwu, Benedict U; McCormick, Frank; Provencher, Matthew T; Roche, Martin; Rubash, Harry E

    2015-01-01

    The purpose of this study was to determine annual Medicare utilization and hospital reimbursement rates for total knee arthroplasty (TKA) and total hip arthroplasty (THA). A PearlDiver review of the entire Medicare database was conducted: 2,040,667 TKAs and 855, 899 THAs performed between 2005 and 2011 were identified. There was a +0.05% and +1.3% year over year growth in the utilization in hospital reimbursement for TKA and THA respectively. There has only been a modest increase in joint arthroplasty utilization for Medicare beneficiaries. Supply side issues, insurance mix and possible prior over-projection may explain this finding. Reimbursement trends suggest that joint arthroplasty may not be a major cost driver for the healthcare system.

  14. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness

    PubMed Central

    van der Woude, J. A. D.; Nair, S. C.; Custers, R. J. H.; van Laar, J. M.; Kuchuck, N. O.; Lafeber, F. P. J. G.; Welsing, P. M. J.

    2016-01-01

    Objective In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. Methods A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Results Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories. Conclusion A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient. PMID:27171268

  15. Preoperative Planning in Primary Total Knee Arthroplasty.

    PubMed

    Tanzer, Michael; Makhdom, Asim M

    2016-04-01

    Preoperative planning is of paramount importance in primary total knee arthroplasty. A thorough preoperative analysis helps the surgeon envision the operation, anticipate any potential issues, and minimize the risk of premature implant failure. Obtaining a thorough history is critical for appropriate patient selection. The physical examination should evaluate the integrity of the soft tissues, the neurovascular status, range of motion, limb deformity, and the status of the collateral ligaments to help determine the soft-tissue balancing and constraint strategy required. Standard radiographs, with a known magnification, should be obtained for preoperative total knee arthroplasty templating. Routine standing AP, lateral, and skyline radiographs of the knee can help the surgeon plan the bone cuts and tibial slope as well as the implant size and position at the time of surgery. In certain circumstances, such as severe coronal deformities, bone deficiencies, and/or extra-articular deformities, additional measures are frequently necessary to successfully reconstruct the knee. Constrained implants, metal augments, and bone graft must be part of the surgeon's armamentarium. PMID:26990712

  16. The impact of including corticosteroid in a periarticular injection for pain control after total knee arthroplasty

    PubMed Central

    Tsukada, S.; Wakui, M.; Hoshino, A.

    2016-01-01

    There is conflicting evidence about the benefit of using corticosteroid in periarticular injections for pain relief after total knee arthroplasty (TKA). We carried out a double-blinded, randomised controlled trial to assess the efficacy of using corticosteroid in a periarticular injection to control pain after TKA. A total of 77 patients, 67 women and ten men, with a mean age of 74 years (47 to 88) who were about to undergo unilateral TKA were randomly assigned to have a periarticular injection with or without corticosteroid. The primary outcome was post-operative pain at rest during the first 24 hours after surgery, measured every two hours using a visual analogue pain scale score. The cumulative pain score was quantified using the area under the curve. The corticosteroid group had a significantly lower cumulative pain score than the no-corticosteroid group during the first 24 hours after surgery (mean area under the curve 139, 0 to 560, and 264, 0 to 1460; p = 0.024). The rate of complications, including surgical site infection, was not significantly different between the two groups up to one year post-operatively. The addition of corticosteroid to the periarticular injection significantly decreased early post-operative pain. Further studies are needed to confirm the safety of corticosteroid in periarticular injection. Take home message: The use of corticosteroid in periarticular injection offered better pain relief during the initial 24 hours after TKA. Cite this article: Bone Joint J 2016;98-B:194–200. PMID:26850424

  17. Comparison of Precision between Optical and Electromagnetic Navigation Systems in Total Knee Arthroplasty

    PubMed Central

    Rhee, Seung Joon; Park, Shi Hwan; Cho, He Myung

    2014-01-01

    Purpose The purpose of this study is to compare and analyze the precision of optical and electromagnetic navigation systems in total knee arthroplasty (TKA). Materials and Methods We retrospectively reviewed 60 patients who underwent TKA using an optical navigation system and 60 patients who underwent TKA using an electromagnetic navigation system from June 2010 to March 2012. The mechanical axis that was measured on preoperative radiographs and by the intraoperative navigation systems were compared between the groups. The postoperative positions of the femoral and tibial components in the sagittal and coronal plane were assessed. Results The difference of the mechanical axis measured on the preoperative radiograph and by the intraoperative navigation systems was 0.6 degrees more varus in the electromagnetic navigation system group than in the optical navigation system group, but showed no statistically significant difference between the two groups (p>0.05). The positions of the femoral and tibial components in the sagittal and coronal planes on the postoperative radiographs also showed no statistically significant difference between the two groups (p>0.05). Conclusions In TKA, both optical and electromagnetic navigation systems showed high accuracy and reproducibility, and the measurements from the postoperative radiographs showed no significant difference between the two groups. PMID:25505703

  18. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes.

    PubMed

    Drexler, M; Dwyer, T; Marmor, M; Abolghasemian, M; Sternheim, A; Cameron, H U

    2012-11-01

    In this study we present our experience with four generations of uncemented total knee arthroplasty (TKA) from Smith & Nephew: Tricon M, Tricon LS, Tricon II and Profix, focusing on the failure rates correlating with each design change. Beginning in 1984, 380 Tricon M, 435 Tricon LS, 305 Tricon 2 and 588 Profix were implanted by the senior author. The rate of revision for loosening was 1.1% for the Tricon M, 1.1% for the Tricon LS, 0.5% for the Tricon 2 with a HA coated tibial component, and 1.3% for the Profix TKA. No loosening of the femoral component was seen with the Tricon M, Tricon LS or Tricon 2, with no loosening seen of the tibial component with the Profix TKA. Regarding revision for wear, the incidence was 13.1% for the Tricon M, 6.6% for the Tricon LS, 2.3% for the Tricon 2, and 0% for the Profix. These results demonstrate that improvements in the design of uncemented components, including increased polyethylene thickness, improved polyethylene quality, and the introduction of hydroxyapatite coating, has improved the outcomes of uncemented TKA over time.

  19. Alpine Skiing With total knee ArthroPlasty (ASWAP): effect on tendon properties.

    PubMed

    Kösters, A; Rieder, F; Wiesinger, H-P; Dorn, U; Hofstaedter, T; Fink, C; Müller, E; Seynnes, O R

    2015-08-01

    The aim of this study was to investigate the effect of alpine skiing on patellar tendon properties in patients with total knee arthroplasty (TKA). Thirty-one adults (70.4 ± 4.7 years) with unilateral TKA were recruited 2.7 ± 0.9 years after surgery and assigned to an intervention (IG) or a control group (CG). The IG underwent a 12-week guided skiing program. Tendon stiffness, Young's modulus, and cross-sectional area (CSA) were measured before and after the intervention. In both groups, mean tendon CSA was 28% (P < 0.001) larger in the operated (OP) than in the non-operated (NOP) leg at baseline, without any difference in other tendon properties. After training, stiffness increased in the IG by 5.8% and 15.8%, respectively, in the OP and NOP legs. Likewise, mean CSA increased in the IG by 2.9% in the OP and 3.8% in the NOP leg, whereas no significant changes were found for the Young's modulus. None of the tendon parameters changed in the CG. Results indicate that patellar tendon structure and/or loading pattern are altered following TKA, but this tissue seems to retain its adaptation capacity. Further, alpine skiing appears to offer a suitable rehabilitation strategy for TKA patients. PMID:26083704

  20. Platelet-rich plasma does not decrease blood loss in total knee arthroplasty.

    PubMed

    Tingstad, Edwin M; Bratt, Sarah N; Hildenbrand, Kasee J; O'Malley, Brittany A; Mitchell, Elisabeth R; Gaddis, Corinne E; Jacobson, Charles A

    2015-05-01

    This study was designed to assess the use of platelet-rich plasma (PRP) during primary total knee arthroplasty (TKA). The authors hypothesized that this would result in less blood loss and greater hemoglobin and hematocrit levels at discharge and would potentially decrease the length of hospital stay. Leukocyte rich PRP was used during the procedure and at wound closure. Two surgeons performed all procedures in a similar fashion. Two different TKA implants were used. Each surgeon used the same implant throughout the study. A limited medial parapatellar approach was used and drains were used at closure. No tranexamic acid preparations were used. Continuous passive motion machines were used in all patients during their hospital stay. A total of 102 consecutive TKAs were performed. The study group (n=46) consecutively received the PRP injections during the TKA, whereas the control group (n=47) did not. Hemoglobin and hematocrit levels were obtained pre- and postoperatively. Estimated blood loss was recorded during surgery, and the auto-collection reinfusion drain system output was measured. The length of hospital stay was collected and recorded. The study showed that hemoglobin and hematocrit levels were not different when comparing study and control groups. Age and sex differences were insignificant. Finally, no statistical difference was seen for the estimated blood loss and hospital stay between the 2 groups. Platelet-rich plasma use during TKA does not decrease hospital stay or reduce estimated blood loss in the perioperative period. PMID:25970373

  1. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes.

    PubMed

    Drexler, M; Dwyer, T; Marmor, M; Abolghasemian, M; Sternheim, A; Cameron, H U

    2012-11-01

    In this study we present our experience with four generations of uncemented total knee arthroplasty (TKA) from Smith & Nephew: Tricon M, Tricon LS, Tricon II and Profix, focusing on the failure rates correlating with each design change. Beginning in 1984, 380 Tricon M, 435 Tricon LS, 305 Tricon 2 and 588 Profix were implanted by the senior author. The rate of revision for loosening was 1.1% for the Tricon M, 1.1% for the Tricon LS, 0.5% for the Tricon 2 with a HA coated tibial component, and 1.3% for the Profix TKA. No loosening of the femoral component was seen with the Tricon M, Tricon LS or Tricon 2, with no loosening seen of the tibial component with the Profix TKA. Regarding revision for wear, the incidence was 13.1% for the Tricon M, 6.6% for the Tricon LS, 2.3% for the Tricon 2, and 0% for the Profix. These results demonstrate that improvements in the design of uncemented components, including increased polyethylene thickness, improved polyethylene quality, and the introduction of hydroxyapatite coating, has improved the outcomes of uncemented TKA over time. PMID:23118390

  2. Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty

    PubMed Central

    Dong, Cui-Cui; Dong, Shu-Ling; He, Fu-Cheng

    2016-01-01

    Abstract A total knee arthroplasty (TKA) has always been associated with moderate-to-severe pain. A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate the efficacy and safety of pain control of adductor canal block (ACB) and femoral nerve block (FNB) after TKA. Relevant literatures about the ACB and FNB after TKA for reducing pain were searched from Medline (1996-January, 2015), Embase (1980-January, 2015), PubMed (1980-January, 2015), Web of Science (1980-January, 2015), and The Cochrane Central Register of Controlled Trials. High-quality RCTs and non-RCTs were picked to evaluate the visual analogue scale (VAS) and other outcome. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The software RevMan 5.30 was used for the meta-analysis. Eight literatures fitted into the inclusion criteria. There were no significant differences in VAS score with rest or mobilization at 4, 24, and 48 h between ACB group and FNB group. There were also no significant differences in the strength of quadriceps and adductor, the length of hospital stay, and complications of vomiting and nausea. Present meta-analysis indicated that ACB shows no superiority than FNB group. Both of them can reduce the pain score after TKA. As referred to which method to adopt, it is determined by the preference of the surgeons and anesthesiologists. PMID:27015172

  3. Can the American College of Surgeons Risk Calculator Predict 30-Day Complications After Knee and Hip Arthroplasty?

    PubMed

    Edelstein, Adam I; Kwasny, Mary J; Suleiman, Linda I; Khakhkhar, Rishi H; Moore, Michael A; Beal, Matthew D; Manning, David W

    2015-09-01

    Accurate risk stratification of patients undergoing total hip (THA) and knee (TKA) arthroplasty is essential in the highly scrutinized world of pay-for-performance, value-driven healthcare. We assessed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator's ability to predict 30-day complications using 1066 publicly-reported Medicare patients undergoing primary THA or TKA. Risk estimates were significantly associated with complications in the categories of any complication (P = .005), cardiac complication (P < .001), pneumonia (P < .001) and discharge to skilled nursing facility (P < .001). However, predictability of complication occurrence was poor for all complications assessed. To facilitate the equitable provision and reimbursement of patient care, further research is needed to develop accurate risk stratification tools in TKA and THA surgery. PMID:26165953

  4. Alterations in lower limb multimuscle activation patterns during stair climbing in female total knee arthroplasty patients

    PubMed Central

    von Tscharner, V.; Hutchison, C.; Ronsky, J. L.

    2015-01-01

    Total knee arthroplasty (TKA) patients commonly experience neuromuscular adaptations that may affect stair climbing competence. This study identified multimuscle pattern (MMP) changes in postoperative female TKA patients during stair climbing with a support vector machine (SVM). It was hypothesized that TKA patients adopt temporal and spectral muscle activation characteristics indicative of muscle atrophy and cocontraction strategies. Nineteen female subjects [10 unilateral sex-specific TKAs, 62.2 ± 8.6 yr, body mass index (BMI) 28.2 ± 5.4 kg/m2; 9 healthy control subjects, 61.4 ± 7.4 yr, BMI 25.6 ± 2.4 kg/m2] were recruited. Surface electromyograms (EMGs) were obtained for seven lower limb muscles of the affected limb of TKA subjects and a randomly assigned limb for control subjects during stair climbing. Stance phase (±30%) EMG data were wavelet transformed and normalized to total power. Data across all muscles were combined to form MMPs and analyzed with a SVM. Statistical analysis was performed with binomial tests, independent group t-tests, or independent group Mann-Whitney U-tests in SPSS (P < 0.05). SVM results indicated significantly altered muscle activation patterns in the TKA group for biceps femoris (recognition rate 84.2%), semitendinosus (recognition rate 73.7%), gastrocnemius (recognition rate 68.4%), and tibialis anterior (recognition rate 68.4%). Further analysis identified no significant differences in spectral activation characteristics between groups. Temporal adaptations, indicative of cocontraction strategies, were, however, evident in TKA MMPs. This approach may provide a valuable tool for clinical neuromuscular function assessment and rehabilitation monitoring. PMID:26354313

  5. Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry

    PubMed Central

    Singh, Jas; Politis, Angelos; Loucks, Lynda; Hedden, David R.; Bohm, Eric R.

    2016-01-01

    Background National joint replacement registries outside North America have been effective in reducing revision risk. However, there is little information on the role of smaller regional registries similar to those found in Canada or the United States. We sought to understand trends in total hip (THA) and knee (TKA) arthroplasty revision patterns after implementation of a regional registry. Methods We reviewed our regional joint replacement registry containing all 30 252 cases of primary and revision THA and TKA performed between Jan. 1, 2005, and Dec. 31, 2013. Each revision case was stratified into early (< 2 yr), mid (2–10 yr) or late (> 10 yr), and we determined the primary reason for revision. Results The early revision rate for TKA dropped from 3.0% in 2005 to 1.3% in 2011 (R2 = 0.84, p = 0.003). Similarly, the early revision rate for THA dropped from 4.2% to 2.1% (R2 = 0.78, p = 0.008). Despite primary TKA and THA volumes increasing by 35.5% and 39.5%, respectively, there was no concomitant rise in revision volumes. The leading reasons for TKA revision were infection, instability, aseptic loosening and stiffness. The leading reasons for THA revision were infection, instability, aseptic loosening and periprosthetic fracture. There were no discernible trends over time in reasons for early, mid-term or late revision for either TKA or THA. Conclusion After implementation of a regional joint replacement registry we observed a significant reduction in early revision rates. Further work investigating the mechanism by which registry reporting reduces early revision risk is warranted. PMID:27438053

  6. Meta-Review of the Quantity and Quality of Evidence for Knee Arthroplasty Devices

    PubMed Central

    Gagliardi, Anna R.; Ducey, Ariel; Lehoux, Pascale; Ross, Sue; Trbovich, Patricia; Easty, Anthony; Bell, Chaim; Takata, Julie; Pabinger, Christof; Urbach, David R.

    2016-01-01

    Introduction Some cardiovascular devices are licensed based on limited evidence, potentially exposing patients to devices that are not safe or effective. Research is needed to ascertain if the same is true of other types of medical devices. Knee arthroplasty is a widely-used surgical procedure yet implant failures are not uncommon. The purpose of this study was to characterize available evidence on the safety and effectiveness of knee implants. Methods A review of primary studies included in health technology assessments (HTA) on total (TKA) and unicompartmental knee arthroplasty (UKA) was conducted. MEDLINE, EMBASE, CINAHL, Cochrane Library and Biotechnology & BioEngineering Abstracts were searched from 2005 to 2014, plus journal tables of contents and 32 HTA web sites. Patients were aged 18 and older who underwent primary TKA or UKA assessed in cohort or randomized controlled studies. Summary statistics were used to report study characteristics. Results A total of 265 eligible primary studies published between 1986 and 2014 involving 59,217 patients were identified in 10 HTAs (2 low, 7 moderate, 1 high risk of bias). Most evaluated TKA (198, 74.5%). The quality of evidence in primary studies was limited. Most studies were industry-funded (23.8%) or offered no declaration of funding or conflict of interest (44.9%); based on uncontrolled single cohorts (58.5%), enrolled fewer than 100 patients (66.4%), and followed patients for 2 years or less (UKA: single cohort 29.8%, comparative cohort 16.7%, randomized trial 25.0%; TKA: single cohort 25.0%, comparative cohort 31.4%, randomized trial 48.6%). Furthermore, most devices were evaluated in only one study (55.3% TKA implants, 61.1% UKA implants). Conclusions Patients, physicians, hospitals and payers rely on poor-quality evidence to support decisions about knee implants. Further research is needed to explore how decisions about the use of devices are currently made, and how the evidence base for device safety and

  7. Influence of the Infrapatellar Fat Pad Resection during Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

    PubMed Central

    Ye, Chenyi; Zhang, Wei; Wu, Weigang; Xu, Mingyuan; Nonso, Nwofor Samuel; He, Rongxin

    2016-01-01

    Background To enhance surgical exposure, resection of the infrapatellar fat pad (IPFP) is usually a routine procedure in total knee arthroplasty (TKA). However, there is conflicting evidence regarding whether IPFP resection during TKA impairs clinical outcome. We performed a systematic review and meta-analysis to clarify the influence of IPFP resection on primary TKA. Methods Embase, PubMed, and the Cochrane Library were systematically searched up to August 2016 to identify relevant studies. All clinical studies comparing IPFP resection (IPFP-R) and IPFP preservation (IPFP-P) in patients undergoing primary TKA were obtained. The meta-analysis was performed with Revman 5.3 and STATA 12.0 software. The weighted mean was estimated by using random effects (RE) models with 95% CIs, heterogeneity was assessed using the H statistic and the inconsistency index (I2). Results Seven studies involving 2,734 patients (3,258 knees) were included. IPFP resection trended to increase the incidence of postoperative anterior knee pain within 2 months postoperatively, compared with patients in whom the IPFP was preserved (odds ratio [OR]s 2.12[0.95, 4.73], p = 0.07). An increased incidence of anterior knee pain was observed in the IPFP resection group > 12 months postoperatively, but the difference was not significant (OR, 3.69 [0.81, 16.82], p = 0.07). In addition, a trend towards more shortening of the patellar tendon was also observed in the IPFP-R group. No significant results were found regarding postoperative knee function. Conclusion These results suggest that preserving the IPFP may be superior to IPFP resection in patients undergoing primary TKA, due to the relatively lower rate of anterior knee pain after short-term follow-up. PMID:27706208

  8. Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty

    PubMed Central

    Espehaug, Birgitte; Havelin, Leif Ivar; Vollset, Stein Emil; Furnes, Ove

    2010-01-01

    Background and purpose Resurfacing of the patella during primary total knee arthroplasty (TKA) is often recommended based on higher revision rates in non-resurfaced knees. As many of these revisions are insertions of a patella component due to pain, and since only patients with a non-resurfaced patella have the option of secondary resurfacing, we do not really know whether these patients have more pain and poorer function. The main purpose of the present paper was therefore to assess pain and function at least 2 years after surgery for unrevised primary non-resurfaced and resurfaced TKA, and secondary among prosthesis brands. Methods Information needed to calculate subscales from the knee injury and osteoarthritis outcome score (KOOS) was collected in a questionnaire given to 972 osteoarthritis patients with intact primary TKAs that had been reported to the Norwegian Arthroplasty Register. Pain and satisfaction on visual analog scales and improvement in EQ-5D index score ΔEQ-5D) were also used as outcomes. Outcomes were measured on a scale from 0 to 100 units (worst to best). To estimate differences in mean scores, we used multiple linear regression with adjustment for possible confounders. Results We did not observe any differences between resurfacing and non-resurfacing in any outcome, with estimated differences of ≤ 1.4 units and p-values of > 0.4. There was, however, a tendency of better results for the NexGen implant as compared to the reference brand AGC for symptoms (difference = 4.9, p = 0.05), pain (VAS) (difference = 8.3, p = 0.004), and satisfaction (VAS) (difference = 7.9, p = 0.02). However, none of these differences reached the stated level of minimal perceptible clinical difference. Interpretation Resurfacing of the patella has no clinical effect on pain and function after TKA. Differences between the brands investigated were small and they were assumed to be of minor importance. PMID:20158405

  9. Timing of manipulation under anaesthesia for stiffness after total knee arthroplasty

    PubMed Central

    Mamarelis, Georgios; Sunil-Kumar, Karadi Hari

    2015-01-01

    Stiffness following total knee arthroplasty (TKA) is a debilitating condition for the patient with limitation of functional outcome. There are various causes of stiffness, which can be classified as pre-operative, per-operative and post-operative. Arthrofibrosis is one of the causes, which can be managed in different ways, and manipulation under anaesthesia (MUA) is routinely performed as the first line of management. The timing of MUA is often debated. We review the paper by Issa et al., which looks at the effect of timing of manipulation on a stiff TKA. They conclude that early manipulation within 12 weeks of performing the TKA had a higher mean flexion gain (36.5°), higher final range of motion (ROM) (119°) and higher knee society score (89 points) compared to those performed after 12 weeks which were 17°, 95° and 84 points respectively. Other studies have also reinforced the idea that early manipulation within 12 weeks has a better outcome than those performed after 12 weeks. There may still be a benefit of manipulation until 26 weeks after which open arthrolysis may be needed to improve ROM. PMID:26697476

  10. "Grand piano sign," a marker for proper femoral component rotation during total knee arthroplasty.

    PubMed

    Moyad, Thomas F; Hughes, Richard E; Urquhart, Andrew

    2011-07-01

    A malpositioned femoral component is an established risk factor for patellar instability and pain after total knee arthroplasty (TKA). In the assessment of femoral rotation, several axes, including the transepicondylar axis, the posterior condylar axis, and the anteroposterior axis, are useful. However, these axes are not always easily applicable, particularly when significant deformity exists. An anecdotal method used by some surgeons involves assessing the shape of the anterior femoral surface osteotomy. Our observations from saw bone models and TKA led to our hypothesis that proper femoral component placement is indicated by a bimodal peak on the anterior femur, approximately twice as high on the lateral side than on the medial side. We use the term "grand piano sign" to describe the shape of the trochlea after the osteotomy is correctly completed. To our knowledge, this common observation has not been studied either in the laboratory or in vivo. Our cadaveric models demonstrated that the grand piano sign correlated with proper femoral rotation during TKA. Surgeons who are knowledgeable about this marker should find it helpful when orienting components during knee replacement surgery. PMID:22013571

  11. A potential mode of action for Anakinra in patients with arthrofibrosis following total knee arthroplasty

    PubMed Central

    Dixon, David; Coates, Jonathon; del Carpio Pons, Alicia; Horabin, Joanna; Walker, Andrew; Abdul, Nicole; Kalson, Nicholas S.; Brewster, Nigel T.; Weir, David J.; Deehan, David J.; Mann, Derek A.; Borthwick, Lee A.

    2015-01-01

    Arthrofibrosis is a fibroproliferative disease characterised by excessive deposition of extracellular matrix components intra-articularly leading to pain and restricted range of movement. Although frequently observed following total knee arthroplasty (TKA) no therapeutic options exist. A pilot study demonstrated that intra-articular injection of Anakinra, an IL-1R antagonist, improved range of movement and pain in patients with arthrofibrosis however the mechanism of action is unknown. We hypothesise that IL-1α/β will drive an inflammatory phenotype in fibroblasts isolated from the knee, therefore identifying a potential mechanism of action for Anakinra in arthrofibrosis following TKA. Fibroblasts isolated from synovial membranes and infra-patellar fat pad of patients undergoing TKA express high levels of IL-1R1. Stimulation with IL-1α/β induced a pro-inflammatory phenotype characterised by increased secretion of GMCSF, IL-6 and IL-8. No significant difference in the inflammatory response was observed between fibroblasts isolated from synovial membrane or infra-patellar fat pad. IL-1α/β treatments induced a pro-inflammatory phenotype in fibroblasts from both synovial membrane and infra-patellar fat pad and therefore Anakinra can likely have an inhibitory effect on fibroblasts present in both tissues in vivo. It is also likely that fibroblast responses in the tissues are controlled by IL-1α/β availability and not their ability to respond to it. PMID:26553966

  12. Safety of Tourniquet Use in Total Knee Arthroplasty in Patients With Radiographic Evidence of Vascular Calcifications.

    PubMed

    Koehler, Steven M; Fields, Adam; Noori, Naudereh; Weiser, Mitchell; Moucha, Calin S; Bronson, Michael J

    2015-09-01

    Tourniquets are often used in total knee arthroplasty (TKA) to improve visualization of structures, shorten operative time, reduce intraoperative bleeding, and improve cementing technique. Despite these advantages, controversy remains regarding the safety of tourniquet use. Tourniquets have been associated with nerve palsies, vascular injury, and muscle damage. Some have hypothesized they may also cause deep vein thrombosis. Last, increased incidence of postoperative wound complications has been reported with use of tourniquets. We conducted a retrospective cohort study to determine whether tourniquet use in TKA in patients with preexisting radiographic evidence of vascular disease increases the risk for wound complications or venous thromboembolism (VTE). Patients (N = 373) were placed in 2 groups: One had no preoperative radiographic evidence of knee arterial calcification (n = 285), and the other had arterial calcifications (n = 88). Overall, arterial calcification did not increase the risk for wound complication or VTE (P > .05). Furthermore, location of arterial calcification did not affect risk for wound complication or VTE. There were no arterial injuries. Diabetes, hypertension, prior VTE, coronary artery disease, and male sex were linked to higher wound complication rates (P < .05). Patients who have preoperative radiographic evidence of arterial calcification can safely undergo tourniquet-assisted TKA.

  13. Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up

    PubMed Central

    Craig, Joseph; Nelson, Fred

    2008-01-01

    Objective The purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years. Materials and methods The entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28–75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed. Results Subjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p = 0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p < 0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p < 0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p < 0.001). However, the BME results were still significant after accounting for the age difference. Conclusion Our classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst

  14. Total knee arthroplasty in patients with a previous patellectomy.

    PubMed

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients. PMID:24151951

  15. Thirty-day complications in rheumatoid patients following total knee arthroplasty.

    PubMed

    Jauregui, Julio J; Kapadia, Bhaveen H; Dixit, Anant; Naziri, Qais; Hip-Flores, David J; Harwin, Steven F; Mont, Michael A

    2016-03-01

    Although total knee arthroplasty (TKA) is highly successful for patients with end-stage rheumatoid arthritis (RA), the risks and complications associated with surgery in this cohort are less defined. The objectives of our study were to analyze the demographic and perioperative factors of RA patients that may affect post-TKA outcomes, as well as to assess the 30-day complication rates compared to osteoarthritis patients. We retrospectively evaluated the National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2012 to assess all patients who underwent a primary TKA and had a diagnosis of rheumatoid arthritis (n = 141) or primary knee osteoarthritis (n = 7125). We evaluated and compared the demographic factors, social factors, preoperative factors, operative factors, and postoperative complications. The RA cohort had a lower mean age and body mass index than patients in the OA group. There was also a significantly higher incidence of women and Hispanics in the RA cohort. There was a lower incidence of diabetes and hypertension requiring medication in the rheumatoid cohort, but also a higher incidence of bleeding disorders. The RA cohort had an increased proportion of patients requiring blood transfusions and had a longer mean length of stay. The incidence of pneumonia and postoperative bleeding that required transfusion was also higher in RA patients. Rheumatoid patients had higher rates of wound infections, pulmonary embolisms, and deep vein thrombosis; however, these findings were not significant. Although RA patients with end-stage knee arthritis may benefit from TKA, these patients should be preoperatively optimized to minimize complication risks. PMID:26238666

  16. Ertapenem Articulating Spacer for the Treatment of Polymicrobial Total Knee Arthroplasty Infection.

    PubMed

    Radoicic, Dragan; Milanovic, Milomir; Marinkovic, Jugoslav; Radoicic, Danica

    2016-01-01

    Introduction. Periprosthetic joint infections (PJIs) are the primary cause of early failure of the total knee arthroplasty (TKA). Polymicrobial TKA infections are often associated with a higher risk of treatment failure. The aim of the study was to assess the efficacy of ertapenem loaded spacers in the treatment of polymicrobial PJI. Methods. There were 18 patients enrolled; nine patients with polymicrobial PJI treated with ertapenem loaded articulating spacers were compared to the group of 9 patients treated with vancomycin or ceftazidime loaded spacers. Results. Successful reimplantation with revision implants was possible in 66.67%. Ertapenem spacers were used in 6 cases in primary two-stage procedure and in 3 cases in secondary spacer exchange. Successful infection eradication was achieved in all cases; final reimplantation with revision knee arthroplasty implants was possible in 6 cases. Conclusion. Ertapenem can be successfully used as antimicrobial addition to the cement spacers in two-stage revision treatment of polymicrobial PJIs. However, this type of spacer may also be useful in the treatment of infections caused by monomicrobial extended spectrum beta-lactamases producing gram-negative bacilli. Further clinical studies are required to evaluate the efficacy and safety of ertapenem spacers in the treatment of polymicrobial and monomicrobial PJIs. PMID:27366173

  17. Effectiveness of femoral nerve blockade for pain control after total knee arthroplasty.

    PubMed

    Duarte, Victor M; Fallis, Wendy M; Slonowsky, Dean; Kwarteng, Kwadwo; Yeung, Colin K L

    2006-10-01

    Control of postoperative pain is a major concern for patients undergoing total knee arthroplasty (TKA). The purpose of this study was to investigate pain control and opioid use, as well as length of stay, ambulation time, antiemetic use, and degree of mobilization for patients undergoing total knee arthroplasty, comparing those receiving femoral nerve block (FNB) to those receiving no femoral nerve block. Using retrospective patient record data, 133 subjects from an acute care community hospital in western Canada were split into three groups: no FNB (control group, n = 49), single-shot FNB (n = 33), and continuous FNB (n = 51). There was a statistically significant improvement in pain control on day of surgery for the FNB group compared with the no-FNB group, and reduction in opioid usage on days 0, 1, and 2 in the continuous FNB group compared with the no-FNB and single-shot group. Also noted was a statistically significant reduction in antiemetic use in the FNB compared with the no-FNB group on the day after surgery. This study is in accordance with earlier studies that support continuous FNB as an effective method for achieving postoperative pain control and reducing opioid use for patients undergoing TKA.

  18. Use of a New Knee Prosthesis as an Articulating Spacer in Two-Stage Revision of Infected Total Knee Arthroplasty

    PubMed Central

    Fabrin, Jesper; Poulsen, Klaus; Schroder, Henrik Morville

    2016-01-01

    Purpose To report our experience with two-stage revision using a new femoral component (NFC) spacer (Depuy Synthes) as an articulating spacer. Materials and Methods In this retrospective study, we reviewed 22 two-stage revisions that were performed using an NFC spacer in 22 patients suspected of having an infected total knee arthroplasty (TKA) from December 2010 to March 2013. The result was considered successful when eradication of infection was achieved using only one NFC spacer. Results The average time from primary TKA to the first stage procedure was 29.1 months and the average time from the first stage procedure until the final second stage procedure was 12.7 weeks. The average range of motion increased from 82° preoperatively to 104° postoperatively. The American Knee Society Knee score increased from 29.3 points to 66 points. The Function score increased from 29.5 points to 64 points. Four cases were reinfected after two-stage revision. The mean follow-up was 37.6 months. Conclusions The new articulating spacer showed promising short-term results both with regard to eradication of infection and functional improvement. PMID:27595079

  19. Acute compartment syndrome of the thigh following total knee arthroplasty.

    PubMed

    Boonstra, R H; Haverkamp, D; Campo, M M; van der Vis, H M

    2012-03-01

    A 62year old man developed a compartment syndrome of the thigh after total knee arthroplasty. Twelve years previously he had a HTO of the same knee complicated by a compartment syndrome of the calf. The clinical diagnosis was confirmed with intracompartmental pressure measurement. Following fasciotomy pressures were normalized and further course was uncomplicated. Compartment syndrome of the thigh is a rare, but potentially devastating, complication following total knee arthroplasty. A previous compartment syndrome of the calf is identified as a risk factor.

  20. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study

    PubMed Central

    2012-01-01

    Background Total knee arthroplasty (TKA) is often associated with a severe local inflammatory reaction which, unless controlled, leads to persistent pain up to one year after surgery. Standard and accelerated rehabilitation protocols are currently being implemented after TKA, but no consensus exists regarding the long-term effects. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been demonstrated to exert an anti-inflammatory effect, to promote early functional recovery and to maintain a positive long-term effect in patients undergoing joint arthroscopy. The aim of this study was to evaluate whether PEMFs can be used to limit the pain and enhance patient recovery after TKA. Methods A prospective, randomized, controlled study in 30 patients undergoing TKA was conducted. Patients were randomized into experimental PEMFs or a control group. Patients in the experimental group were instructed to use I-ONE stimulator 4hours/day for 60days. Postoperatively, all patients received the same rehabilitation program. Treatment outcome was assessed using the Knee Society Score, SF-36 Health-Survey and VAS. Patients were evaluated pre-operatively and one, two, six and 12 months after TKA. Joint swelling and Non Steroidal Anti Inflammatory Drug (NSAID) consumption were recorded. Comparisons between the two groups were carried out using a two-tail heteroschedastic Student’s t-test. Analysis of variance for each individual subject during the study was performed using ANOVA for multiple comparisons, applied on each group, and a Dunnet post hoc test. A p value < 0.05 was considered statistically significant. Results Pre-operatively, no differences were observed between groups in terms of age, sex, weight, height, Knee-Score, VAS, SF-36 and joint swelling, with the exception of the Functional Score. The Knee-Score, SF-36 and VAS demonstrated significantly positive outcomes in the I-ONE stimulated group compared with the controls at follow-ups. In the I

  1. Prophylaxis for Venous Thromboembolism Following Total Knee Arthroplasty: A Survey of Korean Knee Surgeons

    PubMed Central

    Kim, Nam Ki; Kim, Tae Kyun; Kim, Jong Min

    2016-01-01

    Purpose The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. Materials and Methods The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. Results The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. Conclusions The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future. PMID:27595074

  2. Prophylaxis for Venous Thromboembolism Following Total Knee Arthroplasty: A Survey of Korean Knee Surgeons

    PubMed Central

    Kim, Nam Ki; Kim, Tae Kyun; Kim, Jong Min

    2016-01-01

    Purpose The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. Materials and Methods The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. Results The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. Conclusions The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future.

  3. MIS unicondylar knee arthroplasty: surgical approach and early results.

    PubMed

    Gesell, Mark W; Tria, Alfred J

    2004-11-01

    Unicondylar arthroplasty of the knee has seen a resurgence of interest in the United States. The principles of unicondylar arthroplasty of the knee are different from those for total knee arthroplasty, allowing replacement of only the affected joint compartment with less bone loss. Minimally invasive surgery allows for less soft tissue dissection with the potential for less morbidity. The key question is: will the changes associated with the minimally invasive surgery procedure improve the clinical results of the standard unicondylar arthroplasty of the knee or will the changes make the procedure too difficult and lead to an increasing failure rate? This study reviews the surgical technique and presents the 2 to 4 year results of the minimally invasive unicondylar arthroplasty of the knee 47 knees in 41 patients. The average range of motion increased from 121 degrees -132 degrees . The Knee Society pain score improved from 45-80 and the function score improved from 47-78. Only one knee has been revised. With proper patient selection, minimally invasive unicondylar arthroplasty of the knee allows for results that are at least equal to those of the standard open procedure at 2 to 4 years after the surgery.

  4. Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

    PubMed Central

    Vaishya, Raju; Vijay, Vipul; Birla, Vikas P; Agarwal, Amit K

    2016-01-01

    AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty (TKA) using computer tomography (CT) based patient specific blocks (PSB) to conventional instruments (CI). METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle (MFT angle) was measured on long leg x-rays using picture archiving and communication system (PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical analysis. RESULTS: The PSB group (group 1) included 17 females and seven males while in CI group (group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23° (SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73° (SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment (P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB (7 Knee) compared to those operated with CI (17 Knee). CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation. PMID:27458553

  5. Fracture Blisters After Primary Total Knee Arthroplasty.

    PubMed

    Halawi, Mohamad J

    2015-08-01

    Fracture blisters are tense vesicles that arise on markedly swollen skin overlying traumatized soft tissue. While this relatively uncommon complication has been well described in the trauma literature, this article reports for the first time a case of fracture blisters after primary total knee arthroplasty. The fracture blisters developed within 36 hours of surgery and were associated with profound swelling and erythema. There was no evidence of vascular injury, compartment syndrome, iatrogenic fracture, or deep venous thrombosis. The patient was treated with leg elevation, loosely applied nonadhesive dressings, and a short course of oral antibiotics after skin desquamation. Blood-filled blisters required longer time to reepithelialization than fluid-filled blisters. Knee stiffness developed because of pain and fear of participation with physical therapy, but the patient was able to resume intensive rehabilitation after resolution of the blisters. Patient factors, surgical factors, and review of the literature are discussed. PMID:26251947

  6. Outcomes of a Newer-Generation Cementless Total Knee Arthroplasty Design.

    PubMed

    Harwin, Steven F; Elmallah, Randa K; Jauregui, Julio J; Cherian, Jeffrey J; Mont, Michael A

    2015-10-01

    Newer-generation cementless total knee arthroplasties (TKAs) aim to improve durability, function, and longevity. In a large series of cementless TKAs at a mean 4-year follow-up, the authors evaluated (1) survivorship, (2) range of motion, (3) patient-reported outcomes, and (4) complications. Mean age was 66 years (range, 34-88 years) and mean body mass index was 32.5 kg/m(2) (range, 20-54 kg/m(2)). Aseptic and septic implant survivorships were 99.6% and 99.5%, respectively. Mean extension, flexion, and Knee Society scores improved significantly. There were 3 septic failures. Aseptic failures included 3 aseptic loosenings, 1 polyethylene revision, and 1 revision to a cemented patella. This study showed excellent clinical and patient-reported outcomes of cementless TKA.

  7. Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty.

    PubMed

    Voleti, Pramod B; Hamula, Mathew J; Baldwin, Keith D; Lee, Gwo-Chin

    2014-09-01

    The purpose of this systematic review and meta-analysis is to compare patient-specific instrumentation (PSI) versus standard instrumentation for total knee arthroplasty (TKA) with regard to coronal and sagittal alignment, operative time, intraoperative blood loss, and cost. A systematic query in search of relevant studies was performed, and the data published in these studies were extracted and aggregated. In regard to coronal alignment, PSI demonstrated improved accuracy in femorotibial angle (FTA) (P=0.0003), while standard instrumentation demonstrated improved accuracy in hip-knee-ankle angle (HKA) (P=0.02). Importantly, there were no differences between treatment groups in the percentages of FTA or HKA outliers (>3 degrees from target alignment) (P=0.7). Sagittal alignment, operative time, intraoperative blood loss, and cost were also similar between groups (P>0.1 for all comparisons).

  8. Template-directed instrumentation in total knee arthroplasty: cost savings analysis.

    PubMed

    Hsu, Andrew R; Gross, Christopher E; Bhatia, Sanjeev; Levine, Brett R

    2012-11-01

    The use of digital radiography and templating software in total knee arthroplasty (TKA) continues to become more prevalent as the number of procedures performed increases every year. Template-directed instrumentation (TDI) is a novel approach to surgical planning that combines digital templating with limited intraoperative instruments. The purpose of this study was to evaluate the financial implications and radiographic outcomes of using TDI to direct instrumentation during primary TKA. Over a 1-year period, 82 consecutive TKAs using TDI were retrospectively reviewed. Patient demographics and preoperative templated sizes of predicted components were recorded, and OrthoView digital planning software (OrthoView LLC, Jacksonville, Florida was used to determine the 2 most likely tibial and femoral component sizes for each case. This sizing information was used to direct component vendors to prepare 3 lightweight instrument trays based on these sizes. The sizes of implanted components and the number of total trays required were documented. A cost savings analysis was performed to compare TDI and non-TDI surgical expenses for TKA. In 80 (97%) of 82 cases, the prepared sizes determined by TDI using 3 instrument trays were sufficient. Preoperative templating correctly predicted the size of the tibial and femoral component sizes in 90% and 83% of cases, respectively. The average number of trays used with TDI was 3.0 (range, 3-5 trays) compared with 7.5 (range, 6-9 trays) used in 82 preceding non-TDI TKAs. Based on standard fees to sterilize and package implant trays (approximately $26 based on a survey of 10 orthopedic hospitals performing TKA), approximately $9612 was saved by using TDI over the 1-year study period. Overall, digital templating and TDI were a simple and cost-effective approach when performing primary TKA. PMID:23127449

  9. Patient specific instrumentation in total knee arthroplasty: a state of the art.

    PubMed

    Mattei, Lorenzo; Pellegrino, Pietro; Calò, Michel; Bistolfi, Alessandro; Castoldi, Filippo

    2016-04-01

    Patient specific instrumentation (PSI) is a modern technique in total knee arthroplasty (TKA) aiming to facilitate the implant of the prosthesis. The customized cutting blocks of the PSI are generated from pre-operative three-dimensional model, using computed tomography (CT) or magnetic resonance imaging (MRI). A correct surgical plan is mandatory for a good surgical implant. The PSI guide takes into account any slight deformities or osteophytes and applies preoperative planning for bone resection, using the pre-determined implant size, position, and rotation. The apparent benefits of this technology are that neutral postoperative alignment is more reproducible, surgical time is decreased, and the entire procedure results more efficient and cost-effective. The use of PSI is indicated when advanced osteoarthritis, severe pain, and limited function/walking ability are present, such as in a standard instrumentation TKA. In addition to that, PSI finds its indication when intra-medullary guides cannot be used. For example, when there is a post-traumatic femoral deformity. Large debates have taken place about this topic during the last years and, at the moment, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results. Literature does not suggest PSI techniques as a gold standard in TKA, and therefore it cannot be recommended as a standard technique in standard, not complicated primary TKA. Moreover, literature does not underline any improvement in components alignment, surgical time, blood loss or functional outcomes. Nevertheless, many patients who underwent TKA suffered a previous trauma. In case of deformities, like femoral or tibial fractures healed with a malalignment, preoperative planning may result difficult, and some intra-operative technical difficulties can occur, such as the use of intra-medullar rod. In these selected cases, PSIs may be very useful to avoid errors in

  10. Patient specific instrumentation in total knee arthroplasty: a state of the art

    PubMed Central

    Mattei, Lorenzo; Pellegrino, Pietro; Bistolfi, Alessandro; Castoldi, Filippo

    2016-01-01

    Patient specific instrumentation (PSI) is a modern technique in total knee arthroplasty (TKA) aiming to facilitate the implant of the prosthesis. The customized cutting blocks of the PSI are generated from pre-operative three-dimensional model, using computed tomography (CT) or magnetic resonance imaging (MRI). A correct surgical plan is mandatory for a good surgical implant. The PSI guide takes into account any slight deformities or osteophytes and applies preoperative planning for bone resection, using the pre-determined implant size, position, and rotation. The apparent benefits of this technology are that neutral postoperative alignment is more reproducible, surgical time is decreased, and the entire procedure results more efficient and cost-effective. The use of PSI is indicated when advanced osteoarthritis, severe pain, and limited function/walking ability are present, such as in a standard instrumentation TKA. In addition to that, PSI finds its indication when intra-medullary guides cannot be used. For example, when there is a post-traumatic femoral deformity. Large debates have taken place about this topic during the last years and, at the moment, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results. Literature does not suggest PSI techniques as a gold standard in TKA, and therefore it cannot be recommended as a standard technique in standard, not complicated primary TKA. Moreover, literature does not underline any improvement in components alignment, surgical time, blood loss or functional outcomes. Nevertheless, many patients who underwent TKA suffered a previous trauma. In case of deformities, like femoral or tibial fractures healed with a malalignment, preoperative planning may result difficult, and some intra-operative technical difficulties can occur, such as the use of intra-medullar rod. In these selected cases, PSIs may be very useful to avoid errors in

  11. Influences of continuous femoral nerve block on knee function and quality of life in patients following total knee arthroplasty

    PubMed Central

    Wang, Fen; Zhou, Yingjie; Sun, Jiajun; Yang, Chunxi

    2015-01-01

    Objective: Continuous femoral nerve block (CFNB), guided by ultrasound combined nerve stimulations, offers advantages for both sides and provides effective postoperative analgesia after total knee arthroplasty (TKA). The objective of this study was to evaluate the medium-term impact of continuous femoral nerve block on knee function and quality of life in patients following TKA. Methods: This was a follow-up study. Total 168 adult patients scheduled for elective TKA were randomly allocated to receive postoperative continuous femoral nerve block guided by ultrasound combined nerve stimulator (group CFNB, n = 82) or patient-controlled epidural analgesia (group PCEA, n = 86). Quality of life, knee function, patient satisfaction, pain medication and associated adverse effects were compared at 1, 3, 6, and 12 months postoperatively. Quality of life was assessed using the Medical Outcomes Study Short Form-36 Health Survey (MOS SF-36), and clinical results were assessed using the Hospital for Special Surgery (HSS) Knee Scoring System. Patient satisfaction scores were divided into four categories. Results: A total of 162 patients completed the 12-month follow-up. The CFNB group patients had significantly improved SF-36 scores and physical function at 1 month postoperatively (P < 0.05); the remaining seven dimensions were similar between the two groups. No differences were observed at 3, 6 or 12 months. HSS scores for the four observational time points were comparable. The CFNB group patients reported less pain; improved knee function, maximum flexion and strength; less celecoxib consumption and fewer side effects at 1 month than the PCEA group patients. The satisfaction score at 12 months decreased significantly, compared with that at 1 month in both groups (3.6 to 2.95 and 3.4 to 2.45, respectively). No difference in satisfaction score was observed between the two groups. Conclusions: Continuous femoral nerve block not only could provide effective postoperative analgesia

  12. Prospective Randomized Trial of the Efficacy of Continuous Passive Motion Post Total Knee Arthroplasty: Experience of the Hospital for Special Surgery.

    PubMed

    Joshi, Rupali N; White, Peter B; Murray-Weir, Mary; Alexiades, Michael M; Sculco, Thomas P; Ranawat, Amar S

    2015-12-01

    Conflicting evidence has created substantial controversy regarding the use of continuous passive motion (CPM) in the in-patient setting post total knee arthroplasty (TKA). A total of 109 patients were randomly assigned to two groups, CPM or no CPM, applied after TKA. All patients received the same physical therapy protocol (3 sessions per day), with the only exception being the CPM. Both groups had a knee flexion of 115° at 6 weeks and 120° at 3 months, with no significant differences (P=0.69 and P=0.41, respectively). Length of stay was significantly less for the group who did not receive CPM. The use of CPM had no clinically relevant benefits with respect to AROM, clinical outcomes or discharge disposition and was associated with a cost of $235.50 per TKA.

  13. Effects of Cold Irrigation on Early Results after Total Knee Arthroplasty

    PubMed Central

    Li, Zhirui; Liu, Daohong; Dong, Jiyuan; Gong, Long; Wang, Yong; Tang, Peifu; Zhang, Yan

    2016-01-01

    Abstract Several studies have indicated that pain peaks at 24 to 48 hours after total knee arthroplasty (TKA) surgery. TKA has been associated with disruption in normal sleep patterns, swelling knee, and significant blood loss. However, a satisfactory regime to resolve these mentioned problems has yet to be found. In this study, a total of 420 patients were randomly allocated into two groups and treated with continuous irrigation of either 4000 mL cold saline with 0.5% epinephrine or normal temperature solution. Clinical outcomes including pain scores at rest during postoperative three days, drainage output, analgesic consumption, decreased hemoglobin, sleep quality, and satisfaction rate were analyzed. Mean scores and postoperative change in scores were calculated. Visual analog scale (VAS) pain scores in the treatment group were significantly reduced from 4 hours (P = 0.0016) to 24 hours (P = 0.0004) after TKA. Additional benefits including reduced analgesic consumption, improved satisfaction rate, and sleep quality were observed. In addition, a significant reduction in blood loss reflected by decreased Hb and drainage was found. In this study, irrigation with a cold 0.5% epinephrine solution was a beneficial and cost-effective treatment that decreased acute postoperative VAS pain scores immediately after and 1 day after surgery. Patients reported postoperative improvement in sleep quality and overall satisfaction rate with a decrease in morphine usage. In addition, a reduction of intraoperative blood loss might decrease the blood transfusion rate and related costs. Collectively, irrigation with cold 0.5% epinephrine offers a safe, simple, and effective treatment that might improve recovery and enhance quality of life of patients undergoing TKA. PMID:27310945

  14. PHYSICAL EXERCISE AFTER KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW OF CONTROLLED TRIALS

    PubMed Central

    Pozzi, F.; Snyder-Mackler, L.; Zeni, J.

    2014-01-01

    Total knee arthroplasty (TKA) is the gold standard treatment for end-stage knee osteoarthritis. Most patients report successful long-term outcomes and reduced pain after TKA, but recovery is variable and the majority of patients continue to demonstrate lower extremity muscle weakness and functional deficits compared to age-matched control subjects. Given the potential positive influence of post-operative rehabilitation and the lack of established standards for prescribing exercise paradigms after TKA, the purpose of this study was to systematically review randomized, controlled studies to determine the effectiveness of post-operative outpatient care on short- and long-term functional recovery. Nineteen studies were identified as highly relevant for the review and four categories of post-operative intervention were discussed 1) Strengthening Exercises, 2) Aquatic Therapy, 3) Balance Training, and 4) Clinical Environment. Optimal outpatient physical therapy protocols should include: strengthening and intensive functional exercises given through land-based or aquatic programs, the intensity of which is increased based on patient progress. Due to the highly individualized characteristics of these types of exercises, outpatient physical therapy performed in a clinic under the supervision of a trained physical therapist may provide the best long-term outcomes after the surgery. Supervised or remotely supervised therapy may be effective at reducing some of the impairments following TKA, but several studies without direct oversight produced poor results. Most studies did not accurately describe the “usual care” or control groups and information about the dose, frequency, intensity and duration of the rehabilitation protocols were lacking from several studies. PMID:24172642

  15. Blood Loss and Transfusion After Topical Tranexamic Acid Administration in Primary Total Knee Arthroplasty.

    PubMed

    Wang, Hao; Shen, Bin; Zeng, Yi

    2015-11-01

    There has been much debate and controversy about the safety and efficacy of the topical use of tranexamic acid in primary total knee arthroplasty (TKA). The purpose of this study was to perform a meta-analysis to evaluate whether there is less blood loss and lower rates of transfusion after topical tranexamic acid administration in primary TKA. A systematic review of the electronic databases PubMed, CENTRAL, Web of Science, and Embase was undertaken. All randomized, controlled trials and prospective cohort studies evaluating the effectiveness of topical tranexamic acid during primary TKA were included. The focus of the analysis was on the outcomes of blood loss results, transfusion rate, and thromboembolic complications. Subgroup analysis was performed when possible. Of 387 studies identified, 16 comprising 1421 patients (1481 knees) were eligible for data extraction and meta-analysis. This study indicated that when compared with the control group, topical application of tranexamic acid significantly reduced total drain output (mean difference, -227.20; 95% confidence interval, -347.11 to -107.30; P<.00001), total blood loss (mean difference, -311.28; 95% confidence interval, -404.94 to -217.62; P<.00001), maximum postoperative hemoglobin decrease (mean difference, -0.73; 95% confidence interval, -0.96 to -0.50; P<.00001), and blood transfusion requirements (risk ratios, 0.33; 95% confidence interval, 0.24 to 0.43; P=.14). The authors found a statistically significant reduction in blood loss and transfusion rates when using topical tranexamic acid in primary TKA. Furthermore, the currently available evidence does not support an increased risk of deep venous thrombosis or pulmonary embolism due to tranexamic acid administration. Topical tranexamic acid was effective for reducing postoperative blood loss and transfusion requirements without increasing the prevalence of thromboembolic complications. PMID:26558665

  16. Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

    PubMed Central

    Saibaba, Balaji; Chouhan, Devendra K.; Kanojia, Rajendra K.; Prakash, Mahesh; Bachhal, Vikas

    2015-01-01

    Purpose To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). Materials and Methods A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. Results Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4° predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4°, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. Conclusions A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4° is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases. PMID:26389071

  17. Quality-of-life assessment among patients undergoing total knee arthroplasty in Manaus☆

    PubMed Central

    de Souza Leão, Marcos George; Santos Santoro, Erika; Lima Avelino, Rafael; Inoue Coutinho, Lucas; Campos Granjeiro, Ronan; Orlando Junior, Nilton

    2014-01-01

    Objective this study had the aim of assessing the quality of life among patients undergoing total knee arthroplasty (TKA). For this, the SF-36 and WOMAC questionnaires respectively were used to make comparisons with preoperative values. Methods a prospective observational cohort study was conducted, with blinded analysis on the results from 107 TKAs in 99 patients, between June 2010 and October 2011. The present study included 55 knees/patients, among whom 73% were female and 27% were male. The patients’ mean age was 68 years. The SF-36 and WOMAC questionnaires (which have been validated for the Portuguese language) were applied immediately before and six months after the surgical procedure. Results the statistical and graphical analyses indicated that the variables presented normal distribution. From the data, it was seen that all the indices underwent positive changes after the surgery. Conclusions despite the initial morbidity, TKA is a very successful form of treatment for severe osteoarthritis of the knee (i.e. more than two joint compartments affected and/or Ahlback classification greater than 3), from a functional point of view, with improvement of the patients’ quality of life, as confirmed in the present study. This study presented evidence level IV (description of case series), with analysis on the results, without a comparative study. PMID:26229799

  18. Total Knee Arthroplasty Following High Tibial Osteotomy – a Radiological Evaluation

    PubMed Central

    ORBAN, Horia; MARES, Emil; DRAGUSANU, Mihaela; STAN, Gabriel

    2011-01-01

    ABSTRACT The purpose of this study was to evaluate the results of total knee arthroplasty (TKA) following a closed wedge high tibial osteotomy (HTO). A total of 16 TKAs were performed in 16 pacients who had previously undergone a closed wedge (HTO) as a treatement for knee osteoarthritis. The radiographic results were evaluated with respect to the femurotibial angle (FTA), joint line height (JLH), tibial bone resection and Insall-Salvati ratio. The FTA improved in average, from 6.5 degree of varus preoperatively at 5.7 degree of valgus postoperatively. The JLH averaged 14.34 mm preop and 13.81 mm at the last follow-up. The amount of tibial bone resection averaged 5.98 mm, face to 7.5 mm for knees without HTO. The Insall-Salvati ratio was 1.127 preop and 1.172 postop. A meticulous surgical technique may lead to satisfactory results in TKA after HTO, considering the correction of the deformity, the re-estabilish of JLH and the amount of the tibial bone resection. PMID:21977186

  19. Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty.

    PubMed

    Krackow, K A; Holtgrewe, J L

    1990-09-01

    Total knee arthroplasty (TKA) after valgus proximal tibial osteotomy poses no major difficulties in most cases. There is, however, a small subgroup of severely overcorrected patients in whom TKA is particularly difficult. These patients require special considerations. A complex ligament reconstruction has been developed to allow simultaneous implantation of a minimally constrained total knee prosthesis for patients with failed, severely overcorrected valgus high tibial osteotomies. The technique is described in five patients. The mean age of the group was 57 years and the average follow-up period was 34 months (range, 12-72 months). A 100-point knee-evaluation scale was used to rate the knees before and after TKA. The average pre- and postoperative scores were 50 and 94, respectively. None of the patients was noted to have any more than mild instability in any direction postoperatively. Despite this extensive reconstruction, the group functioned as well as most recipients of more standard primary TKAs and demonstrated it is possible to avoid highly constrained implants, custom prostheses, or major bone grafts.

  20. Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

    PubMed

    Saffo, Zaid; Ognjan, Anthony

    2016-01-01

    The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a

  1. Sports Activity after Low-contact-stress Total Knee Arthroplasty - A long term follow-up study.

    PubMed

    Vielgut, Ines; Leitner, Lukas; Kastner, Norbert; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-04-19

    The purpose of this study was to provide comprehensive long-term data about sports activity levels in patients following total knee arthroplasty (TKA) and to determine the impact of pre-operative function, pain and specific performed sports on the results. 236 patients who have undergone TKA for severe osteoarthritis of the knee were asked to provide specific information regarding exercised types of sports before surgery and after at least 10 years following TKA. Pre- and postoperative function and pain were evaluated by the use of Tegner-, WOMAC- and VAS Score. After a mean of 14.9 years, a significant improvement regarding pain and function was observed. Pre-operative Tegner- and WOMAC scores revealed significant positive correlations with the post-operative Tegner-Score. Accordingly, a high percentage of patients (70.9%) stayed actively involved in sports. Nevertheless, the number of performing patients has decreased according to the sports impact. 71.3% continued practising low-impact-, 43.7% intermediate-impact sports whereas only 16.4% kept performing high impact sports. We conclude that TKA is highly effective in long-time pain reduction as well as improvement of function. Additionally, we found considerable sports activities preserved in the investigated series. However, sports activities in particular, seem to decrease according to the impact of sports.

  2. Sports Activity after Low-contact-stress Total Knee Arthroplasty – A long term follow-up study

    PubMed Central

    Vielgut, Ines; Leitner, Lukas; Kastner, Norbert; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    The purpose of this study was to provide comprehensive long-term data about sports activity levels in patients following total knee arthroplasty (TKA) and to determine the impact of pre-operative function, pain and specific performed sports on the results. 236 patients who have undergone TKA for severe osteoarthritis of the knee were asked to provide specific information regarding exercised types of sports before surgery and after at least 10 years following TKA. Pre- and postoperative function and pain were evaluated by the use of Tegner-, WOMAC- and VAS Score. After a mean of 14.9 years, a significant improvement regarding pain and function was observed. Pre-operative Tegner- and WOMAC scores revealed significant positive correlations with the post-operative Tegner-Score. Accordingly, a high percentage of patients (70.9%) stayed actively involved in sports. Nevertheless, the number of performing patients has decreased according to the sports impact. 71.3% continued practising low-impact-, 43.7% intermediate-impact sports whereas only 16.4% kept performing high impact sports. We conclude that TKA is highly effective in long-time pain reduction as well as improvement of function. Additionally, we found considerable sports activities preserved in the investigated series. However, sports activities in particular, seem to decrease according to the impact of sports. PMID:27090945

  3. Effect of shed blood retransfusion on pulmonary perfusion after total knee arthroplasty: a prospective controlled study

    PubMed Central

    Kaya, Eser; Kose, Kamil Cagri; Fidan, Fatma; Ergan, Volkan; Fidan, Hüseyin

    2006-01-01

    Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations, such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed with autotransfusion (the study group) and 15 unilateral and three bilateral TKAs were performed in a control group. Lung X-rays, arterial blood gases (ABG), D-dimer values, and lung perfusion scintigraphies were performed preoperatively and postoperatively. A mean of 300.0 ± 335.6 ml of bank blood was needed in the autotransfusion group and a mean of 685.7 ± 365.5 ml of bank blood was needed in the control group (p=0.001). There was a postoperative segmental perfusion defect at the lateral segment of the superior lobe of the left lung in one patient of the control group and he also had risk factors for thrombosis. Although both groups had a decrease in lung perfusion postoperatively, there were no significant differences among the groups regarding the lung perfusion scintigraphy, chest X-rays, ABG, and D-dimer values. In conclusion, although pulmonary perfusion diminishes following TKA, shed blood retransfusion does not add any risk to pulmonary perfusion. PMID:17115155

  4. Perceptions of Physiotherapy Best Practice in Total Knee Arthroplasty in Hospital Outpatient Settings

    PubMed Central

    Majumdar, Sampa Samanta; Luccisano, Mary

    2011-01-01

    ABSTRACT Purpose: The primary purpose of this study was to examine experienced physiotherapists' perceptions of best practices for patients following total knee arthroplasty (TKA) in publicly funded outpatient hospital settings in the Greater Toronto Area (GTA). The secondary objective was to identify the facilitators of and barriers to implementing best practices in the subacute phase of rehabilitation. Methods: A qualitative, descriptive, focused ethnographic approach was used to explore physiotherapists' perceptions of best practices for patients with TKA. In-depth semi-structured interviews were conducted with expert physiotherapists acting as key informants. A snowball sampling method was used to recruit physiotherapists in the GTA. Interviews were conducted in person by two of the investigators. Results: Physiotherapists from seven acute-care hospitals in the GTA participated in the study. Analysis of the 140 pages of transcripts from the interviews with 10 physiotherapists revealed that participants perceived best practices as encompassing the adoption of a client-centred approach; inter-professional collaboration; aggressive rehabilitation for patients who are unsuccessful in achieving their outcomes; the use of relevant outcome measures; and consideration of the impact of scarce resources on care. Conclusions: The findings of this study highlight physiotherapists' perceived best practices for patients with TKA and the unique contribution that hospital-based outpatient physiotherapy can make to patients' rehabilitation. PMID:22379264

  5. Two-Stage Revision Total Knee Arthroplasty in Cases of Periprosthetic Joint Infection: An Analysis of 50 Cases

    PubMed Central

    Claassen, Leif; Plaass, Christian; Daniilidis, Kiriakos; Calliess, Tilman; von Lewinski, Gabriela

    2015-01-01

    Objectives: A periprosthetic joint infection (PJI) is a significant complication after total knee arthroplasty (TKA). Still there is no agreement on a perfect diagnosis and treatment algorithm. The aim of this study was to evaluate the success and revision rates after two-stage revision total knee arthroplasty (TKA) and factors that affect the success rate. Material and Methods: 50 consecutive two-stage revision TKAs were performed between January 2011 and December 2012. We retrospectively reviewed study patient's charts including demographics, prior surgeries, comorbidities, incidence of persistent infection and revisions. At the final follow-up examination the patient's satisfaction, pain level and disorders were evaluated. A successful clinical outcome was defined as a functioning prosthesis without wound healing disorders, no sinuses tracts or other clinical evidence of a persistent infection. Results : Re-implantation of prosthesis was performed in 47 cases; three patients received a septic arthrodesis. Twelve patients had a persistent infection despite two-stage re-implantation resulting in a success rate of 76.0%. In eight of these twelve patients an infecting germ was isolated during second-stage procedure. Three patients received another two-stage revision arthroplasty and one patient an above knee amputation. A revision was performed in 23 of 50 patients (46.0%). Factors that diminish the success rate were further operations after primary TKA (p = 0.048), prior revision arthroplasties after TKA (p = 0.045), nicotine abuse (p = 0.048), Charlson comorbidity index above a score of 2 (p = 0.031) and a mixed flora during first-stage procedure (p < 0.001). Age, sex, immune status, chronic anticoagulant use, rheumatoid arthritis, body mass index and the presence of multidrug resistant germs showed no significant effect on success rate (p > 0.05). Conclusion : We found that patients who required surgery after the primary TKA, had a higher Charlson comorbidity

  6. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.].

  7. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.]. PMID:27135453

  8. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report.

    PubMed

    Finger, Eric; Willis, F Buck

    2008-01-01

    Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20 degrees to -12 degrees (stiff knee still lacking full extension), and after eight additional weeks with nightly wear of dynamic splint, the patient regained full knee extension, (active extension improved from -12 degrees to 0 degrees ).

  9. Tranexamic Acid Reduces Blood Loss and Transfusion in Patients Undergoing Total Knee Arthroplasty without Tourniquet: A Prospective Randomized Controlled Trial

    PubMed Central

    Bidolegui, Fernando; Arce, Guillermo; Lugones, Alfonso; Pereira, Sebastián; Vindver, Gabriel

    2014-01-01

    Introduction : Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and to decrease transfusion rates in patients undergoing TKA. Tranexamic acid is an antifibrinolytic agent with known efficacy for achieving these goals. Currently, many surgeons are performing TKA without the use of tourniquet. Consequently, the aim of the study is to evaluate whether tranexamic acid reduces blood loss during and after TKA without the adjunctive use of above-the-knee tourniquet. Methods : We performed a prospective randomized controlled trial (1:1 fashion) on the use of tranexamic acid versus placebo in 50 patients undergoing TKA (without tourniquet). The treatment group received two (preoperative and postoperative) 15 mg/kg doses. The primary endpoint was blood transfusion rate. We collected data about demographic and procedural characteristics, hemoglobin and hematocrit values, drain blood loss at 24 hours as well as adverse events. Results : There were no transfusions in the treatment group, whereas 32% of the control group required transfusion (p<0.01). The treatment group had higher hematocrit and hemoglobin levels at 24, 48 and 72 hours after surgery (all p<0.01) and lower drain loss at 24hours (363.4±141 vs 626±260ml, p=<0,001). There were no in-hospital or six-month thromboembolic complications. Discussion : A double-dose of tranexamic acid was safe and effective, reducing blood loss and preventing the need of blood transfusion in patients undergoing TKA without above-the-need tourniquet. PMID:25132872

  10. Incidences of Deep Vein Thrombosis and Pulmonary Embolism after Total Knee Arthroplasty Using a Mechanical Compression Device with and without Low-Molecular-Weight Heparin

    PubMed Central

    Park, Sin Hyung; Ahn, Joong Hyeon; Park, Yong Bok; Lee, Sun Geun

    2016-01-01

    Purpose To investigate the incidence of thromboembolic events and complications related to bleeding after total knee arthroplasty (TKA) with a mechanical compression device alone or in combination with low-molecular-weight heparin (LMWH). Materials and Methods A total of 489 TKA patients (776 knees) were retrospectively reviewed for the incidence of thromboembolic events and complications related to bleeding. While 233 patients (354 knees) were treated with a mechanical compressive device without LMWH, 256 patients (422 knees) were treated with the mechanical compressive device along with LMWH. Results The incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 15 of 375 knees (4.0%) and 5 of 375 knees (1.3%), respectively, in the group that used only a mechanical compressive device, and 14 of 401 knees (3.4%) and 5 of 401 knees (1.2%), respectively, in the group that used the mechanical compressive device with LMWH. There was no significant difference between the two groups (p=0.125 and p=0.146, respectively). The postoperative hemovac drainage amount was 635±57 mL in the group with a mechanical compressive device only and 813±84 mL in the group with the device and LMWH; therefore, the amount of drainage was significantly greater in the latter group (p=0.013). Conclusions Mechanical compression alone for prophylaxis against DVT and PE after TKA can be an attractive option in Korean patients. PMID:27595075

  11. Incidences of Deep Vein Thrombosis and Pulmonary Embolism after Total Knee Arthroplasty Using a Mechanical Compression Device with and without Low-Molecular-Weight Heparin

    PubMed Central

    Park, Sin Hyung; Ahn, Joong Hyeon; Park, Yong Bok; Lee, Sun Geun

    2016-01-01

    Purpose To investigate the incidence of thromboembolic events and complications related to bleeding after total knee arthroplasty (TKA) with a mechanical compression device alone or in combination with low-molecular-weight heparin (LMWH). Materials and Methods A total of 489 TKA patients (776 knees) were retrospectively reviewed for the incidence of thromboembolic events and complications related to bleeding. While 233 patients (354 knees) were treated with a mechanical compressive device without LMWH, 256 patients (422 knees) were treated with the mechanical compressive device along with LMWH. Results The incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 15 of 375 knees (4.0%) and 5 of 375 knees (1.3%), respectively, in the group that used only a mechanical compressive device, and 14 of 401 knees (3.4%) and 5 of 401 knees (1.2%), respectively, in the group that used the mechanical compressive device with LMWH. There was no significant difference between the two groups (p=0.125 and p=0.146, respectively). The postoperative hemovac drainage amount was 635±57 mL in the group with a mechanical compressive device only and 813±84 mL in the group with the device and LMWH; therefore, the amount of drainage was significantly greater in the latter group (p=0.013). Conclusions Mechanical compression alone for prophylaxis against DVT and PE after TKA can be an attractive option in Korean patients.

  12. Effects of a Foot Pump on the Incidence of Deep Vein Thrombosis After Total Knee Arthroplasty in Patients Given Edoxaban

    PubMed Central

    Sakai, Tatsuya; Izumi, Masahiro; Kumagai, Kenji; Kidera, Kenichi; Yamaguchi, Takayuki; Asahara, Tomohiko; Kozuru, Hideko; Jiuchi, Yuka; Mawatari, Masaaki; Osaki, Makoto; Motokawa, Satoru; Migita, Kiyoshi

    2016-01-01

    Abstract We conducted a randomized clinical trial to compare the effectiveness of the A-V Impulse System foot pump for reducing the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in patients under edoxaban thromboprophylaxis. Patients undergoing primary TKA at our institution between September 2013 and March 2015 were enrolled after obtaining informed consent. The patients were randomized to use the foot pump (n = 58) and not to use the foot pump (n = 62). Both groups were given prophylactic edoxaban. Primary outcomes were any DVT as detected by bilateral ultrasonography up to postoperative day 10 (POD10) and pulmonary embolism (PE) up to POD28. The safety outcomes were bleeding and death of any cause up to POD28. Plasma D-dimer levels were measured before TKA and on POD10 after TKA. Immunoglobulin G (IgG)-class anti-PF4/heparin antibodies were measured using an IgG-specific enzyme-linked immunosorbent assay. The incidences of any DVT up to POD28 were 31.0% and 17.7% in patients with or without the foot pump, respectively. The incidences of major bleeding up to POD28 were 5.1% and 4.8% in patients with or without the foot pump, respectively. Foot pump use did not significantly reduce the incidence of DVTs in patients undergoing TKA under edoxaban thromboprophylaxis. Although seroconversion of anti-PF4/heparin antibodies was confirmed in one-fourth of patients, the seroconversion rates did not differ between patients with (20.7%) or without (25.8%) foot pump use. This study shows that the A-V Impulse system foot pump did not affect the incidence of DVT under edoxaban thromboprophylaxis in patients undergoing TKA. Seroconversion of anti-PF4/heparin antibodies was detected in a significant number of patients who underwent TKA under antithrombotic prophylaxis using edoxaban. PMID:26735531

  13. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study

    PubMed Central

    van Raaij, Tom M; Bakker, Wouter; Reijman, Max; Verhaar, Jan AN

    2007-01-01

    Background We performed a matched case control study to assess the effect of prior high tibia valgus producing osteotomy on results and complications of total knee arthroplasty (TKA). Methods From 1996 until 2003 356 patients underwent all cemented primary total knee replacement in our institution. Twelve patients with a history of 14 HTO were identified and matched to a control group of 12 patients with 14 primary TKA without previous HTO. The match was made for gender, age, date of surgery, body mass index, aetiology and type of prosthesis. Clinical and radiographic outcome were evaluated after a median duration of follow-up of 3.7 years (minimum, 2.3 years). The SPSS program was used for statistical analyses. Results The index group had more perioperative blood loss and exposure difficulties with one tibial tuberosity osteotomy and three patients with lateral retinacular releases. No such procedures were needed in the control group. Mid-term HSS, KSS and WOMAC scores were less favourable for the index group, but these differences were not significant. The tibial slope of patients with prior HTO was significantly decreased after this procedure. The tibial posterior inclination angle was corrected during knee replacement but posterior inclination was significantly less compared to the control group. No deep infection or knee component loosening were seen in the group with prior HTO. Conclusion We conclude that TKA after HTO seems to be technically more demanding than a primary knee arthroplasty, but clinical outcome was almost identical to a matched group that had no HTO previously. PMID:17683549

  14. Unexplained Pain Following Total Knee Arthroplasty – Is Rotational Malalignment the Problem?

    PubMed Central

    Young, Simon; Roberts, Catherine; Bauman, Alicia; Sperlak, Cynthia; Spangehl, Mark; Clarke, Henry

    2016-01-01

    Objective: Malrotation of both tibial and femoral components has been suggested as a potential source of pain following total knee arthroplasty (TKA). However previous studies have been small, with variable control groups. The aim of this study was to compare component rotational alignment in TKA patients with unexplained pain to a control group with well-functioning TKA. Method: Seventy-one patients presenting with unexplained pain following primary TKA were included in this retrospective, comparative study. Diagnostic work-up included clinical examination, blood tests, x-rays, long-leg films, and CT scan. Patients with an identifiable diagnosis or with initially well-functioning TKAs were excluded. A control group of 41 patients with well-functioning TKAs also underwent CT scans. Femoral component rotation was measured relative to the surgical epicondylar axis, and tibial component rotation relative to the medial third of the tibial tubercle using a previously validated method involving 3D-image reconstruction. Findings were compared between painful and control TKA groups. Results: We found no difference in femoral component rotation between the painful and control groups (mean 0.6° vs 1.0° external rotation (ER), p=0.4), and no difference in tibial component rotation (mean 11.2° vs 9.5° internal rotation(IR), p=0.3). Fifty-nine percent of patients in the painful group had tibial component rotation >9°IR versus 49% in the control group. 6% of patients in the painful group and 2% in the control group had femoral component rotation >3°IR. There was no difference in overall coronal alignment between groups (mean 1.3° varus vs 0.5° varus, p=0.23). Conclusion: In this the largest study yet reported on component rotation in TKA, we found no difference in the incidence of tibial or femoral component malalignment in painful versus well-functioning TKAs. Tibial component IR in particular appears to be a common finding, and its significance when evaluating the

  15. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty.

    PubMed

    Park, Caroline N; White, Peter B; Meftah, Morteza; Ranawat, Amar S; Ranawat, Chitranjan S

    2016-01-01

    Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty. PMID:26811953

  16. Two- to Four-Year Follow-up Results of Total Knee Arthroplasty Using a New High-Flexion Prosthesis

    PubMed Central

    Kim, Man Soo; Koh, In Jun; Jang, Sung Won; Jeon, Neung Han

    2016-01-01

    Purpose The purpose of this study was to evaluate minimum 2-year follow-up results of total knee arthroplasty (TKA) performed using a new high-flexion prosthesis design (LOSPA). Materials and Methods The 2- to 4-year results of 191 consecutive TKAs (177 patients) with the LOSPA posterior-stabilized prosthesis were evaluated. The patients were assessed clinically and radiographically using the Knee Society scoring system (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results The mean range of motion (ROM) increased significantly from 117.4° (range, 75° to 140°) preoperatively to 126.7° (range, 80° to 144°) postoperatively (p<0.001). The mean KSS and WOMAC scores improved significantly from 121.4 (range, 42 to 185) and 56.1 (range, 23 to 88) preoperatively to 174.0 (range, 130 to 200) and 16.4 (range, 0 to 85) postoperatively, respectively (both, p<0.001). One knee required revision for deep infection. No knee had aseptic loosening or osteolysis. Radiolucent lines were noted in 15 knees (7.9%). Conclusions The new high-flexion total knee prosthesis resulted in no early aseptic loosening of the component and improved postoperative ROM comparable to other high-flexion TKA prostheses at 2- to 4-year follow-ups. PMID:26955612

  17. Insert dissociation after fixed bearing PS constrained Genesis II total knee arthroplasty. A case series of nine patients.

    PubMed

    Voskuijl, Timothy; Nijenhuis, Thijs A; Van Hellemondt, Gijs G; Goosen, Jon H M

    2015-12-01

    Dissociation of the polyethylene insert after fixed bearing posterior stabilized Genesis II total knee arthroplasty has been rarely described. We present a case series of nine patients with a dissociation of the insert within a period of two years after surgery. Revision surgery was performed in all patients. In this report we discuss clinical presentation, patient characteristics and possible etiologies for tibial insert dissociation seen in the presented cases. In conclusion, tibial insert dissociation does not lead to a uniform clinical presentation. Therefore, in this point of view regular physical examination and imaging after TKA regardless the presence of symptoms seems to be indicated.

  18. Retrograde Intramedullary Nailing with a Blocking Pin Technique for Reduction of Periprosthetic Supracondylar Femoral Fracture after Total Knee Arthroplasty: Technical Note with a Compatibility Chart of the Nail to Femoral Component

    PubMed Central

    Hamada, Daisuke; Takasago, Tomoya; Tsutsui, Takahiko; Suzue, Naoto; Sairyo, Koichi

    2014-01-01

    Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA. PMID:25574411

  19. Total Knee Arthroplasty for Post-Traumatic Proximal Tibial Bone Defect: Three Cases Report

    PubMed Central

    Tigani, D; Dallari, D; Coppola, C; Ben Ayad, R; Sabbioni, G; Fosco, M

    2011-01-01

    Bone stock deficiency in primary as well as in revision total knee arthroplasty (TKA) represents a difficult problem to surgeon with regard to maintaining proper alignment of the implant components and in establishing a stable bone-implant interface. Different surgical procedures are available in these situations, for instances the use of bone cement, prosthetic augments, custom implant, and wire mesh with morsellized bone grafting and structural bone allograft. Structural allograft offers a numerous advantages as easy remodeling and felling cavitary or segmental defects, excellent biocompatibility, bone stock restoration and potential for ligamentous reattachment. In this article we report a short term result of three cases affected by severe segmental medial post/traumatic tibial plateau defect in arthritic knee, for which massive structural allograft reconstruction and primary total knee replacement were carried. The heights of the bone defect were between 27-33 mm and with moderate medio-lateral knee instability. Pre-operative AKS score in three cases was 30, 34 and 51 points consecutively and improved at the last follow-up to 83, 78 and 85 consecutively. No acute or chronic complication was observed. Last radiological exam referred no signs of prosthetic loosening, no secondary resorption of bone graft and well integrated graft to host bone. These results achieved in our similar three cases have confirmed that the structural bone allograft is a successful biological material to restore hemi-condylar segmental tibial bone defect when total knee replacement is indicated. PMID:21584202

  20. Failure of total knee arthroplasty with or without patella resurfacing

    PubMed Central

    2011-01-01

    Background and purpose Patella resurfacing during primary total knee arthroplasty (TKA) is disputed and new prosthesis designs have been introduced without documentation of their survival. We assessed the impact on prosthesis survival of patella resurfacing and of prosthesis brand, based on data from the Norwegian Arthroplasty Register. Patients and methods 5 prosthesis brands in common use with and without patella resurfacing from 1994 through 2009 were included n = 11,887. The median follow-up times were 9 years for patella-resurfaced implants and 7 years for implants without patella resurfacing. For comparison of prosthesis brands, also brands in common use with only one of the two treatment options were included in the study population (n = 25,590). Cox regression analyses were performed with different reasons for revision as endpoints with adjustment for potential confounders. Results We observed a reduced overall risk of revision for patella resurfaced (PR) TKAs, but the statistical significance was borderline (RR = 0.84, p = 0.05). At 15 years, 92% of PR and 91% of patella non resurfaced (NR) prostheses were still unrevised. However, PR implants had a lower risk of revision due to pain alone (RR = 0.1, p < 0.001), but a higher risk of revision due to loosening of the tibial component (RR = 1.4, p = 0.03) and due to a defective polyethylene insert (RR = 3.2, p < 0.001). At 10 years, the survival for the reference NR brand AGC Universal was 93%. The NR brands Genesis I, Duracon, and Tricon (RR = 1.4–1.7) performed statistically significantly worse than NR AGC Universal, while the NR prostheses e.motion, Profix, and AGC Anatomic (RR = 0.1–0.7), and the PR prostheses NexGen and AGC Universal (RR = 0.4–0.5) performed statistically significantly better. LCS, NexGen, LCS Complete (all NR), and Tricon, Genesis I, LCS, and Kinemax (all PR) showed no differences in this respect from the reference brand. A lower risk of revision (crude) was found for TKAs

  1. Alcohol Misuse is an Independent Risk Factor for Poorer Postoperative Outcomes Following Primary Total Hip and Total Knee Arthroplasty.

    PubMed

    Best, Matthew J; Buller, Leonard T; Gosthe, Raul G; Klika, Alison K; Barsoum, Wael K

    2015-08-01

    The influence of alcohol misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. Using the National Hospital Discharge Survey, a cohort representative of 8,372,232 patients (without cirrhosis) who underwent THA or TKA between 1990 and 2007 was identified and divided into two groups: (1) those who misused alcohol (n=50,861) and (2) those who did not (n=8,321,371). Differences in discharge status, comorbidities and perioperative complications were analyzed. Compared to patients with no diagnosis of alcohol misuse, alcohol misusers were nine times more likely to leave against medical advice and had longer hospital stays (P<0.001). Alcohol misuse was independently associated with higher odds of in hospital complications (OR: 1.334, range: 1.307-1.361), surgery related complications (OR: 1.293, range: 1.218-1.373) and general medical complications (OR: 1.300, range: 1.273-1.327). PMID:25769745

  2. Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

    PubMed

    Siegel, Geoffrey W; Patel, Neil N; Milshteyn, Michael A; Buzas, David; Lombardo, Daniel J; Morawa, Lawrence G

    2015-12-01

    Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs.

  3. Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

    PubMed

    Siegel, Geoffrey W; Patel, Neil N; Milshteyn, Michael A; Buzas, David; Lombardo, Daniel J; Morawa, Lawrence G

    2015-12-01

    Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs. PMID:26231077

  4. A Randomized Controlled Trial of an Individualized Preoperative Education Intervention for Symptom Management After Total Knee Arthroplasty.

    PubMed

    Wilson, Rosemary A; Watt-Watson, Judith; Hodnett, Ellen; Tranmer, Joan

    2016-01-01

    Pain and nausea limit recovery after total knee arthroplasty (TKA) patients. The aim of this study was to determine the effect of a preoperative educational intervention on postsurgical pain-related interference in activities, pain, and nausea. Participants (n = 143) were randomized to intervention or standard care. The standard care group received the usual teaching. The intervention group received the usual teaching, a booklet containing symptom management after TKA, an individual teaching session, and a follow-up support call. Outcome measures assessed pain, pain interference, and nausea. There were no differences between groups in patient outcomes. There were no group differences for pain at any time point. Respondents had severe postoperative pain and nausea and received inadequate doses of analgesia and antiemetics. Individualizing education content was insufficient to produce a change in symptoms for patients. Further research involving the modification of system factors affecting the provision of symptom management interventions is warranted. PMID:26814004

  5. Oxidized Zirconium Bearing Surfaces in Total Knee Arthroplasty: Lessons Learned.

    PubMed

    Schüttler, Karl Friedrich; Efe, Turgay; Heyse, Thomas J; Haas, Steven B

    2015-10-01

    Polyethylene wear in total knee arthroplasty is a still unsolved problem resulting in osteolysis and long-term failure of knee joint replacement. To address the problem of polyethylene wear, research aimed for an optimal implant design and for an optimal combination of bearing surfaces. Oxidized zirconium was introduced to minimize surface wear and thus potentially increase long-term implant survival. This review comprises the current literature related to in vitro and in vivo studies evaluating performance of oxidized zirconium total knee arthroplasty and results from retrieval analyses. PMID:26216647

  6. Oxidized Zirconium Bearing Surfaces in Total Knee Arthroplasty: Lessons Learned.

    PubMed

    Schüttler, Karl Friedrich; Efe, Turgay; Heyse, Thomas J; Haas, Steven B

    2015-10-01

    Polyethylene wear in total knee arthroplasty is a still unsolved problem resulting in osteolysis and long-term failure of knee joint replacement. To address the problem of polyethylene wear, research aimed for an optimal implant design and for an optimal combination of bearing surfaces. Oxidized zirconium was introduced to minimize surface wear and thus potentially increase long-term implant survival. This review comprises the current literature related to in vitro and in vivo studies evaluating performance of oxidized zirconium total knee arthroplasty and results from retrieval analyses.

  7. In vivo determination of total knee arthroplasty kinematics

    SciTech Connect

    Komistek, Richard D; Mahfouz, Mohamed R; Bertin, Kim; Rosenberg, Aaron; Kennedy, William

    2008-01-01

    The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.

  8. Reliable Alignment in Total Knee Arthroplasty by the Use of an iPod-Based Navigation System

    PubMed Central

    Koenen, Paola; Schneider, Marco M.; Fröhlich, Matthias; Driessen, Arne; Bouillon, Bertil; Bäthis, Holger

    2016-01-01

    Axial alignment is one of the main objectives in total knee arthroplasty (TKA). Computer-assisted surgery (CAS) is more accurate regarding limb alignment reconstruction compared to the conventional technique. The aim of this study was to analyse the precision of the innovative navigation system DASH® by Brainlab and to evaluate the reliability of intraoperatively acquired data. A retrospective analysis of 40 patients was performed, who underwent CAS TKA using the iPod-based navigation system DASH. Pre- and postoperative axial alignment were measured on standardized radiographs by two independent observers. These data were compared with the navigation data. Furthermore, interobserver reliability was measured. The duration of surgery was monitored. The mean difference between the preoperative mechanical axis by X-ray and the first intraoperatively measured limb axis by the navigation system was 2.4°. The postoperative X-rays showed a mean difference of 1.3° compared to the final navigation measurement. According to radiographic measurements, 88% of arthroplasties had a postoperative limb axis within ±3°. The mean additional time needed for navigation was 5 minutes. We could prove very good precision for the DASH system, which is comparable to established navigation devices with only negligible expenditure of time compared to conventional TKA. PMID:27313898

  9. Sports activity following total knee arthroplasty in patients older than 60 years.

    PubMed

    Mayr, Hermann O; Reinhold, Maik; Bernstein, Anke; Suedkamp, Norbert P; Stoehr, Amelie

    2015-01-01

    In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports.

  10. A FUNCTIONAL AND ROENTGENOGRAPHIC PRELIMINARY COMPARATIVE STUDY USING METAL-BACKED AND ALL-POLYETHYLENE TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    de Andrade, Marco Antônio Percope; dos Santos, Juliano Rodrigues; Gonzaga, Luiz Gustavo Alves; Silva, Guilherme Moreira Abreu e

    2015-01-01

    Objective: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. Methods: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. Results: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). Conclusions: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV – case series study. PMID:27022556

  11. Prolonged Epidural Infusion Improves Functional Outcomes Following Knee Arthroscopy in Patients with Arthrofibrosis after Total Knee Arthroplasty: A Retrospective Evaluation.

    PubMed

    Saltzman, Bryan M; Dave, Ankur; Young, Adam; Ahuja, Mukesh; Amin, Sandeep D; Bush-Joseph, Charles A

    2016-01-01

    A total of 20 consecutive patients with knee stiffness post total knee arthroplasty (TKA) underwent arthroscopic lysis of adhesions and manipulation plus indwelling epidural were evaluated retrospectively. Epidural catheters were placed preoperatively for an intended 6 weeks of postoperative analgesia to facilitate intensive physical therapy. The mean loss of knee extension immediately before incision was 13.5 ± 9.1 degrees (range, 0-35 degrees) and flexion was 77.65 ± 19.2 degrees (range, 45-125 degrees). At the 6-week and final (mean, 0.47 years) follow-up, the loss of extension was 1.5 ± 5.1 degrees (range, -10 to +7 degrees) and 5.4 ± 4.7 degrees (range, 0-15 degrees), respectively, and flexion was 99.7 ± 12.3 degrees (range, 75-120 degrees) and 98.5 ± 16.1 degrees (range, 75-130 degrees), respectively. Of the 20 patients, 2 missed their 6-week clinic visit. Improvements in motion immediately preoperative to 6-week and final follow-up were each significant (p < 0.01). At examination 6 weeks postoperatively, 94.4% of patients met the definition for clinical motion success and 70% maintained success at final follow-up. Visual analog scale improved significantly from 5.4 to 2.0 (p < 0.01) at 6 weeks postoperative in the 12 patients with this data recorded. On the basis of this data, use of tunneled epidurals with arthroscopic lysis of adhesions for arthrofibrosis after TKA is correlated with a high likelihood of functional success postoperatively as measured by range of motion improvement.

  12. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study.

    PubMed

    Memtsoudis, Stavros G; Poeran, Jashvant; Cozowicz, Crispiana; Zubizarreta, Nicole; Ozbek, Umut; Mazumdar, Madhu

    2016-10-01

    The role of anesthesia techniques on perioperative outcomes on a population level has recently gained widespread interest. Although mainly neuraxial vs general anesthesia has been addressed, population-level data on the impact of peripheral nerve blocks (PNBs) are still lacking. Therefore, we investigated the association between PNB use and outcomes using retrospective data on 1,062,152 recipients of hip and knee arthroplasties (total hip arthroplasty [THA]/total knee arthroplasty [TKA]) from the national Premier Perspective database (2006-2013). Multilevel multivariable logistic regression models measured associations between PNB use and outcomes. Complications included cardiac, pulmonary, gastrointestinal and renal complications, cerebrovascular events, infections, wound complications, thromboembolic complications, inpatient falls, and mortality. Resource utilization variables included blood transfusions, intensive care unit admissions, opioid consumption, cost, and length of stay. Overall, 12.5% of patients received a PNB, with an increase over time particularly among TKAs. Peripheral nerve block use was associated with lower odds for most adverse outcomes mainly among patients with THA. Notable beneficial effects were seen for wound complications (odds ratio 0.60 [95% confidence interval, 0.49-0.74]) among THA recipients and pulmonary complications (odds ratio 0.83 [95% confidence interval, 0.72-0.94]) in patients with TKA. Peripheral nerve block use was significantly (P < 0.0001) associated with a -16.2% and -12.7% reduction in opioid consumption for patients with THA and TKA, respectively. In conclusion, our results indicate that PNBs might be associated with superior perioperative population-level outcomes. In light of the inability to establish a causal relationship and the presence of residual confounding, we strongly advocate for further prospective investigation, ideally in multicenter, randomized trials, to establish the potential impact of PNBs on

  13. Robot-Assisted Navigation versus Computer-Assisted Navigation in Primary Total Knee Arthroplasty: Efficiency and Accuracy.

    PubMed

    Clark, Tanner C; Schmidt, Frank H

    2013-01-01

    Background. Since the introduction of robot-assisted navigation in primary total knee arthroplasty (TKA), there has been little research conducted examining the efficiency and accuracy of the system compared to computer-assisted navigation systems. Objective. To compare the efficiency and accuracy of Praxim robot-assisted navigation (RAN) and Stryker computer-assisted navigation (CAN) in primary TKA. Methods. This was a retrospective study consisting of 52 patients who underwent primary TKA utilizing RAN and 29 patients utilizing CAN. The primary outcome measure was navigation time. Secondary outcome measures included intraoperative final mechanical axis alignment, intraoperative robot-assisted bone cut accuracy, tourniquet time, and hospitalization length. Results. RAN navigation times were, on average, 9.0 minutes shorter compared to CAN after adjustment. The average absolute intraoperative malalignment was 0.5° less in the RAN procedures compared to the CAN procedures after adjustment. Patients in the RAN group tended to be discharged 0.6 days earlier compared to patients in the CAN group after adjustment. Conclusions. Among patients undergoing TKA, there was decreased navigation time, decreased final malalignment, and decreased hospitalization length associated with the use of RAN when compared to CAN independent of age, BMI, and pre-replacement alignment.

  14. Distal femoral cut perpendicular to the mechanical axis may induce varus instability in flexion in medial osteoarthritic knees with varus deformity in total knee arthroplasty: a pitfall of the navigation system.

    PubMed

    Nagamine, Ryuji; Kondo, Keiichi; Ikemura, Satoshi; Shiranita, Atsushi; Nakashima, Satoshi; Hara, Toshihiko; Ihara, Hidetoshi; Sugioka, Yoichi

    2004-01-01

    Two factors that influence the external rotation angle of the femoral rotational axis in total knee arthroplasty (TKA) were assessed in 40 medial osteoarthritic knees with varus deformity. First, the anatomic configuration of the femur was assessed using standardized radiographs of the patients' lower extremities before TKA. Second, the degree of medial soft tissue release was assessed during TKA. The radiographs showed that the characteristics of the femur were lateral bowing of the shaft and external rotation of the condyle in the coronal plane. Therefore, when the distal femur is cut perpendicular to the mechanical axis, the cut surface may be in too much of a valgus position. Furthermore, some degree of medial soft tissue release was necessary in all knees. Medial soft tissue release rotates the femur externally in extension in the coronal plane, and it rotates the femur externally around the femoral axis in flexion relative to the tibia. A distal femoral cut in too much of a valgus position and medial soft tissue release induces varus instability in flexion in knees with lateral bowing of the femoral shaft. Anatomic variation such as femoral bowing should be considered when a navigation system is used for TKA because the navigation system shows only the mechanical axis.

  15. Distal femoral cut perpendicular to the mechanical axis may induce varus instability in flexion in medial osteoarthritic knees with varus deformity in total knee arthroplasty: a pitfall of the navigation system.

    PubMed

    Nagamine, Ryuji; Kondo, Keiichi; Ikemura, Satoshi; Shiranita, Atsushi; Nakashima, Satoshi; Hara, Toshihiko; Ihara, Hidetoshi; Sugioka, Yoichi

    2004-01-01

    Two factors that influence the external rotation angle of the femoral rotational axis in total knee arthroplasty (TKA) were assessed in 40 medial osteoarthritic knees with varus deformity. First, the anatomic configuration of the femur was assessed using standardized radiographs of the patients' lower extremities before TKA. Second, the degree of medial soft tissue release was assessed during TKA. The radiographs showed that the characteristics of the femur were lateral bowing of the shaft and external rotation of the condyle in the coronal plane. Therefore, when the distal femur is cut perpendicular to the mechanical axis, the cut surface may be in too much of a valgus position. Furthermore, some degree of medial soft tissue release was necessary in all knees. Medial soft tissue release rotates the femur externally in extension in the coronal plane, and it rotates the femur externally around the femoral axis in flexion relative to the tibia. A distal femoral cut in too much of a valgus position and medial soft tissue release induces varus instability in flexion in knees with lateral bowing of the femoral shaft. Anatomic variation such as femoral bowing should be considered when a navigation system is used for TKA because the navigation system shows only the mechanical axis. PMID:16228670

  16. Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review

    PubMed Central

    Lungu, E.; Vendittoli, P-A.; Desmeules, F.

    2016-01-01

    Background: A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA. Method: A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies. Results: Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies). Conclusion: Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required. PMID:27398109

  17. Low-power SoC design for ligament balance measuring system in total knee arthroplasty.

    PubMed

    Liu, Ming; Chen, Hong; Zhang, Xu; Zhang, Chun; Jiang, Hanjun; Wang, Zhihua

    2011-01-01

    A design of a low-power wireless System-on-Chip (SoC) for the Ligament Balance Measuring System (LBMS) in Total Knee Arthroplasty (TKA) is presented in this paper. It includes a signal conditioning circuit that can support up to 15 force sensors, a 433 MHz RF front-end for data transmission, an 8-bit low-power microprocessor, and a FIFO with a digital filter. Idle and wake-up modes are well designed to reduce the power consumption since the device should be used for the whole surgical procedure. Test results show that the signal conditioning circuit with 16-bit single line output can operate under a wide voltage range, which is from 1.2V to 3.6V. The minimal power consumption is 139μ.W@1.2V with a 200 KHz clock. Experimental results demonstrated in static and body tests are given in the paper also. The chip will be used in an aided monitoring system for Total Knee Arthroplasty in the future work.

  18. Early recovery after fast-track Oxford unicompartmental knee arthroplasty

    PubMed Central

    2012-01-01

    Background and purpose After total knee arthroplasty with conventional surgical approach, more than half of the quadriceps extension strength is lost in the first postoperative month. Unicompartmental knee arthroplasty (UKA) operated with minimally invasive surgery (MIS) results in less operative trauma. We investigated changes in leg-extension power (LEP) in the first month after MIS Oxford UKA and its relation to pain, knee motion, functional performance, and knee function. Patients and methods In 35 consecutive Oxford UKA patients, LEP was measured 1 week before and 1 month after surgery together with knee motion, knee swelling, the 30-second chair-stand test, and Oxford knee score. Assessment of knee pain at rest and walking was done using a visual analog scale. Results 30 patients were discharged on the day after surgery, and 5 on the second day after surgery. LEP and functional performance reached the preoperative level after 1 month. Only slight postoperative knee swelling was observed with rapid restoration of knee flexion and function. A high level of pain during the first postoperative night and day fell considerably thereafter. None of the patients needed physiotherapy supervision in the first month after discharge. Interpretation Fast-track MIS Oxford UKA with discharge on the day after surgery is safe and leads to early recovery of knee motion and strength even when no physiotherapy is used. PMID:22313368

  19. [Development, terminology, principles, and controversies in minimally invasive knee arthroplasty].

    PubMed

    Hofmann, S; Pietsch, M

    2007-12-01

    Minimally invasive total knee arthroplasty is a logical and further improvement of the good results achieved with minimally invasive unicondylar knee arthroplasty. The terminology for minimally invasive surgery (MIS) is confusing and comparison of different techniques is therefore difficult. A simple separation between less invasive and minimally invasive techniques will be presented. Besides the approach, minimally invasive surgical principles are very important. MIS in total knee arthroplasty is discussed very controversially at the moment. The preliminary results of these new techniques are very promising. Up to now there is much more feeling then knowing. Important questions (risk-benefit analysis, which technique for which patient and surgeon, education and cost-effectiveness) must be addressed by the proponents of this MIS technique. Step by step learning of these new techniques (evolution instead of revolution) in specific education centres is strongly recommended. Ultimately, patients and surgeons will have to decide whether these new techniques will only be a modern trend or represent the future.

  20. Radiographic and scintigraphic evaluation of total knee arthroplasty

    SciTech Connect

    Schneider, R.; Soudry, M.

    1986-04-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent.

  1. Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty – Could a Regional Programme be Beneficial?

    PubMed Central

    McCusker, Darren; Gupta, Nidhi; Bunn, Jonathon; Murnaghan, Mark

    2016-01-01

    Introduction Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. Objectives The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. Methods A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intra-operative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant. Results A total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p<0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p<0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of

  2. Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty – Could a Regional Programme be Beneficial?

    PubMed Central

    McCusker, Darren; Gupta, Nidhi; Bunn, Jonathon; Murnaghan, Mark

    2016-01-01

    Introduction Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. Objectives The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. Methods A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intra-operative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant. Results A total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p<0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p<0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of

  3. Prophylactic antibiotics in elective hip and knee arthroplasty

    PubMed Central

    Hickson, C. J.; Metcalfe, D.; Elgohari, S.; Oswald, T.; Masters, J. P.; Rymaszewska, M.; Reed, M. R.; Sprowson†, A. P.

    2015-01-01

    Objectives We wanted to investigate regional variations in the organisms reported to be causing peri-prosthetic infections and to report on prophylaxis regimens currently in use across England. Methods Analysis of data routinely collected by Public Health England’s (PHE) national surgical site infection database on elective primary hip and knee arthroplasty procedures between April 2010 and March 2013 to investigate regional variations in causative organisms. A separate national survey of 145 hospital Trusts (groups of hospitals under local management) in England routinely performing primary hip and/or knee arthroplasty was carried out by standard email questionnaire. Results Analysis of 189 858 elective primary hip and knee arthroplasty procedures and 1116 surgical site infections found statistically significant variations for some causative organism between regions. There was a 100% response rate to the prophylaxis questionnaire that showed substantial variation between individual trust guidelines. A number of regimens currently in use are inconsistent with the best available evidence. Conclusions The approach towards antibiotic prophylaxis in elective arthroplasty nationwide reveals substantial variation without clear justification. Only seven causative organisms are responsible for 89% of infections affecting primary hip and knee arthroplasty, which cannot justify such widespread variation between prophylactic antibiotic policies. Cite this article: Bone Joint Res 2015;4:181–189. PMID:26585304

  4. Computer assisted surgery for total knee arthroplasty.

    PubMed

    Nizard, R

    2002-06-01

    The author has attempted to assess the value of computer-assisted surgery in arthroplasty of the knee. Basic requisites in TKR include adequate alignment and ligament balance. These requisites have become easier to meet as ancillary instrumentations have improved over time. Numerical tools are now available; they are sometimes presented as an essential technical step. The author reviews the various available options, with their advantages and disadvantages. Satisfactory alignment in the three planes classically relies on anatomic landmarks, the reliability of which is limited, and on ligament tension. Targeting systems, intra- or extramedullary, all have a margin of error. Computer-assisted surgery aims at increasing the precision of implant positioning and achieving optimal ligament balance. Among the systems currently available, a distinction must be made between active and passive systems. The former correspond to the "surgical robots", which are capable of performing the various parts of the operation following adequate preparation, at least regarding the bone cuts. Passive systems remain under control from the surgeon and assist him in positioning the cutting jigs. Among localization systems, a distinction must be made between optical and magnetic systems. Certain systems require preoperative imaging--usually CT scan--in order to first reconstruct a 3-D model of the knee. This step is time-consuming, but this will likely improve in the future. Image matching requires the use of a software, with specific landmarks defined preoperatively by the surgeon. Such systems may be used in cases with major deformities; their main drawback is the need for preoperative imaging. Other systems do not require preoperative imaging: a few points are identified by kinematic analysis of the hip, knee and ankle; they are used for 2-D or 3-D reconstruction. Computer-assisted systems may improve the precision in defining anatomic landmarks and achieving accurate location and

  5. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs

    PubMed Central

    Rogge, R. D.; Malinzak, R. A.; Reyes, E. M.; Cook, P. L.; Farley, K. A.; Ritter, M. A.

    2016-01-01

    Objectives Initial stability of tibial trays is crucial for long-term success of total knee arthroplasty (TKA) in both primary and revision settings. Rotating platform (RP) designs reduce torque transfer at the tibiofemoral interface. We asked if this reduced torque transfer in RP designs resulted in subsequently reduced micromotion at the cemented fixation interface between the prosthesis component and the adjacent bone. Methods Composite tibias were implanted with fixed and RP primary and revision tibial trays and biomechanically tested under up to 2.5 kN of axial compression and 10° of external femoral component rotation. Relative micromotion between the implanted tibial tray and the neighbouring bone was quantified using high-precision digital image correlation techniques. Results Rotational malalignment between femoral and tibial components generated 40% less overall tibial tray micromotion in RP designs than in standard fixed bearing tibial trays. RP trays reduced micromotion by up to 172 µm in axial compression and 84 µm in rotational malalignment models. Conclusions Reduced torque transfer at the tibiofemoral interface in RP tibial trays reduces relative component micromotion and may aid long-term stability in cases of revision TKA or poor bone quality. Cite this article: Mr S. R. Small. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs. Bone Joint Res 2016;5:122–129. DOI: 10.1302/2046-3758.54.2000481. PMID:27095658

  6. Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty

    PubMed Central

    de Steiger, Richard N; Muratoglu, Orhun; Lorimer, Michelle; Cuthbert, Alana R; Graves, Stephen E

    2015-01-01

    Background and purpose — While highly crosslinked polyethylene has shown reduced in vivo wear and lower rates of revision for total hip arthroplasty, there have been few long-term studies on its use in total knee arthroplasty (TKA). We compared the rate of revision of non-crosslinked polyethylene to that of crosslinked polyethylene in patients who underwent TKA for osteoarthritis. Patients and methods — We examined data from the Australian Orthopaedic Association National Joint Replacement Registry on 302,214 primary TKA procedures with non-crosslinked polyethylene and 83,890 procedures with crosslinked polyethylene, all of which were performed for osteoarthritis. The survivorship of the different polyethylenes was estimated using the Kaplan-Meier method and was compared using proportional hazard models. Results — The 10-year cumulative revision rate for non-crosslinked polyethylene was 5.8% (95% CI: 5.7–6.0) and for crosslinked polyethylene it was 3.5% (95% CI: 3.2–3.8) (> 6.5-year HR = 2.2 (1.5–3.1); p < 0.001). There was no effect of surgical volume or method of prosthesis fixation on outcome. There were 4 different TKA designs that had a minimum of 2,500 procedures in at least 1 of the polyethylene groups and a follow-up of ≥ 5 years. 2 of these, the NexGen and the Natural Knee II, had a lower rate of revision for crosslinked polyethylene. The Scorpio NRG/Series 7000 and the Triathlon Knee did not show a lower rate of revision for crosslinked polyethylene. Interpretation — There is a lower rate of revision for crosslinked polyethylene in TKA, and this appears to be prosthesis-specific and when it occurs is most evident in patients < 65 years of age. The difference in revision rates was mainly due to revisions because of lysis and loosening. PMID:26119884

  7. SIX MONTH FOLLOW-UP OF PATIENTS SUBMITTED TO TOTAL KNEE ARTHROPLASTY WITH AND WITHOUT PLACEMENT OF SUCTION DRAINAGE DEVICES

    PubMed Central

    de Andrade, Marco Antônio Percope; de Oliveira Campos, Túlio Vinícius; Silva, Bruno Flúvio Alves; de Assis, Mauricio Ernesto; de Castro Boechat, Lucas; Biondi, Lúcio Flavio; Lemos, Wagner Guimarães; Silva, Guilherme Moreira Abreu

    2015-01-01

    Objective: The aim of this study was to prospectively evaluate the evolution and postoperative complication patterns relating to the use of suction drains, in comparison with not using these devices in total knee arthroplasty (TKA) procedures. Methods: Forty-two patients at a knee surgery referral clinic were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of motion, hematological indices, knee circumference and complication rate. The observation period was for six months after the surgical procedure. Results: There were no statistically significant differences between the groups regarding knee circumference, hemoglobin, hematocrit, transfusion rate or infection index. Regarding range of motion, there was no statistically significant difference between the groups with and without drains preoperatively (p = 0.126), during the first postoperative day (p = 0.583), on the fifth to seventh postoperative day (p = 0.076) or at the six-month follow-up (p = 0.848). There was a statistically significant difference between the groups in the evaluation performed between the 14th and 28th postoperative days (p = 0.025). Conclusion: From this study, it was concluded that there was no benefit from using closed suction drains in TKA cases beyond six months after the operation. However, the range of movement at the end of the first month was greater in the patients that received suction drainage. PMID:27026962

  8. Active Flexion in Weight Bearing Better Correlates with Functional Outcomes of Total Knee Arthroplasty than Passive Flexion

    PubMed Central

    Song, Young Dong; Jain, Nimash; Kang, Yeon Gwi; Kim, Tae Yune

    2016-01-01

    Purpose Correlations between maximum flexion and functional outcomes in total knee arthroplasty (TKA) patients are reportedly weak. We investigated whether there are differences between passive maximum flexion in nonweight bearing and other types of maximum flexion and whether the type of maximum flexion correlates with functional outcomes. Materials and Methods A total of 210 patients (359 knees) underwent preoperative evaluation and postoperative follow-up evaluations (6, 12, and 24 months) for the assessment of clinical outcomes including maximum knee flexion. Maximum flexion was measured under five conditions: passive nonweight bearing, passive weight bearing, active nonweight bearing, and active weight bearing with or without arm support. Data were analyzed for relationships between passive maximum flexion in nonweight bearing by Pearson correlation analyses, and a variance comparison between measurement techniques via paired t test. Results We observed substantial differences between passive maximum flexion in nonweight bearing and the other four maximum flexion types. At all time points, passive maximum flexion in nonweight bearing correlated poorly with active maximum flexion in weight bearing with or without arm support. Active maximum flexion in weight bearing better correlated with functional outcomes than the other maximum flexion types. Conclusions Our study suggests active maximum flexion in weight bearing should be reported together with passive maximum flexion in nonweight bearing in research on the knee motion arc after TKA. PMID:27274468

  9. No statistically significant kinematic difference found between a cruciate-retaining and posterior-stabilised Triathlon knee arthroplasty: a laboratory study involving eight cadavers examining soft-tissue laxity.

    PubMed

    Hunt, N C; Ghosh, K M; Blain, A P; Rushton, S P; Longstaff, L M; Deehan, D J

    2015-05-01

    The aim of this study was to compare the maximum laxity conferred by the cruciate-retaining (CR) and posterior-stabilised (PS) Triathlon single-radius total knee arthroplasty (TKA) for anterior drawer, varus-valgus opening and rotation in eight cadaver knees through a defined arc of flexion (0º to 110º). The null hypothesis was that the limits of laxity of CR- and PS-TKAs are not significantly different. The investigation was undertaken in eight loaded cadaver knees undergoing subjective stress testing using a measurement rig. Firstly the native knee was tested prior to preparation for CR-TKA and subsequently for PS-TKA implantation. Surgical navigation was used to track maximal displacements/rotations at 0º, 30º, 60º, 90º and 110° of flexion. Mixed-effects modelling was used to define the behaviour of the TKAs. The laxity measured for the CR- and PS-TKAs revealed no statistically significant differences over the studied flexion arc for the two versions of TKA. Compared with the native knee both TKAs exhibited slightly increased anterior drawer and decreased varus-valgus and internal-external roational laxities. We believe further study is required to define the clinical states for which the additional constraint offered by a PS-TKA implant may be beneficial.

  10. Functionality and Safety of an Ultra-Congruent Rotating Platform Knee Prosthesis at 5.6 Years: More than 5- Year Follow-Up of the e.motion® UC-TKA

    PubMed Central

    Chavoix, Jean-Baptiste

    2013-01-01

    Background: Mobile bearing TKA prostheses were designed to minimize polyethylene wear by increasing implant conformity and reducing stresses between the articulating prosthesis components. It is the purpose of this study to assess the mid-term functionality and clinical outcome associated with a highly congruent mobile platform design, the e.motion® UC total knee prosthesis. Material and Methods: Functional and clinical outcomes were assessed after an average of 5.6 years (5.1 – 6.0 years) after total knee arthroplasty in 28 patients (24 women), aged 77.8±7.5 years. The Knee injury and Osteoarthritis Outcome Score (KOOS) was assessed. Secondary outcomes included the Knee Society Score (KSS), radiological evaluation of radiolucent lines and recording of adverse events. Results: The average KOOS subscore for the activities of daily life was 77.8 points after 5.6 years. Both the clinical and functional KSS improved at 2.4 and 5.6 years. Two patients showed radiolucent lines at 5.6 years. Adverse events over 5.6 years included 3 subluxations, 1 tilting and 1 misalignment of the patella. None of the prostheses were revised. Conclusion: This pilot study shows promising outcomes for the e.motion® UC prosthesis. In the small sample, the implant performed comparably to the LCS prosthesis (the gold standard). There were no loosenings or revisions observed at 5.6 years. PMID:23730378

  11. Bone anatomy and rotational alignment in total knee arthroplasty.

    PubMed

    Uehara, K; Kadoya, Y; Kobayashi, A; Ohashi, H; Yamano, Y

    2002-09-01

    The purpose of the current study was to investigate the bone anatomy in determining the rotational alignment in total knee arthroplasty using computed tomography. Axial images of 109 knees in 83 patients with varus osteoarthritis who had total knee arthroplasty were analyzed. On the images of the distal femur and the proximal tibia, a baseline for the anteroposterior axis of each component was drawn based on the epicondylar axis for the femur and the medial (1/3) of the tibial tuberosity for the tibia. The angle between these two lines was analyzed as the rotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Fifty-four knees (49.5%) had an angle of 5 degrees or greater and 13 knees (11.9%) had an angle of 10 degrees or greater. There was a tendency to align the tibial component in external rotation relative to the femoral component. The results indicated that the landmarks of each bone were the intrinsic cause of the rotational mismatch in knees with varus osteoarthritis. Surgeons doing total knee arthroplasties should be aware of this and check the rotational mismatch between the components. When it is present, the tibial component should be realigned to match the femoral component rotation to minimize problems caused by the mismatch.

  12. Genu Recurvatum versus Fixed Flexion after Total Knee Arthroplasty

    PubMed Central

    Silva, Amila; Chong, Hwei Chi; Chin, Pak Lin; Chia, Shi Lu; Lo, Ngai Ngung; Yeo, Seng Jin

    2016-01-01

    Background To date, there is no study comparing outcomes between post-total knee replacement genu recurvatum and fixed flexion. This study aims to provide data that will help in deciding which side to err on when neutral extension is not achieved. Methods A prospective cohort study of primary total knee arthroplasties was performed, which compared the 6-month and 2-year clinical outcomes between fixed flexion and genu recurvatum deformities at 6 months. Results At 6 months, knees in genu recurvatum did better than knees in fixed flexion deformity in terms of knee flexion. However, at 2 years, knees in fixed flexion deformity did better in terms of knee scores and showed better improvement in the degree of deformity. Conclusions We conclude that it is better to err on the side of fixed flexion deformity if neutral alignment cannot be achieved. PMID:27583106

  13. Alpine Skiing With total knee ArthroPlasty (ASWAP): effects on strength and cardiorespiratory fitness.

    PubMed

    Pötzelsberger, B; Stöggl, T; Lindinger, S J; Dirnberger, J; Stadlmann, M; Buchecker, M; Hofstaedter, T; Gordon, K; Müller, E

    2015-08-01

    This study investigated the effect of a 12-week recreational skiing intervention on lower limb muscle strength and cardiorespiratory fitness in participants with unilateral total knee arthroplasty (TKA). Twenty-seven older adults (70 ± 5 years) were assigned to the intervention (n = 13) or control group (n = 14) after surgery (2.5 ± 1 years). Leg muscle strength was measured using an IsoMed 2000 dynamometer and cardiorespiratory fitness was determined by cycle ergometry before and after the intervention as well as after an 8-week retention period. The skiing intervention led to increased muscle strength in the operated leg during unilateral single joint isometric extension (maximal force: 11%; P < 0.05; rate of torque development: 24%; P < 0.05) and during the unilateral multi-joint isokinetic single leg strength test (8%; P < 0.05). This resulted in a decreased asymmetry index in the isokinetic test (13% to 5%; P < 0.05). These adaptations remained unchanged toward the retention test. No effect was observed for cardiorespiratory fitness. The results demonstrate that muscle contraction forces required during recreational skiing in individuals with TKA seem adequate and effective to increase quadriceps and hamstrings muscle strength in the initially weaker operated leg and to reduce an augmented post-operative asymmetry index.

  14. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

    PubMed Central

    Besculides, Melanie C.; Gaber, Licia; Liu, Spencer; González Della Valle, Alejandro

    2008-01-01

    Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient’s risk of PE after surgery. PMID:18925395

  15. Alternative bearings in total knee arthroplasty: risk of early revision compared to traditional bearings

    PubMed Central

    2013-01-01

    Background and purpose There is no substantial clinical evidence for the superiority of alternative bearings in total knee arthroplasty (TKA). We compared the short-term revision risk in alternative surface bearing knees (oxidized zirconium (OZ) femoral implants or highly crosslinked polyethylene (HXLPE) inserts) with that for traditional bearings (cobalt-chromium (CoCR) on conventional polyethelene (CPE)). The risk of revision with commercially available HXLPE inserts was also evaluated. Methods All 62,177 primary TKA cases registered in a Total Joint Replacement Registry between April 2001 and December 2010 were retrospectively analyzed. The endpoints for the analysis were all-cause revisions, septic revisions, or aseptic revisions. Bearing surfaces were categorized as OZ-CPE, CoCr-HXLPE, or CoCr-CPE. HXLPE inserts were stratified according to brand name. Confounding was addressed using propensity score weights. Marginal Cox-regression models adjusting for surgeon clustering were used. Results The proportion of females was 62%. Average age was 68 (SD 9.3) years, and median follow-up time was 2.8 (IQR 1.2–4.9) years. After adjustments, the risks of all-cause, aseptic, and septic revision with CoCr-HXLPE and OZ-CPE bearings were not statistically significantly higher than with traditional CoCr-CPE bearings. No specific brand of HXLPE insert was associated with a higher risk of all-cause, aseptic, or septic revision compared to CoCr-CPE. Interpretation At least in the short term, none of the alternative knee bearings evaluated (CoCr-HXLPE or OZ-CPE) had a greater risk of all-cause, aseptic, and septic revision than traditional CoCr-CPE bearings. PMID:23485105

  16. Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness

    PubMed Central

    Nakagawa, Shuji; Inoue, Hiroaki; Kan, Hiroyuki; Hino, Manabu; Ichimaru, Shohei; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Amaya, Fumimasa; Sawa, Teiji; Kubo, Toshikazu

    2016-01-01

    Purpose This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. Materials and Methods Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. Results The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. Conclusions The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.

  17. Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness

    PubMed Central

    Nakagawa, Shuji; Inoue, Hiroaki; Kan, Hiroyuki; Hino, Manabu; Ichimaru, Shohei; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Amaya, Fumimasa; Sawa, Teiji; Kubo, Toshikazu

    2016-01-01

    Purpose This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. Materials and Methods Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. Results The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. Conclusions The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture. PMID:27595078

  18. Periprosthetic Bone Remodelling in Total Knee Arthroplasty

    PubMed Central

    GEORGEANU, Vlad; ATASIEI, Tudor; GRUIONU, Lucian

    2014-01-01

    Introduction: The clinical studies have shown that the displacement of the prosthesis components, especially of the tibial one is higher during the first year, after which it reaches an equilibrum position compatible with a good long term functioning. This displacement takes place due to bone remodelling close to the implant secondary to different loading concentrations over different areas of bone. Material and Method: Our study implies a simulation on a computational model using the finite element analysis. The simulation started taking into account arbitrary points because of non-linear conditions of bone-prosthesis interface and it was iterative.. A hundred consecutive situations corresponding to intermediate bone remodelling phases have been calculated according to given loadings. Bone remodelling was appreciated as a function of time and bone density for each constitutive element of the computational model created by finite element method. For each constitutive element a medium value of stress during the walking cycle was applied. Results: Analyse of proximal epiphysis-prosthesis complex slices showed that bone density increase is maintained all over the stem in the immediately post-operative period. At 10 months, the moment considered to be the end of bone remodelling, areas with increased bone density are fewer and smaller. Meanwhile, their distribution with a concentration toward the internal compartment in the distal metaphysis is preserved. Conclusions: After the total knee arthroplasty the tibial bone suffered a process of remodelling adapted to the new stress conditions. This bone remodelling can influence, sometimes negatively, especially in the cases with tibial component varus malposition, the fixation, respectively the survival of the prosthesis. This process has been demonstrated both by clinical trials and by simulation, using the finite elements method of periprosthetic bone remodelling. PMID:25553127

  19. Novel computer-assisted method for revision arthroplasty of the knee

    PubMed Central

    Hoffart, Hanns-Edgar; Dinges, Harald; Kolbeck, Stefan; Ritschl, Peter; Hommel, Hagen

    2015-01-01

    AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty (TKA). METHODS: We present an imageless navigation system for revision TKA, with optical point and tracker identification to assess kinematic and anatomical landmarks. The system automatically positions the cutting guides with a motorized cutting unit. The cutting unit is placed on the distal femur with a femoral clamp and acts as a rigid body and the base for all femoral cuts. The surgical technique for using the navigation system for revision TKA is based on the technique used in primary TKA. However, there are some important differences. The most notable are: (1) differences in estimation of the position of the primary implant relative to the bone and the mechanical axes; (2) the specific possibilities the revision navigation software offers in terms of optimal joint level positioning; and (3) the suggested “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are taken into account to find the optimal femoral component position. We assessed the surgical technique, and accompanying software procedural steps, of the system, identifying any advantages or disadvantages that they present. RESULTS: The system aims to visualize critical steps of the procedure and is intended as a tool to support the surgeon in surgical decision-making. Combining a computer-assisted cutting device with navigation makes it possible to carry out precise cuts without pinning. Furthermore, the femoral clamp provides a stable fixation mechanism for the motorized cutting unit. A stable clamp is paramount in the presence of periarticular bony defects. The system allows the position of the primary implant relative to the bone and mechanical axes to be estimated, at which point any malalignments can be corrected. It also offers an optimal joint level position for

  20. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    PubMed Central

    Jeong, Min; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures. PMID:26981521

  1. The effect of patient age, gender, and tibial component fixation on pain relief after cementless total knee arthroplasty.

    PubMed

    Whiteside, L A

    1991-10-01

    Cementless total knee arthroplasties (TKAs) were prospectively evaluated for pain relief in 1110 knees. The effect of screws in the tibial component, the age of the patients, and the gender of the patients were studied to determine the effect of these parameters on pain relief one and two years postsurgery. The group with screws in the tibial component (Ortholoc II) had a significantly higher percentage of pain-free knees at one year than at two years postsurgery, and the older patients had a significantly higher rate of pain-free knees at one- and two years postsurgery than the younger patients. Older female patients with Ortholoc I TKAs had a significantly higher percentage of pain-free knees than did older male patients at one-year postsurgery, but not at two years. The group with screws in the tibial components (Ortholoc II) had a higher percentage of pain-free knees at one-year postsurgery than did the Ortholoc I knees, but there was no difference between Ortholoc I and II at two-years postsurgery. In the Ortholoc II group, there was also no difference in results among sexes or between patients older and younger than 65 years old. The correlation coefficient was calculated to evaluate the relationship between body weight and the degree of pain after TKA. No significant correlation could be found at one and two years after surgery. PMID:1914298

  2. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report

    PubMed Central

    Finger, Eric; Willis, F Buck

    2008-01-01

    Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20° to -12° (stiff knee still lacking full extension), and after eight additional weeks with nightly wear of dynamic splint, the patient regained full knee extension, (active extension improved from -12° to 0°). PMID:19113998

  3. Reliability of the anteroposterior axis and the posterior condylar axis for determining rotational alignment of the femoral component in total knee arthroplasty.

    PubMed

    Nagamine, R; Miura, H; Inoue, Y; Urabe, K; Matsuda, S; Okamoto, Y; Nishizawa, M; Iwamoto, Y

    1998-01-01

    We examined the reliability of the anteroposterior and posterior condylar axes for determining rotational alignment of the femoral component in total knee arthroplasty (TKA). A computed tomography scan was taken at the level of the femoral epicondyle in 84 knees (27 varus knees with medial femorotibial arthritis (FT-OA) in 26 patients, 17 knees with patellofemoral arthritis in 14 patients, and 40 normal knees in 40 volunteers). On the image, an anteroposterior axis, a line perpendicular to the anteroposterior axis, an epicondylar axis and a posterior condylar axis were drawn, and the relationship between the three axes was assessed. The mean values for the 84 knees were evaluated, and the posterior condylar axis was 6.0 degrees +/- 2.4 degrees internally rotated relative to the epicondylar axis, while the line perpendicular to the anteroposterior axis was 1.4 degrees +/- 3.3 degrees internally rotated relative to the epicondylar axis. The internal rotation angle of the posterior condylar axis relative to the epicondylar axis was 6.2 degrees +/- 1.9 degrees in the knees with medial femorotibial arthritis, 6.4 degrees +/- 2.4 degrees in the knees with patellofemoral arthritis, and 5.8 degrees +/- 2.7 degrees in the normal knees, showing consistent values in normal and osteoarthritic knees. The internal rotation angle of the line perpendicular to the anteroposterior axis relative to the epicondylar axis was 0.1 degrees +/- 3.3 degrees, 1.3 degrees +/- 3. 3 degrees, and 2.3 degrees +/- 3.1 degrees in the three groups, respectively (i.e., there were significant differences between the medial FT-OA knees and the normal knees). The results demonstrated that the anteroposterior axis was rotated externally to a significant degree in medial FT-OA knees and was less reliable than the posterior condylar axis for use in alignment for TKA on medial FT-OA knees.

  4. Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur.

    PubMed

    Choi, Hyung Suk; Nho, Jae Hwi; Kim, Chung Hyun; Kwon, Sai Won; Park, Jong Seok; Suh, You Sung

    2016-11-01

    Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips. PMID:27593884

  5. Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur

    PubMed Central

    Choi, Hyung-Suk; Kim, Chung-Hyun; Kwon, Sai-Won; Park, Jong-Seok; Suh, You-Sung

    2016-01-01

    Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips. PMID:27593884

  6. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?

    PubMed Central

    Imam, M. A.; Eifert, A.; Freeman, M. A. R.; Pinskerova, V.; Field, R. E.; Skinner, J.; Banks, S. A.

    2016-01-01

    Objectives Throughout the 20th Century, it has been postulated that the knee moves on the basis of a four-bar link mechanism composed of the cruciate ligaments, the femur and the tibia. As a consequence, the femur has been thought to roll back with flexion, and total knee arthroplasty (TKA) prostheses have been designed on this basis. Recent work, however, has proposed that at a position of between 0° and 120° the medial femoral condyle does not move anteroposteriorly whereas the lateral femoral condyle tends, but is not obliged, to roll back – a combination of movements which equates to tibial internal/ femoral external rotation with flexion. The aim of this paper was to assess if the articular geometry of the GMK Sphere TKA could recreate the natural knee movements in situ/in vivo. Methods The pattern of knee movement was studied in 15 patients (six male: nine female; one male with bilateral TKAs) with 16 GMK Sphere implants, at a mean age of 66 years (53 to 76) with a mean BMI of 30 kg/m2 (20 to 35). The motions of all 16 knees were observed using pulsed fluoroscopy during a number of weight-bearing and non-weight-bearing static and dynamic activities. Results During maximally flexed kneeling and lunging activities, the mean tibial internal rotation was 8° (standard deviation (sd) 6). At a mean 112° flexion (sd 16) during lunging, the medial and lateral condyles were a mean of 2 mm (sd 3) and 8 mm (sd 4) posterior to a transverse line passing through the centre of the medial tibial concavity. With a mean flexion of 117° (sd 14) during kneeling, the medial and lateral condyles were a mean of 1 mm (sd 4) anterior and 6 mm (sd 4) posterior to the same line. During dynamic stair and pivoting activities, there was a mean anteroposterior translation of 0 mm to 2 mm of the medial femoral condyle. Backward lateral condylar translation occurred and was linearly related to tibial rotation. Conclusion The GMK Sphere TKA in our study group shows movements similar in

  7. Nerve Injury in Patients Following Hip and Knee Arthroplasties and Knee Arthroscopy

    PubMed Central

    Yacub, Jennifer N.; Rice, J. Bradford; Dillingham, Timothy R.

    2016-01-01

    Objective To examine the reporting of lower limb neuropathy within 90 days of surgery for patients undergoing hip arthroplasty, knee arthroplasty or knee arthroscopy. Design This was a retrospective study utilizing data from the 1998 MarketScan Commercial Claims and Encounter Database (The MEDSTAT Group) to identify lower limb neuropathy following these surgeries. The sample was selected within the first nine months of 1998 using ICD-9 and CPT codes for hip and knee surgical procedures. Lower limb nerve injuries as determined by ICD-9 codes within 90 days post surgery were the main outcome measures. The influence of diabetes on the rates of nerve injuries following surgery was also examined. Results 14,979 patients underwent these surgical procedures, 10 of whom were reported to have sustained a nerve injury post surgery (0.07%). A majority (53.1%) of the sample was male and the largest age groups consisted of those aged 45–54 years (27.0%) and those aged 55–64 years (27.7%). Nerve injury occurred at a rate of 0.03% after hip arthroplasty, 0.01% following knee arthroplasty and 0.02% within three months of arthroscopic knee surgery. Overall, nerve injuries were two times more prevalent in the diabetic vs. non-diabetic population (0.11% vs. 0.06%); however, this difference did not meet conventional levels of statistical significance. Specific to knee arthroplasty, there were ten-fold differences in nerve injury rates between diabetics and non-diabetics, 0.11% vs. 0.01% respectively (p ≤ 0.01) – although the overall risks were small. Conclusion Nerve injuries following hip and knee arthroplasty, and knee arthroscopy were rare in a large population of patients younger than 65 years. Although the overall rates were low, there was an increased occurrence of nerve injuries in the diabetic population. This information is useful when counseling patients and benchmarking surgical complication rates. PMID:19620828

  8. [Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature].

    PubMed

    Ziętek, Paweł; Ziętek, Joanna; Szczypiór, Karina

    2014-01-01

    The rapid progress in knee implants technology and operational techniques go together with more and more modem medical programs, designed to optimize the patients' care and shorten their stay in hospital. However, this does not guarantee any elimination ofperioperative stress in patients. Anxiety is a negative emotional state arising from stressful circumstances accompanied by activation of the autonomous nervous system. Anxiety causes negative physiological changes, including wound healing, resistance to anesthetic induction, it is associated with an increased perioperative pain and prolong recovery period. The purpose of this work is to present the current state of knowledge on the preoperative anxiety and discuss its impact on pain and other parameters in patients undergoing fast-track arthroplasty of big joints. The work also shows selected issues of anxiety pathomechanism, and actual methods reducing preoperative anxiety in hospitalized patients. The common prevalence of anxiety in patients undergoing surgery induces the attempt to routinely identify patients with higher anxiety, which may be a predictive factor of worse results after TKA. Undertaking widely understood psychological support in these patients before and after the operation could be a favorable element, which would influence thefinal result of the treatment of patients after big joints arthroplasties. PMID:25639020

  9. Radiological Outcomes and Operative Time following Total Knee Arthroplasty using Accelerometer-based, Portable Navigation versus Conventional Inter-Medullary Alignment Guides

    PubMed Central

    MacDessi, Samuel; Solayar, GN; Thatcher, N; Chen, Darren B

    2016-01-01

    Objectives: Accelerometer-based, portable navigation instrumentation is a new method of achieving desired resection alignments in total knee arthroplasty (TKA). Methods: After randomisation and the application of exclusion criteria, 79 knees were analysed. 42 patients which underwent TKA using conventional intra-medullary (IM) alignment guides were compared to 37 patients with the use of accelerometer-based, portable navigation device (KneeAlign; OrthoAlign Inc, Aliso Viejo, California). Radiographic results were obtained from post-operative computer-tomography following the CT Perth Protocol. Results: In the IM cohort, 81.0% of patients had a coronal alignment within 3° of a neutral mechanical axis (vs 83.8% with KneeAlign, p=0.74), 81.0% had a femoral coronal alignment within 2° of perpendicular to the femoral mechanical axis (vs 89.2% with KneeAlign, p=0.31), and 92.9% had a tibial coronal alignment within 2° of perpendicular to the tibial mechanical axis (vs 81.1% with KneeAlign, p=0.12). Regarding sagittal alignment, the IM cohort had 90.5% of patients with femoral component alignment within 2° of optimum (vs 91.9% with KneeAlign, p=0.83) and 92.9% had a tibial component alignment within 2° of the optimal tibial slope (vs 89.2% with KneeAlign, p=0.57). The mean tourniquet time (from incision to completion of coronal bone resections) in the IM cohort was 16.5± 8.9 minutes vs 22.2 ± 7.6 minutes in the KneeAlign cohort (p<0.003). Conclusion: Accelerometer-based, portable navigation has a statistically similar outcome in alignment following TKA as IM guides. It is noted that using the portable navigation device does prolong surgical time compared to conventional IM surgery and this may be due to the learning curve.

  10. Outcome and incidence of periprosthetic supracondylar femoral fractures in TKA

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: Periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) are infrequent, but is a devastating complication. The purpose of this study was to evaluate the incidence and outcomes of periprosthetic supracondylar femoral fractures following TKA using nonoperative as well as open reduction and internal fixation (ORIF) techniques. Materials and Methods: Between January 2004 and December 2010, we followed 3,920 operated patients of total knee arthroplasty (TKA) and identified 23 patients with periprosthetic supracondylar fractures. A retrospective analysis of the records of these patients was conducted. Details regarding pre fracture status, treatment offered and the present status were also recorded and analyzed. Time from index arthroplasty to periprosthetic fracture ranged from five days to six years. There were 17 women and 6 men and the average age was 68.26 years (range 52-83 years). Of the 23 patients, 20 patients were treated by operative method, whereas only three patients with relatively undisplaced fractures were treated nonoperatively. Results: The total incidence of periprosthetic fractures in operated cases of TKA was 0.58%. Three patients had infection after surgery. As per radiological assessment, two of three conservatively treated cases had malunion, whereas among 20 cases treated operatively, 16 had primary union with one malunion. Two patients had union after bone grafting, whereas two had nonunion. The average reduction in the knee score after fracture was 20.53%. Twenty one patients were able to achieve limited but independent activity. Conclusions: Desirable results for periprosthetic fractures can be obtained if proper and timely intervention is done, taking into account the other comorbid conditions. However, short duration of followup and small number of patients were major limiting factors in this study. PMID:24379465

  11. A Finite-Element Study of Metal Backing and Tibial Resection Depth in a Composite Tibia Following Total Knee Arthroplasty.

    PubMed

    Tokunaga, Susumu; Rogge, Renee D; Small, Scott R; Berend, Michael E; Ritter, Merrill A

    2016-04-01

    Prosthetic alignment, patient characteristics, and implant design are all factors in long-term survival of total knee arthroplasty (TKA), yet the level at which each of these factors contribute to implant loosening has not been fully described. Prior clinical and biomechanical studies have indicated tibial overload as a cause of early TKA revision. The purpose of this study was to determine the relationship between tibial component design and bone resection on tibial loading. Finite-element analysis (FEA) was performed after simulated implantation of metal backed (MB) and all-polyethylene (AP) TKA components in 5 and 15 mm of tibial resection into a validated intact tibia model. Proximal tibial strains significantly increased between 13% and 199% when implanted with AP components (p < 0.05). Strain significantly increased between 12% and 209% in the posterior tibial compartment with increased bone resection (p < 0.05). This study indicates elevated strains in AP implanted tibias across the entirety of the proximal tibial cortex, as well as a posterior shift in tibial loading in instances of increased resection depth. These results are consistent with trends observed in prior biomechanical studies and may associate the documented device history of tibial collapse in AP components with increased bone strain and overload beneath the prosthesis. PMID:26810930

  12. Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: a randomized double-blind controlled trial

    PubMed Central

    Sathitkarnmanee, Thepakorn; Tribuddharat, Sirirat; Noiphitak, Kanlayarat; Theerapongpakdee, Sunchai; Pongjanyakul, Sasiwimon; Huntula, Yuwadee; Thananun, Maneerat

    2014-01-01

    Purpose To assess the efficacy of a transdermal fentanyl patch (TFP) (50 μg/hour) applied 10–12 hours before surgery versus placebo for postoperative pain control of total knee arthroplasty (TKA). Materials and methods We enrolled 40 patients undergoing elective TKA under spinal anesthesia using isobaric or hyperbaric bupivacaine. Subjects were randomized to receive a TFP (Duragesic® 50 μg/hour) or placebo patch applied with a self-adhesive to the anterior chest wall 10–12 hours before spinal anesthesia. Every patient was given patient-controlled morphine for postoperative pain control. Patients were evaluated every 4 hours until 48 hours. Results Morphine consumption at 24 and 48 hours in the TFP group versus the placebo group was 15.40±12.65 and 24.90±20.11 mg versus 33.60±19.06 and 57.80±12.65 mg (P≤0.001). Numeric rating scale scores at rest and during movement over 48 hours were lower in the TFP group. Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group. Sedation scores were low and not statistically significantly different between groups. There was no severe respiratory depression. Conclusion TFP (50 μg/hour) applied 10–12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery. PMID:25120375

  13. Alpine Skiing With total knee ArthroPlasty (ASWAP): impact on molecular and architectural features of musculo-skeletal ageing.

    PubMed

    Narici, M; Conte, M; Salvioli, S; Franceschi, C; Selby, A; Dela, F; Rieder, F; Kösters, A; Müller, E

    2015-08-01

    This study investigated features of skeletal muscle ageing in elderly individuals having previously undergone unilateral total knee arthroplasty (TKA) and whether markers of sarcopenia could be mitigated by a 12-week alpine skiing intervention. Novel biomarkers agrin, indicative of neuromuscular junction (NMJ) degeneration, tumor suppressor protein p53, associated with muscle atrophy, and a new ultrasound-based muscle architecture biomarker were used to characterize sarcopenia. Participant details and study design are presented by Kösters et al. (2015). The results of this study show that NMJ degeneration is widespread among active septuagenarians previously subjected to TKA: all participants showed elevated agrin levels upon recruitment. At least 50% of individuals were identified as sarcopenic based on their muscle architecture, supporting the hypothesis that NMJ alterations precede sarcopenia. Notably, sarcopenia was strongly associated with the expression of p53, which seems to confirm its validity as a biomarker of muscle atrophy. Training did not significantly modify any of these biomarkers. In view of the lack of accretion of muscle mass in response to the alpine skiing intervention, we hypothesize that local muscle inflammation and oxidative stress may have blunted the anabolic response to training and promoted muscle breakdown in this elderly post-TKA population. PMID:26083700

  14. Alpine Skiing With total knee ArthroPlasty (ASWAP): impact on molecular and architectural features of musculo-skeletal ageing.

    PubMed

    Narici, M; Conte, M; Salvioli, S; Franceschi, C; Selby, A; Dela, F; Rieder, F; Kösters, A; Müller, E

    2015-08-01

    This study investigated features of skeletal muscle ageing in elderly individuals having previously undergone unilateral total knee arthroplasty (TKA) and whether markers of sarcopenia could be mitigated by a 12-week alpine skiing intervention. Novel biomarkers agrin, indicative of neuromuscular junction (NMJ) degeneration, tumor suppressor protein p53, associated with muscle atrophy, and a new ultrasound-based muscle architecture biomarker were used to characterize sarcopenia. Participant details and study design are presented by Kösters et al. (2015). The results of this study show that NMJ degeneration is widespread among active septuagenarians previously subjected to TKA: all participants showed elevated agrin levels upon recruitment. At least 50% of individuals were identified as sarcopenic based on their muscle architecture, supporting the hypothesis that NMJ alterations precede sarcopenia. Notably, sarcopenia was strongly associated with the expression of p53, which seems to confirm its validity as a biomarker of muscle atrophy. Training did not significantly modify any of these biomarkers. In view of the lack of accretion of muscle mass in response to the alpine skiing intervention, we hypothesize that local muscle inflammation and oxidative stress may have blunted the anabolic response to training and promoted muscle breakdown in this elderly post-TKA population.

  15. Is the use of computer navigation in total knee arthroplasty improving implant positioning and function? A comparative study of 198 knees operated at a Norwegian district hospital

    PubMed Central

    2013-01-01

    Background There are few Scandinavian studies on the effect of computer assisted orthopedic surgery (CAOS) in total knee arthroplasty (TKA), compared to conventional technique (CON), and there is little information on effects in pain and function scores. This retrospective study has evaluated the effects of CAOS on radiological parameters and pain, function and quality of life after primary TKA. Methods 198 primary TKAs were operated by one surgeon in two district hospitals; 103 CAOS and 95 CON. The groups were evaluated based on 3 months post-operative radiographs and a questionnaire containing the knee osteoarthritis outcome score (KOOS), the EQ-5D index score and a visual analogue scale (VAS) two years after surgery. Multiple linear regression method was used to investigate possible impact from exposure (CON or CAOS). Results On hip-knee-ankle radiographs, 20% of measurements were > ±3° of neutral in the CAOS group and 25% in the CON group (p = 0.37). For the femoral component, the number was 5% for CAOS and 18% for CON (p < 0.01). For the tibial component, the difference was not statistically significant (p = 0.58). In the sagittal plane, the surgeon tended to apply more femoral flexion and more posterior tibial slope with CAOS. We observed no statistically or clinically significant difference in KOOS score, VAS or ∆EQ-5D (all p values >0.05), but there was a trend towards better scores for CAOS. Operation time was 3 minutes longer for CON (p = 0.37). Conclusions CAOS can improve radiological measurements in primary TKA, and makes it possible to adjust component placement to the patient’s anatomy. Over-all, the two methods are equal in pain, function and quality-of-life scores. PMID:24228727

  16. Mobile-bearing total knee arthroplasty: a full traumatic rotation of 180°.

    PubMed

    Sudanese, Alessandra; Castiello, Emanuela; Affatato, Saverio

    2013-06-25

    From February 2008 to September 2012 we implanted 204 mobile-bearing knee prostheses in 192 patients. All the prostheses were cemented (both femoral and tibial components), and the patella was not replaced. Only one early complication of the implants (1/204 = 0.004%) occurred after a traumatic event as a full 180° rotation of the mobile-bearing polyethylene insert. A 78-year-old woman presented with swelling and severe pain at her right knee. This traumatic event was the only case among our mobile-bearing insert patients. 
The failed polyethylene inserts were retrieved and studied using a scanning electron microscope (SEM, ZEISS EVO 50 EP, Cambridge, UK) operating at 20 kV. 
Scratching and pitting were found on the UHMWPE insert perpendicular to the machining tracks for the concave surface. SEM micrographs of the insert showed burnishing on the concave surfaces and longitudinal scratches were clearly detectable and well-marked on the analyzed surfaces. 
A traumatic, fully rotating, polyethylene insert is rare and our case is the first report describing a traumatic event with a complete 180 degree rotation mobile-bearing in a total knee prosthesis. 
In the literature few reports discuss clinical outcomes after total knee arthroplasty in patients with Parkinson's disease and they cite mixed results. However, some authors suggest that posterior-stabilized and cruciate-retaining TKA should work well while others prefer cruciate-retaining, condylar constrained kinetics, or hinged devices. Although we did not implant a posterior-stabilized mobile-bearing total knee prosthesis or a constrained prosthesis, we obtained good clinical and radiological results at the 2-year followup. PMID:23653296

  17. Effects of a Foot Pump on the Incidence of Deep Vein Thrombosis After Total Knee Arthroplasty in Patients Given Edoxaban: A Randomized Controlled Study.

    PubMed

    Sakai, Tatsuya; Izumi, Masahiro; Kumagai, Kenji; Kidera, Kenichi; Yamaguchi, Takayuki; Asahara, Tomohiko; Kozuru, Hideko; Jiuchi, Yuka; Mawatari, Masaaki; Osaki, Makoto; Motokawa, Satoru; Migita, Kiyoshi

    2016-01-01

    We conducted a randomized clinical trial to compare the effectiveness of the A-V Impulse System foot pump for reducing the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in patients under edoxaban thromboprophylaxis. Patients undergoing primary TKA at our institution between September 2013 and March 2015 were enrolled after obtaining informed consent. The patients were randomized to use the foot pump (n = 58) and not to use the foot pump (n = 62). Both groups were given prophylactic edoxaban. Primary outcomes were any DVT as detected by bilateral ultrasonography up to postoperative day 10 (POD10) and pulmonary embolism (PE) up to POD28. The safety outcomes were bleeding and death of any cause up to POD28. Plasma D-dimer levels were measured before TKA and on POD10 after TKA. Immunoglobulin G (IgG)-class anti-PF4/heparin antibodies were measured using an IgG-specific enzyme-linked immunosorbent assay. The incidences of any DVT up to POD28 were 31.0% and 17.7% in patients with or without the foot pump, respectively. The incidences of major bleeding up to POD28 were 5.1% and 4.8% in patients with or without the foot pump, respectively. Foot pump use did not significantly reduce the incidence of DVTs in patients undergoing TKA under edoxaban thromboprophylaxis. Although seroconversion of anti-PF4/heparin antibodies was confirmed in one-fourth of patients, the seroconversion rates did not differ between patients with (20.7%) or without (25.8%) foot pump use. This study shows that the A-V Impulse system foot pump did not affect the incidence of DVT under edoxaban thromboprophylaxis in patients undergoing TKA. Seroconversion of anti-PF4/heparin antibodies was detected in a significant number of patients who underwent TKA under antithrombotic prophylaxis using edoxaban. PMID:26735531

  18. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

  19. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion. PMID:26486536

  20. Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA.

    PubMed

    Luyckx, Lucas; Luyckx, Thomas; Bellemans, Johan; Victor, Jan

    2010-08-01

    This study aimed at systematic documentation of lateral knee pain in a consecutive series of 1102 cruciate-substituting, guided motion total knee arthroplasties (TKA) (Journey, Smith and Nephew, Memphis, TN, USA) performed in 1085 patients; 1070 knees were available for review. Follow-up time ranged from one to five years, with a mean of 2.5 years. Symptoms mimicking the well known iliotibial band (ITB) friction syndrome were observed in 77 knees (7.2%). Initial conservative treatment consisted of anti-inflammatory medication (77 knees) and local steroid injection (35 knees). The pain persisted in 22 knees (2%), leading to a surgical release of the iliotibial band. Other surgical interventions included revision for infection (6 knees, 0.5%), revision for tibial component loosening (6 knees, 0.5%), revision for tibiofemoral dislocation (3 knees, 0.3%), revision for patellar component loosening (5 knees, 0.4%), revision for instability (1 knee, 0.1%) and secondary patellar resurfacing (1 knee, 0.1%). The overall survivorship with partial or total implant revision as an endpoint was 98%. The development of lateral knee pain in association with the use of a guided motion design can be explained by the forced posterior translation of the lateral condyle in flexion. The asymmetric cam and post mechanism, acting as a hard driver of posterior femoral translation and internal tibial rotation during flexion, does not allow for the natural kinematic variability occurring in native knees. This repetitive and forced stretching of the ITB seems to induce a painful traction syndrome in some patients.

  1. Early outcomes of patella resurfacing in total knee arthroplasty

    PubMed Central

    Clements, Warren J; Miller, Lisa; Whitehouse, Sarah L; Graves, Stephen E; Ryan, Philip

    2010-01-01

    Background Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. Methods We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. Results At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and “patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001). Interpretation Rates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years. PMID:19968604

  2. Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

    PubMed

    Hasenkamp, W; Villard, J; Delaloye, J R; Arami, A; Bertsch, A; Jolles, B M; Aminian, K; Renaud, P

    2014-06-01

    Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL).

  3. Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury

    PubMed Central

    Kim, Ha-Jung; Koh, Won-Uk; Kim, Sae-Gyeol; Park, Hyeok-Seong; Song, Jun-Gol; Ro, Young-Jin; Yang, Hong-Seuk

    2016-01-01

    Abstract Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA. The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis. Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01–1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65–5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26–1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48–4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08–87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09–3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03–3.24, P = 0.041) and longer hospital stay (P = 0.001). In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA. PMID:27495094

  4. Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis

    PubMed Central

    Kowalczewski, Jacek B.; Chevalier, Yan; Okon, Tomasz; Innocenti, Bernardo; Bellemans, Johan

    2015-01-01

    Introduction Correct restoration of the joint line is generally considered as crucial when performing total knee arthroplasty (TKA). During revision knee arthroplasty however, elevation of the joint line occurs frequently. The general belief is that this negatively affects the clinical outcome, but the reasons are still not well understood. Material and methods In this cadaveric in vitro study the biomechanical consequences of joint line elevation were investigated using a previously validated cadaver model simulating active deep knee squats and passive flexion-extension cycles. Knee specimens were sequentially tested after total knee arthroplasty with joint line restoration and after 4 mm joint line elevation. Results The tibia rotated internally with increasing knee flexion during both passive and squatting motion (range: 17° and 7° respectively). Joint line elevation of 4 mm did not make a statistically significant difference. During passive motion, the tibia tended to become slightly more adducted with increasing knee flexion (range: 2°), while it went into slighlty less adduction during squatting (range: –2°). Neither of both trends was influenced by joint line elevation. Also anteroposterior translation of the femoral condyle centres was not affected by joint line elevation, although there was a tendency for a small posterior shift (of about 3 mm) during squatting after joint line elevation. In terms of kinetics, ligaments lengths and length changes, tibiofemoral contact pressures and quadriceps forces all showed the same patterns before and joint line elevation. No statistically significant changes could be detected. Conclusions Our study suggests that joint line elevation by 4 mm in revision total knee arthroplasty does not cause significant kinematic and kinetic differences during passive flexion/extension movement and squatting in the tibio-femoral joint, nor does it affect the elongation patterns of collateral ligaments. Therefore, clinical

  5. Are Western Knee Designs Dimensionally Correct for Korean Women? A Morphometric Study of Resected Femoral Surfaces during Primary Total Knee Arthroplasty

    PubMed Central

    Lyu, Suk-Joo; Kang, Hyung Wook

    2016-01-01

    Background The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. Methods Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. Results Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. Conclusions Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population. PMID:27583107

  6. Total knee arthroplasty in a rheumatoid arthritic knee with large geode: a case report.

    PubMed

    Shih, H N; Hsu, K Y; Tan, C F; Hsueh, S; Hsu, R W

    1997-09-01

    Geodes (subchondral cysts) are a well-known manifestation of rheumatoid arthritis. Solitary cysts or cysts larger than 2 cm are not generally found in the knee joint of patients with rheumatoid arthritis (RA). We report a case of RA involving both knees with a giant geode over the right proximal tibia. Surgical treatment was performed including synovectomy, cyst enucleation and packing of autogenous bone chips followed by primary total knee arthroplasty. The postsurgical result was excellent with the knee restored to good function and complete healing of the cystic lesion.

  7. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study.

    PubMed

    Czurda, Thomas; Fennema, Peter; Baumgartner, Martin; Ritschl, Peter

    2010-07-01

    Previous studies have noted an adverse relationship between implant malalignment during total knee arthroplasty (TKA) and post-operative pain. Although some evidence exists indicating that computer-assisted surgical navigation for TKA can improve the accuracy of component alignment, its impact on clinical outcomes is currently unknown. The dual goals of the present cohort/nested case-control study were to (1) compare self-reported responses to the Western Ontario-McMaster Osteoarthritis Index (WOMAC) questionnaire between computer-assisted TKA (123 patients) using the imageless PiGalileo navigation system and conventional TKA (207 patients) [cohort analysis], and (2) to investigate a potential association between malalignment and post-operative pain in 19 painful knees and 19 asymptomatic knees obtained from the cohort analysis using matched sampling [nested case-control study]. In the cohort analysis, a relevant but non-significant (P = 0.06) difference in the occurrence of chronic pain was observed between the navigated (12%) and conventional arms (20%). Median post-operative WOMAC pain score was 100 (range, 50-100) in the conventional group and 100 (range, 65-100) in the navigated group. However, the Mann-Whitney test revealed a significant difference in favor of the navigated group (P = 0.01). In the nested case-control analysis, radiological outcomes and computer tomography (CT) measurements of femoral rotation were compared between the groups. The CT rotation measurements yielded evidence of a relationship between post-operative pain and incorrect rotational alignment of the femoral component of more than 3 degrees (OR: 7; 95% CI: 1.2-42; P = .033). In conclusion, there was no clinical benefit to computer-assisted navigation; however, a statistically significant relationship was observed between incorrect rotational alignment of the femoral component and symptoms of post-operative pain following TKA.

  8. Obesity, knee osteoarthritis and knee arthroplasty: a review

    PubMed Central

    2013-01-01

    The incidence of obesity is rising worldwide. Obesity is a risk factor for developing osteoarthritis in the knee. Obesity and knee osteoarthritis are independently disabling conditions and in combination pose difficult therapeutic challenges. This review will discuss obesity, osteoarthritis, and the problems associated with knee osteoarthritis in an obese population. Treatment options including surgery and its success will be discussed. PMID:24304704

  9. Establishing Realistic Patient Expectations Following Total Knee Arthroplasty.

    PubMed

    Husain, Adeel; Lee, Gwo-Chin

    2015-12-01

    Nearly 20% of patients are dissatisfied following well-performed total knee arthroplasty with good functional outcomes. Surgeons must understand the drivers of dissatisfaction to minimize the number of unhappy patients following surgery. Several studies have shown that unfulfilled expectations are a principal source of patient dissatisfaction. Patients contemplating total knee arthroplasty expect pain relief, improved walking ability, return to sports, and improvement in psychological well-being and social interactions. However, patients are typically overly optimistic with regard to expected outcomes following surgery. Patient expectations and satisfaction can be influenced by age, socioeconomic factors, sex, and race. The interplay of these factors can be complex and specific to each person. Published data on clinical and functional outcomes show that persistence of symptoms, such as pain, stiffness, and failure to return to preoperative levels of function, are common and normal. Therefore, the surgeon needs to help the patient to establish realistic expectations. PMID:26493969

  10. Sagittal plane balancing in the total knee arthroplasty.

    PubMed

    Manson, Theodore T; Khanuja, Harpal S; Jacobs, Michael A; Hungerford, Marc W

    2009-01-01

    Postoperative stiffness or instability may result from a total knee arthroplasty imbalanced in the sagittal plane. Total knee arthroplasty instrumentation systems differ in the basic strategies used to assure this balance. In an anterior referencing system, changes in femoral size affect flexion gap tightness, and femoral size selection is paramount to assure sagittal plane balance. Conversely, in posterior referencing systems, femoral size changes do not affect the flexion gap but, rather, influence femoral component-patella articulation. Flexion/extension gap systems use calibrated spacer blocks to ensure gap balance but do not guarantee midrange stability; if used incorrectly, they may cause component malposition and joint line elevation. The authors reviewed the strengths and weaknesses of system types and provided system-specific troubleshooting guidelines for clinicians addressing intraoperative sagittal plane imbalance.

  11. Knitted outer gloves in primary hip and knee arthroplasty.

    PubMed

    Tanner, J; Wraighte, P; Howard, P

    2006-01-01

    A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty. Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves. A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer. Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001).

  12. Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty.

    PubMed

    Nestor, Bryan J; Toulson, Charles E; Backus, Sherry I; Lyman, Stephen L; Foote, Kristin L; Windsor, Russell E

    2010-09-01

    The purpose of this study was to determine whether the mini-midvastus approach to total knee arthroplasty (TKA) results in differences in quadriceps muscle strength as well as previously cited advantages in a double blind prospective randomized trial. Twenty-seven patients (54 TKAs) scheduled for bilateral TKA were randomized to undergo mini-midvastus approach on one knee and standard approach on the other. Incision lengths were the same. Postoperative strength was determined by isokinetic and isometric peak torque testing. Range of motion, pain Visual analog scale, side-preference, and gait analysis were assessed preoperatively and postoperatively. The only significant difference in strength testing was increased isokinetic and isometric extension torque at 3 weeks postoperatively for the mini-midvastus approach. No differences between the mini-midvastus and standard approach were observed for stride length, stance time, pain Visual analog scale, or knee range of motion. The mini-midvastus approach has limited benefit compared to the standard approach for TKA.

  13. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

    Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

    2015-01-01

    The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

  14. Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee.

    PubMed

    Ranawat, C S; Rose, H A; Rich, D S

    1984-01-01

    Total condylar knee arthroplasty was performed on 64 knees with fixed valgus or valgus/flexion deformities. The technique for release of tight lateral and posterior structures is important to balance the ligament. Clinical results were rated good and excellent in 95% of the knees. Four patients with excessive flexion deformities required 6 weeks of cast bracing in the immediate postoperative period for instabilities caused by an imbalance in the spacing in flexion and extension. In no joint in the entire series did stability deteriorate with time. There were no patellar complications or nerve palsies noted. Radiographic evaluation revealed well-fixed components in 92% of the arthroplasties. None has required revision for mechanical loosening to date. With proper technique the total condylar prosthesis can be employed in knees with valgus or valgus/flexion deformities to give predictably good results. The total condylar III prosthesis may be required in severe combined deformities for added stability. PMID:6546120

  15. Two Case Studies Related to Total Knee Arthroplasty

    PubMed Central

    Hale, David

    2016-01-01

    Objectives: Report on Two Case Studies related to Total Knee Arthroplasty Previously Discussed by AKS Members Methods: Case Series Case 1: A 76 year old woman requiring a right total knee replacement in the presence of marked dystrophic calcification affecting the quadriceps tendon on a background of having sustained a post operative quadriceps tendon rupture post left TKR in 2013 Case 2: Management issues related to performing a TKR in a 80 year old woman with a possible past history of TB affecting the joint Conclusion: Both procedures went smoothly and particularly as advice was given by AKS members, these are presented largely for feedback.

  16. Analysis and Treatment of Complications after Unicompartmental Knee Arthroplasty

    PubMed Central

    Lee, Song; Lee, Jae Il; Kim, Jin Woo

    2016-01-01

    Purpose To analyze the causes and types of complications after unicompartmental knee arthroplasty (UKA) and determine proper prevention and treatment methods. Materials and Methods A total of 1,576 UKAs were performed for osteoarthritis of the knee from January 2002 to December 2014 at one institution. We analyzed complications after UKA retrospectively and investigated proper methods of treatment. Results A total of 89 complications (5.6%) occurred after UKA. Regarding the type of complications after UKA, there were 42 cases of dislocation of the mobile bearing, 23 cases of loosening of the prosthesis, 6 cases of periprosthetic fracture, 3 cases of polyethylene wear, 3 cases of progression of arthritis in the contralateral compartment, 2 cases of medial collateral ligament injury, 2 cases of impingement, 5 cases of infection, 1 case of arthrofibrosis, and 2 cases of failure due to unexplained pain. The most common complication after UKA was mobile bearing dislocation in the mobile-bearing knees and loosening of the prosthesis in the fixed-bearing knees, but polyethylene wear and progression of arthritis were relatively rare. The complications were treated with conversion to total knee arthroplasty in 58 cases and simple bearing change in 21 cases. Conclusions The most common complication after UKA was dislocation of the mobile bearing. When a complication occurs after UKA, appropriate treatment should be performed after accurate analysis of the cause of complication. PMID:26952551

  17. Patellar fractures following total knee arthroplasty: a review.

    PubMed

    Sayeed, Siraj A; Naziri, Qais; Patel, Yashika D; Boylan, Matthew R; Issa, Kimona; Mont, Michael A

    2013-01-01

    There are several periprosthetic complications associated with total knee arthroplasty, with femoral fracture as the most common and patellar fractures as the second most common. Patellar fractures are challenging complications that occur almost exclusively on the resurfaced patellae, although unresurfaced patellar fractures have been reported in literature. The purpose of this study is to describe the anatomy of the patella, the etiology of patellar fractures, and strategies to treat and manage these fractures following knee arthroplasty. The vascular supply to the patella may be compromised during total knee arthroplasty and special care must be taken to preserve it. Vessel injury may result in further complications, most notably avascular necrosis with subsequent fracture. Other patient-, surgical-, and prosthetic-related factors can contribute to increased risk of patellar fracture. Patellar fractures are classified into three types. Type I fractures have an intact extensor mechanism with a stable implant. Type II fractures have a complete disruption of the extensor mechanism with or without a stable implant. Type III fractures, which are further subclassified into types IIIa and IIIb, have an intact extensor mechanism but a loose patellar component. While type IIIa fractures have reasonable remaining bone stock, type IIIb fractures have poor bone stock. Type I patellar fractures may be best managed nonoperatively, but types II and III patellar fractures often necessitate surgical intervention. Patellectomy should be reserved for comminuted fractures, as well as fractures in patients with poor bone stock. Larger prospective randomized studies are necessary to better evaluate the treatment algorithm for patellar fractures following total knee arthroplasty.

  18. Mechanical and kinematic alignment in total knee arthroplasty

    PubMed Central

    Bonzanini, Giancarlo; Chirillo, Danilo; de Tullio, Vito

    2016-01-01

    In the last 10 years many studies have questioned if the strive to mechanical align any knee may pose some problems related to ligament misbalancing that could explain the high rate of disappointed patients, almost 20% in some reports. Proper indication and difference between patient’s and surgeon’s expectations are among the most important one’s but it must be underlined that, there is indeed a sharp difference between normal knee kinematics, prosthetic knee kinematics and arthritic knee kinematics being the last one extremely variable. A so called kinematic alignment has recently been developed in order to improve patient’s knee function and pain control minimizing any surgical gesture focused on ligaments balance. The amount of bone resections may not affect limb alignment but has an important consequence in ligament tension and balance, clinical result and function therefore a measured bone resection technique is essential in order to perform a proper kinematic alignment. Purpose of this paper is to briefly review the different alignment procedures used for TKA and to discuss their definitions, concepts and evidence on outcome. PMID:27162780

  19. Blood Loss Control with Two Doses of Tranexamic Acid in a Multimodal Protocol for Total Knee Arthroplasty

    PubMed Central

    Ortega-Andreu, Miguel; Pérez-Chrzanowska, Hanna; Figueredo, Reyes; Gómez-Barrena, Enrique

    2011-01-01

    Average blood loss after total knee arthroplasty (TKA) usually ranges from 1500 to 1900 cc, including both the postoperative drain and hidden blood loss. This represents about 46% of TKA patients requiring postoperative blood transfusion. Not only the risks of disease transmission but also those of ABO incompatibility, infection due to immunosupression, increased procedure costs, and increased length of hospital stay, are potential problems that foster blood saving strategies. In this study, 71 unilateral TKAs using a multimodal protocol to decrease blood loss were compared to 61 historical cases. Patients in both groups underwent cemented TKA with the same system, surgical technique, and multimodal protocol (MIS approach, plug in the femoral canal, tourniquet removal after wound closure and compressive bandage, analgesic periarticular infiltration with vasoconstrictor, postoperative drain at atmospheric pressure, opened 2 hours after the end of the surgical procedure and removed after 24 hours). The study series incorporated intravenous tranexamic acid (TXA) infusion in 2 doses of 10-15 mg/kg, 15 minutes before tourniquet release and 3 hours later. Results showed no transfusion requirements in the TXA series (0%), with 23/61 (37.7%) transfusions in the control, with an average cost decrease of 240 euros per patient. Visible bleeding in 24h significantly decreased from 553.36 cc (range 50-1500) to 169.72 cc (range 10-480) in the TXA series. As a conclusion, implementing a TXA-based multimodal protocol produced significant decrease in the transfusion rate, visible blood loss, and cost per patient, thus proving effectiveness and efficiency in the surgical management of TKA. PMID:21552468

  20. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty

    PubMed Central

    Yuan, Z. F.; Yin, H.; Xing, D. L.

    2016-01-01

    Objectives Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA. Materials and Methods A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software. Results A total of ten RCTs (1143 patients) were included in this study. All the included studies were randomised and the quality of included studies still needed improvement. The results indicated that, compared with either placebo or the single-dose TXA (IV or IA) group, the combination of IV and IA TXA group had significantly less total blood loss, hidden blood loss, total drain output, a lower transfusion rate and a lower drop in haemoglobin level. There were no statistically significant differences in complications such as wound infection and deep vein thrombosis between the combination group and the placebo or single-dose TXA group. Conclusions Compared with placebo or the single-dose TXA, the combined use of IV and IA TXA provided significantly better results with respect to all outcomes related to post-operative blood loss without increasing the risk of thromboembolic complications in TKA. Cite this article: Z. F. Yuan, H. Yin, W. P. Ma

  1. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.

    PubMed

    Patel, A; Pavlou, G; Mújica-Mota, R E; Toms, A D

    2015-08-01

    Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales. The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future. PMID:26224824

  2. The influence of joint line position on knee stability after condylar knee arthroplasty.

    PubMed

    Martin, J W; Whiteside, L A

    1990-10-01

    Using a special knee-testing device, ten knees obtained at autopsy were subjected to varus-valgus, anterior-posterior, and flexion-rotation analysis in the intact state and after total knee arthroplasty. The ten knees showed no significant change in stability after knee replacement when the joint line was maintained in its natural position. When the femoral component was repositioned 5 mm proximally and 5 mm anteriorly, a significant increase in laxity occurred during midflexion. When the joint line was shifted 5 mm distal and 5 mm posterior to its anatomic location, significant tightening occurred in midrange of motion. Coupled rotation of the tibia with knee flexion was decreased after surgery in all knees with no specific relationship to joint line position. Coupled rotation with varus-valgus testing, however, remained within the normal range through the first 30 degrees of flexion only when the joint line was restored to its normal anatomic position. Stability in condylar knee arthroplasty is in part dependent on position of the joint line. Surgical techniques that rely on restoring the flexion and extension gap without regard to joint line position may result in alteration of varus-valgus or anterior-posterior displacement in midrange flexion. PMID:2208849

  3. A Systematic Literature Review of Three Modalities in Technologically Assisted TKA

    PubMed Central

    Leone, William A.; Elson, Leah C.; Anderson, Christopher R.

    2015-01-01

    In effort to reduce the revision burden of total knee arthroplasty (TKA), industry emphasis has focused on replacing manual techniques—which are subject to variability—with technological implements. Unfortunately, technological innovation often continues before adequate time for critical evaluation has passed. Therefore, the purpose of this descriptive literature review was to collect a large sample of international data and report on the clinical and economic efficacy of three major types of technologically assisted TKA: navigation, patient-specific instrumentation, and sensorized trials. PMID:26664755

  4. Modulation and predictors of periprosthetic bone mineral density following total knee arthroplasty.

    PubMed

    Mau-Moeller, Anett; Behrens, Martin; Felser, Sabine; Bruhn, Sven; Mittelmeier, Wolfram; Bader, Rainer; Skripitz, Ralf

    2015-01-01

    Total knee arthroplasty (TKA) leads to a loss of periprosthetic bone mineral density (BMD). Great importance is attached to the prevention of periprosthetic bone loss with a view to ensuring a long service life of the prosthesis. In order to provide appropriate recommendations for preventive movement therapy measures to combat peri-implant bone loss, it is necessary to know the predictors of periprosthetic BMD. The aim of this study was (1) to determine the change of periprosthetic BMD of the femur and tibia and (2) to analyse the effects of different predictors on periprosthetic BMD. Twenty-three patients with primary TKA were evaluated 10 days and 3 months postoperatively. The data analysis comprised (1) the change in periprosthetic BMD from pretest to posttest and (2) the correlations between BMD and the variables isometric maximum voluntary force, lean mass, physical activity (step count), and BMI using multiple linear regression and structural equation modelling (SEM). BMD of the distal femur was significantly reduced by 19.7% (P = 0.008) 3 months after surgery, while no changes were found in BMD of the tibia. The results of SEM demonstrate that 55% of the BMD variance was explained by the model (χ(2) = 0.002; df = 1; P = 0.96; χ(2)/df = 0.002; RMSEA < 0.01; TLI = 1.5; CFI = 1.0). A significant direct effect was only evidenced by the variable lean mass (β = 0.38; b = 0.15; SE = 0.07; C.R. = 2.0; P = 0.046). It can be assumed that a large muscle mass with accompanying distribution of high mechanical load in the bones can contribute to local changes of periprosthetic BMD. Concrete recommendations for preventing peri-implant bone loss therefore include exercises which have the aim of maintaining or building up muscle mass. PMID:25793194

  5. Validity of physical activity measures in individuals after total knee arthroplasty

    PubMed Central

    Almeida, Gustavo J.; Wert, David M.; Brower, Kelly S.; Piva, Sara R.

    2015-01-01

    OBJECTIVE To determine the concurrent criterion-related validity of two activity monitors in comparison to the criterion method of indirect calorimetry in older adults after total knee arthroplasty (TKA). DESIGN Validation study. SETTING Subjects completed 9 increasingly demanding daily activities in a research laboratory; each activity was performed for 7 minutes, for a total of 80-minutes while the activity monitors and criterion method were used concurrently. PARTICIPANTS Twenty-one subjects, 67% female, mean age 68±7 years old, and BMI 29±4. INTERVENTIONS not applicable. MAIN OUTCOME MEASURE Energy expenditure (EE) in kcal/min measured by accelerometer-based and multisensor-based monitors, and the criterion method. Validity was assessed by paired t-test, intra-class correlation coefficient (ICC), and Bland-Altman plots comparing the measurements from the activity monitors to the criterion method. RESULTS Measurements from the accelerometer-based monitor were significantly lower than those of the criterion method across all walking and non-walking activities. The underestimations ranged from 40% to 100%. The accelerometer-based monitor demonstrated small to moderate agreement compared to the criterion method (ICCs from 0 to 0.38). Measurements from the multisensor-based monitor were significantly lower than the criterion method during several non-walking activities; yet, the differences were minor (2% to 19%). Measurements from the multisensor-based monitor during walking activities were not different compared to the criterion method. The multisensor-based monitor demonstrated moderate to excellent agreement with the criterion method (ICCs from 0.48 to 0.81). CONCLUSION The multisensor-based monitor showed better criterion-related validity than the accelerometer-based monitor, and should be considered as a tool to measure physical activity in individuals after TKA. PMID:25450127

  6. Patient - implant dimension mismatch in total knee arthroplasty: Is it worth worrying? An Indian scenario

    PubMed Central

    Thilak, Jai; George, Melvin J

    2016-01-01

    Background: The correct sizing of the components in both anteroposterior and mediolateral (ML) dimensions is crucial for the success of a total knee arthroplasty (TKA). The size of the implants selected is based on the intraoperative measurements. The currently used TKA implants available to us are based on morphometric measurements obtained from a Western/Caucasian population. Hence, the risk of component ML mismatch is more common in Asian sub-population, as they are of a smaller built and stature. This study aims to look into the following aspects agnitude of the ML mismatch between the femoral component and the patient's anatomical dimension, evaluation of gender variations in distal femur dimensions, and gender-wise and implant-wise correlation of ML mismatch. Materials and Methods: Intraoperatively, the distal femoral dimensions were measured using sterile calipers after removing the osteophytes and compared with the ML dimension of the implant used. ML mismatch length thus obtained is correlated with the various parameters. Results: Males showed larger distal femoral dimensions when compared to females. Males had larger ML mismatch. None of the implants used perfectly matched the patient's anatomical dimensions. Patients with larger mismatch had lower scorings at 2 years postoperative followup. Conclusion: Implant manufacturers need to design more options of femoral implants for a better fit in our subset of patients. The exact magnitude of mismatch which can cause functional implications need to be made out. The mismatch being one of the important factors for the success of the surgery, we should focus more on this aspect. PMID:27746494

  7. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    PubMed

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency. PMID:26021908

  8. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    PubMed

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency.

  9. Continuous Local Infiltration Analgesia for Pain Control After Total Knee Arthroplasty

    PubMed Central

    Sun, Xiao-Lei; Zhao, Zhi-Hu; Ma, Jian-Xiong; Li, Feng-Bo; Li, Yan-Jun; Meng, Xin-Min; Ma, Xin-Long

    2015-01-01

    Abstract A total knee arthroplasty (TKA) has always been associated with moderate to severe pain. As more research is conducted on the use of continuous local infiltration analgesia (CLIA) to manage pain after a TKA, it is necessary to reassess the efficacy and safety of the TKA method. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the efficacy and safety of pain control of CLIA versus placebo after a TKA. In January 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science, Google database, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement criteria. The primary endpoint was the visual analog scale score after a TKA with rest or mobilization at 24, 48, and 72 hours, which represents the effect of pain control after TKA. The complications of infection, nausea, and whether it prolonged wound drainage were also compiled to assess the safety of CLIA. RevMan 5.30 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary. Ten studies involving 735 patients met the inclusion criteria. The meta-analysis revealed that continuous infusion analgesia provided better pain control with rest at 24 hours (mean difference [MD] −12.54, 95% confidence interval [CI] −16.63 to 8.45), and with mobilization at 24 hours (MD −18.27, 95% CI −27.52 to 9.02) and 48 hours (MD −14.19, 95% CI −21.46 to 6.93). There was no significant difference with respect to the visual analog scale score at 48 hours (MD −6.15, 95% CI −13.51 to 1.22, P = 0.10) and 72 hours (MD −3.63, 95% CI −10.43 to 3.16, P = 0.29) with rest and at 72 hours with mobilization (MD −4.25, 95% CI

  10. Radiographic results of an accelerometer-based, handheld surgical navigation system for the tibial resection in total knee arthroplasty.

    PubMed

    Nam, Denis; Cross, Michael; Deshmane, Prashant; Jerabek, Seth; Kang, Michael; Mayman, David J

    2011-10-05

    In total knee arthroplasty (TKA), intramedullary and extramedullary tibial alignment guides are not proven to be highly accurate in obtaining alignment perpendicular to the mechanical axis in the coronal plane. The objective of this study was to determine the accuracy of an accelerometer-based, handheld surgical navigation system in obtaining a postoperative tibial component alignment within 2° of the intraoperative goal in both the coronal and sagittal planes. A total of 151 TKAs were performed by 2 surgeons using a handheld surgical navigation system to perform the tibial resection. Postoperatively, standing anteroposterior hip-to-ankle radiographs and lateral knee-to-ankle radiographs were performed to determine the varus/valgus alignment and the posterior slope of the tibial components relative to the mechanical axis in both the coronal and sagittal planes. Findings showed that 95.3% of the tibial components were placed within 2° of the intraoperative goal in the coronal plane and 96.1% of the components were placed within 2° of the intraoperative goal in the sagittal plane. Overall, mean postoperative lower-extremity alignment was -0.3°±2.1°, with 97% of patients having an alignment within 3° of a neutral mechanical axis. The handheld surgical navigation system improves the accuracy of the tibial resection and subsequent tibial component alignment in TKA. It is able to combine the accuracy of computer-assisted surgery systems with the ease of use and familiarity of conventional, extramedullary alignment systems, and the ability to adjust both the coronal and sagittal alignments intraoperatively may prove clinically useful in TKA.

  11. Liposomal Bupivacaine Suspension Can Reduce Lengths of Stay and Improve Discharge Status of Patients Undergoing Total Knee Arthroplasty.

    PubMed

    Chughtai, Morad; Cherian, Jeffrey Jai; Mistry, Jaydev B; Elmallah, Randa D K; Bennett, Alicia; Mont, Michael A

    2016-04-01

    The purpose of this study was to use a large hospital database to assess: (1) length of hospital stay (LOS) and (2) discharge status among patients undergoing total knee arthroplasty (TKA) with or without the use of a liposomal bupivacaine suspension injection. We utilized an all-payer hospital administrative database from July 1, 2013 to June 30, 2014. We then selected patients age 18 years or older who had an inpatient stay for TKA in the data window based on International Classification of Diseases, Ninth Revision (ICD-9) procedure codes (ICD-9-CM = 81.54), which resulted in 103,152 TKA patients. Patients who had nerve blocks were excluded, which resulted in 94,828 TKA patients. The TKA cohort who received a liposomal bupivacaine suspension consisted of 14,668 patients (9,211 females; 5,457 males) who had a mean age of 66 years, while the TKAs without injections or block consisted of 80,160 patients (49,699 females; 30,461 males) who had a mean age of 66 years. Analyses of LOS were performed using a linear model, controlling for age, sex, race, region, Charlson index, and operating time. Discharge status to home versus rehabilitation or short-term nursing facility was evaluated using logistic regression analysis controlling for the above covariates. The adjusted mean LOS for the injection cohort was significantly shorter at 2.58 days compared with 2.98 days in the no injection cohort. The unadjusted distribution of patients being discharged to home compared with short-term nursing facility or rehabilitation was higher in the injection cohort compared with the cohort who did not receive injections (73.2 vs. 66.6%). Logistic regression analysis demonstrated that there was a higher likelihood of being discharged to home with liposomal bupivacaine. Patients who underwent TKA with liposomal bupivacaine had a significantly shorter LOS and a higher likelihood of being discharged to home. These results suggest that liposomal bupivacaine may represent a promising

  12. Liposomal Bupivacaine Suspension Can Reduce Lengths of Stay and Improve Discharge Status of Patients Undergoing Total Knee Arthroplasty.

    PubMed

    Chughtai, Morad; Cherian, Jeffrey Jai; Mistry, Jaydev B; Elmallah, Randa D K; Bennett, Alicia; Mont, Michael A

    2016-04-01

    The purpose of this study was to use a large hospital database to assess: (1) length of hospital stay (LOS) and (2) discharge status among patients undergoing total knee arthroplasty (TKA) with or without the use of a liposomal bupivacaine suspension injection. We utilized an all-payer hospital administrative database from July 1, 2013 to June 30, 2014. We then selected patients age 18 years or older who had an inpatient stay for TKA in the data window based on International Classification of Diseases, Ninth Revision (ICD-9) procedure codes (ICD-9-CM = 81.54), which resulted in 103,152 TKA patients. Patients who had nerve blocks were excluded, which resulted in 94,828 TKA patients. The TKA cohort who received a liposomal bupivacaine suspension consisted of 14,668 patients (9,211 females; 5,457 males) who had a mean age of 66 years, while the TKAs without injections or block consisted of 80,160 patients (49,699 females; 30,461 males) who had a mean age of 66 years. Analyses of LOS were performed using a linear model, controlling for age, sex, race, region, Charlson index, and operating time. Discharge status to home versus rehabilitation or short-term nursing facility was evaluated using logistic regression analysis controlling for the above covariates. The adjusted mean LOS for the injection cohort was significantly shorter at 2.58 days compared with 2.98 days in the no injection cohort. The unadjusted distribution of patients being discharged to home compared with short-term nursing facility or rehabilitation was higher in the injection cohort compared with the cohort who did not receive injections (73.2 vs. 66.6%). Logistic regression analysis demonstrated that there was a higher likelihood of being discharged to home with liposomal bupivacaine. Patients who underwent TKA with liposomal bupivacaine had a significantly shorter LOS and a higher likelihood of being discharged to home. These results suggest that liposomal bupivacaine may represent a promising

  13. Highly Cross-Linked Versus Conventional Polyethylene in Posterior-Stabilized Total Knee Arthroplasty at a Mean 5-Year Follow-up.

    PubMed

    Meneghini, R Michael; Lovro, Luke R; Smits, Shelly A; Ireland, Philip H

    2015-10-01

    Concerns of highly cross-linked polyethylene (XLPE) in total knee arthroplasty (TKA) exist regarding fatigue resistance and oxidation, particularly in posterior-stabilized (PS) designs. A prospective cohort study of 114 consecutive PS TKAs utilized conventional polyethylene in 50 knees and second-generation annealed XLPE in 64 TKAs. Clinical (Short-Form 36, Knee Society Scores, and LEAS) and radiographic outcomes were evaluated at a mean of 5 years in 103 TKAs. Mean KSS scores were 12 points higher (P=0.01) and SF-36 physical function subset 14 points higher (P=0.005) in the XLPE group. There was no radiographic osteolysis or mechanical failure related to the tibial polyethylene in either group. At 5-year follow-up, no deleterious effects related to highly cross-linked posterior stabilized tibial polyethylene inserts were observed.

  14. Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system.

    PubMed

    Casino, Daniela; Zaffagnini, Stefano; Martelli, Sandra; Lopomo, Nicola; Bignozzi, Simone; Iacono, Francesco; Russo, Alessandro; Marcacci, Maurilio

    2009-04-01

    Interest in the kinematics of reconstructed knees has increased since it was shown that the alteration of knee motion could lead to abnormal wear and damage to soft tissues. We performed intraoperative kinematic measurements using a navigation system to study knee kinematics before and after posterior substituting rotating platform total knee arthroplasty (TKA). We verified intraoperatively (1) if varus/valgus (VV) laxity and anterior/posterior (AP) laxity were restored after TKA; (2) if TKA induced abnormal femoral rollback; and (3) how tibial axial rotation was influenced by TKA throughout the range of flexion. We found that TKA improved alignment in preoperative osteoarthritic varus knees which became neutral after surgery and maintained a neutral alignment in neutral knees. The VV stability at 0 degrees was restored while AP laxity at 90 degrees significantly increased after TKA. Following TKA, the femur had an abnormal anterior translation up to 60 degrees of flexion, followed by a small rollback of 12 +/- 5 mm. TKA influenced the tibia rotation pattern during flexion, but not the total amount of internal/external rotation throughout whole range of flexion, which was preserved after TKA (6 degrees +/- 5 degrees ). This study showed that the protocol proposed might be useful to adjust knee stability at time zero and that knee kinematic outcome during total knee replacement can be monitored by a navigation system.

  15. Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty: A Systematic Review and Meta-analysis.

    PubMed

    Dong, Cui-Cui; Dong, Shu-Ling; He, Fu-Cheng

    2016-03-01

    A total knee arthroplasty (TKA) has always been associated with moderate-to-severe pain. A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate the efficacy and safety of pain control of adductor canal block (ACB) and femoral nerve block (FNB) after TKA.Relevant literatures about the ACB and FNB after TKA for reducing pain were searched from Medline (1996-January, 2015), Embase (1980-January, 2015), PubMed (1980-January, 2015), Web of Science (1980-January, 2015), and The Cochrane Central Register of Controlled Trials. High-quality RCTs and non-RCTs were picked to evaluate the visual analogue scale (VAS) and other outcome. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The software RevMan 5.30 was used for the meta-analysis.Eight literatures fitted into the inclusion criteria. There were no significant differences in VAS score with rest or mobilization at 4, 24, and 48 h between ACB group and FNB group. There were also no significant differences in the strength of quadriceps and adductor, the length of hospital stay, and complications of vomiting and nausea.Present meta-analysis indicated that ACB shows no superiority than FNB group. Both of them can reduce the pain score after TKA. As referred to which method to adopt, it is determined by the preference of the surgeons and anesthesiologists. PMID:27015172

  16. The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

    PubMed Central

    Kömürcü, Erkam; Kaymaz, Burak; Gölge, Umut Hatay; Nusran, Gürdal; Göksel, Ferdi; Şahin, Hasan; Ömür, Dilek; Hancı, Volkan

    2015-01-01

    Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient's mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed. PMID:25793222

  17. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track program

    PubMed Central

    Valeberg, Berit T; Høvik, Lise H; Gjeilo, Kari H

    2016-01-01

    Background and purpose This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03). Interpretation This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings.

  18. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track program

    PubMed Central

    Valeberg, Berit T; Høvik, Lise H; Gjeilo, Kari H

    2016-01-01

    Background and purpose This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03). Interpretation This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings. PMID:27660489

  19. High-impact sports after total knee arthroplasty.

    PubMed

    Mont, Michael A; Marker, David R; Seyler, Thorsten M; Jones, Lynne C; Kolisek, Frank R; Hungerford, David S

    2008-09-01

    Many patients will attempt high-impact loading activities after total knee arthroplasty. This study analyzed the clinical and radiographic results of these high-demand sports patients. A total of 31 patients (33 knees) were identified who participated in high-impact sports on average 4 times per week (range, 1-7 times per week) for a mean of 3.5 hours per week (range, 1 to 10 hours), including jogging, downhill skiing, singles tennis, racquetball, squash, and basketball. At 4 years mean follow-up (range, 2-9 years), 32 of 33 knees had successful clinical and radiographic outcomes. Overall satisfaction was a mean of 9.1 points on a scale of 0 to 10 points. These results indicate that some patients will participate in high-impact sports and enjoy excellent clinical outcomes at a minimum 4 years after surgery.

  20. Influence of fear of movement on total knee arthroplasty outcome.

    PubMed

    Kocic, Mirjana; Stankovic, Anita; Lazovic, Milica; Dimitrijevic, Lidija; Stankovic, Ivona; Spalevic, Marija; Stojiljkovic, Predrag; Milenkovic, Marina; Stojanovic, Zorica; Nikolic, Dejan

    2015-01-01

    RiassuntoLo scopo dello studio è quello di verificare l’incidenza del timore postoperatorio ai movimenti nei pazienti sottoposti ad artroplastica totale del ginocchio (TKA) e di determinare l’associazione di questo timore con i provvedimenti da adottare. Lo studio prospettico riguarda 78 pazienti sottoposti ad TKA primaria per osteoartrite. L’incidenza di timore al movimento è stata detenninata con l’uso della Tampa Scale of Kinesiophobia (TSK). I pazienti sono stati valutati in tre fasi temporali: 2 settimane. 4 settimane e 6 mesi dopo l’intervento chirurgico. In tutte e tre le fasi sono stati valutati il dolore e l’entità della flessione, mentre l’aspetto funzionale è stato preso in considerazione soltanto sei mesi dopo l’intervento, secondo la Oxford knee score 1. Il timore al movimento è stato registrato in 17 pazienti (21,8%). Quelli con maggiore entità di timore hanno dimostrato di conseguire risultati significativamente meno buoni in termini di dolore, grado di flessione e funzionalità rispetto a quelli con limitata paura. Miglioramento del dolore e della flessione sono stati progressivamente conseguiti nel tempo in entrambi i gruppi, ma i risultati migliori vengono raggiunti nel gruppo con minore paura al movimento. Lo studio ha dimostrato che la paura postoperatoria alla motilità si associa significativamente con il dolore, l’entità della flessione e la funzionalità del ginocchio. Altri Autori haImo rilevato che il timore preoperatorio alla motilità del ginocchio fa prevedere limitazioni funzionali postoperatorie. In conclusione il timore della motilità si rileva in una significativa proporzione dei pazienti dopo TKA e si associa con gonalgia, e minore flessione e funzionalità, e dunaue questa paura rappresenta un richio di scarsi risultati dopo artroplastica totale del ginocchio.

  1. Compartment syndrome after total knee arthroplasty: regarding a clinical case.

    PubMed

    Pinheiro, Ana Alexandra da Costa; Marques, Pedro Miguel Dantas Costa; Sá, Pedro Miguel Gomes; Oliveira, Carolina Fernandes; da Silva, Bruno Pombo Ferreira; de Sousa, Cristina Maria Varino

    2015-01-01

    Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

  2. DIAGNOSTIC AND THERAPEUTIC ARTHROSCOPY IN SYMPTOMATIC PATIENTS AFTER KNEE ARTHROPLASTY

    PubMed Central

    Severino, Fabricio Roberto; Souza, Clodoaldo José Duarte de; Severino, Nilson Roberto

    2015-01-01

    Objectives: Assess the worthiness of arthroscopy in investigating and treating knee pain after arthroplasty unexplained by clinical and subsidiary examinations. Methods: Among 402 patients submitted to total or unicompartimental arthroplasty between September 2001 and April 2007 at a public university hospital, 17 presented with pain on prosthetic articulation, without clear diagnosis by clinical, X-ray, laboratory, scintiscan, or nuclear magnetic resonance tests. All patients were submitted to arthroscopy and symptoms were assessed by using the Lysholm scale, comparing pre-and post-arthroscopy periods. Peroperative findings have been recorded. Results: The procedure was effective for pain relief in 14 of 17 patients (82.35%). The median for Lysholm scale climbed from 36 points before arthroscopy to 94 points after the procedure (p < 0.001). Most of the patients (12) were arthroscopically diagnosed with fibrosis known as “cyclop”; on the remaining five patients, anterior synovitis was found. All patients were treated by resection. Conclusions: Knee arthroscopy after arthroplasty in patients presenting unclear persistent pain shows localized arthrofibrosis (“cyclops”) or synovitis, which can be treated by using the same procedure, resulting in pain relief. PMID:27022517

  3. Innovations in Total Knee Arthroplasty: Improved Technical Precision, But Unclear Clinical Benefits.

    PubMed

    Keeney, James A

    2016-07-01

    Total knee arthroplasty has been an effective treatment for advanced degenerative joint disease. Traditional knee designs and surgical approaches have resulted in consistently high performance, but some patients may remain dissatisfied after their surgery. Several surgical innovations, including accelerometer-based navigation, patient-specific instrumentation, and robotic-assisted total knee arthroplasty, have been developed to improve the accuracy and precision of total knee arthroplasty surgery, with anticipated secondary benefits of improved functional outcomes and implant survivorship. This article reviews the current status of these technologies as reported in contemporary orthopedic literature. [Orthopedics. 2016; 39(4):217-220.]. PMID:27434889

  4. Alpine Skiing With total knee ArthroPlasty (ASWAP): effects on gait asymmetries.

    PubMed

    Pötzelsberger, B; Lindinger, S J; Stöggl, T; Buchecker, M; Müller, E

    2015-08-01

    The aim of the study was to examine the effect of a 12-week recreational skiing intervention on functional gait performance in people with unilateral total knee arthroplasty (TKA). Twenty-three older adults (71 ± 5 years) were assigned to the intervention (IG) or control group (CG). Test time and ground reaction forces (GRF) were recorded at pre- and post-intervention and in the retention phase during functional gait tests. Ground contact was recorded bilaterally and divided into the weight acceptance and push-off phases. In IG, a faster stair descent time (16%) was observed at post-test with no further change at the retention test. The asymmetry indices for all analyzed variables were decreased in stair descent and during weight acceptance in stair ascent and level walking without further changes between post- and retention test. The reduced asymmetries occurred mainly because of increased loading of the operated leg. Most variables were unchanged in CG. Similar to the force data, the asymmetry index for temporal stride characteristics was reduced in all stair descent variables. These results demonstrate that alpine skiing as a leisure-time activity has a beneficial effect on gait performance and leads to a more balanced load distribution between the legs during daily activities.

  5. Extramedullary guides versus portable, accelerometer-based navigation for tibial alignment in total knee arthroplasty: a randomized, controlled trial: winner of the 2013 HAP PAUL award.

    PubMed

    Nam, Denis; Cody, Elizabeth A; Nguyen, Joseph T; Figgie, Mark P; Mayman, David J

    2014-02-01

    Extramedullary (EM) tibial alignment guides have demonstrated a limited degree of accuracy in total knee arthroplasty (TKA). The purpose of this study was to compare the tibial component alignment obtained using a portable, accelerometer-based navigation device versus EM alignment guides. One hundred patients were enrolled in this prospective, randomized controlled study to receive a TKA using either the navigation device, or an EM guide. Standing AP hip-to-ankle and lateral knee-to-ankle radiographs were obtained at the first, postoperative visit. 95.7% of tibial components in the navigation cohort were within 2° of perpendicular to the tibial mechanical axis, versus 68.1% in the EM cohort (P<0.001). 95.0% of tibial components in the navigation cohort were within 2° of a 3° posterior slope, versus 72.1% in the EM cohort (P=0.007). A portable, accelerometer-based navigation device decreases outliers in tibial component alignment compared to conventional, EM alignment guides in TKA.

  6. Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data

    PubMed Central

    Kotela, Andrzej; Lorkowski, Jacek; Kucharzewski, Marek; Wilk-Frańczuk, Magdalena; Śliwiński, Zbigniew; Frańczuk, Bogusław; Łęgosz, Paweł  ; Kotela, Ireneusz

    2015-01-01

    Total knee arthroplasty (TKA) is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA. PMID:26301241

  7. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic

    PubMed Central

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0–3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  8. Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study.

    PubMed

    Sun, Peng-Fei; Jia, Yu-Hua

    2012-03-01

    We prospectively evaluated a consecutive series of 56 patients with unicompartmental knee arthritis who underwent unicompartmental knee replacement or total knee arthroplasty and received an average of 52months of follow-up. These patients were enrolled in a prospective randomized clinical trial. There were no significant differences in the pre-operative parameters of both groups. All the patients were followed up and evaluated preoperatively and yearly, the data was collected and statistical analysis was performed. At an average of 52months after surgery the mean Knee Society score was 80.5 (range: 70-100) and 78.9 (range: 70-87) for Unicompartmental knee replacement and total knee arthroplasty, mean range of postoperative motion for TKA is 115(0)±4(0) and 117(0)±7(0) for the group of UKA, with the numbers available, the difference between the two groups could not be shown to be significant. The average operation time of UKA and TKA is 68.8min and 81.5min(p<0.01). Blood drainage after operation had a significant difference between the two groups (p<0.01). Seven cases of UKA were converted to total knee arthroplasty - all of them within the first 2years of starting the procedure and all of them in relatively young patients. From the study we concluded that mobile bearing UKA can obtain similar clinical effect with TKA by surgeons who have the adequate training and experience. After the learning curve UKA should be considered the primary treatment option for unicompartmental knee arthritis.

  9. Results of a Second-generation Constrained Condylar Prosthesis in Complex Primary and Revision Total Knee Arthroplasty: A Mean 5.5-Year Follow-up

    PubMed Central

    Ye, Chen-Yi; Xue, De-Ting; Jiang, Shuai; He, Rong-Xin

    2016-01-01

    Background: The application of second-generation constrained condylar knee (CCK) prostheses has not been widely studied. This retrospective study was carried out to evaluate the clinical and radiographic outcomes of a second-generation CCK prosthesis for complex primary or revision total knee arthroplasty (TKA). Methods: In total, 51 consecutive TKAs (47 patients) were performed between June 2003 and June 2013 using second-generation modular CCK prostheses. The follow-up was conducted at 3rd day, 1st, 6th, and 12th months postoperatively and later annually. Anteroposterior (AP), lateral, skyline, and long-standing AP radiographs of the affected knees were taken. The Hospital for Special Surgery (HSS) Knee Score, the Knee Society Knee Score (KSKS), the Knee Society Function Score (KSFS), and range of motion (ROM) were also recorded. Heteroscedastic two-tailed Student's t-tests were used to compare the HSS score and the Knee Society score between primary and revision TKAs. A value of P < 0.05 was considered statistically significant. Results: Four knees (two patients) were lost to follow-up, and 47 knees (31 primary TKAs and 16 revision TKAs) had a mean follow-up time of 5.5 years. The mean HSS score improved from 51.1 ± 15.0 preoperatively to 85.3 ± 8.4 points at the final follow-up (P < 0.05). Similar results were observed in terms of the KSKS and KSFS, which improved from 26.0 ± 13.0 to 80.0 ± 12.2 and from 40.0 ± 15.0 to 85.0 ± 9.3 points, respectively (P < 0.05). No significant difference in the HSS, KSKS, KSFS, or ROM was found between primary and revision TKAs (P > 0.05). Two complications were observed in the revision TKA group (one intraoperative distal femur fracture and one recurrence of infection) while one complication (infection) was observed in the primary TKA group. No prosthesis loosening, joint dislocation, patella problems, tibial fracture, or nerve injury were observed. Radiolucent lines were observed in 4% of the knees without progressive

  10. Computer-assisted surgery simulations and directed practice of total knee arthroplasty: educational benefits to the trainee.

    PubMed

    Myden, C A; Anglin, C; Kopp, G D; Hutchison, C R

    2012-01-01

    Orthopaedic residents typically learn to perform total knee arthroplasty (TKA) through an apprenticeship-type model, which is a necessarily slow process. Surgical skills courses, using artificial bones, have been shown to improve technical and cognitive skills significantly within a couple of days. The addition of computer-assisted surgery (CAS) simulations challenges the participants to consider the same task in a different context, promoting cognitive flexibility. We designed a hands-on educational intervention for junior residents with a conventional tibiofemoral TKA station, two different tibiofemoral CAS stations, and a CAS and conventional patellar resection station, including both qualitative and quantitative analyses. Qualitatively, structured interviews before and after the course were analyzed for recurring themes. Quantitatively, subjects were evaluated on their technical skills before and after the course, and on a multiple-choice knowledge test and error detection test after the course, in comparison to senior residents who performed only the testing. Four themes emerged: confidence, awareness, deepening knowledge and changed perspectives. The residents' attitudes to CAS changed from negative before the course to neutral or positive afterwards. The junior resident group completed 23% of tasks in the pre-course skills test and 75% of tasks on the post-test (p<0.01), compared to 45% of tasks completed by the senior resident group. High-impact educational interventions, promoting cognitive flexibility, would benefit trainees, attending surgeons, the healthcare system and patients.

  11. Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-analysis.

    PubMed

    Jiang, Xuan; Ma, Xin-Long; Ma, Jian-Xiong

    2016-08-01

    The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case-control studies met the inclusion criteria. The current meta-analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0.01), drainage volume (P < 0.01), transfusion rate (P < 0.01) and units transfused (P = 0.006). There were no significant differences in length of stay (P = 0.66), operation time (P = 0.81) or and incidence of adverse effects such as infection (P = 0.42), deep venous thrombosis (DVT) (P = 0.88) and pulmonary embolism (PE) (P = 0.11). Our results show that i.v. administration of TXA in simultaneous bilateral TKA reduces postoperative drops in hemoglobin concentration, drainage volume, and transfusion requirements and does not prolong length of stay or operation time. Moreover, no adverse effects, such as infection, DVT or PE, were associated with TXA.

  12. Alpine Skiing With total knee ArthroPlasty (ASWAP): physical self-concept, pain, and life satisfaction.

    PubMed

    Amesberger, G; Müller, E; Würth, S

    2015-08-01

    Physical self-concept in the elderly is assumed to be structured in terms of different domains and to contribute substantially to life satisfaction. However, little is known about the role of the physical self-concept in older persons that are engaged in physical activity while suffering from typical age-related impairments or chronic diseases. The present study aimed to investigate the structure of physical self-concept in a group of older persons with total knee arthroplasty (TKA), its development throughout a 12-week skiing intervention, and its importance to life satisfaction. Factor analyses of the present data reveal that the physical self-concept consists of four dimensions addressing strength, flexibility/coordination, endurance, and sportiness. One higher order factor extracted by hierarchical factor analyses reflects a global physical self-concept. The 12-week skiing intervention had no substantial impact in terms of an improvement of self-concept. Life satisfaction is best predicted by positive changes in the subjective ratings between pre- and post-test (i.e., global physical self-concept, flexibility and coordination, and perceived sportiness) and not by objective physical performance (isokinetic strength, endurance, or coordination). Results support the assumption that physical self-concept of older people with TKA is only marginally sensitive to a 12-week skiing intervention.

  13. Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-analysis.

    PubMed

    Jiang, Xuan; Ma, Xin-Long; Ma, Jian-Xiong

    2016-08-01

    The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case-control studies met the inclusion criteria. The current meta-analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0.01), drainage volume (P < 0.01), transfusion rate (P < 0.01) and units transfused (P = 0.006). There were no significant differences in length of stay (P = 0.66), operation time (P = 0.81) or and incidence of adverse effects such as infection (P = 0.42), deep venous thrombosis (DVT) (P = 0.88) and pulmonary embolism (PE) (P = 0.11). Our results show that i.v. administration of TXA in simultaneous bilateral TKA reduces postoperative drops in hemoglobin concentration, drainage volume, and transfusion requirements and does not prolong length of stay or operation time. Moreover, no adverse effects, such as infection, DVT or PE, were associated with TXA. PMID:27627710

  14. Two-Year Incidence and Predictors of Future Knee Arthroplasty in Persons with Symptomatic Knee Osteoarthritis: Preliminary Analysis of Longitudinal Data from the Osteoarthritis Initiative

    PubMed Central

    Kong, Xiangrong; Jiranek, William A.

    2009-01-01

    Objective There is little evidence to guide physicians when discussing future likelihood of knee arthroplasty with patients who have symptomatic knee osteoarthritis. Data from Osteoarthritis Initiative (OAI) was used to determine the incidence of and predictors for knee arthroplasty. Methods OAI data were collected on a sample of 778 persons aged 45 to 79 years with symptomatic knee osteoarthritis. An extensive set of measurements were obtained at baseline and persons were followed for 2 years to identify who underwent knee arthroplasty. Random forest analysis was used to identify optimal variables that discriminate among those who did and those who did not undergo knee arthroplasty. Results The two year incidence of knee arthroplasty in the cohort was 3.7% (95%CI, 2.6%, 5.3%). Because of the low number of knee arthroplasty procedures, the predictor analysis was preliminary in nature. The analysis identified several variables that could be used to assist in identifying patients at future risk for knee arthroplasty. Conclusion For persons at high risk of knee arthroplasty, the two year incidence of knee arthroplasty is very low. The most powerful predictors were those that accounted for disease severity and functional loss. These data could assist physicians in advising patients with knee osteoarthritis on future surgical care. PMID:19419874

  15. A Randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty: 5–10 year follow-up

    PubMed Central

    2012-01-01

    Background The primary purpose of this randomized controlled trial (RCT) was to compare knee-specific outcomes (stiffness, pain, function) between patellar retention and resurfacing up to 10 years after primary total knee arthroplasty (TKA). Secondarily, we compared re-operation rates. Methods 38 subjects with non-inflammatory arthritis were randomized at primary TKA surgery to receive patellar resurfacing (n = 21; Resurfaced group) or to retain their native patella (n = 17; Non-resurfaced group). Evaluations were performed preoperatively, one, five and 10 years postoperatively by an evaluator who was blinded to group allocation. Self-reported knee-specific stiffness, pain and function, the primary outcomes, were measured by the Western Ontario McMaster Osteoarthritis Index (WOMAC). Revision rate was determined at each evaluation and through hospital record review. Results 30 (88%) and 23 (72%) of available subjects completed the five and 10-year review respectively. Knee-specific scores continued to improve for both groups over the 10-years, despite diminishing overall health with no significant group differences seen. All revisions occurred within five years of surgery (three Non-resurfaced subjects; one Resurfaced subject) (p = 0.31). Two revisions in the Non-resurfaced group were due to persistent anterior knee pain. Conclusions We found no differences in knee-specific results between groups at 5–10 years postoperatively. The Non-resurfaced group had two revisions due to anterior knee pain similar to rates reported in other studies. Knee-specific results provide useful postoperative information and should be used in future studies comparing patellar management strategies. ClinicalTrials.gov identifier NCT01500252 PMID:22676495

  16. The influence of total knee arthroplasty geometry on mid-flexion stability: an experimental and finite element study.

    PubMed

    Clary, Chadd W; Fitzpatrick, Clare K; Maletsky, Lorin P; Rullkoetter, Paul J

    2013-04-26

    Fluoroscopic evaluation of total knee arthroplasty (TKA) has reported sudden anterior translation of the femur relative to the tibia (paradoxical anterior motion) for some cruciate-retaining designs. This motion may be tied to abrupt changes in the femoral sagittal radius of curvature characteristic of traditional TKA designs, as the geometry transitions from a large load-bearing distal radius to a smaller posterior radius which can accommodate femoral rollback. It was hypothesized that a gradually reducing radius may attenuate sudden changes in anterior-posterior motion that occur in mid-flexion with traditional discrete-radius designs. A combined experimental and computational approach was employed to test this hypothesis. A previously developed finite element (FE) model of the Kansas knee simulator (KKS), virtually implanted with multiple implant designs, was used to predict the amount of paradoxical anterior femoral slide during a simulated deep knee bend. The model predicted kinematics demonstrated that incorporating a gradually reducing radius in mid-flexion reduced the magnitude of paradoxical anterior translation between 21% and 68%, depending on the conformity of the tibial insert. Subsequently, both a dual-radius design and a modified design incorporating gradually reducing radii were tested in vitro in the KKS for verification. The model-predicted and experimentally observed kinematics exhibited good agreement, while the average experimental kinematics demonstrated an 81% reduction in anterior translation with the modified design. The FE model demonstrated sufficient sensitivity to appropriately differentiate kinematic changes due to subtle changes in implant design, and served as a useful pre-clinical design-phase tool to improve implant kinematics. PMID:23499227

  17. Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

    PubMed Central

    2010-01-01

    Background There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices and outcomes in groups of individuals identified as key stakeholders. Methods Separate focus groups and interviews were conducted with patients (THA or TKA within past year) and three health professional groups: allied health professionals (AHPs), orthopaedic surgeons, and other physicians, in Canada and the United States. Pairs of moderators led the focus groups using a standardized discussion guide. Discussions were audiotaped and transcribed verbatim. A content analysis within and across groups identified key themes. Results Eleven focus groups and eight interviews took place in six sites. Patients (n = 32) varied in age, stage of recovery, and surgical and rehabilitation experiences. Health professionals (n = 44) represented a range of disciplines, practice settings and years of experience. Six key themes emerged: 1) Let's talk (issues related to patient-health professional and inter-professional communication); 2) Expecting the unexpected (observations about unanticipated recovery experiences); 3) It's attitude that counts (the importance of the patient's positive attitude and participation in recovery); 4) It takes all kinds of support (along the continuum of care); 5) Barriers to recovery (at patient, provider and system levels), and 6) Back to normal (reflecting diversity of expected outcomes). Patients offered different, but overlapping views compared to health professionals regarding rehabilitation practices and outcomes following THA and TKA. Conclusion Results will inform subsequent phases of guideline development and ensure stakeholders

  18. Predictors of bone loss in revision total knee arthroplasty.

    PubMed

    Bloomfield, Michael R; Klika, Alison K; Lee, Ho H; Joyce, David M; Mehta, Priyesh; Barsoum, Wael K

    2010-03-01

    Revision total knee arthroplasty (RTKA) requires preoperative planning to enable the reconstruction of bony deficiencies. The objective of this project was to identify predictors of bone loss management at RTKA based on the preoperative failure mode and patient demographics known preoperatively. We retrospectively reviewed 245 consecutive RTKA procedures in which the same revision knee system was utilized. Patient demographic and treatment data were recorded, and locations of bone loss were identified based on the reconstructive management. We identified significant predictors for use of femoral augments at all four positions. Several predictors significantly predisposed to use of a thick (>19 mm) polyethylene; however, no predictors of tibial augments were significant. Although the reconstruction of bone loss is primarily based on the intraoperative assessment, these findings may provide additional information to help the surgeon prepare for difficult revision procedures. PMID:20812582

  19. Diagnosis, Causes and Treatments of Instability Following Total Knee Arthroplasty

    PubMed Central

    Chang, Moon Jong; Lim, Hyungtae; Lee, Na Rae

    2014-01-01

    Instability following total knee arthroplasty is one of the major causes of revision surgery. In most cases, it can be prevented by using an appropriate prosthesis and a good surgical technique. Particular attention should be given to confirmation of diagnosis for which thorough history taking, complete physical examination and radiographic evaluation are needed. With regard to treatment, identification of the etiology of instability is crucial for establishing proper treatment plans; instability would persist without correction of the cause of the initial instability. For successful revision surgery, balanced medio-lateral and flexion-extension gaps should be achieved. Constrained or rotating-hinge total knee prosthesis should also be considered as an alternative option for certain subsets of patients with instability. PMID:24944970

  20. Bilateral custom-fit total knee arthroplasty in a patient with poliomyelitis.

    PubMed

    Tardy, Nicolas; Chambat, Pierre; Murphy, Colin G; Fayard, Jean-Marie

    2014-09-01

    In limbs affected by poliomyelitis, total knee arthroplasty results in satisfactory pain relief. However, the risk of failure is high, especially if the preoperative quadriceps power is low. Therefore, treating osteoarthritis in the current patient represented a challenging procedure. A 66-year-old man presented with tricompartmental osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee. He walked with a bilateral knee recurvatum of 30° and a grade 1 quadriceps power. The authors treated both knees with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel. Clinical scores showed good results 1 year postoperatively, especially on the subjective data of quality of life and function. At follow-up, radiographs showed good total knee arthroplasty positioning on the right side and a small mechanical loosening at the end of the tibial keel on the left side. Only 5 studies (Patterson and Insall; Moran; Giori and Lewallen; Jordan et al; and Tigani et al) have reported total knee arthroplasty results in patients with poliomyelitis. This study reports an original case of bilateral custom-fit hinged total knee arthroplasty in a patient with poliomyelitis. To the authors' knowledge, this is the first report of this type of procedure in the literature. The key point is the degree of recurvatum that is needed to allow walking, avoiding excessive constraints on the implants that can lead to early mechanical failure.

  1. Tranexamic Acid Reduces Hidden Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Comparative Study and Meta-Analysis

    PubMed Central

    Huang, Guang-Ping; Jia, Xu-Feng; Xiang, Zhou; Ji, Yong; Wu, Guo-Yong; Tang, Yi; Li, Jian; Zhang, Jun

    2016-01-01

    Background To explore the efficacy of tranexamic acid (TXA) on reducing hidden blood loss (HBL) in total knee arthroplasty (TKA) by conducting a comparative study and meta-analysis. Material/Methods A total of 108 patients underwent TKA was equally distributed to experimental and control groups. The only difference between two groups was the administrations of 15 mg of TXA mixed in 100 mL normal saline for experimental group and 100 mL of normal saline for control group. The volumes of blood loss, red blood loss (RBL) were recorded, calculated and analyzed. Stata 12.0 software was applied for data analysis. Results The intraoperative and postoperative blood loss volume in experimental group were remarkably reduced compared with those in control group (intraoperative: 105.1±12.1 mL vs. 185.5±20.3 mL, P<0.001; postoperative: 220.7±16.8 mL vs. 290.5±22.4 mL, P<0.001). Accordingly, the control group had significantly higher transfusion rate than experimental group (3.7% vs.25.9%, P=0.001). Our results also found that both the measured and hidden RBL were obviously reduced in experimental group compared with control group (measured RBL: 96.9±11.8 mL vs. 135.2±13.5 mL, P<0.001; hidden RBL: 170.8±37.2 mL vs. 364.2±41.5 mL, P<0.001). Furthermore, meta-analysis confirmed that TXA can notably decrease HBL (SMD=2.68, 95%CI=1.55~3.80, P<0.001). Conclusions TXA can significantly reduce the intraoperative and postoperative blood loss and HBL, therefore decreasing the transfusion need in TKA. PMID:26961597

  2. A2-3: Impact of Mild Chronic Kidney Disease Stage on Outcomes after Total Hip or Knee Arthroplasty

    PubMed Central

    Graham, Jove; Deegan, Brian; Bowen, Thomas; Richard, Raveesh; Perkins, Robert; Foltzer, Michael

    2014-01-01

    Background/Aims Dialysis and kidney transplantation adversely impact outcomes of total hip or knee arthroplasty (THA, TKA), but complication rates have not been reported for patients with less advanced stages of chronic kidney disease (CKD). Surgeons lack the data necessary to have informed discussions regarding anticipated outcomes of joint replacement for these patients. Methods We retrospectively reviewed electronic health records of 779 adults with stages 1, 2, and 3 CKD not requiring dialysis or transplantation who underwent THA or TKA from 2004–2011, to assess infection, revision, 90-day readmission and mortality rates. Patients with less than 12 months follow-up, open fracture, prior joint surgery, pregnancy, or acute kidney injury were excluded. Chi-square analysis and Cox survival analysis compared these outcomes between the stage 1–2 and stage 3 groups, stratified by joint replaced (THA vs TKA). All models adjusted for age, sex and BMI at surgery. Results No statistically different rates of revision or infection between Stage 3 vs. Stages 1–2 were seen, although there was a trend toward increased infections in Stage 3. THA patients with Stage 3 showed a significantly increased mortality rate compared to Stage 1–2 THA patients (HR 3.40, 95% CI = 1.25–9.23, P = 0.02). Conclusions CKD affects nearly 15% of the U.S. population many of whom undergo joint replacement. End stage kidney disease (patients post-transplant or on hemodialysis) has been consistently associated with increased rates of infection and revision in excess of our observed outcomes, but the overall rate of infection/revision in our study population was only slightly higher than reported rates in the general population (2–7% vs. 1–2%, respectively). CKD should not preclude joint replacement, but these data can help clinicians engage in meaningful informed discussions with patients with mild kidney disease regarding risks for infection, revision and death following joint

  3. Can Optimism, Pessimism, Hope, Treatment Credibility and Treatment Expectancy Be Distinguished in Patients Undergoing Total Hip and Total Knee Arthroplasty?

    PubMed Central

    Haanstra, Tsjitske M.; Tilbury, Claire; Kamper, Steven J.; Tordoir, Rutger L.; Vliet Vlieland, Thea P. M.; Nelissen, Rob G. H. H.; Cuijpers, Pim; de Vet, Henrica C. W.; Dekker, Joost; Knol, Dirk L.; Ostelo, Raymond W.

    2015-01-01

    Objectives The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting. Methods Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA) (Total N = 361; 182 THA; 179 TKA), completed the Life Orientation Test-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models. Results The results of the theory driven confirmatory factor analysis showed that a five factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactor model in which (besides the 5 separate factors) a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. All specific factors, except for the hope factor, showed to explain a substantial amount of variance beyond the general factor. Conclusion Based on our primary analyses we conclude that optimism, pessimism, hope, treatment credibility and treatment expectancy are distinguishable in THA and TKA patients. Postdoc, we determined that all constructs, except hope, showed substantial specific variance, while also sharing some general variance. PMID:26214176

  4. Can knees kneel? Kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty.

    PubMed

    Hassaballa, M A; Porteous, A J; Newman, J H; Rogers, C A

    2003-06-01

    This study investigates patients' perception of kneeling ability before and at 1 and 2 years after total, unicompartmental knee replacement (UKR) and patellofemoral knee replacement (PFR), for osteoarthritis. Kneeling is an important function of the knee joint required for many daily activities and inability to kneel after knee surgery is a frequent cause of dissatisfaction. Data were prospectively collected on 253 knees. A kneeling score was obtained by analysis of the relevant section of the Oxford knee score. Scores were obtained pre-operatively and at 1 and 2 years post-operatively. Absolute values and change following surgery were recorded. Correlations with pain and other knee functions were also made. Kneeling ability prior to surgery was poor in all 3 groups (80% found it extremely difficult or impossible to kneel) and improved in all groups after surgery (20% had little or no difficulty to kneel at 2 years). Kneeling ability was best in UKR and worst in PFR. These results suggest that kneeling ability in osteoarthritic patients is poor but improves with knee arthroplasty surgery, however the majority of patients will still have difficulty in kneeling.

  5. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

    PubMed Central

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

  6. Review of Arthroscopic and Histological Findings Following Knee Inlay Arthroplasty.

    PubMed

    Markarian, Gregory G; Kambour, Michael T; Uribe, John W

    2016-01-01

    The phenomenon of cartilage rim loading in defects exceeding the threshold diameter of 10 mm is well documented. Contoured defect fill off-loads the perimeter and counteracts further delamination and progression of defects. When biological procedures have failed, inlay arthroplasty follows these concepts. The human biological response to contoured metallic surface implants has not been described. Four patients underwent non-implant-related, second-look arthroscopy following inlay arthroplasty for bi- (n=3) and tricompartmental (n=1) knee arthrosis without subchondral bone collapse. Arthroscopic probing of the implant-cartilage interface of nine prosthetic components did not show signs of implant-cartilage gap formation, loosening, or subsidence. The implant periphery was consistently covered by cartilage confluence leading to a reduction of the original defect size diameter. Femoral condyle cartilage flow appeared to have more hyaline characteristics. Trochlear cartilage flow showed greater histological variability and less organization with fibrocartilage and synovialized scar tissue. This review reconfirmed previous basic science results and demonstrated effective defect fill and rim off-loading with inlay arthroplasty.

  7. Review of Arthroscopic and Histological Findings Following Knee Inlay Arthroplasty.

    PubMed

    Markarian, Gregory G; Kambour, Michael T; Uribe, John W

    2016-01-01

    The phenomenon of cartilage rim loading in defects exceeding the threshold diameter of 10 mm is well documented. Contoured defect fill off-loads the perimeter and counteracts further delamination and progression of defects. When biological procedures have failed, inlay arthroplasty follows these concepts. The human biological response to contoured metallic surface implants has not been described. Four patients underwent non-implant-related, second-look arthroscopy following inlay arthroplasty for bi- (n=3) and tricompartmental (n=1) knee arthrosis without subchondral bone collapse. Arthroscopic probing of the implant-cartilage interface of nine prosthetic components did not show signs of implant-cartilage gap formation, loosening, or subsidence. The implant periphery was consistently covered by cartilage confluence leading to a reduction of the original defect size diameter. Femoral condyle cartilage flow appeared to have more hyaline characteristics. Trochlear cartilage flow showed greater histological variability and less organization with fibrocartilage and synovialized scar tissue. This review reconfirmed previous basic science results and demonstrated effective defect fill and rim off-loading with inlay arthroplasty. PMID:27082884

  8. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture.

    PubMed

    Lee, Yong Seuk; Min, Byoung-Hyun; Han, Kyeong-Jin; Cho, Jae Ho; Han, Seung Hwan; Lee, Doo-Hyung; Oh, Kyung Soo

    2010-05-12

    We report a case of simultaneous reconstruction of a quadriceps tendon rupture after total knee arthroplasty (TKA) and neglected Achilles tendon rupture, which occurred before TKA with an ipsilateral hamstring autograft. A 64-year-old woman presented with persistent right knee pain. She also had right heel pain and had received multiple steroid injections at the knee joint and heel. On examination, she showed osteoarthritis in the medial and lateral compartments of the knee joint and an Achilles tendon rupture in the ipsilateral limb. There was skin dimpling and the proximal portion of tendon was migrated. We performed TKA, and the postoperative course was satisfactory. She returned 3 months postoperatively, however, with skin dimpling around the suprapatellar area and weakness of knee extension. Her ankle symptoms were also aggravated because she could not use the knee joint freely. We performed simultaneous reconstruction of the quadriceps tendon and the Achilles tendon using an ipsilateral hamstring autograft.Hamstring autograft offers a good alternative treatment option for rupture repair, particularly with concommitant ruptures of multiple sites when primary repair is not possible or the viability of repaired tissue is poor.

  9. A Novel Non-Invasive Adjuvant Biomechanical Treatment for Patients with Altered Rehabilitation after Total Knee Arthroplasty: Results of a Pilot Investigation

    PubMed Central

    Kosashvili, Yona; Segal, Ganit; Shemesh, Shai; Velkes, Steven; Mor, Amit; Debi, Ronen; Bernfeld, Benjamin; Elbaz, Avi

    2015-01-01

    Background Many factors contribute to suboptimal results after total knee arthroplasty (TKA) but little is known regarding the value of postsurgical rehabilitation after TKA. We examined the effects of an enhanced closed kinematic chain exercises program (AposTherapy) on gait patterns and clinical outcomes among patients with a lack of progress in their postsurgical rehabilitation. Methods Twenty-two patients were prospectively followed during the study. Gait spatiotemporal parameters were measured at the initial evaluation, after 15 minutes of therapy, and after 3 months of therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the short form (SF) 36 health survey were completed by patients before treatment and after 3 months of treatment. Results The WOMAC and SF-36 scores improved significantly after 3 months of treatment. Gait velocity, single limb support, and step length of the operated leg improved significantly even after a single 15 minutes treatment. Normal gait velocity was observed in 36% of patients after 3 months of treatment. Conclusions A physiotherapy program that included enhanced closed kinematic chain biomechanical therapy was beneficial for patients who experienced a suboptimal rehabilitation course after TKA. PMID:26217465

  10. Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty

    PubMed Central

    Cho, Chul-Hyun; Lee, Kyung-Jae; Son, Eun-Seok; Lee, Si-Wook; Lee, Suk-Joong; Lim, Kyung Hwan

    2014-01-01

    Purpose To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA). Materials and Methods We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed. Results Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05). Conclusions The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding. PMID:25505706

  11. Effect of Closed Suction Drain on Blood Loss and Transfusion Rates in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Study

    PubMed Central

    Shetty, Gautam M.; Gupta, Vinay; Saxena, Purvi; Singh, Nidhi

    2016-01-01

    Purpose Simultaneous bilateral total knee arthroplasty (TKA) is associated with excessive blood loss and morbidity arising from postoperative reduction in hemoglobin (Hb). The purpose of this prospective randomized study was to determine if drains have any effect on blood loss, postoperative reduction in Hb levels and transfusion rates compared to no drainage in simultaneous bilateral TKAs. Materials and Methods Two hundred and thirty patients who underwent simultaneous bilateral TKA by a single surgeon were randomly allotted to drain or no-drain group (n=115 in each group). Postoperative Hb level, blood loss volume and transfusion rate were compared between the two groups. Results The mean postoperative Hb level (p=0.38), blood loss volume (p=0.33) and transfusion rate (p=0.52) in the drain group were not significantly different compared to the no-drain group. No statistical difference was found in terms of complications, readmissions and mortality rates between the two groups. Conclusions No significant difference was observed in the two groups with respect to blood loss and blood transfusion. Non-drainage does not offer an advantage over drainage with respect to conserving blood in simultaneous bilateral TKA. PMID:27595073

  12. Comparison of Blood Loss between Neutral Drainage with Tranexamic Acid and Negative Pressure Drainage without Tranexamic Acid Following Primary Total Knee Arthroplasty

    PubMed Central

    Lee, Gwang Chul; Lee, Sang Hong; Pak, Chi-Hyoung; Park, Sang Ha; Jung, Sung

    2016-01-01

    Purpose There are many methods to reduce massive bleeding during total knee arthroplasty (TKA). In our study, tranexamic acid and neutral drainage were used to decrease total blood loss. Materials and Methods The study was performed on 97 TKA patients from March 2012 to January 2013. In the study group, tranexamic acid was administered and neutral drainage was applied. The study group had group I (unilateral, n=29) and group III (bilateral, n=17). The control group had group II (unilateral, n=35) and group IV (bilateral, n=16). Results In group I, the drainage volume on the 1st and 2nd postoperative days and the total drainage decreased with statistical significance (p<0.05). Between group III and group IV, group III had less drainage volume. In group III, the drainage volume on the 1st postoperative day and total drainage volume decreased statistically significantly (p<0.05). Between groups I and II, total blood loss showed no statistically significant difference, whereas between groups III and IV, the value was significantly different. Conclusions Intravenous administration of tranexamic acid with neutral drainage for 3 postoperative hours is a recommendable method because it can be helpful in reducing total blood loss in bilateral TKA. PMID:27595072

  13. Comparison of Blood Loss between Neutral Drainage with Tranexamic Acid and Negative Pressure Drainage without Tranexamic Acid Following Primary Total Knee Arthroplasty

    PubMed Central

    Lee, Gwang Chul; Lee, Sang Hong; Pak, Chi-Hyoung; Park, Sang Ha; Jung, Sung

    2016-01-01

    Purpose There are many methods to reduce massive bleeding during total knee arthroplasty (TKA). In our study, tranexamic acid and neutral drainage were used to decrease total blood loss. Materials and Methods The study was performed on 97 TKA patients from March 2012 to January 2013. In the study group, tranexamic acid was administered and neutral drainage was applied. The study group had group I (unilateral, n=29) and group III (bilateral, n=17). The control group had group II (unilateral, n=35) and group IV (bilateral, n=16). Results In group I, the drainage volume on the 1st and 2nd postoperative days and the total drainage decreased with statistical significance (p<0.05). Between group III and group IV, group III had less drainage volume. In group III, the drainage volume on the 1st postoperative day and total drainage volume decreased statistically significantly (p<0.05). Between groups I and II, total blood loss showed no statistically significant difference, whereas between groups III and IV, the value was significantly different. Conclusions Intravenous administration of tranexamic acid with neutral drainage for 3 postoperative hours is a recommendable method because it can be helpful in reducing total blood loss in bilateral TKA.

  14. Three-step sequential management for knee arthroplasty after severe ballistic injury: Two cases.

    PubMed

    Herry, Y; Boucher, F; Neyret, P; Ferry, T; Lustig, S

    2016-02-01

    Management of knee bone loss after gunshot trauma requires a multidisciplinary approach. Two cases of knee arthroplasty after devastating ballistic trauma are reported. Treatment comprised several steps: sampling, bone resection, reinforced cement spacer, latent sepsis control, and prosthetic reconstruction. The patients showed no neurovascular disorder and had a functioning extensor mechanism. At follow-up of at least 2 years, results were satisfactory, with return to unaided walking and mean International Knee Society (IKS) score improved from 18 to 59 points. In light of these observations, knee reconstruction arthroplasty using a sequential strategy can provide satisfactory functional outcome after severe ballistic trauma. PMID:26774900

  15. Three-step sequential management for knee arthroplasty after severe ballistic injury: Two cases.

    PubMed

    Herry, Y; Boucher, F; Neyret, P; Ferry, T; Lustig, S

    2016-02-01

    Management of knee bone loss after gunshot trauma requires a multidisciplinary approach. Two cases of knee arthroplasty after devastating ballistic trauma are reported. Treatment comprised several steps: sampling, bone resection, reinforced cement spacer, latent sepsis control, and prosthetic reconstruction. The patients showed no neurovascular disorder and had a functioning extensor mechanism. At follow-up of at least 2 years, results were satisfactory, with return to unaided walking and mean International Knee Society (IKS) score improved from 18 to 59 points. In light of these observations, knee reconstruction arthroplasty using a sequential strategy can provide satisfactory functional outcome after severe ballistic trauma.

  16. Computer Assisted Mechanical Axis and Kinematic TKA

    PubMed Central

    McEwen, Peter; Mahoharan, Varaguna

    2016-01-01

    Introduction: Total knee arthroplasty (TKA) has traditionally been and largely continues to be aligned mechanically, that being with a neutral coronal plane mechanical tibiofemoral axis and a joint line orientated at 900 to this axis. Femoral component rotation is set by gap balancing or by externally rotating 30 from any of a number femoral reference lines. This produces a rectangular flexion gap and relaxes patellar tracking. Kinematic alignment (KA) is an alternative technique that aims to restore premorbid alignment, joint orientation and ligament tension. The basic premise for this technique is based on evidence that the medial and lateral femoral condyles consistently equate to cylinders of equal or near equal size and that therefore with a fixed radius, cruciate retaining implant, matched distal femoral, posterior femoral and proximal tibial resections, accounting for bone and cartilage already lost will reproduce the premorbid joint line and restore native premorbid kinematics. Femoral rotation is therefore referenced off the prearthritic posterior condylar axis (PCA) that is on average internally rotated to the AP axis. Kinematic alignment therefore has the potential to challenge patellar tracking, increase patellar load and potentially increase patellar complications. Method: Case control study – level of evidence III-2. Between November 2012 and June 2013 the senior author completed 104 consecutive computer assisted (CAS) kinematically aligned total knee arthroplasties (TKA) with a cruciate retaining, fixed bearing, single radius implant. The results of these surgeries were compared with the results of 91 consecutive CAS mechanically aligned TKA done between November 2011 and October 2012 using the same navigation system and implant Implant sizing and positioning as well as gap measurement and ligament balance was done with computer assistance in all cases. Data was collected prospectively and analysed retrospectively. Results: The Oxford Knee Score

  17. Resection arthroplasty for failed patellar components.

    PubMed

    Lavernia, Carlos J; Alcerro, Jose C; Drakeford, Michael K; Tsao, Audrey K; Krackow, Kenneth A; Hungerford, David S

    2009-12-01

    A total of 1,401 primary total knee arthroplasties (TKA) were reviewed; 44 (3.2%) had at least the patellar component revised. Nine of these knees (eight patients) had insufficient bone stock to allow reimplantation of another patellar component. Clinical data on the nine knees were obtained with recent follow-up evaluation, review of their medical records and radiographs. Evaluation included Hospital for Special Surgery (HSS) scores. Average follow-up was 4 years and 7 months, 2-year range (2 months to 8 years and 4 months). Common factors found in these nine knees included: thin patella after primary TKR status, osteoarthritis, good range of motion and patella alta. Results were good to excellent in seven knees and fair in two. The untoward associations with patellectomy such as quadriceps lag, extension weakness and anterior knee pain were not experienced. Resection of the patellar component, without reimplantation, is an acceptable alternative in revision TKA lacking adequate remaining bone stock.

  18. RELATIONSHIP BETWEEN PATELLAR HEIGHT AND RANGE OF MOTION AFTER TOTAL KNEE ARTHROPLASTY

    PubMed Central

    Júnior, Lúcio Honório de Carvalho; Soares, Luiz Fernando Machado; Gonçalves, Matheus Braga Jacques; Pereira, Marcelo Lobo; Lessa, Rodrigo Rosa; Costa, Lincoln Paiva

    2015-01-01

    To evaluate whether, after total knee arthroplasty, there is any correlation between patellar height and range of motion (ROM) achieved by patients six months after the operation. Methods: Forty-five patients who underwent total knee arthroplasty were assessed at least 12 months after the operation (total of 54 knees). The maximum and minimum ROM of all the knees was recorded under fluoroscopy, along with patellar height according to the Blackburne and Peel ratio. Two possible correlations were evaluated: patellar height and ROM; and patellar height and ROM variation from before to after the operation. Results: A correlation was found between patellar height and postoperative ROM (p = 0.04). There was no correlation between patellar height and ROM variation (p = 0.182). Conclusion: After total knee arthroplasty, the lower the patella is, the worse the ROM is. PMID:27027029

  19. Changes in Femoral Posterior Condylar Offset, Tibial Posterior Slope Angle, and Joint Line Height after Cruciate-Retaining Total Knee Arthroplasty

    PubMed Central

    Song, Sang Jun; Kim, Kang Il; Jeong, Ho Yeon

    2016-01-01

    Purpose Changes in the femoral posterior condylar offset (PCO), tibial posterior slope angle (PSA), and joint line height (JLH) after cruciate-retaining total knee arthroplasty (CR-TKA) were evaluated to determine their influence on the flexion angle. Materials and Methods A total of 125 CR-TKAs performed on 110 patients were retrospectively reviewed. Pre- and postoperative PCO, PSA, and JLH were compared using correlation analysis. Independent factors affecting the postoperative flexion angle of the knee were analyzed. Results The PCO was 28.2±2.0 mm (range, 24.5 to 33.1 mm) preoperatively and 26.7±1.8 mm (range, 22.2 to 31.2 mm) postoperatively (r=0.807, p<0.001). The PSA was 10.4°±4.9° (range, 1.6° to 21.2°) preoperatively and decreased to 4.9°±2.0° (2.2° to 10.7°) postoperatively (r=–0.023, p=0.800). The JLH was 16.2±3.0 mm (range, 10.2 to 27.5 mm) preoperatively and 16.1±2.6 mm (range, 11.1 to 24.8 mm) postoperatively (r=0.505, p<0.001). None of the independent factors affected the flexion angle (p>0.291). Conclusions Although the PCO and JLH did not change significantly after CR-TKA, the PSA decreased by 5.5° with a small range of variation. Restoration of the PCO and JLH could promote optimization of knee flexion in spite of the decreased PSA after CR-TKA. PMID:26955610

  20. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    PubMed

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

  1. A new approach to implant alignment and ligament balancing in total knee arthroplasty focussing on joint loads.

    PubMed

    Zimmermann, Frauke; Schwenninger, Christoph; Nolten, Ulrich; Firmbach, Franz Peter; Elfring, Robert; Radermacher, Klaus

    2012-08-01

    Preservation and recovery of the mechanical leg axis as well as good rotational alignment of the prosthesis components and well-balanced ligaments are essential for the longevity of total knee arthroplasty (TKA). In the framework of the OrthoMIT project, the genALIGN system, a new navigated implantation approach based on intra-operative force-torque measurements, has been developed. With this system, optical or magnetic position tracking as well as any fixation of invasive rigid bodies are no longer necessary. For the alignment of the femoral component along the mechanical axis, a sensor-integrated instrument measures the torques resulting from the deviation between the instrument's axis and the mechanical axis under manually applied axial compression load. When both axes are coaxial, the resulting torques equal zero, and the tool axis can be fixed with respect to the bone. For ligament balancing and rotational alignment of the femoral component, the genALIGN system comprises a sensor-integrated tibial trial inlay measuring the amplitude and application points of the forces transferred between femur and tibia. Hereby, the impact of ligament tensions on knee joint loads can be determined over the whole range of motion. First studies with the genALIGN system, including a comparison with an imageless navigation system, show the feasibility of the concept. PMID:22868781

  2. Effects of Group-Based Exercise on Range of Motion, Muscle Strength, Functional Ability, and Pain During the Acute Phase After Total Knee Arthroplasty: A Controlled Clinical Trial.

    PubMed

    Hiyama, Yoshinori; Kamitani, Tsukasa; Wada, Osamu; Mizuno, Kiyonori; Yamada, Minoru

    2016-09-01

    Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (P<.001) and quadriceps strength (P<.001) were significantly better in the G-EXE group than those in the I-EXE group at discharge. The pain intensity improved more in the G-EXE group than in the I-EXE group at discharge (P<.001). However, the changes in the timed up-and-go scores were not significantly different. Conclusion Patients performing G-EXE in addition to regular ambulation and activities-of-daily-living exercises demonstrated greater changes in knee ROM, quadriceps strength, and knee pain than those performing I-EXE in addition to regular ambulation and activities-of-daily-living exercises. The nonrandomized, asynchronous design decreases certainty of these findings. Level of Evidence Therapy, level 2b

  3. Open Periprosthetic Patellar Fracture after Total Knee Replacement

    PubMed Central

    Masmoudi, Karim; Grissa, Yamen; Benzarti, Sofien; Cheikhrouhou, Hassen; Mensi, Zied

    2016-01-01

    Introduction: Periprosthetic patellar fracture after total knee arthroplasty (TKA) is a rare complication. Their management can be very challenging with unpredictable results. Literature analysis showed few articles about this complication, but no publication has described the management of open patella fracture around total knee arthroplasty. Case Presentation: We report a unique case of an open patellar fracture above a total knee arthroplasty, sustained by a 56-year-old female patient. Conclusion: Despite the poor outcome of operative management in patellar periprosthetic fracture, this approach should be considered for acute and post traumatic fractures in young patients with a good remaining bone stock.

  4. Clinical experience with novel oral anticoagulants for thromboprophylaxis after elective hip and knee arthroplasty.

    PubMed

    Messerschmidt, Cory; Friedman, Richard J

    2015-04-01

    Anticoagulant medications help to reduce the risk of thromboembolic events after total hip arthroplasty and total knee arthroplasty. Traditionally, this has been accomplished with medications, such as low-molecular-weight heparin and warfarin. However, these traditional anticoagulants possess a variety of shortcomings that leave much room for improvement. A new class of oral anticoagulants is now available, and present a more convenient option for safe and efficacious thromboprophylaxis in post arthroplasty patients, particularly in the outpatient setting. This review focuses on the direct thrombin inhibitor, dabigatran, and the selective factor Xa inhibitors, rivaroxaban and apixaban, and the clinical data to date about their use in total hip arthroplasty and total knee arthroplasty patients. PMID:25767271

  5. Differences in Anatomy and Kinematics in Asian and Caucasian TKA Patients: Influence on Implant Positioning and Subsequent Loading Conditions in Mobile Bearing Knees

    PubMed Central

    Kim, Tae Kyun; Miehlke, Rolf K.; Grupp, Thomas M.

    2014-01-01

    The objective of our study was to determine the mechanical stress conditions under tibiofemoral loading with an overlay of knee kinematics in deep flexion on two different mobile bearing designs in comparison to in vivo failure modes. This study investigates the seldom but severe complication of fatigue failure of polyethylene components at mobile bearing total knee arthroplasty designs. Assuming a combination of a floor-based lifestyle and tibial malrotation as a possible reason for a higher failure rate in Asian countries we developed a simplified finite element model considering a tibiofemoral roll-back angle of 22° and the range of rotational motion of a clinically established floating platform design (e.motion FP) at a knee flexion angle of 120° in order to compare our results to failure modes found in retrieved implants. Compared to the failure mode observed in the clinical retrievals the locations of the occurring stress maxima as well as the tensile stress distribution show analogies. From our observations, we conclude that the newly introduced finite element model with an overlay of deep knee flexion (lateral roll-back) and considerable internally rotated tibia implant positioning is an appropriate analysis for knee design optimizations and a suitable method to predict clinical failure modes. PMID:25538943

  6. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  7. Posterior Cruciate Ligament Function Following Total Knee Arthroplasty

    PubMed Central

    Emodi, George J; Callaghan, John J; Pedersen, Douglas R; Brown, Thomas D

    1999-01-01

    One of the most commonly cited reasons for retaining the posterior cruciate ligament (PCL) during total knee arthroplasty is to preserve femoral rollback and theoretically improve extensor mechanism efficiency (lengthening the moment arm). This study was undertaken to assess PCL function in this regard and to delineate the effects of joint line elevation that can be manipulated intraoperatively by the surgeon. The anterior movement of tibiofemoral contact following PCL resection at flexion angles 60 degrees demonstrated the beneficial effect of the PCL on extensor function. This anterior translation and the concomitant increases in quadriceps tendon load and patellofemoral contact pressures were consistently observed. This study demonstrated that small changes of the joint line position significantly influenced PCL strain and knee kinematics. In order to preserve the desired functions that would be lost with an overly lax PCL and to avoid the potential adverse effects of an overly tight PCL (posterior edge loading and increased tibiofemoral contact), the surgeon should make every effort to restore the preoperative joint line. If this is not possible, consideration should be given to posterior cruciate recession or use of a posterior cruciate substituting design. PMID:10847521

  8. A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament

    PubMed Central

    Lee, Seung-Yup; Yang, Jae-Hyuk; Lee, Yong-In

    2016-01-01

    Introduction Numerous methods of medial soft tissue release for severe varus deformity during total knee arthroplasty (TKA) have been reported. These include tibial stripping of the superficial medial collateral ligament (MCL), pie-crusting technique, and medial epicondylar osteotomy. However, there are inherent disadvantages in these techniques. Authors hereby present a novel quantitative method: femoral origin release of the medial collateral ligament (FORM). Surgical Technique For medial tightness remaining even after the release of the deep MCL and semimembranosus, the FORM is initiated with identification of the femoral insertion area of the MCL with the knee in flexion. Starting from the most posterior part of the femoral insertion, one third of the MCL femoral insertion is released from its attachment. If necessary, further sequential medial release is performed. Materials and Methods Seventeen knees that underwent the FORM were evaluated for radiological and clinical outcomes. Results Regardless of the extent of the FORM, no knees showed residual valgus instability at 24 weeks after surgery. Conclusions As the FORM is performed in a stepwise manner, fine adjustment during medial release might be beneficial to prevent inadvertent over-release of the medial structures of the knee. PMID:27274473

  9. Malassezia species infection of the synovium after total knee arthroplasty surgery

    PubMed Central

    Leylabadlo, Hamed Ebrahimzadeh; Zeinalzadeh, Elham; Akbari, Najibeh Asl Rahnemaii; Kafil, Hossein Samadi

    2016-01-01

    Infection is a serious complication after implantation of total knee-prostheses. However, fungal infection is rarely found in periprosthetic joints, and in most reports, the infecting organism is a Candida species. This is a case report of infection after left knee total arthroplasty caused by Malassezia species. The patient is still undergoing antifungal therapy with voriconazole and is still being followed-up. To the authors’ knowledge, the present case is the first report of Malassezia species in a patient after total knee arthroplasty. PMID:27730027

  10. Use of a turndown quadriceps tendon flap for rupture of the patellar tendon after total knee arthroplasty.

    PubMed

    Lin, Po-Chun; Wang, Jun-Wen

    2007-09-01

    Patellar tendon rupture is a devastating complication after total knee arthroplasty. The results of surgical treatment of this complication were discouraging in most of the reports. We describe a case of rupture of patellar tendon 7 weeks after total knee arthroplasty treated with a turndown quadriceps flap and circumferential wiring. Two years and 6 months after operation, the patient had no extension lag of the knee and knee flexion to 110 degrees .

  11. The use of gabapentin in the management of postoperative pain after total knee arthroplasty: A PRISMA-compliant meta-analysis of randomized controlled trials.

    PubMed

    Han, Chao; Li, Xiao-Dan; Jiang, Hong-Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2016-06-01

    Pain management after total knee arthroplasty (TKA) varies and has been widely studied in recent years. Some randomized controlled studies have carried out to evaluate the effects of gabapentin on pain relief after TKA. However, no solid result was made about it. The purpose of this Meta-Analysis of Randomized Controlled Trials (RCTs) was to estimate the overall effect of pain control of gabapentin versus placebo after a TKA. An electronic-based search using the following databases: PubMed, EMBASE, Ovid MEDLINE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trial from 1966 to June 2015. RCTs involving gabapentin and placebo for total knee arthroplasty were included. The meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Six trials with 859 participants met the inclusion criteria. The primary endpoint was cumulative narcotic consumption and the visual analog scale scores at 12 hours, 24 hours, and 48 hours, postoperatively. The knee flexion degree and treatment side effects were also compiled to evaluate the safety of gabapentin. After testing for the heterogeneity and publication bias among studies, data were aggregated for random-effects modeling when necessary. There was a significant decrease in morphine consumption at 12 hours (MD = -4.69, 95% CI: -7.18 to -2.21, P = 0.0002), 24 hours (MD = -5.30, 95% CI: -9.94 to -0.66, P = 0.03), and 48 hours (MD = -17.80, 95% CI: -31.95 to -3.64, P = 0.01), respectively. Compared with the control group, the rate of pruritus was less in the gabapentin group (RR 0.20, 95% CI 0.10 to 0.38, P = 0.00). In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. More high-quality large randomized controlled trials with long follow

  12. Can intra-articular therapies prior to total knee arthroplasty increase the risk of periprosthetic infection?

    PubMed

    Yeo, Q Y; Lye, D C; Sathappan Ss, S S

    2015-02-01

    Intra-articular therapies, such as steroid injection, viscosupplement injection and acupuncture, are common non-surgical options for patients with osteoarthritis of the knee. With any intra-articular injection or acupuncture procedure, there is a potential for inoculation with bacteria leading to possible knee infection. The authors report a patient who incurred an acute infection found after a total knee arthroplasty attributed to prior acupuncture procedure done as part of conservative treatment.

  13. Characterization of hip and knee arthroplasties and factors associated with infection☆

    PubMed Central

    da Silva Pinto, Cibele Zdebsky; Alpendre, Francine Taporosky; Stier, Christiane Johnscher Niebel; Maziero, Eliane Cristina Sanches; de Alencar, Paulo Gilberto Cimbalista; de Almeida Cruz, Elaine Drehmer

    2015-01-01

    Objective To characterize arthroplasty procedures, calculate the surgical infection rate and identify related risk factors. Methods This was a retrospective cohort study. Data on operations performed between 2010 and 2012 were gathered from documental sources and were analyzed with the aid of statistical software, using Fisher's exact test, Student's t test and the nonparametric Mann–Whitney and Wilcoxon tests. Results 421 total arthroplasty procedures performed on 346 patients were analyzed, of which 208 were on the knee and 213 on the hip. It was found that 18 patients (4.3%) were infected. Among these, 15 (83.33%) were reoperated and 2 (15.74%) died. The prevalence of infection in primary total hip arthroplasty procedures was 3%; in primary total knee arthroplasty, 6.14%; and in revision of total knee arthroplasty, 3.45%. Staphylococcus aureus was prevalent. The length of the surgical procedure showed a tendency toward being a risk factor (p = 0.067). Conclusion The prevalence of infection in cases of primary total knee arthroplasty was greater than in other cases. No statistically significant risk factors for infection were identified. PMID:27218082

  14. Analgesic Efficacy of Adductor Canal Block in Total Knee Arthroplasty: A Meta-analysis and Systematic Review.

    PubMed

    Jiang, Xu; Wang, Qian-Qian; Wu, Cheng-Ai; Tian, Wei

    2016-08-01

    The aim of this meta-analysis and systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of adductor canal block (ACB) for early postoperative pain management in patients undergoing total knee arthroplasty (TKA). Relevant manuscripts comparing ACB with saline or femoral nerve block (FNB) in TKA patients were searched for in the databases of PubMed, EMBASE, and Cochrane library. The outcomes assessed included cumulative analgesic consumption, pain at rest or during movement, ability to ambulate, quadriceps strength, and complications (nausea, vomiting or sedation). For continuous outcomes, pooled effects were measured using weighted mean difference (WMD) or standard mean difference (SMD), together with 95% confidence intervals (CIs). For outcomes without sufficient data for synthesis, qualitative interpretation of individual studies was summarized. Finally, 11 RCTs involving 675 patients met the inclusion criteria. The pooled results showed that ACB resulted in less postoperative analgesic consumption than saline (WMD, -12.84 mg; 95% CI, -19.40 mg to -6.27 mg; P < 0.001) and less pain at rest or during activity. No conclusions could be drawn regarding ability to ambulate and quadriceps strength, because only one study reported these variables. Most studies comparing ACB and FNB reported similar effects on postoperative analgesic consumption (WMD, -0.56 mg; 95% CI, -8.05 mg to 6.93 mg; P = 0.884) and pain; however, ability to ambulate and quadriceps strength were significantly better with ACB (SMD, 0.99; 95% CI, 0.04-1.94; P = 0.041). Additionally, ACB did not increase the rate of complications. Our results suggest that, compared with saline, ACB decreases analgesic consumption and offers short-term advantages in terms of pain relief. Compared with FNB, ACB was associated with better ability to ambulate and quadriceps strength. PMID:27627711

  15. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

    PubMed Central

    Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M.

    2016-01-01

    Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to