WorldWideScience

Sample records for arthroplasty replacement knee

  1. Total Knee Replacement Arthroplasty with Buechel and Pappas Knee: Minimum 2-Year Follow-up

    OpenAIRE

    Moon, Kyoung Ho; Hong, Seung Hyun; Hong, Taek Ho

    2015-01-01

    Background Clinical and radiologic evaluation and analyses of the surgeries using Buechel and Pappas (B-P) knee implants. Methods The study was conducted on 60 patients who underwent 94 total knee replacement arthroplasty with B-P knee implants from May 2009 to December 2010. The results were compared to the results of 41 patients who underwent 60 knee joint surgeries using NexGen-LPS implants from January 2008 to August 2009. Results The American Knee Society score of the B-P knee group incr...

  2. Total Knee Replacement (Arthroplasty) (Beyond the Basics)

    Science.gov (United States)

    ... demonstrate that 80 to 90 percent of total knees will last between 15 to 20 years, early failures may occur due to a variety of reasons. These include loosening of the implants, infection, fractures of the bone around the implants, and instability. ...

  3. Dabigatran Etexilate, A Novel Oral Direct Thrombin Inhibitor, for Preventing Thromboembolic Events After Knee Replacement Arthroplasty

    OpenAIRE

    Yegane A; Farahini H; Shahhoseini Gh; Moghtadaee M; Rajabpour S

    2012-01-01

    Background: Dabigatran etexilate is one of the few direct thrombin inhibitors with anti-coagulant activities and the following distinctive features: taken orally, no need to closely monitor for complications, and no need for regular dose adjustments. Relying on the above mentioned valuable advantages, dabigatran etexilate can be considered as a premier choice for the prevention of venous thromboembolism after knee replacement arthroplasty. Methods: Forty five patients undergoing 50 knee repla...

  4. Bicompartmental knee arthroplasty

    OpenAIRE

    Sabatini, Luigi; Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect o...

  5. Fracture of the Anterior Locking Flange of a Total Knee Arthroplasty Polyethylene Liner Presenting with Pain following Knee Replacement

    Science.gov (United States)

    Jeavons, Richard; Dowen, Daniel; Rushton, Paul; Ryan, Daniel; Gill, Peter

    2014-01-01

    Introduction: Fracture of the modern polyethylene insert of a total knee arthroplasty is rare. We describe the first case of a fractured anterior locking flange of the commonly used Depuy Press-fit Condylar (PFC) Sigma prosthesis. Case Report: The 80 year old Caucasian gentleman presented 8 years following previously uncomplicated and successful primary total knee replacement with pain, swelling and symptoms of instability of the knee. He was able to sublux his knee posteriorly using his hamstrings. Dissociation of the liner was evident on radiographs. He underwent revision of the polyethylene liner. It was evident during the revision that the anterior locking flange of the polyethylene liner had fractured allowing it to dissociate from the tibial tray. At 12 months following this revision he continues to do well and has similar range of movement and function to prior to the episode. This cause of the failure is not clear. Conclusion: Surgeons should be aware of this rare complication when assessing a painful or unstable total knee replacement. PMID:27298962

  6. Medium-term evaluation of total knee arthroplasty without patellar replacement

    Directory of Open Access Journals (Sweden)

    José Wanderley Vasconcelos

    2013-06-01

    Full Text Available OBJECTIVE: To mid-term evaluate patients who were submitted to total knee arthroplasty without patellar resurfacing. METHODS: It was realized a retrospective cross-sectional study of patients who were submitted to total knee arthroplasty without patellar resurfacing. In all patients clinical examination was done based on the protocol of the Knee Society Scoring System, which assessed pain, range of motion, stability, contraction, knee alignment and function, and radiological evaluation. RESULTS: A total of 36 patients were evaluated. Of these, 07 were operated only on left knee, 12 only on right knee and 17 were operated bilaterally, totaling 53 knees. Ages ranged from 26 to 84 years. Of the 53 knees evaluated, 33 (62.26% had no pain. The maximum flexion range of motion averaged 104.7°. No knee had difficulty in active extension. As to the alignment for anatomical axis twelve knees (22.64% showed deviation between 0° and 4° varus. Thirty-nine (75.49% knees showed pace without restriction and the femorotibial angle ranged between 3° varus and 13° valgus with an average of 5° valgus. The patellar index ranged from 0.2 to 1.1. CONCLUSION: Total knee arthroplasty whitout patellar resurfacing provides good results in mid-term evaluation.

  7. Introduction of total knee arthroplasty in Lithuania

    OpenAIRE

    Tarasevicius, Sarunas; Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. ...

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

    Directory of Open Access Journals (Sweden)

    Prefontaine Paul

    2008-11-01

    Full Text Available Abstract 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 ( 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 protocol for providing care after a TKA.

  9. 99mTc-HMPAO-labelled leucocyte scintigraphy in the diagnosis of infection after total knee replacement arthroplasty

    International Nuclear Information System (INIS)

    This study was performed to evaluate the usefulness of 99mTc-HMPAO-labelled leucocyte scintigraphy for diagnosing prosthetic infection after total knee replacement arthroplasty without the aid of following bone marrow scintigraphy. The study subjects were 25 prostheses of 17 patients (one man and 16 women, mean age: 65 years) who had total knee replacement arthroplasty. After injection of 99mTc-HMPAO-labelled leucocyte, the whole body planar and knee SPECT images were obtained in all patients. The subjects were classified into three groups according to clinical suspicion of prosthetic infection: Group A (n=11) with high suspicion of infection; Group B (n=6) with equivocal suspicion of infection, and Group C (n=8) with asymptomatic contralateral prostheses. Final diagnosis of infection was based on surgical, histological and bacteriological data and clinical follow-up. Infection was confirmed in 13 prostheses (11 in Group A and 2 in Group B). All prostheses in Group A were true positive. There were two true positive, one false positive and three true negative in Group B, and six true negatives and two false positive in Group C. Overall sensitivity, specificity, and accuracy for diagnosis of the infected knee prosthesis were 100%, 75% and 88%, respectively. 99mTc-HMPAO-labelled leucocyte scintigraphy is a sensitive method for the diagnosis of infected knee prosthesis. However, false positive uptakes even in asymptomatic prosthesis suggest that bone marrow scintigraphy may be needed to achieve improved specificity

  10. Bicompartmental knee arthroplasty

    Science.gov (United States)

    Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  11. Bicompartmental knee arthroplasty.

    Science.gov (United States)

    Sabatini, Luigi; Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  12. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... Institute. We're going to be doing an MIS total knee arthroplasty with the Zimmer mobile bearing ... this point. And there is many recipes for MIS knee surgery as there are surgeons. What’s kind ...

  13. Introduction of total knee arthroplasty in Lithuania

    Science.gov (United States)

    Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790

  14. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  15. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... the NexGen® LPS-Flex Mobile and LPS-Mobile Bearing Knees March 5, 2009 Welcome to this "OR ... MIS total knee arthroplasty with the Zimmer mobile bearing knee. We invite all of you who have ...

  16. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... NexGen® LPS-Flex Mobile and LPS-Mobile Bearing Knees March 5, 2009 Welcome to this "OR Live" ... re going to be doing an MIS total knee arthroplasty with the Zimmer mobile bearing knee. We ...

  17. Knee Muscles Power Evolution in Patients with Total Knee Arthroplasty

    OpenAIRE

    Ileana Monica BORDA; IRSAY Laszlo; Rodica UNGUR; Viorela CIORTEA; Ioan ONAC; Alina SUSMAN; Liviu POP

    2012-01-01

    Purpose: To measure changes in muscle power from before to 6 months after total knee arthroplasty and to compare outcomes with those from a control group of healthy adults. Material and Methods: 26 patients who underwent a total knee replacement were compared with 12 healthy age-matched adults in a prospective cohort study. Patients’ assessment was performed preoperatively, as well as at 1, 2 and 6 months postoperatively, by the isokinetic method. Healthy adults were assessed once by the same...

  18. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series To use the sharing features on ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  19. Prevention of infection after knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2010-01-01

    expert opinions.The evidence of the effectiveness of intravenous prophylaxis with antibiotics in knee arthroplasty on a high level of evidence is also missing. The recommendations use evidence on the intravenous antibiotic prophylaxis transferred from RCT in hip arthroplasty to the arthroplasty of all joints including knee replacement. Moreover, no evidence is found for differences in the effectiveness between various antibiotics in knee arthroplasty. The presented report finds strong hints for the effectiveness of antibiotics in cement in addition to the intravenous prophylaxis; however, evidence of the effectiveness may be accepted only for operating rooms without clean-air measures. Discussion: The conclusiveness of the results from non-RCT and from studies for clinically non-relevant endpoints is relatively low. The determined evidence from studies for other clinical indications may be generally transferred to knee replacement operations. Conclusions: No proposal to change the recommendations of the Robert Koch Institute with respect to hygiene interventions and intravenous antibiotic prophylaxis can be made from the presented analysis. Also, no recommendations on the selection of certain antibiotic can be derived from the analysed data. The use of antibiotics in cement in addition to the intravenous prophylaxis may be generally recommended. The cost-effectiveness of different interventions to prevent infections in knee arthroplasty remains unclear. There are no signs for concern regarding any ethical, social and/or legal consequences in the use of interventions to prevent infections in knee arthroplasty.

  20. The Cruciate Ligaments in Total Knee Arthroplasty.

    Science.gov (United States)

    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. PMID:27327919

  1. Knee joint replacement

    Science.gov (United States)

    Knee joint replacement is a surgery to replace a knee joint with a man-made joint. The artificial joint is called a prosthesis . ... cartilage and bone are removed from the knee joint. Man-made pieces are then placed in the ...

  2. Total Knee Replacement

    Science.gov (United States)

    ... following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other ... to the final success of your surgery. To learn more about the full value of total knee ...

  3. Knee joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series To use the sharing features ... 4 out of 4 Normal anatomy Overview The knee is a complex joint. It contains the distal ...

  4. Revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty.

    Science.gov (United States)

    Memişoğlu, Kaya; Müezzinoğlu, U Sefa; Kesemenli, Cumhur Cevdet

    2010-01-01

    The Gunston polycentric knee arthroplasty, first designed and performed by Frank Gunston in 1971, is the first prosthesis considering the natural knee biomechanics. Although the polycentric knee arthroplasty showed encouraging results to relieve pain and to preserve the preoperative range of motion and joint instability, the improvements in prosthesis design and arthroplasty technology rapidly made the polycentric knee prosthesis obsolete. Herein, we report a 58-year old male patient who had revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty performed 32 years after the initial operation. PMID:21343693

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

    Science.gov (United States)

    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

  6. MedlinePlus: Knee Replacement

    Science.gov (United States)

    ... Knee Pain and the Weekend Warriors (OR-Live) - Mercy Hospital, Miami, FL, 3/17/2009 Also in ... 2012 Small Incision Total Knee Arthroplasty (OR-Live) - Mercy Hospital, Miami, FL, 3/01/2011 Also in ...

  7. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper;

    2010-01-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....

  8. Factors Influencing Range of Motion after Total Knee Arthroplasty

    OpenAIRE

    H Farahini; Moghtadaei, M; Bagheri, A; Akbarian, E

    2012-01-01

    Background The range of motion after a total knee arthroplasty is an important clinical outcome affecting the life of the patient. The aim of this study was to determine the most important factors influencing the postoperative knee flexion in Tehran, Iran. Methods Between July 2007 and January 2009, on 95 cases of total knee joint replacement (89 patients), who were followed for 1 year postoperatively, the risk factors were assessed. Patient demographics (sex, age, body mass index, previous s...

  9. Revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty

    OpenAIRE

    Memisoglu, Kaya; Muezzinoglu, U. Sefa; Kesemenli, Cumhur Cevdet

    2011-01-01

    The Gunston polycentric knee arthroplasty, first designed and performed by Frank Gunston in 1971, is the first prosthesis considering the natural knee biomechanics. Although the polycentric knee arthroplasty showed encouraging results to relieve pain and to preserve the preoperative range of motion and joint instability, the improvements in prosthesis design and arthroplasty technology rapidly made the polycentric knee prosthesis obsolete. Herein, we report a 58-year-old male patient who had ...

  10. Influence of navigation system updates on total knee arthroplasty

    OpenAIRE

    Inui, Hiroshi; Taketomi, Shuji; Nakamura, Kensuke; Takei, Seira; Takeda, Hideki; Tanaka, Sakae; NAKAGAWA, TAKUMI

    2013-01-01

    Background The purpose of this study was to evaluate the influence of image-free computer-assisted navigation system update on outcome in total knee arthroplasty. Methods Thirty-three knees were replaced using the Stryker 3.1 image-free navigation system and 49 knees were replaced using the Stryker 4.0 system. One surgeon took part in all procedures as chief surgeon or first assistant. All patients received the Stryker Scopio NRG CR total knee prosthesis. We compared the accuracy of component...

  11. Outcome of total knee arthroplasty with insall burstein-11 prosthesis

    International Nuclear Information System (INIS)

    Patients with severe degenerative knee joint disease often require knee arthroplasty to reduce pain, improve stability and restore function. Insall Burstein II prosthesis is posteriorly stabilized condylar prosthesis, which provide posterior cruciate ligament substitution. It was designed to improve range of motion, stair climbing ability and to prevent posterior subluxation. Evaluate the functional outcome of total knee arthroplasty with IB II prosthesis and Evaluate the alignment of prosthetic components by radiological parameters and its correlation with functional outcome. Sixty knees of sixty patients were replaced by using Insall Burstein II prosthesis. Postoperative radiographs were evaluated for alignment of knee and prosthetic components by criteria selected from knee society roentogenographic evaluation system. Functional outcome was evaluated by rationale of knee society knee rating system. Prosthetic component was aligned in 93% and mal-alignment in 7% of the cases. There was significant improvement in functions core from mean score 33.83 +-15.5 to 59.5+-17.7 and knee score from 37 +- 12.5 to 76.4 +-2.2. Postoperative functional score was found correlated with alignment significantly. Conclusion: Total knee arthroplasty with I-B-II prosthesis is a safe durable and predictable procedure with proper surgical technique and expertise good alignment and satisfactory functional out come can be achieved. (author)

  12. CLINICAL STUDY ON PATELLAR REPLACEMENT IN TOTAL KNEE ARTHROPLASTY%人工全膝关节置换术中髌骨置换的临床研究

    Institute of Scientific and Technical Information of China (English)

    鲍亮; 高智慧; 施小强; 房晓敏; 金群华

    2013-01-01

    目的 通过与非髌骨置换比较,探讨髌骨置换对人工全膝关节置换术疗效的影响. 方法 将2010年9月-11月符合选择标准的63例(63膝)拟行人工全膝关节置换术的骨关节炎患者随机分为两组,其中32例关节置换术中行髌骨置换(置换组),31例不作置换(非置换组).两组患者性别、年龄、病程、骨关节炎分级、美国膝关节协会评分系统(KSS)标准临床评分及关节功能评分、髌骨评分、髌骨倾斜角、胫股角及髌韧带比值等一般资料比较,差异均无统计学意义(P>0.05),具有可比性.术后6周及3、6、12个月对疗效进行临床及影像学评定. 结果 两组患者术后切口均Ⅰ期愈合,置换组6例、非置换组8例出现下肢深静脉血栓形成.患者均获12个月随访.置换组术后3、6、12个月时膝前疼痛发生率均低于非置换组(P<0.05).两组术后各时间点KSS临床评分比较,差异无统计学意义(P>0.05);除术后6周及3个月,其余各时间点置换组关节功能评分明显高于非置换组(P<0.05).两组髌骨评分除术后12个月外,其余各时间点组间比较差异均无统计学意义(D>0.05).X线片复查示,两组均无髌骨骨折、髌骨脱位、髌骨不稳、假体松动及断裂发生;术后12个月两组股胫角、髌韧带比值、髌骨倾斜角比较,差异均无统计学意义(P> 0.05). 结论 人工全膝关节置换术中行髌骨置换可以一定程度改善膝关节功能评分、髌骨评分及降低术后膝前疼痛的发生率.%Objective To evaluate the influence of patellar replacement on total knee arthroplasty by comparing with non pattelar replacement. Methods Between September 2010 and November 2010, 63 patients (63 knees) with osteoarthritis who met the selection criteria and underwent total knee arthroplasty, were randomly divided into 2 groups: patellar replacement in 32 cases (replacement group), non patellar replacement in 31 cases (non pattelar

  13. Patients’ decision making in total knee arthroplasty

    OpenAIRE

    Barlow, T.; Griffin, D.; Barlow, D; Realpe, A.

    2015-01-01

    Objectives A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty. Methods A systematic literature review using Medline and Embase was conducted to ...

  14. Polyethylene in knee arthroplasty: A review

    OpenAIRE

    Chakrabarty, Gautam; Vashishtha, Mayank; Leeder, Daniel

    2015-01-01

    Polyethylene (PE) has been used extensively in knee arthroplasty since the mid 20th century. Progress in material manufacturing and processing has led to newer polyethylenes over last few decades with different material properties. It has been established that PE wear in knee arthroplasty causes particle induced osteolysis which is the main reason for late failure and requires revision surgery. Although there are various causes of wear, the properties of PE have long been a matter of investig...

  15. Total knee arthroplasty in vascular malformation

    Directory of Open Access Journals (Sweden)

    Harish Bhende

    2015-01-01

    Full Text Available In Klippel–Trenaunay syndrome, vascular malformations are not only in skin and superficial soft tissues but also in deep tissues like muscles bones and joints. It is well documemted that these recurrent intraarticular bleeds can cause early arthritis and joint pain. Performing arthroplasty in such patients is difficult and fraught with complications. We describe such a case where navigated total knee arthroplasty was performed with success to avoid the problems of intra medullary alignment used in the presence of intra medullary vascular malformations. We also suggest certain measures when knee arthroplasty is considered in such patients.

  16. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    Science.gov (United States)

    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

  17. Knee arthroplasty: are patients' expectations fulfilled?

    DEFF Research Database (Denmark)

    Nilsdotter, Anna K; Toksvig-Larsen, Sören; Roos, Ewa

    2009-01-01

    to pain and physical function after knee arthroplasty. PATIENTS AND METHODS: 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations...

  18. The efficacy of 99mTc-ciprofloxacin (infecton) imaging in suspected prosthetic infection following total knee replacement arthroplasty (pilot study)

    International Nuclear Information System (INIS)

    The aims of this study were 1) to increase the labelling efficiency of 99mTc-ciprofloxacin (infecton) and 2) to determine the value of infecton imaging in demonstrating infection following total knee replacement arthroplasty (TKRA). Five patients (4 female, 1 male: mean age 52.8±13.5 years, both TKRA in 3 pt) with suspected prosthetic infective conditions were included. In order to increase labelling efficiency, infection was labelled with stannous tartrate instead of previousely used formamidine sulfinic acid (FSA). Immediate perfusion, 5min blood pool, 1hr, 4hr and 24hr delayed images were perfomed. All images were blindly interpreted by two independent observers with visual findings being classified according to a four-grade scale(0.1.2.3). Images graded 0 and 1, and also those regions which showed faintly increase or unchanged uptake grade on late images as compared with early images, were classified as negative; grades 2 and 3 were classified as positive. The diagnosis was confirmed by intraoperative microbiological / histological findings or by the presence of gross purulence. Labelling efficiency increased up to over 98% with formation of radiocolloid less than 1%. All of four pt with prosthetic infection showed positive infecton images but one pt with sterile loosening of prosthesis showed negative infection images. The easy availability as well as new labelling technique make infecton imaging the better option for the detection of prosthetic orthopedic infection

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

    OpenAIRE

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

    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.

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

    Science.gov (United States)

    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

  1. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects of the...... hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few...

  2. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens;

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...

  3. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... ll be moderating a Zimmer Gender Solutions total knee, performed by my partner, Dr. Ken Gustke. At ... I’m going to be doing a total knee replacement utilizing the Gender Flex implants on a ...

  4. Knee Arthroplasty: With or Without Patellar Component?

    Directory of Open Access Journals (Sweden)

    Árpád Sólyom

    2015-09-01

    Full Text Available Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components or a tricompartimental (femoral, tibial and patellar components prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component.

  5. Hip and knee arthroplasty: quo vadis?

    NARCIS (Netherlands)

    Ho, J.; Meis, J.F.G.M.; Nabuurs-Franssen, M.H.; Voss, A.

    2015-01-01

    Despite of the steady decrease of surgical site infection (SSI) over the last two decades, the incidence of SSI after hip and knee arthroplasty has recently surged. This may be explained by technical changes that may result in an increased risk of SSI, such as the broad implementation of fast track

  6. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B;

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  7. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... ligaments well balanced, that almost any knee will work. But if we'll maximize and think about ... and cam design which allow this knee to work will in high flexion without the threat of ...

  8. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... female. The knee is a little -- I would grade it a one plus lax knee but it’s ... and/or rapid aware problems. Heavy hookup, please. Good point. Just make sure you do it well, ...

  9. Is cold therapy really efficient after knee arthroplasty?

    Directory of Open Access Journals (Sweden)

    Ersin Kuyucu

    2015-12-01

    Conclusion: After knee arthroplasty, the preoperative and postoperative use of cryotherapy is effective in terms of the pain control and functional knee scores without a significant change in surgical blood loss.

  10. Snapping Pes Syndrome after Unicompartmental Knee Arthroplasty

    Science.gov (United States)

    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.

  11. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... female. The knee is a little -- I would grade it a one plus lax knee but it’s ... I do not see problems with loss of blood supply in my patella and I don't ... I don't have problems with losing my blood supply of this patella. So this lady measured ...

  12. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... up the midline to come down into the knee joint. The nice thing about that is when we ... whole lot of their own valgus into the knee. And I feel that those, if you set them in slightly less valgus, will tend to end up with a more parallel joint line with the floor and hopefully a longer- ...

  13. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... brought to you by Zimmer. During the program, it’s easy for you to learn more about the ... The knee is a little -- I would grade it a one plus lax knee but it’s basically ...

  14. Infected total knee arthroplasty treatment outcome analysis

    OpenAIRE

    Radoičić Dragan; Popović Zoran; Barjaktarović Radoslav; Marinković Jugoslav

    2012-01-01

    Background/Aim. Infected total knee arthroplasty (TKA) is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA) in Belgrade. ...

  15. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... the midline to come down into the knee joint. The nice thing about that is when we ... prevent , you know, essentially bleeding out of the joint in the postoperative phase? We'd like to ...

  16. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... the knees well balanced, which I think we should be doing anyhow for all of our cases. ... tibial component. Do you agree with that or should we- Well, certainly the -- let’s have a pin -- ...

  17. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... actually rotate and dislocate, if you would, and cause problems that direction. This, at least, will not ... to correct those deformities that we will then cause enough instability that will require a knee that ...

  18. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... that certainly is personal preference. And is that gender-specific or is that for all comers? No, ... of the other knee systems, indeed, there are gender-specific femoral components that can be used. With ...

  19. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... just elevating a flap subperiosteally from the medial aspect of this knee. I'll do some pretty ... fat pad, I can see the whole distal aspect of the femur and even the tibia there, ...

  20. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... get started. We've prepped our knee in standard fashion. We have actually already exsanguinated this leg. ... poorly, we still will end up with our standard instability and/or rapid aware problems. Heavy hookup, ...

  1. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... started. We've prepped our knee in standard fashion. We have actually already exsanguinated this leg. Load ... re going to come just in a peripatellar fashion but we're only going to come to ...

  2. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... because, once again, I don't want to leave any communicating passages up into that sub-q ... the knee into its native position. If we leave it subluxed here laterally, we tend to very ...

  3. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... and drill her. And how much are you rotating there? This rotates 3 degrees externally with respect ... femoral components that can be used. With the rotating knee system, a class III device at this ...

  4. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... there’s any change that makes us concentrate and focus on ligament balancing a little more than we ... be used. With the rotating knee system, a class III device at this point, with respect to ...

  5. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... that the knee has indeed improved in its design. The pivot point of the mobile bearing in ... reading about with some of the other mobile designs. So I've been so far very pleased ...

  6. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... things and then take advantage of these nice new mobile designs I think we find ourselves in ... we really can maximize the benefits of these new knees. But even if the designs are wonderful, ...

  7. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... Sekundiak. I'm an Assistant Professor at Creighton University Medical Center in Omaha, Nebraska. We're actually ... male knee. Dr. Mafoos I believe at the University of Missouri proved that point. And with some ...

  8. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... contractures after I remove that. So it certainly aids in my being able to see. What I' ... you can see how just a little bit aids in Denton's ability to show me this knee. ...

  9. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... to a full knee replacement, what are the risks of stiffness with a partial knee replacement? Yeah, also known as arthrofibrosis for the doctors out there, knee surgery has a very - on average a pretty high ...

  10. Preoperative Planning in Primary Total Knee Arthroplasty.

    Science.gov (United States)

    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

  11. Anteroposterior glide versus rotating platform low contact stress (LCS knee arthroplasty: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Wynn-Jones Charles

    2007-08-01

    Full Text Available Abstract Background Fifty thousand knee replacements are performed annually in the UK at an estimated cost of £150 million. Post-operative improvement depends on a number of factors including implant design and patient associated factors. To our knowledge there are no published study's comparing the results of AP glide and rotating platform designs of LCS knee arthroplasty. Therefore we feel that a study is required to investigate and compare the effects of two types of LCS total knee arthroplasty on joint proprioception and range of motion. Methods/Design Patients will be randomised to receive either a LCS AP glide or Rotating platform prosthesis. Clinical scores (Oxford knee score, American knee society score, EuroQol, range of motion and proprioception will be assessed prior to and at 3,6, 12 and 24 months after the operation. Proprioception will be assessed in terms of absolute error angle (mean difference between the target angle and the response angle. Knee angles will be measured in degrees using an electromagnetic tracking device, Polhemus 3Space Fastrak that detects positions of sensors placed on the test limb. Student's t-test will be used to compare the mean of two groups. Discussion Evidence is lacking concerning the best prosthesis to use for patients undergoing total knee replacement. This pragmatic randomised trial will test the null hypothesis that anteroposterior glide LCS knee arthroplasty does not result in better post operative knee motion and proprioception as compared to rotating platform LCS knee. Trial Registration ISRCTN52943804

  12. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... the knee when they're kind of tight? Well, we'll try to be pretty careful -- pickup -- pretty careful as we put ... a little bit of tilt there, what would be your next step? What would you do? Well, I'd need to make sure, and I ...

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

    Science.gov (United States)

    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

  14. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B; Kehlet, Henrik

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...

  15. Navigated minimally invasive unicompartmental knee arthroplasty.

    Science.gov (United States)

    Jenny, Jean-Yves; Müller, Peter E; Weyer, R; John, Michael; Weber, Patrick; Ciobanu, Eugène; Schmitz, Andreas; Bacher, Thomas; Neumann, Wolfram; Jansson, Volkmar

    2006-10-01

    Unicompartmental knee arthroplasty (UKA) is an alternative procedure to high tibial osteotomy. This study assessed the procedure using computer navigation to improve implantation accuracy and presents early radiological results of a group of patients implanted with the univation UKA (B. Braun Aesculap, Tuttlingen, Germany) with navigation instrumentation and a minimally invasive approach. The authors concluded that navigated implantation of a UKA using a nonimage-based system improved radiologic accuracy implantation without significant inconvenience and minimal change in the conventional operating technique. PMID:17407935

  16. Hip and knee arthroplasty: quo vadis?

    OpenAIRE

    Ho, J; Meis, J. F. G. M.; Nabuurs-Franssen, M.H.; Voss, A.

    2015-01-01

    Despite of the steady decrease of surgical site infection (SSI) over the last two decades, the incidence of SSI after hip and knee arthroplasty has recently surged. This may be explained by technical changes that may result in an increased risk of SSI, such as the broad implementation of fast track programs, and/or early interventions on suspected SSI. By definition, early intervention may lead to a higher SSI score, even in the absence of a true SSI. In any case, the reverse trend of SSI war...

  17. Fracture Blisters After Primary Total Knee Arthroplasty.

    Science.gov (United States)

    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

  18. Robot-assisted unicompartmental knee arthroplasty.

    Science.gov (United States)

    Pearle, Andrew D; O'Loughlin, Padhraig F; Kendoff, Daniel O

    2010-02-01

    The outcomes of unicompartmental knee arthroplasties (UKAs) have demonstrated inconsistent long-term survival. We report the first clinical series of UKA using a semiactive robotic system for the implantation of an inlay unicondylar knee arthroplasty. Ten patients were selected for this study. Preoperative mechanical leg alignment values ranged from 0.3 degrees varus to 9.8 degrees varus. A haptic guidance system was used; a detailed description is given in the manuscript. The setup time for the robot was 41 minutes; intraoperative registration process, 7.5 minutes (6-13 minutes); skin incision, 8 cm; robot-assisted burring, 34.8 minutes (18-50 minutes); mean tourniquet time, 87.4 minutes (68-113 minutes); and overall operation time, 132 minutes (118-152 minutes). The planned and intraoperative tibiofemoral angle was within 1 degrees. The postoperative long leg axis radiographs were within 1.6 degrees. Haptic guidance in combination with a navigation module allows for precise planning and execution of both inlay components in UKA. PMID:19056227

  19. Periprosthetic fracture-dislocation in a loosened total knee replacement treated by knee arthrodesis

    International Nuclear Information System (INIS)

    We present a patient who was operated four years before performing a total knee replacement. She fell down resulting a periprosthetic femoral fracture and a prosthetic dislocation. After evaluating different treatments, we decided to do prosthetic removal and a knee arthrodesis using an intramedullar nail. The femoral fracture was fixed with wire cerclages. Knee arthrodesis is a procedure uses as a last option for the treatment of infected or loosed arthroplasties. In our case it was difficult to consider any other reconstructive procedure due to the association of fracture, dislocation and loosening. The evolution has been satisfactory with good functional result and without pain

  20. Total knee arthroplasty for severe valgus knee deformity

    Institute of Scientific and Technical Information of China (English)

    Zhou Xinhua; Wang Min; Liu Chao; Zhang Liang; Zhou Yixin

    2014-01-01

    Background Primary total knee arthroplasty (TKA) in severe valgus knees may prove challenging,and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release.The purpose of this study was to review 8 to 11 years (mean,10 years) follow-up results of primary TKA for varient-Ⅲ valgus knee deformity with use of different type implants.Methods Between January 2002 and January 2005,20 women and 12 men,aged 47 to 63 (mean,57.19±6.08) years old,with varient-Ⅲ valgus knees underwent primary TKA.Of the 32 patients,37 knees had varient-Ⅲ deformities.Pie crusting was carefully performed with small,multiple inside-out incisions,bone resection balanced the knee in lieu of soft tissue releases that were not used in the series.Cruciate-retaining knees (Gemini MKⅡ,Link Company,Germany) were used in 13 knees,Genesis Ⅱ (Simth & Nephew Company,USA) in 14 knees,and hinged knee (Endo-Model Company,Germany) in 10 knees.In five patients with bilateral variant-Ⅲll TKAs,three patients underwent 1-stage bilateral procedures,and two underwent 2-stage procedures.All implants were cemented and the patella was not resurfaced.The Hospital for Special Surgery (HSS) knee score was assessed.Patients were followed up from 8 to 11 years.Results The mean HSS knee score were improved from 50.33±11.60 to 90.06±3.07 (P <0.001).The mean tibiofemoral alignment were improved from valgus 32.72°±9.68° pre-operation to 4.89°±0.90° post-operation (P <0.001).The mean range of motion were improved from 93.72°±23.69° pre-operation to 116.61±16.29° post-operation (P <0.001).No patients underwent revision.One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years.Three patients developed transient peroneal nerve palsies,which resolved within nine months.Two patients developed symptomatic deep vein thrombosis that was managed with rivaroxaban

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Advil and anti-inflammatories, as well as some physical therapy. Continuing with other non-operative treatment modalities, she ... is the full knee replacement. Some of the benefits of a partial knee replacement include a less ...

  2. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is the full knee replacement. Some of the benefits of a partial knee replacement include a less ... get a lot of information, both on the Internet, from other doctors, from friends, and I think ...

  3. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... doesn't have a lot of the mechanical sensations that a total knee replacement patient has, they ... a full knee replacement probably has a better sense of which one will be more helpful for ...

  4. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... aspect of the partial knee replacement at this stage is you'll see another cut in the ... all practice components. Now how important is this stage, Dr. McCauley, during the knee replacement? Well, it's ...

  5. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... bones grinding against each other, leading to pain, stiffness and inflammation. At times in younger patients this ... full knee replacement, what are the risks of stiffness with a partial knee replacement? Yeah, also known ...

  6. Fungal prosthetic joint infection after total knee arthroplasty

    OpenAIRE

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

    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. Tot...

  7. Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

    OpenAIRE

    Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

    2007-01-01

    Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not been reported previously after unicompartmental knee arthroplasty in the literature. Low level of suspicion may delay the diagnosis, as popliteal vascular injury and compartment syndrome are not well ...

  8. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    OpenAIRE

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

    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 pseudo...

  9. Systematic review of patellar resurfacing in total knee arthroplasty

    OpenAIRE

    Li, Shuzhen; Chen, Yueping; Su, Wei; Zhao, Jinmin; He, Shunqing; Luo, Xiangping

    2010-01-01

    Controversies existing over resurfacing the patella in total knee arthroplasty remain in the literature. The purpose of this review was to evaluate the effectiveness of resurfacing versus nonresurfacing the patella in total knee arthroplasty. We searched the Cochrane Library, MEDLINE and EMBASE for published randomised clinical trials relevant to patellar resurfacing. The relative risk of reoperation was significantly lower for the patellar resurfacing group than for the nonresurfacing group ...

  10. MOBILE TIBIAL POLYETHYLENE BEARING IN TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    de Araújo Barros Cobra, Hugo Alexandre; da Palma, Idemar Monteiro

    2015-01-01

    Debris of polyethylene tibial bearings have been recognized as a major cause for the onset of the cascade of biological events leading to osteolysis and loosening of prosthetic components after total knee arthroplasty. Since then, research has been focused on alternative bearing surfaces in order to minimize the amount and rate of polyethylene wear off and, in doing so, increasing the survivorship rate for knee arthroplasties. One such option is to have a mobile tibial bearing allowing more c...

  11. Effect of compression therapy on knee swelling and pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Jensen, Niels J F; Andersen, Ida;

    2013-01-01

    PURPOSE: Knee swelling after total knee arthroplasty may impair postoperative mobilisation and training, and as medical elastic compression stockings are well tolerated and effective to prevent oedema, haematoma and postoperative pain after venous surgery, we wanted to study whether this effect...... could be transferred to total knee arthroplasty surgery reducing postoperative swelling and pain and thereby facilitating mobilisation and improving patient-reported knee function. METHODS: In a randomised controlled study, 88 patients were randomised to use either a medical elastic compression stocking...... or no stocking from the first postoperative day and the following 4 weeks after total knee arthroplasty. Outcome measures were knee, calf and ankle swelling, knee flexion, pain and patient-reported knee function. RESULTS: Seventy per cent of the swelling had occurred before application of the...

  12. Metaphyseal bone loss in revision knee arthroplasty.

    Science.gov (United States)

    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

  13. Revision of infected knee arthroplasties in Denmark.

    Science.gov (United States)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens; Schrøder, Henrik M; Kehlet, Henrik

    2016-08-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death ≤ 90 days postoperatively, re-revision due to infection, or not reaching the second stage for a planned 2-stage procedure within a median follow-up period of 3.2 (2.2-4.2) years. Results - The failure rate of the partial revisions was 43%. 71 of the partial revisions (67%) were revisions of a primary prosthesis with a re-revision rate due to infection of 34%, as compared to 55% in revisions of a revision prosthesis (p = 0.05). The failure rate of the 2-stage revisions was 30%. Median time interval between stages was 84 (9-597) days. 117 (54%) of the 2-stage revisions were revisions of a primary prosthesis with a re-revision rate due to infection of 21%, as compared to 29% in revisions of a previously revised prosthesis (p = 0.1). Overall postoperative mortality was 0.6% in high-volume centers (> 30 procedures within 2 years) as opposed to 7% in the remaining centers (p = 0.003). Interpretation - The failure rates of 43% after the partial revision procedures and 30% after the 2-stage revisions in combination with the higher mortality outside high-volume centers call for centralization and reconsideration of surgical strategies. PMID:26900908

  14. Early clinical effect of patellar replacement on anterior knee pain in patients with knee osteoarthritis after total knee arthroplasty%全膝关节置换术中髌骨置换对骨性关节炎患者早期疗效及膝前痛的影响

    Institute of Scientific and Technical Information of China (English)

    朱伟民; 唐本森; 张涛; 周广福; 田晓滨

    2015-01-01

    目的:探讨全膝关节置换术中是否进行髌骨置换对骨性关节炎患者的临床疗效及术后疼痛的影响。方法笔者采用随机数字表法将骨科2011年5月~2013年7月收治的93例行人工全膝关节置换术患者分为髌骨置换组43例和未置换组50例,比较两组患者治疗前与治疗后不同时间的相关指标变化差异。结果术前髌骨置换组与非置换组的膝关节KSS(美国膝关节协会)评分、Feller评分差异不显著( P>0.05);术后第3、6、12个月髌骨置换组膝关节KSS评分、Feller评分显著高于非置换组(P<0.05);术前髌骨置换组与非置换组的膝关节视觉模拟评分(VAS)差异不显著(P>0.05);术后第3、6、12个月髌骨置换组膝关节VAS评分显著低于非置换组(P<0.05);两组患者术前、术后的胫股角,髌韧带比值,关节活动度ROM屈、伸值在两组间比较差异均不显著( P>0.05);术后第12个月两组患者的胫股角、髌韧带比值,关节活动度ROM屈、伸值较治疗前均显著好转( P<0.05)。结论全膝关节置换术中进行髌骨置换对改善膝关节功能评分、髌骨评分、术后疼痛评分均有显著的效果。%Objective To discuss the clinical efficacy and postoperative pain of patellar replacement in pa-tients with osteoarthritis in total knee arthroplasty.Methods A total of 93 cases with total knee arthroplasty in our hospital from May 2011 to Jul.2013 were randomly selected and divided into replacement group( n=43) and non-replacement group( n=50) by the stochastic indicator method.The differences of related indicators at different time points between the two groups were compared.Results The differences of KSS knee score and Feller score be-tween the preoperative replacement group and non-replacement group were not significant(P>0.05);3,6 and 12 months after the surgery,the KSS knee score and Feller score of the replacement

  15. Clinical Application of Total Knee Arthroplasty on Patients with Advanced Knee Osteoarthritis

    OpenAIRE

    WU Zhi-sen; ZHENG Chen-xiao; Qi, Liang; CHANG Shang-yi

    2014-01-01

    Objective: To investigate the clinical value of total knee arthroplasty (TKA) on patients with advanced knee osteoarthritis. Methods: The clinical data and efficacy of 26 patients with advanced knee osteoarthritis (26 knees) who were given TKA in our department from June 2012 to May 2013 were retrospectively observed and analyzed. The knee function scores before operation and after follow up were evaluated according to American HSS scoring standard. Results: At the end of follow up, of...

  16. Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty

    OpenAIRE

    Choy, Won-Sik; Kim, Kap Jung; Lee, Sang Ki; Yang, Dae Suk; Lee, Neung Ki

    2011-01-01

    Background This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty. Methods One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni® in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preo...

  17. The association between metal allergy, total knee arthroplasty, and revision

    DEFF Research Database (Denmark)

    Münch, Henrik J; Jakobsen, Stig Storgaard; Olesen, Jens T; Menné, Torkil; Søballe, Kjeld; Johansen, Jeanne D; Thyssen, Jacob P

    2015-01-01

    Background and purpose - It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to...... common metal allergens, and revision surgery in patients who underwent knee arthroplasty. Patients and methods - The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test...... database from the greater Copenhagen area (n = 27,020). Results - 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery...

  18. Total knee replacement for posttraumatic degenerative arthritis of the knee

    Institute of Scientific and Technical Information of China (English)

    WU Li-dong; XIONG Yan; YAN Shi-gui; YANG Quan-sen

    2005-01-01

    Objective: To evaluate the results of total knee arthroplasty (TKA) in patients with posttraumatic degenerative arthritis due to a previous fracture around the knee. Methods: We analyzed the results of 15 TKAs, performed from 1997 to 2003, in 15 patients with post-traumatic degenerative arthritis due to a previous fracture around knee. There were 3 women and 12 men with an average age of 58 years (range, 31-76 years). The time from fracture to arthroplasty averaged 8.2 years (range, 2-27 years). Internal fixation had previously been performed in 8 patients resulting in retained hardware. At the time of arthroplasty a femoral fracture malunion was present in two knees. Lateral retinacular release (4 knees), extensor mechanism realignment (1 knee) or medial collateral ligament reconstruction (1 knee) were needed at the time of arthroplasty. Results: Follow-up averaged 35 months (range, 12-73 months). No patient was lost for follow-up. According to the Knee Society Score scale, the mean preoperative knee score was 37 (range, 10-70) and functional score was 41 (range, 0-60). They were improved significantly to a mean of 84 (range, 10-100) and 76 (range, 20-100) points, respectively at the latest follow-up. The mean knee arc of motion were improved from 84° preoperation to 94° at the latest follow-up. Postoperative manipulation under anesthesia for poor motion was carried out in 4 knees. No knee had aseptic loosening that required subsequent revision. Two knees developed superficial infection and were treated with debridement. It subsequently recovered with the retention of components. Conclusions: Significant improvement in function and relief of pain has been achieved in patients with previous fractures undergoing subsequent TKA. However, this procedure is technically demanding and patients are at increased risk for restricted motion and need more care following TKA. This study suggests that the outcome of TKA may be improved further by making special efforts to

  19. The influence of knee function to patella replacement and patellar plasty in totle knee arthroplasty%全膝关节置换术中髌骨置换与髌骨成形对膝关节功能的影响

    Institute of Scientific and Technical Information of China (English)

    杨小春; 郝邵文; 马晓军; 金群华

    2013-01-01

    Objective To investigate the effects on knee function between patella plasty and patellar replacement in total knee arthroplasty.Methods From August 2010 to November 2010,48 patients (69 knees) of osteoarthritis performed TKA were covered in this study.All the patients were randomly assigned to the following two groups:one group contained 24 patients (34 knees) performed patella plasty,and the other group contained other 24 patients (35 knees) performed patellar replacement.There was no significant difference between the two groups in age,weight,height,BMI,patellar score and the American Knee Society Score (KSS).Every patient was followed up for 6 weeks,3 months,6 months,one year,and two years.All the results,which were used to compare the difference between the two groups,in KSS knee score,knee function score,patellar score,the incidence of anterior knee pain,and imaging findings.Results In this clinical study,20 patients (30 knees) in patellar replacement group and 20 patients (29 knees) in patella plasty group were followed up.No significant difference was found in the postoperative KSS knee score between 2 groups at each time point.The KSS knee function score in replacement group was significantly higher than that in arthroplasty group at 6,12 and 24 months after operation.The incidence of anterior knee pain after the surgery in replacement group was significant different from the plasty group at every time point after operation.There was no significant difference in tibiofemoral angle,patellar ligament ratio,patellar tilt angle,congruence angle and lateral patellar displacement between two groups at last follow-up.Conclusion Total knee arthroplasty with patella replacement can improve both knee function and patella function,and reduce the incidence of postoperative anterior knee pain.%目的 探讨髌骨置换与髌骨成形对全膝关节置换术后膝关节功能的影响.方法 对2010年8月至11月拟行全膝关节置换术的48例(69膝)膝关节骨

  20. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is gone through the skin and we're working our way down to the knee joint capsule ... that medial partial knee replacements don't really work. So they come in with the idea that ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... is what you see on the left, which has a good full healthy layer of articular cartilage ... bone showing that only part of the knee has been replaced, whereas the rest of the knee ...

  2. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... itself. And again, this is when only one part of the knee, what we call a compartment ... prosthesis secured to the bone showing that only part of the knee has been replaced, whereas the ...

  3. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... to introduce our patient. We're going to go into the definition of arthritis. We're going ... a full knee replacement. We are going to go through a surgical video of a partial knee ...

  4. The Attenborough total knee replacement.

    Science.gov (United States)

    Attenborough, C G

    1978-08-01

    The stabilised gliding knee prosthesis is a compromise between hinged joints and condylar prostheses. It is a two-piece implant designed to allow normal gliding movements of flexion and extension and which, stabilised by a connecting rod between the femoral and tibial components, allows a designed laxity of rotation and lateral movements. A modification of the original femoral component is described. Two hundred and forty-five knee replacement operations have been done between January 1973 and September 1977 and the results are reported. The results using this prosthesis are at least equal to those using hinged or condylar prostheses. So far there has been no case of spontaneous loosening of the components and the implant can be used in patients who, because of severe deformities and instability, are unsuitable for condylar prostheses. PMID:681407

  5. Infected total knee arthroplasty treatment outcome analysis

    Directory of Open Access Journals (Sweden)

    Radoičić Dragan

    2012-01-01

    Full Text Available Background/Aim. Infected total knee arthroplasty (TKA is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA in Belgrade. A total of 654 primary and revised TKAs were performed in the said period. We registered and surgically treated 28 infected TKAs (primary TKAs: MMA - 22, other institutions - 6. The incidence of TKA infection in the MMA was 3.36%. The most common pathogens were: Staphylococcus aureus - 14 (50% cases, and Staph. epidermidis - 3 (10.7% cases. Other isolated pathogens were: Enterococcus faecalis, Klebsiella pneum., Klebsiella spp., Streptoccocus viridans, Seratia spp, Micrococcus luteus and Peptostreptococcus spp. In one case we had mixed anaerobic flora, and in 3 cases cultures were negative. We analyzed diagnostic challenges, risk factors (such as age and previous viscosupplementation and treatment outcomes in our series of infected TKAs. Results. In our series 2 infections healed after iv antibiotics and debridement, 1 patient responded to open debridement with component retention, 4 patients responded fully to one-stage reimplantation, 10 cases responded fully to two-stage reimplantation, 11 patients ended with arthrodesis and we had 1 patient with above knee amputation. Conclusion. Two-stage reimplantation remains gold standard for treatment of infected TKA, and we recommend it as treatment of choice for eradication of infection. The antibiotic loaded spacer prothesis concept in most cases allows infection eradication, good function and high patient satisfaction.

  6. Lateral dislocation of the knee joint after total knee arthroplasty: a case report

    OpenAIRE

    Ugutmen, Ender; Ozkan, Korhan; Unay, Koray; Mahirogullari, Mahir; Eceviz, Engin; Taser, Omer

    2008-01-01

    Background Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint. But it can be associated with many complications, one of which is instability. Case presentation A 70-year-old woman was referred to our hospital because of right knee dislocation after TKA was performed on her right knee due to severe varus deformity and flexion contracture. This instability was caused by persistent MCL tightness ...

  7. Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study

    DEFF Research Database (Denmark)

    Holm, Bente; Husted, Henrik; Kehlet, Henrik;

    2012-01-01

    Objective: To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty.Design: A prospective, single-blinded, randomized, cross-over study.Setting: A fast-track orthopaedic arthroplasty unit at a university hospital.......Participants: Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty.Interventions: The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30...... minutes of elbow icing (control treatment). The order of treatments was randomized.Main outcome measures: Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments by an...

  8. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

    Directory of Open Access Journals (Sweden)

    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  9. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing

    Directory of Open Access Journals (Sweden)

    Yulou Si

    2015-01-01

    Full Text Available To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients’ indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05 and the differences were statistically significant; the postoperative patients’ flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05 and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients’ joint recovery.

  10. The constraints on day-case total knee arthroplasty

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...... 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...

  11. Unilateral vs one stage bilateral total knee replacement in rheumatoid and osteoarthritis - A comparative study

    Directory of Open Access Journals (Sweden)

    Kiran E

    2005-01-01

    Full Text Available Background : A controversy exists regarding simultaneous or staged bilateral total knee replacement. Methods: Fifty patients undergoing simultaneous bilateral and 50 undergoing unilateral total knee arthroplasty were evaluated prospectively to compare the clinical, radiological results and complication rates. Eighty-four patients belonged to ASA category II or III preoperatively. The study included a high proportion of rheumatoid patients and osteoarthritis patients with severe deformities. Results: Bilateral group had greater blood loss and required more blood transfusion, but there was no difference in requirement of postoperative intensive care and the complication rates. Rheumatoid knees had lower pre and postoperative knee score and functional score as compared to osteoarthritic knees. Morbidity and mortality of one stage bilateral knee replacement was no greater than unilateral operation. Conclusion: Simultaneous bilateral knee replacement in younger patients with advanced rheumatoid arthritis is safe and effective

  12. Computer-Navigated Total Knee Arthroplasty Utilization.

    Science.gov (United States)

    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

  13. EFFECT OF PROPRIOCEPTIVE EXERCISES IN OSTEOARTHRITIC AND REPLACED KNEES

    Directory of Open Access Journals (Sweden)

    Santosh Metgud

    2015-12-01

    Full Text Available Background: Osteoarthritis is a degenerative joint disease involving thinning or destruction of the smooth cartilage that covers the ends of bones and changes to the bone. Joint arthroplasty is an intervention for those patients who have severe disease, with severe pain and radiographic evidence. Objective: To compare the effect of proprioceptive exercises in osteoarthritic and total replaced knees using the Knee Society Score and Joint Position Sense. Design: A randomised clinical trial. Subjects: A total of 95 subjects were selected based on the inclusion and exclusion criteria. Intervention: Participants were divided into two groups; Group A comprised of the Total Knee Replacement and Group B was the osteoarthritic group. Group A was given exercises along with ambulation and static and resistance cycling and training of functional activities. Group B was given exercises and seven proprioceptive exercises followed by continuous short wave diathermy cross-fire method for 15 minutes. Outcome measure: Pain Intensity, Functional Outcome and Joint Position Sense (JPS were measured by using Visual Analog Scale (VAS, Knee Society Score (KSS and Absolute angle of error, respectively. Results: The results show a significant difference between the two groups using VAS and JPS whereas showed no significant difference between the two groups on using the KSS. Conclusion: Based on the results of this study, it was observed that proprioceptive exercises are beneficial in improving the joint position sense in patients with osteoarthritis as well as total knee replacements.

  14. TOTAL KNEE ARTHROPLASTY IN A PATIENT WITH HOFFA FRACTURE PSEUDARTHROSIS: CASE REPORT

    OpenAIRE

    Rodrigo Pires e Albuquerque; Giordano, Vincenzo; Amaral, Ney Pecegueiro do; Carvalho, Antônio Carlos Pires; Barretto, João Maurício

    2015-01-01

    A rare occurrence of a case of Hoffa fracture pseudarthrosis in an alcoholic patient with genu valgum associated with venous insufficiency who underwent total knee arthroplasty is reported. The literature is reviewed and the main factors for surgical indication of total knee arthroplasty after a fracture of the knee are discussed. Total knee arthroplasty was a viable option in a 60-year-old patient with Hoffa fracture pseudarthrosis and comorbidities.

  15. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... this knee differ from the high-flex mobile bearing knee?” Well this is not a mobile bearing knee. There is a lot of controversy as to whether or not a mobile-bearing knee provides any significant benefit to the patient. ...

  16. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacement. At the end, we'll try and go over some questions of some common topics that come up when talking about partial knee replacements. So, let's get to our patient. She's a 42-year- ...

  17. Importance of Attenuating Quadriceps Activation Deficits after Total Knee Arthroplasty

    OpenAIRE

    Thomas, Abbey C.; Jennifer E Stevens-Lapsley

    2012-01-01

    Total knee arthroplasty (TKA) is associated with persistent quadriceps dysfunction. Since quadriceps dysfunction impairs functional performance, minimizing quadriceps dysfunction by attenuating central activation deficits early after surgery may improve function later in life. Rehabilitation strategies incorporating neuromuscular electrical stimulation and early, aggressive quadriceps strengthening may prove beneficial. Further, surgical approaches such as minimally invasive TKA may minimize ...

  18. Traditions and myths in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Gromov, Kirill; Malchau, Henrik;

    2014-01-01

    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...

  19. Early morbidity after simultaneous and staged bilateral total knee arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer Calov; Husted, Henrik;

    2015-01-01

    PURPOSE: The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime. METHODS: The Danish National Patient Registry was searched for all...

  20. Periprosthetic fractures of the femur after total knee arthroplasty

    OpenAIRE

    McGraw, Phil; Kumar, Arun

    2010-01-01

    Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur.

  1. Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

    2007-01-01

    Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not bee

  2. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill;

    2015-01-01

    Background and purpose - Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which m...

  3. Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient

    Directory of Open Access Journals (Sweden)

    Gaines Steven T

    2010-06-01

    Full Text Available Abstract Background Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty. Methods The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates. Results Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p Conclusions Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.

  4. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... get it as close to the knee, the hip, and the ankle being in perfect alignment, and ... there was a long-term results with cemented hips and cemented knees reported in the Swedish registry ...

  5. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... The initial setting for the distal femoral resection guide is making these parallel to the posterior condyle. ... does this knee differ from the high-flex mobile bearing knee?” Well this is not a mobile ...

  6. Prediction of Wear in Crosslinked Polyethylene Unicompartmental Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jonathan Netter

    2015-05-01

    Full Text Available Wear-related complications remain a major issue after unicompartmental arthroplasty. We used a computational model to predict knee wear generated in vitro under diverse conditions. Inverse finite element analysis of 2 different total knee arthroplasty designs was used to determine wear factors of standard and highly crosslinked polyethylene by matching predicted wear rates to measured wear rates. The computed wear factor was used to predict wear in unicompartmental components. The articular surface design and kinematic conditions of the unicompartmental and tricompartmental designs were different. Predicted wear rate (1.77 mg/million cycles was very close to experimental wear rate (1.84 mg/million cycles after testing in an AMTI knee wear simulator. Finite element analysis can predict experimental wear and may reduce the cost and time of preclinical testing.

  7. SPECT/CT in patients with painful knee arthroplasty - what is the evidence?

    Energy Technology Data Exchange (ETDEWEB)

    Hirschmann, Michael T. [Kantonsspital Baselland-Bruderholz, Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Henckel, Johann [Imperial College London, London (United Kingdom); Rasch, Helmut [Kantonsspital Baselland-Bruderholz, Institute for Radiology and Nuclear Medicine, Bruderholz (Switzerland)

    2013-09-15

    SPECT/CT is increasingly recognized as a promising imaging modality for the investigation of patients with a painful knee after knee arthroplasty. In this review article, we give an overview of the clinical value and current and future applications of SPECT/CT for patients with knee pain following joint arthroplasty. A detailed evidence-based literature review is performed and presented. (orig.)

  8. Clinical Application of Total Knee Arthroplasty on Patients with Advanced Knee Osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    WU Zhi-sen; ZHENG Chen-xiao; QI Liang; CHANG Shang-yi

    2014-01-01

    Objective:To investigate the clinical value of total knee arthroplasty (TKA) on patients with advanced knee osteoarthritis. Methods:The clinical data and efficacy of 26 patients with advanced knee osteoarthritis (26 knees) who were given TKA in our department from June 2012 to May 2013 were retrospectively observed and analyzed. The knee function scores before operation and after follow up were evaluated according to American HSS scoring standard. Results:At the end of follow up, of the 26 patients, 18 were excellent, 6 were good and 2 were not bad in knee function and mobility without sense of pain, which was regarded to be associated with the poor enthusiasm in knee function training, and the total rate of excellent and good was 92.3%. Conclusion:TKA has signiifcant clinical value and favorable efifcacy on patients with advanced knee osteoarthritis.

  9. Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

    Directory of Open Access Journals (Sweden)

    Yatinder Kharbanda

    2014-01-01

    Full Text Available Background: Large posteromedial defects encountered in severe varus knees during primary total knee arthroplasty can be treated by cementoplasty, structural bone grafts or metallic wedges. The option is selected depending upon the size of the defect. We studied the outcome of autograft (structural and impaction bone grafting reconstruction of medial tibial bone defects encountered during primary total knee replacement in severe varus knees. Materials and Methods: Out of 675 primary varus knees operated, bone defects in proximal tibia were encountered in 54 knees. Posteromedial defects involving 25-40% of the tibial condyle cut surface and measuring more than 5 mm in depth were grafted using a structural graft obtained from cut distal femur or proximal tibia in 48 knees. For larger, peripheral uncontained vertical defects in six cases, measuring >25 mm in depth and involving >40% cut surface of proximal tibial condyle, impaction bone grafting with a mesh support was used. Results: Bone grafts incorporated in 54 knees in 6 months. There was no graft collapse or stress fractures, loosening or nonunion. The average followup period was 7.8 years (range 5-10 years. We observed an average postoperative increase in the Knee Society Score from 40 to 90 points. There was improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC scores in terms of pain, stiffness and physical function during activities of daily living. Conclusion: Bone grafting for defects in primary total knee is justified as it is biological, available then and is cost effective besides preserving bone stock for future revisions. Structural grafts should be used in defects >5 mm deep and involving 25-40% of the cut proximal tibial condyle surface. For larger peripheral vertical defects, impaction bone grafting contained in a mesh should be done.

  10. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    OpenAIRE

    Singh Alka; Singh Yashwant; Singh Pankaj; Singh Vinay; Javed Sadaf; Abdunabi Murad

    2010-01-01

    Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in...

  11. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available Arthritic Pain Relief through Partial Knee Replacement NewYork-Presbyterian New York City, New York May 4, 2010 I've always felt ... cortisone injections, which really only provided short-lived relief. Ultimately, she underwent a knee arthroscopy procedure, where ...

  12. [Recovery from total knee arthroplasty through continuous passive motion].

    Science.gov (United States)

    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

  13. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... Don't you think that doing a certain number of these a year is kind of important ... t happen as it can happen in small numbers of total knee replacement patients. And do you ...

  14. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... through Partial Knee Replacement NewYork-Presbyterian New York City, New York May 4, 2010 I've always ... out every single day. Located in New York City, New York Presbyterian is ranked among the top ...

  15. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... cementation, which, as Dr. McCauley mentioned before, basically acts as a gout to hold the components into ... training is that partial knee replacements don’t work in people with high body mass indexes or ...

  16. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... old woman who I'm sure in your practice is on the extremely young side for perhaps ... full knee replacement. Now Dr. McCauley, in your practice have you seen many people that have had ...

  17. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... all practice components. Now how important is this stage, Dr. McCauley, during the knee replacement? Well, it's ... m wondering, you know, one of the classic teachings that we grew up on as surgeons in ...

  18. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... the knee has become more deformed, there's more limited range of motion. And when somebody has damaged ... replacement in general, right? Yeah, that's right on, Bill. So the kneecap, you will see, is just ...

  19. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... hospitals in America by "US News and World Report." New York Presbyterian is affiliated with two Ivy ... that we grew up on as surgeons in training is that partial knee replacements don’t work ...

  20. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... remove a little bit of excess cement that creeps out. Generally, we remove this to make sure ... come into the office who ask about different types of partial knee replacements? Are there any other ...

  1. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... it's the rehab, as you know, is pretty standard. Almost all the physical therapists out there have ... metal to help reduce friction. And that's pretty standard with just about any knee replacement system that ...

  2. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... that medial partial knee replacements don't really work. So they come in with the idea that ... would expect, on average, those to continue to work for another 10 to 15 years. So, just ...

  3. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... about partial knee replacement due to her young age. Specifically with her symptoms, she was unable to ... them that if I had this procedure at age 42, I probably would not use it to ...

  4. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... at about one month and three-month time intervals, as you know, because I think you do ... that we grew up on as surgeons in training is that partial knee replacements don’t work ...

  5. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... affiliated with two Ivy League medical schools: Columbia University College of Physicians and Surgeons, and Wilde Cornell ... Knee Replacement at New York Presbyterian Hospital, Columbia University. Today we're going to be discussing several ...

  6. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... soon. What's your rationale for that? In this system, the way the guides are for the distal ... pretty standard with just about any knee replacement system that you use. At this point what I ...

  7. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... are interested in this, or physicians who are thinking about referring their patients to this kind of ... McCauley, during the knee replacement? Well, it's definitely critical because, as you mentioned before, you've made ...

  8. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... felt that the mission of helping somebody with healthcare when they're in trouble is as wonderful, ... about partial knee replacement due to her young age. Specifically with her symptoms, she was unable to ...

  9. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... Ken, here’s another question. “Do you utilize highly cross linked polyethylene for all your total knees or just in younger patients? I use the highly cross linked polyethylene in all the knees. I think ...

  10. Postoperative Autologous Reinfusion in Total Knee Replacement

    OpenAIRE

    A. Crescibene; Martire, F.; Gigliotti, P.; Rende, A.; Candela, M

    2015-01-01

    Surgeries for total knee replacement (TKR) are increasing and in this context there is a need to develop new protocols for management and use of blood transfusion therapy. Autologous blood reduces the need for allogeneic blood transfusion and the aim of the present study was to verify the safety and the clinical efficacy. An observational retrospective study has been conducted on 124 patients, undergoing cemented total knee prosthesis replacement. Observed population was stratified into two g...

  11. Severe Heterotopic Ossification following Total Knee Replacement

    OpenAIRE

    Dodds, Alexander L.; Keene, Gregory C. R.

    2014-01-01

    Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO) is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-...

  12. Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss

    Institute of Scientific and Technical Information of China (English)

    ZHANG Fu-jiang; XIAO Yu; LIU Ya-bin; TIAN Xu; GAO Zhi-guo

    2010-01-01

    Background Tourniquets used during total knee arthroplasty may lead to many complications. The aim of this study was to determine perioperative blood loss and its clinical relevance in total knee replacement surgery after applying a tourniquet.Methods From June 2009 to October 2009, 60 consecutive patients who underwent routine total knee arthroplasty were randomly divided into two groups and were treated with or without a tourniquet (30 patients/group). There were no significant differences in patient baseline characteristics between the two groups. We compared the two groups of patients in terms of intra- and postoperative bleeding, invisible or visible bleeding, and total blood loss.Results None of the patients showed poor wound healing, lower extremity deep venous thrombosis or other complications. The amount of blood loss during surgery was lower in the tourniquet group than in the control group (P<0.01). However, postoperative visible bleeding (P <0.05) and occult bleeding (P <0.05) were significantly greater in the toumiquet group than in the control group. There was no significant difference in the total amount of blood loss between the two groups (P >0.05).Conclusions Tourniquet can reduce bleeding during total knee replacement surgery, but is associated with greater visible and invisible blood loss.

  13. Medial Unicompartmental Knee Arthroplasty in Patients with Spontaneous Osteonecrosis of the Knee

    OpenAIRE

    Choy, Won-Sik; Kim, Kap Jung; Lee, Sang Ki; Yang, Dae Suk; Kim, Choon Myeon; Park, Ju Sang

    2011-01-01

    Background We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated by minimally invasive medial unicompartmental arthroplasty using Oxford Uni. Methods We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patients included one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was 70.3 months (range, 48 to 93 months). The clinical resul...

  14. Tibial stress fracture after computer-navigated total knee arthroplasty

    OpenAIRE

    Massai, F.; Conteduca, F.; Vadalà, A.; Iorio, R.; Basiglini, L.; Ferretti, A.

    2010-01-01

    A correct alignment of the tibial and femoral component is one of the most important factors determining favourable long-term results of a total knee arthroplasty (TKA). The accuracy provided by the use of the computer navigation systems has been widely described in the literature so that their use has become increasingly popular in recent years; however, unpredictable complications, such as displaced or stress femoral or tibial fractures, have been reported to occur a few weeks after the ope...

  15. Short-Term Results of Medial Unicondylar Knee Arthroplasty

    OpenAIRE

    Murat Yılmaz; Samed Ordu; Erhan Bayram; İbrahim Sungur; Ercan Çetinus

    2014-01-01

    Aim: This study aimed to determine the short-term clinical and radiologic results of medial unicondylar knee arthroplasty (UKA). Methods: We retrospectively evaluated hospital records of eight patients who have undergone Oxford phase-3 medial UKA between 2011 and 2013. We included seven patients (two males and five females) in the study. The mean age of the patients was 63 years and the mean follow-up period was 17 months. The patients underwent UKA with the Oxford phase 3 cemented mobile ...

  16. Patient-reported outcome measures after total knee arthroplasty

    OpenAIRE

    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 prim...

  17. Spontaneous arteriorrhexis in affected lower limb following total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ya-feng; JIANG Qing; WANG Jun-fei

    2008-01-01

    @@ Total knee arthroplasty ( TKA) is now a standard treatment for serious osteoarthritis all over the world. Although it is a standard treatment, it has many complications, among which deep vein thrombosis ( DVT) is the exclusive blood vessel complication that has been reported.1,2 However, we found a new blood vessel complication of TKA in this study, which is spontaneous arteriorrhexis in the affected lower limb.

  18. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... to Dr. Gustke, who is live with the patient right now. Ken. Hello. I’m Ken Gustke, ... You can see the X-rays of this patient. She has classic osteoarthritis of the knee. She ...

  19. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... do most of my younger patients with computer navigation. I believe that that does help with the ... knee. And I think with use of computer navigation we can obtain that essentially a hundred percent ...

  20. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... that and successfully. But there are some cost issues between cements and cementless implants that have to ... to spin out you can have can dislocation issues. So mobile-bearing knees require absolutely perfect balancing ...

  1. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... do my tibial resection, so I put the large bent knee lateral to the posterior cruciate ligament, ... like I just did. Can I have a large tibial punch. And really you just need the ...

  2. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... notch anteriorly. If you can give me the male size two. You can see that there’s a difference in the gender knee between the males and the females. Females tend to have narrower ...

  3. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... that we feel because of their health and age has the potential for a total knee to ... I can evaluate? Is there any cut-off age that you would put in regular polyethylene or ...

  4. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... it’s going to cause abnormal loading of the plastic posteriorly, which will wear it out and won’ ... a higher ramp anteriorly, which gives you stability against posterior subluxation throughout the entire knee range of ...

  5. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... m removing some lateral osteophytes, which, again, will help me getting my patella subluxated laterally. Now I ... with computer navigation. I believe that that does help with the overall alignment of the knee. We’ ...

  6. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... are you dialing up on that jig to account for cartilage loss and bony erosion? Right now ... younger patients I do cement less knees, which accounts for about 20 -- 25 percent of my practice, ...

  7. Total knee arthroplasty using computer assisted navigation in patients with severe valgus deformity of the knee

    Institute of Scientific and Technical Information of China (English)

    SHAO Jun-jie; ZHANG Xian-long; WANG Qi; CHEN Yun-su; SHEN Hao; JIANG Yao

    2010-01-01

    Background Severe valgus deformity often has bone defect and laxity of the medial ligamentous, and total knee arthroplasty in severe valgus knee is, in most cases, more challenging for surgeons. The usefulness of a computer assisted navigation system in reestablishing the mechanical axis has been well established. Hence, the interest for surgeons is how the navigation system makes the procedure of total knee arthroplasty with severe valgus knee easier.Methods From June 2006 to March 2008 in Department of Joint Surgery, Shanghai Sixth People's Hospital, 6 patients (7 knees) with severe valgus knee underwent total knee arthroplasty using the Stryker Navigation system, which is an active wireless and imageless system. All the patients were followed up for 12 to 18 months after surgery. The X-ray radiographs for whole limbs were obtained on all patients to determine preoperative and postoperative alignments.Results A primary, posterior stabilized prosthesis was utilized in all cases. The average preoperative overall mechanical axis of the seven knees was 19.6°±4.6° of valgus (range 16° to 29°), and the average postoperative mechanical axis was 0.4°±0.7° (range 0.8° varus to 1.4° valgus ).Conclusions The navigation system is a very effective and useful tool for accurate intraoperative restoration of alignment in the face of significant deformity with valgus knee. To prevent component malposition, we did not reduce the knee before solidification of bone cement but controlled alignment using the navigation system up to implantation of the final component.

  8. Total dislodgement of the femoral component following cemented total knee arthroplasty: a case report

    OpenAIRE

    Arac, Sukru; Karatosun, Vasfi

    2004-01-01

    Total dislodgement of the components, which is the most severe form of loosening, has hitherto been unreported following total knee arthroplasty. An eighty-four-year-old woman presented with complaints of pain and sensation of insecurity of her right knee after cemented total knee arthroplasty. On physical examination, a clunk was elicited during movements of the knee; however, radiographs appeared normal except for a separated fragment of the medial femoral condyle. Further examination with ...

  9. Radiation dose reduction in digital plain radiography of the knee after total knee arthroplasty

    International Nuclear Information System (INIS)

    To reduce radiation exposure of frequently performed radiographs of the knee in follow-up of total-knee arthroplasty ensuring accurate assessment by using objective quality control criteria. In this prospective randomized study 278 radiographs of the knee in follow-up of total-knee arthroplasty were performed with standard and 37 % reduced radiation dose. The evaluation of the plain-radiographs was conducted using the following criteria: bone-implant interface, implant-surface character, implant-implant discrimination and periarticular heterotopic ossification. Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score ≥ 3 or more than 2 criteria with ≥ 2 points, the radiograph was score das ''not assessable''. The study was designed as non-inferiority-trial. 100 % of examined radiographs were scored as assessable, hence no statistical inferiority between the examinations with standard and reduced dose could be observed. Singular assessment of the defined criteria was likewise dose-independent. Plain-radiography of the knee following total-knee arthroplasty can be performed with 63 % of standard dose without loss of diagnostic validity.

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

    OpenAIRE

    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 mil...

  11. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacement - a total knee replacement - is a rehab process. And so, to go through a rehab process and still have pain is not necessarily worth ... ll do a femoral nerve block, which helps control pain for about 24 hours or so. These ...

  12. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacement. One of the things I had in mind is I'm wondering, you know, one of the classic teachings that we grew up on as surgeons in training is that partial knee replacements don’t work in people with high body mass indexes or people who are overweight. What ...

  13. An Unexpected Complication of Hip Arthroplasty: Knee Dislocation

    Directory of Open Access Journals (Sweden)

    Serdar Yilmaz

    2015-01-01

    Full Text Available An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as “ultra-low velocity dislocation.” The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

  14. Hip or knee replacement - after - what to ask your doctor

    Science.gov (United States)

    ... Below are some questions you may want to ask your health care provider to help you take ... What to ask your doctor after hip or knee replacement; Hip replacement - after - what to ask your doctor; Knee replacement - after - ...

  15. Minimally Invasive Total Hip and Knee Arthroplasty-Implications for the Elderly Patient

    NARCIS (Netherlands)

    Reininga, Inge H. F.; Stevens, Martin; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2012-01-01

    Total hip arthroplasty and total knee arthroplasty have proven to be effective surgical procedures for the treatment of hip and knee osteoarthritis. In recent decades, there have been considerable efforts to improve the component designs, modes of fixation, and surgical techniques. Minimally invasiv

  16. Revision total knee arthroplasty with the use of trabecular metal cones

    DEFF Research Database (Denmark)

    Jensen, Claus L; Petersen, Michael Mygind; Schrøder, Henrik; Flivik, Gunnar; Lund, Bjarne

    2012-01-01

    "Trabecular Metal Cone" (TM Cone) (Zimmer, Inc, Warsaw, Ind) for reconstruction of bone loss in the proximal tibia during revision total knee arthroplasty is now optional. Forty patients were randomized to receive revision total knee arthroplasty with or without TM Cone (No TM Cone). The Anderson...

  17. High tibial osteotomy or total knee arthroplasty in treatment of osteoarthritis of the knee joint

    OpenAIRE

    Aydogdu, Semih; Yalcin, Murat; On, Arzu; Murat KAYALAR; Hepguler, Simin; Sur, Hakki

    2004-01-01

    In this cross-sectional study; in order to evaluate the subjective and objective effects of High Tibial Osteotomy (HTO) and Total Knee Arthroplasty (TKA) operations on the same patient, 11 cases undergone these operations on each knee in different time periods were retrospectively reviewed. The mean age was 63 for HTO and 68 for TKA at the time of operations. There were 1 man and 10 women. Mean follow-up was 7.6 Years for HTO, 3.6 years for TKA. Subjective evaluation form of the knee which in...

  18. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... size two. You can see that there’s a difference in the gender knee between the males and the females. Females tend to have narrower condyles from medial to lateral, and they have a smaller ... female, with a difference of about two millimeters on either side of ...

  19. Total Knee Replacement for Women

    Medline Plus

    Full Text Available Zimmer Combines Gender Solutions technology May 27, 2009 Good evening. Welcome to “OR-Live” at Tampa General Hospital. My name is Steve Lyons, ... Tonight I’ll be moderating a Zimmer Gender Solutions total knee, performed by my partner, Dr. Ken ...

  20. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... put my knee up at a 90- degree angle and I assess how much roll back I have. Now true roll back should be more on the lateral side than the medial side. So if I see the femur sitting more than two millimeters posterior to the ...

  1. Total Knee Replacement for Women

    Medline Plus

    Full Text Available Zimmer Combines Gender Solutions technology May 27, 2009 Good evening. Welcome to “OR-Live” at Tampa General Hospital. My name is ... Florida. Tonight I’ll be moderating a Zimmer Gender Solutions total knee, performed by my partner, Dr. ...

  2. Total Knee Replacement for Women

    Medline Plus

    Full Text Available ... here’s another question. “This being a posterior referencing system, how many times do you find that you ... longer is the recovery on a cementless knee system?” So do you do anything post operatively to ...

  3. Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

    OpenAIRE

    Pua Yong-Hao; Ong Peck-Hoon; Chong Hwei-Chi; Yeo William; Tan Celia; Lo Ngai-Nung

    2013-01-01

    Abstract Background Knee extensor strength and knee extension range of motion (ROM) are important predictors of physical function in patients with a total knee arthroplasty (TKA). However, the relationship between the two knee measures remains unclear. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension ROM and self-report physical function. Methods Data from 441 patients with a TKA were collected preoper...

  4. Severe Heterotopic Ossification following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Alexander L. Dodds

    2014-01-01

    Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.

  5. Lateral dislocation of the knee joint after total knee arthroplasty: a case report

    Science.gov (United States)

    Ugutmen, Ender; Ozkan, Korhan; Unay, Koray; Mahirogullari, Mahir; Eceviz, Engin; Taser, Omer

    2008-01-01

    Background Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint. But it can be associated with many complications, one of which is instability. Case presentation A 70-year-old woman was referred to our hospital because of right knee dislocation after TKA was performed on her right knee due to severe varus deformity and flexion contracture. This instability was caused by persistent MCL tightness and iatrogenic lateral collateral, arcuate ligament, and popliteus tendon injury. The torn lateral collateral ligament and arcuate ligament were sutured with no. 2 non-absorbable (Ethibond) sutures with plication of the posterolateral knee capsule. A deep-dish liner was inserted to optimize soft tissue tension. Conclusion This is a very severe complication, and surgeons must be cautious about ligament balancing and soft tissue resection during TKA for severe varus and valgus deformities. PMID:18687153

  6. Reliability and Validity of the Dutch Version of the International Physical Activity Questionnaire in Patients After Total Hip Arthroplasty or Total Knee Arthroplasty

    NARCIS (Netherlands)

    Blikman, Tim; Stevens, Martin; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge; Reininga, Inge H. F.

    2013-01-01

    STUDY DESIGN: Psychometric assessment. OBJECTIVES: To determine test-retest reliability and concurrent validity of the International Physical Activity Questionnaire (IPAQ) in patients after total hip arthroplasty or total knee arthroplasty. BACKGROUND: Despite recognized benefits of regular physical

  7. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... you can do in life. And I think we're fortunate to have a greet staff who ... of medicine. At the end of the day, we can all walk away and say, "This is ... Geller. I'm here with Dr. William McCauley. We're here to talk about partial knee replacements. ...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... all walk away and say, "This is our team and it's a great team." Welcome to this OR Live Webcast presentation live ... that medial partial knee replacements don't really work. So they come in with the idea that ...

  9. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Pain Relief through Partial Knee Replacement NewYork-Presbyterian New York City, New York May 4, 2010 I've always felt ... carry it out every single day. Located in New York City, New York Presbyterian is ranked among ...

  10. Is There an Ideal Patellar Thickness Following Total Knee Arthroplasty?

    Science.gov (United States)

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

    2016-01-01

    Orthopedic surgeons resurface the patella during total knee arthroplasty to avoid complications such as pain, patello-femoral arthritis, and patellar maltracking and to reduce the risk for reoperation. However, many complications, such as decreased range of motion, increased fractures, and polyethylene wear, have been described with this procedure. One determinant when resurfacing a patella is the thickness of its cuts. This review aims to investigate the relationship between patellar thickness and outcome parameters such as range of motion, patient-reported outcomes, periprosthetic fractures, and reoperations. PMID:26726982

  11. Total Knee Arthroplasty Using a Posterior Cruciate Ligament Sacrificing Medial Pivot Knee: Minimum 5-year Follow-up Results

    OpenAIRE

    Youm, Yoon-Seok; Cho, Sung-Do; Lee, Seon-Ho; Cho, Hye-Yong

    2014-01-01

    Purpose To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee. Materials and Methods One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemor...

  12. A knee clinical state affects the preoperative level of anxiety in patients undergoing knee arthroplasty – preliminary report

    OpenAIRE

    Ziętek, Paweł; Ziętek, Joanna; Szczypiór, Karina; Kołodziej, Łukasz; Kotrych, Daniel; Bohatyrewicz, Andrzej

    2014-01-01

    Aim. The aim of this study was to evaluate whether intensity of state anxiety before operation depends on knee function. Material and method. The study was conducted among 81 patients qualified to knee arthroplasty because of severe arthrosis. A knee function was evaluated with Knee Society score and Oxford questionnaires, and level of anxiety – with State-Trait Anxiety Inventory by C.D. Spielberger a day before the operation. Results. Patients with higher intensity of trait anxiety ...

  13. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt;

    2014-01-01

    BACKGROUND: Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is...... unknown how these exercise variables influence knee pain after TKA. OBJECTIVE: To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. DESIGN: Cross-sectional study. SETTING: Consecutive sample of patients from the Copenhagen area, Denmark......, receiving a TKA, between November 2012 and April 2013. PARTICIPANTS: Seventeen patients, no more than 3 weeks after their TKA. MAIN OUTCOME MEASURES: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and...

  14. Fast track in total hip and knee arthroplasty--experiences from Hvidovre University Hospital, Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte

    2006-01-01

    This study investigated whether unselected patients operated on with total hip arthroplasty (THA) or total knee arthroplasty (TKA) could accomplish a self-developed accelerated track, ANORAK-HH, with a planned length of stay (LOS) of maximum 5 days and patient satisfaction at all parts of the track....... 307 patients who sustained 329 hip and knee arthroplasties were included in the study with the main material constituted from 243 primary unilateral THA and TKA arthroplasties. ANORAK-HH includes pre-operative patient clinic, patient motivation, dedicated staff, unchanged criteria for discharge and a...

  15. Predictors of bone loss in revision total knee arthroplasty.

    Science.gov (United States)

    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

  16. Accuracy of external rotation guide in total knee arthroplasty

    International Nuclear Information System (INIS)

    We use different guides for determining femoral rotational alignment in total knee arthroplasty (TKA) according to the technique applied. The purpose of this study was to evaluate the accuracy of the external rotation guide. Fifty knees of 25 patients were enrolled. TKA was performed with the measured resection technique for one side and gap control technique for the opposite side. The patients were classified into two groups; measured group and gap group. Condylar twist angle (CTA) was measured before and after TKA in each group. In the measured group, there was more discrepancy between the planned CTA preoperatively and measured CTA postoperatively than those of the gap group. The result demonstrated that the 3 degree external rotation guide has poorer accuracy than the JDK-mini guide. (author)

  17. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial

    DEFF Research Database (Denmark)

    Turpie, Alexander G G; Lassen, Michael R; Davidson, Bruce L; Bauer, Kenneth A; Gent, Michael; Kwong, Louis M; Cushner, Fred D; Lotke, Paul A; Berkowitz, Scott D; Bandel, Tiemo J; Benson, Alice; Misselwitz, Frank; Fisher, William D

    2009-01-01

    BACKGROUND: Prophylaxis for venous thromboembolism is recommended for at least 10 days after total knee arthroplasty; oral regimens could enable shorter hospital stays. We aimed to test the efficacy and safety of oral rivaroxaban for the prevention of venous thromboembolism after total knee.......1096). INTERPRETATION: Oral rivaroxaban 10 mg once daily for 10-14 days was significantly superior to subcutaneous enoxaparin 30 mg given every 12 h for the prevention of venous thromboembolism after total knee arthroplasty. FUNDING: Bayer Schering Pharma AG, Johnson & Johnson Pharmaceutical Research & Development......BACKGROUND: Prophylaxis for venous thromboembolism is recommended for at least 10 days after total knee arthroplasty; oral regimens could enable shorter hospital stays. We aimed to test the efficacy and safety of oral rivaroxaban for the prevention of venous thromboembolism after total knee arthroplasty. METHODS: In a...

  18. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  19. Platelet-rich plasma (PRP applied during total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    João Paulo Fernandes Guerreiro

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the efficacy of platelet-rich plasma regarding healing, pain and hemostasis after total knee arthroplasty, by means of a blinded randomized controlled and blinded clinical study.METHODS: Forty patients who were going to undergo implantation of a total knee prosthesis were selected and randomized. In 20 of these patients, platelet-rich plasma was applied before the joint capsule was closed. The hemoglobin (mg/dL and hematocrit (% levels were assayed before the operation and 24 and 48 h afterwards. The Womac questionnaire and a verbal pain scale were applied and knee range of motion measurements were made up to the second postoperative month. The statistical analysis compared the results with the aim of determining whether there were any differences between the groups at each of the evaluation times.RESULTS: The hemoglobin (mg/dL and hematocrit (% measurements made before the operation and 24 and 48 h afterwards did not show any significant differences between the groups (p > 0.05. The Womac questionnaire and the range of motion measured before the operation and up to the first two months also did not show any statistical differences between the groups (p > 0.05. The pain evaluation using the verbal scale showed that there was an advantage for the group that received platelet-rich plasma, 24 h, 48 h, one week, three weeks and two months after the operation (p < 0.05.CONCLUSIONS: In the manner in which the platelet-rich plasma was used, it was not shown to be effective for reducing bleeding or improving knee function after arthroplasty, in comparison with the controls. There was an advantage on the postoperative verbal pain scale.

  20. COMPUTERISED TOMOGRAPHIC STUDY OF HIP AND KNEE DIMENSIONS IN INDIAN FEMALES WITH ARTHROPLASTY PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Vinoth Kumar

    2014-10-01

    Full Text Available : INTRODUCTION: Hip and knee replacement surgeries have become one of the most commonly performed surgeries in India. Most of the arthroplasty implants are designed and manufactured based on western dimensions, which are not suited for some of the Indian females. In this study we measured the various dimensions of hip and knee using computerised tomography in 30 indian females. MATERIALS AND METHODS: We measured 8 parameters in the hip and 5 parameters in the knee with CT Scan in 30 females (30 hips,30 knees while maintaining a specified and fixed configuration while taking CT cuts.The parameters measured in the hip are Cup size, Cup version, Cup inclination, Head size, Neck shaft angle, Version of neck, Offset and diameter at the level of isthmus.The parameters measured in the knee are patellar thickness, Anteroposterior diameter of distal femur, Mediolateral diameter of distal femur, Anteroposterior diameter of proximal tibia, Mediolateral diameter of Proximal Tibia. RESULTS: We calculated the mean, median, range, standard error of the mean and subjected the values to KS test and P value test. The observations in different subjects are listed in the Tables. DISCUSSION: The measurements from these study are compared with the sizes of the smallest implant dimensions and recommendations for the implant sizing has been given.

  1. Navigation in total knee arthroplasty. A multicenter study

    OpenAIRE

    Maculé-Beneyto, F.; Hernández-Vaquero, D.; Segur-Vilalta, J. M.; Colomina-Rodríguez, R.; Hinarejos-Gomez, P.; García-Forcada, I.; Seral Garcia, B.

    2006-01-01

    We carried out a multicentre study to compare the postoperative femorotibial radiographic axis in two total knee replacement groups; one using manual instrumentation and the other using navigation. In the latter group, three navigation systems were used: Stryker, Orthopilot and Navitrack. The prior circumstances of patients in terms of age, weight, aetiology, epicondylar perimeter, patellar tendon length and knee deformity was similar in both groups. The duration of the operation was longer i...

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

    Science.gov (United States)

    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

  3. A knee clinical state affects the preoperative level of anxiety in patients undergoing knee arthroplasty – preliminary report

    Directory of Open Access Journals (Sweden)

    Ziętek, Paweł

    2014-10-01

    Full Text Available Aim. The aim of this study was to evaluate whether intensity of state anxiety before operation depends on knee function. Material and method. The study was conducted among 81 patients qualified to knee arthroplasty because of severe arthrosis. A knee function was evaluated with Knee Society score and Oxford questionnaires, and level of anxiety – with State-Trait Anxiety Inventory by C.D. Spielberger a day before the operation. Results. Patients with higher intensity of trait anxiety had higher level of state anxiety before operation. To agroup with higher intensity of trait anxiety belonged above all elderly persons. In addition, in these patients the knee function was worse. It was indicated that the better knee state and knee function were, the higher level of state anxiety before operation was. Conclusions. The knee clinical state prior to knee arthroplasty and trait anxiety are the predictors of the preoperative state anxiety. In the group of patients undergoing knee arthroplasty trait anxiety levels were found to be higher in older persons. Before the operation worse clinical knee state was found in patients with primary education as compared to patients with secondary education and university degree. No statistically significant correlation were found between preoperative anxiety and gender, patient’s work status and marital status.

  4. Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2016-07-01

    Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

  5. Early changes in muscle strength after total knee arthroplasty. A 6-month follow-up of 30 knees

    DEFF Research Database (Denmark)

    Lorentzen, J S; Petersen, M M; Brot, C;

    1999-01-01

    We studied 30 patients with arthrosis in one knee operated on with a cemented (n 26) or an uncemented total knee arthroplasty (TKA) (n 4). Full weight-bearing from the first postoperative day was allowed in all patients, and they received standard postoperative physiotherapy. 1 week prior to...... factor for evaluation of muscle strength....

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

    Directory of Open Access Journals (Sweden)

    Villanueva Manuel

    2010-01-01

    Full Text Available 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.

  7. The patient's experience of temporary paralysis from spinal anaesthesia, a part of total knee replacement

    DEFF Research Database (Denmark)

    Bager, Louise; Konradsen, Hanne; Dreyer, Pia Sander

    the experience of spinal anaesthesia, as a part of having a total knee replacement. METHODS: Twelve patients were interviewed in March 2014 after undergoing an elective total knee arthroplasty under spinal anaesthesia. The interviews were analysed with a Ricoeur-inspired interpretation method. RESULTS......: Three themes were derived from the interviews: 'anaesthesia - an unavoidable necessity', 'an unrecognisable and incomprehensible body' and 'the body returns - joy and agony'. CONCLUSION: The results reveal that trust in the health care personnel and knowledge of the course of events play a key role in...

  8. Perioperative pain management in hip and knee replacement surgery.

    Science.gov (United States)

    Barrington, John W; Halaszynski, Thomas M; Sinatra, Raymond S; Expert Working Group On Anesthesia And Orthopaedics Critical Issues In Hip And Knee Replacement Arthroplasty, For The

    2014-04-01

    Many patients who undergo hip or knee replacement surgery today experience high levels of postoperative pain. Data from clinical studies and analyses of hospital records have demonstrated that severe postoperative pain is associated with an increased risk for complications, slowing of the rehabilitation process, delayed return to normal functioning, progression to persistent pain states, prolonged length of hospital stay, elevated rates of readmission, and higher overall costs. Orthopedic surgeons may now play a more active role in reducing the severity of pain following surgery, decreasing both opioid use and the incidence of opioid-related adverse events, and eliminating breakthrough pain and analgesic gaps. The benefits of multimodal regimens that include a combination of agents acting synergistically have been established unequivocally, and many analgesic and anesthetic agents are now available, as well as treatment options that differ according to route of administration. It is therefore possible to individualize treatment based on the type of procedure and patient need. One exciting advance that offers effective, safe, and efficient analgesia for many kinds of surgical procedures is the introduction of an extended-release local anesthetic (liposomal bupivacaine) for infiltration. This new option, which can be administered directly into the knee or hip by an orthopedic surgeon, is an example of the changing paradigm in perioperative analgesia, where commitment, communication, and coordination across all members of the clinical care team- including the surgeon, anesthesiologist, pharmacist, physical therapist, and nursing staff-are fundamental elements of an improved standard of care. An Expert Working Group on Anesthesia and Orthopaedics: Critical Issues in Hip and Knee Replacement Arthroplasty (April 13, 2013; Dallas, Texas) evaluated current approaches to perioperative pain management and proposed new regimens to help achieve optimal outcomes in these

  9. The Isolated Effect of Adductor Canal Block on Quadriceps Femoris Muscle Strength After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Sørensen, Johan Kløvgaard; Jæger, Pia; Dahl, Jørgen Berg;

    2016-01-01

    BACKGROUND: Using peripheral nerve block after total knee arthroplasty (TKA), without impeding mobility, is challenging. We hypothesized that the analgesic effect of adductor canal block (ACB) could increase the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle after...

  10. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk; Harazuk, Jørgen; Pedersen, Niels A; Søballe, Kjeld

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion on...

  11. Three-step sequential management for knee arthroplasty after severe ballistic injury: Two cases.

    Science.gov (United States)

    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

  12. Small increase of actual physical activity 6 months after total hip or knee arthroplasty

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid); J.B.J. Bussmann (Hans); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

    2008-01-01

    textabstractLimitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA o

  13. Biomechanical Considerations in the Design of High-Flexion Total Knee Replacements

    Directory of Open Access Journals (Sweden)

    Cheng-Kung Cheng

    2014-01-01

    Full Text Available Typically, joint arthroplasty is performed to relieve pain and improve functionality in a diseased or damaged joint. Total knee arthroplasty (TKA involves replacing the entire knee joint, both femoral and tibial surfaces, with anatomically shaped artificial components in the hope of regaining normal joint function and permitting a full range of knee flexion. In spite of the design of the prosthesis itself, the degree of flexion attainable following TKA depends on a variety of factors, such as the joint’s preoperative condition/flexion, muscle strength, and surgical technique. High-flexion knee prostheses have been developed to accommodate movements that require greater flexion than typically achievable with conventional TKA; such high flexion is especially prevalent in Asian cultures. Recently, computational techniques have been widely used for evaluating the functionality of knee prostheses and for improving biomechanical performance. To offer a better understanding of the development and evaluation techniques currently available, this paper aims to review some of the latest trends in the simulation of high-flexion knee prostheses.

  14. Tibial base design and patient morphology affecting tibial coverage and rotational alignment after total knee arthroplasty

    OpenAIRE

    Clary, Chadd; Aram, Luke; Deffenbaugh, Daren; Heldreth, Mark

    2014-01-01

    Purpose To understand interactions between total knee arthroplasty tibial base design attributes, variations in tibial morphology, and the resulting tibial coverage and rotational alignment. Methods Tibial anthropometric measurements, including aspect ratio (medial–lateral width/anterior–posterior length) and tibial asymmetry, were taken for 14,791 total knee arthroplasty patients and compared with the ability of four different commercial tibial base designs to cover the resected plateau. The...

  15. Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty

    OpenAIRE

    Tsukada, Sachiyuki; Wakui, Motohiro; Matsueda, Munenori

    2013-01-01

    Background Stable and well-aligned placement of tibial components during primary total knee arthroplasty is challenging in patients with bone defects. Although rectangular block-shaped augmentations are widely used to reduce the shearing force between the tibial tray and bone compared with wedge-shaped augmentations, the clinical result remains unclear. This study aimed to evaluate the outcome of primary total knee arthroplasty with metal block augmentation. Methods We retrospectively reviewe...

  16. Magnetic resonance imaging of the knee after medial unicompartmental arthroplasty

    International Nuclear Information System (INIS)

    Objective: We evaluated safety and potential diagnostic value of magnetic resonance (MR) imaging of the knee treated with medial unicompartmental arthroplasty (MUA). Methods: The treated knee of 8 patients who underwent MUA was studied with four different 1.5-T MR sequences. Two radiologists independently evaluated eleven anatomical items using a score from 0 (not assessable) to 3 (completely assessable). The sum of the scores for each sequence was divided by the potential maximal sum, obtaining a percentage visibility index (PVI) for each item. Results: No adverse effect was reported during or within 30 min after the exam. Posterior cruciate ligament was unseen in all patients by both observers. The following PVIs were reported for the remaining ten items: femoral–patellar relationship 83–100%; femoral–patellar cartilage 92–100%; Hoffa's fat pad 75–92%; patellar ligament 79–100%; lateral meniscus 100%; femoral–tibial lateral joint 100%; lateral collateral ligament 96–100%; anterior cruciate ligament 54–83%; femoral–tibial lateral cartilages 92–100%; posterolateral corner 100%. Agreement between readers was found in 331/352 (94%) evaluations (k = 0.74–0.78). Conclusions: MR imaging after MUA offers a safe and reproducible evaluation of residual knee anatomy except for cruciate ligament, and can be used to follow-up these patients.

  17. Asymptomatic deep venous thrombosis in the calf: accuracy and limitations of ultrasonography as a screening test after total knee arthroplasty.

    Science.gov (United States)

    Vanninen, R; Manninen, H; Soimakallio, S; Katila, T; Suomalainen, O

    1993-03-01

    Patients who have recently undergone total knee arthroplasty are at high risk of developing deep venous thrombosis (DVT) in the calf. The clinical diagnosis of DVT is difficult in these patients owing to recent operation. A combination of compression ultrasonography (US) and colour flow imaging was used as a screening method of asymptomatic DVT in 51 patients who had undergone total knee replacement surgery. Both limbs were examined by US from the common femoral vein to the ankle approximately 7 days after operation and the results were compared with bilateral venography. 12 patients (24%) developed infrapopliteal DVT on the operated side, in two cases the thrombosis extended to the lower part of popliteal vein. One patient had bilateral thrombosis. US showed sensitivity of 77%, specificity of 96% and overall accuracy of 93%. US seems to be a useful screening method for DVT after knee replacement operation. PMID:8472111

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... the inner aspect of her knee, what we call the medial compartment of her knee, she's got ... only one part of the knee, what we call a compartment of the knee, when one compartment ...

  19. Hip or knee replacement - after - what to ask your doctor

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000232.htm Hip or knee replacement - after - what to ask your doctor To ... had surgery to get a new hip or knee joint while you were in the hospital. Below ...

  20. Analysis of stem tip pain in revision total knee arthroplasty.

    Science.gov (United States)

    Kimpton, Christine I; Crocombe, Andrew David; Bradley, William Neil; Gavin Huw Owen, Brigstocke

    2013-06-01

    Stem tip pain following revision total knee arthroplasty is a significant cause of patient dissatisfaction, which in the presence of an aseptic well-fixed component has no widely accepted surgical solution. A definitive cause of stem tip pain remains elusive, however it has been suggested that high stress concentrations within the region of the stem tip may play a role. This paper reports a finite element study of a novel clinical technique where a plate is attached to the tibia within the region of the stem tip to reduce stem tip pain. The results demonstrate that the plate reduces stress concentrations in the bone at the stem tip of the implant. The magnitude of stress reduction is dependent upon plate location, material and attachment method. PMID:23523204

  1. Mobile bearing and fixed bearing total knee arthroplasty

    Science.gov (United States)

    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

  2. Posttraumatic pseudoaneurysm of popliteal artery following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Sanjay R Agarwala

    2013-01-01

    Full Text Available We report a case of posttraumatic false aneurysm of popliteal artery after a total knee arthroplasty in an 82-year-old woman. This case is characterized by the distinct history of trauma to the popliteal fossa in the immediate postoperative period and the location of false aneurysm. In addition, the clinical symptoms were similar to those of deep vein thrombosis. The ultrasonographic examination and computed tomography (CT angiography confirmed the diagnosis on 6 th day after the surgery. Ultrasonographic examination 1 day later revealed no increase in the size of false aneurysm. She was treated with open surgical repair. Presenting the difficulty in the diagnosis, unusual location, etiology, and its management is the intention of this case report.

  3. Alpine Skiing With total knee ArthroPlasty (ASWAP)

    DEFF Research Database (Denmark)

    Kristensen, M; Pötzelsberger, B; Scheiber, P; Bergdahl, A; Hansen, C.N.; Andersen, J.L.; Narici, M; Salvioli, S; Conte, M; Müller, E.; Dela, F

    patients participated in the intervention group (IG) and nine in the control group (CG). Blood samples and muscle biopsies were obtained before (PRE) and 7.3 ± 0.8 days after (POST) the intervention, and blood samples again after a retention (RET) phase of 8 weeks. With skiing, glucose homeostasis improved......We investigated the effect of alpine skiing for 12 weeks on skeletal muscle characteristics and biomarkers of glucose homeostasis and cardiovascular risk factors. Twenty-three patients with a total knee arthroplasty (TKA) were studied 2.9 ± 0.9 years (mean ± SD) after the operation. Fourteen...... in IG (decrease in fasting insulin, increase in muscle glycogen) but not in CG. Fiber type distribution and size, as well as capillary density and number of capillaries around the fibers (CAF), were not different between the operated and the non-operated leg in either group. The relative number of...

  4. Blood Conservation Strategies in Total Hip and Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    David Liu

    2015-01-01

    Full Text Available Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

  5. Salvage of infected total knee arthroplasty with Ilizarov external fixator

    Directory of Open Access Journals (Sweden)

    Venkata Gurava Reddy

    2011-01-01

    Full Text Available Background: Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA. Materials and Methods: 16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator. Results: Union was achieved in 15 patients (93.75%. The mean duration for union (frame application time in these patients was 28.33 weeks (range 22 to 36 weeks. Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034. Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035. Conclusion: Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.

  6. Short-Term Results of Medial Unicondylar Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Murat Yılmaz

    2014-09-01

    Full Text Available Aim: This study aimed to determine the short-term clinical and radiologic results of medial unicondylar knee arthroplasty (UKA. Methods: We retrospectively evaluated hospital records of eight patients who have undergone Oxford phase-3 medial UKA between 2011 and 2013. We included seven patients (two males and five females in the study. The mean age of the patients was 63 years and the mean follow-up period was 17 months. The patients underwent UKA with the Oxford phase 3 cemented mobile insert unicondylar prosthesis using minimally invasive surgery technique. The patients were assessed preoperatively, postoperatively and at final controls according to the Knee Society’s clinical and Functional Scoring system (KSS. The mean anatomic tibiofemoral angle was measured preoperatively and postoperatively and any complication was recorded. Results: The mean knee score according to the KSS was 37.50 preoperatively and was 90.75 at the final follow-up; the mean function score according to the KSS was 31.88 preoperatively and was 93.12 at the final follow-up. The mean anatomic tibiofemoral angle was improved from 4.37 degree varus to 4.75 degree valgus. There was no complication in any patient except one with superficial infection who was treated by simply antibiotic treatment. Conclusion: UKA is a favorable surgical technique for appropriately selected patients with medial unicompartmental knee osteoarthritis. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 191-4

  7. Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Gabriela R Lauretti

    2013-01-01

    Full Text Available Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml. The control group (CG received saline as IT test drug. The morphine group (MG received IT 200 g morphine, the ketorolac group (KG IT 2 mg ketorolac and the morphine-ketorolac group (MKG 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P < 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively. Both groups were longer when compared to the CG (170 ± 13 min (P < 0.01. The MG and KG had lesser ketoprofen consumption compared to the CG (P < 0.05. The time to first rescue analgesic was longer to the MKG (926 ± 222 min (15 h compared to CG (P < 0.001 and to the MG and the KG (P < 0.01. MKG displayed lesser ketoprofen consumption compared to MG and KG (P < 0.05 and to the CG (P < 0.02. Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.

  8. Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials.

    Science.gov (United States)

    Urish, Kenneth L; DeMuth, Peter W; Craft, David W; Haider, Hani; Davis, Charles M

    2014-06-01

    In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty. PMID:24439797

  9. Functional outcomes of uni-knee arthroplasty for medial compartment knee arthropathy in asian patients

    Directory of Open Access Journals (Sweden)

    To Wong

    2014-12-01

    Full Text Available Background: Uni-knee arthroplasty (UKA has shown better knee kinematics and motion that may better suit the activities of daily living in Eastern countries. The purpose of this study was to evaluate the functional outcomes of UKA for medial compartment knee arthropathy in Asian patients. Methods: The study cohort consisted of 48 patients with 51 UK A knees. Only one type of prosthesis was used and all components were cemented. Postoperative management included ambulation with weight bearing, range of motion, and muscle strengthening exercises as tolerated until full recovery. The average follow-up was 52.0 ± 24.0 (range 12-92 months. The evaluation included functional assessment, the Knee Society knee and functional scores, the International Knee Document Committee (IKDC subjective and objective scores, and radiographs of the knee. Results: The overall clinical outcomes of the knee showed the functional outcome of the knee to be normal in 51%, nearly normal in 37%, abnormal in 8%, and severely abnormal in 4%. The functional activities included stair climbing in 96%, squatting in 76%, jogging in 71% and kneeling in 47%. Three-quarters of the patients were able to kneel for daily activities. Approximately 98% of the patients were satisfied with the operation. The survivorship of the prosthesis was 98% with one revision pending. Radiographic evaluations revealed the components were centered in 82% and off-centered in 18%. Osteoarthritis was 22% preoperative and 27% postoperative for the patellofemoral compartment, and 0% before and 4% after surgery for the lateral compartment. The functional outcomes showed no difference between patients with and without patellofemoral arthritis. The complications included one component malposition and one knee pain of undetermined origin. Conclusions: UKA provides excellent pain relief and restoration of knee function including kneeling, squatting, and sit-to-stand activities that perfectly fit the oriental

  10. Difference between right and left side in total knee and unicondylar knee replacement: An interesting observation

    Directory of Open Access Journals (Sweden)

    Vasudevan Thirumal Selvan

    2005-02-01

    Full Text Available We report an observation made about the differences between right and left side in case of total knee and unicondylar knee replacement. It was found that unicondylar knee replacement was performed more commonly on the left side (66%, as compared to only 34% on right side, where as total knee replacement was more common on the right side (64% as compared to 36% on left side. The exact clinical utility of this difference is yet to be known.

  11. Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Husted, Henrik;

    2011-01-01

    OBJECTIVE: To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. DESIGN: A prospective......, descriptive, hypothesis-generating study. SETTING: A special unit for fast-track hip and knee arthroplasty operations at a university hospital. PARTICIPANTS: Twenty-four patients (20 women and 4 men; ages 69 ± 6.1 years) scheduled for primary unilateral THA. METHODS: All patients were evaluated before surgery...... and on the day of hospital discharge. MAIN OUTCOME MEASURES: Knee-extension strength, thigh and knee joint circumference, hip pain, and functional performance (Timed Up & Go, 30-Second Chair Stand, and 10-Meter Walk tests). RESULTS: All investigated variables changed significantly from before to after...

  12. Total Hip Replacement (Arthroplasty) (Beyond the Basics)

    Science.gov (United States)

    ... stiffening caused by extra bone formation, also called heterotopic ossification, is a process in which some soft ... replacement (prosthetic) parts, with the goal of relieving pain and improving function. ● Most patients require total hip ...

  13. The use of postoperative suction drainage in total knee arthroplasty: a systematic review.

    LENUS (Irish Health Repository)

    Quinn, Mark

    2014-07-16

    The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, length of hospital stay and haemoglobin levels following TKA.

  14. Periarticular regional analgesia in total knee arthroplasty: a review of the neuroanatomy and injection technique.

    Science.gov (United States)

    Guild, George N; Galindo, Rubin P; Marino, Joseph; Cushner, Fred D; Scuderi, Giles R

    2015-01-01

    Postoperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation. PMID:25435030

  15. Three-dimensional measured cutting method in total knee arthroplasty

    International Nuclear Information System (INIS)

    Authors have developed a unique three-dimensional (3D) measured cutting method in total knee arthroplasty without navigation (TKA), using estimates obtained by preoperative planning and the cooperative jig during operation. In the present study, examined is the usefulness of this intra-operative assistance system for accuracy improvement of TKA: The procedure is; 3D bone model of femur and tibia is reconstructed from CT images of the whole lower limb, then the bone component form model is obtained by adapting to the 3D preoperative planning software (LEXI Co.) and to data of computer aided design of the bones for determination of the target volume and angle, and the direction of insertion of intramedullary alignment rod and the angles/volumes of ostectomy are preoperatively defined. During operation, quantitative angle and volume estimates are reproduced for confirmation with the specific cooperative jig (Wright Medical Tech. Inc.). The TKA method was applied in 16 knees of 12 female patients (average age, 71 y) with osteoarthritis and was found for its utility and efficacy to be comparative to the method with navigation hitherto. (R.T.)

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

    Science.gov (United States)

    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

  17. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    predictor of chronic pain persisting ≥3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates. Conclusion: This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery. Keywords: pain catastrophizing, total knee arthroplasty, total knee replacement, knee arthroplasty, risk factors, chronic pain

  18. Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

    Directory of Open Access Journals (Sweden)

    Burak Akan

    2013-01-01

    Full Text Available Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode.

  19. Increase in the Tibial Slope Reduces Wear after Medial Unicompartmental Fixed-Bearing Arthroplasty of the Knee

    OpenAIRE

    2015-01-01

    Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of a medial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental...

  20. Complications of fixed infrared emitters in computer-assisted total knee arthroplasties

    Directory of Open Access Journals (Sweden)

    Suárez-Vázquez Abelardo

    2007-07-01

    Full Text Available Abstract Background The first stage in the implant of a total knee arthroplasty with computer-assisted surgery is to fasten the emitters to the femur and the tibia. These trackers must be hard-fixed to the bone. The objectives of our study are to evaluate the technical problems and complications of these tracker-pins, the necessary time to fix them to the bone and the possible advantages of a new femoral-fixed tracker-pin. Methods Three hundred and sixty seven tracker-pins were used in one hundred and fifty one computer-assisted total knee replacements. A bicortical screw was used to fix the tracker to the tibia in all cases; in the femur, however, a bicortical tracker was used in 112 cases, while a new device (OrthoLock with percutaneous fixation pins was employed in the remaining 39. Results Technical problems related to the fixing of the trackers appeared in nine cases (2.5%. The mean surgery time to fix the tracker pin to the tibia was 3 minutes (range 2–7, and 5 minutes in the case of the femoral pin (range: 4–11, although with the new tool it was only three minutes (range 2–4 (p Conclusion The incidence of problems and complications with the fixing systems used in knee navigation is very small. The use of a new device with percutaneous pins facilitates the fixing of femoral trackers and decreases the time needed to place them.

  1. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Christensen, Malene; Christensen, Stine Sommer;

    2010-01-01

    -tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. METHOD......: The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were...... and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6 degrees and 10 degrees (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within...

  2. Mid- term results of stryker® scorpio plus mobile bearing total knee arthroplasty

    OpenAIRE

    Kobayashi Hideo; Mitsugi Naoto; Mochida Yuichi; Taki Naoya; Akamatsu Yasushi; Aratake Masato; Ota Hirohiko; Ishii Katsushi; Harigane Kengo; Ideno Taichi; Saito Tomoyuki

    2012-01-01

    Abstract Background The mobile bearing knee system was introduced to lessen contact stress on the articular bearing surface and reduce polyethylene wear. The purpose of the current study was to investigate the mid-term results of patients undergoing total knee arthroplasties (TKAs) using Scorpio Plus Mobile Bearing Knee System (Stryker, Mahwah, NJ), and compare the outcomes between patients with osteoarthritis and osteonecrosis (OA·ON group) and patients with rheumatoid arthritis (RA group). ...

  3. Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Emmanuel Gomes Ciolac

    2011-01-01

    Full Text Available OBJECTIVES: To analyze muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty. METHODS: Twenty-three community-dwelling women were divided into the following groups: older, with knee osteoarthritis and total knee arthroplasty in the contralateral limb (OKG; N= 7; older, without symptomatic osteoarthritis (OG; N= 8; and young and healthy (YG; N= 8. Muscle strength (1-repetition maximum strength test and exercise intensity progression (workload increases of 5%-10% were made whenever adaptation occurred were compared before and after 13 weeks of a twice-weekly progressive resistance-training program. RESULTS: At baseline, OKG subjects displayed lower muscle strength than those in both the OG and YG. Among OKG subjects, baseline muscle strength was lower in the osteoarthritic leg than in the total arthroplasty leg. Muscle strength improved significantly during follow-up in all groups; however, greater increases were observed in the osteoarthritic leg than in the total knee arthroplasty leg in OKG subjects. Greater increases were also seen in the osteoarthritic leg of OKG than in OG and YG. The greater muscle strength increase in the osteoarthritic leg reduced the interleg difference in muscle strength in OKG subjects, and resulted in similar posttraining muscle strength between OKG and OG in two of the three exercises analyzed. Greater exercise intensity progression was also observed in OKG subjects than in both OG and YG subjects. CONCLUSIONS: OKG subjects displayed greater relative muscle strength increases (osteoarthritic leg than subjects in the YG, and greater relative exercise intensity progression than subjects in both OG and YG. These results suggest that resistance training is an effective method to counteract the lower-extremity strength deficits reported in older women with knee osteoarthritis and total knee arthroplasty.

  4. Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty?

    DEFF Research Database (Denmark)

    Nielsen, Katrine Abildgaard; Thomsen, Morten Grove; Latifi Yaghin, Roshan;

    2016-01-01

    awareness) with decreasing knee awareness for decreasing tibio-femoral angles. Post-operative alignment did not significantly affect FJS. CONCLUSION: Knee awareness did not differ significantly between the "best" and the "worst" knee. Bilateral simultaneous TKA can be performed without compromising the...

  5. Why Patients Do Not Participate in Sports Activities After Total Knee Arthroplasty

    Science.gov (United States)

    Chang, Moon Jong; Kang, Yeon Gwi; Chung, Byung June; Chang, Chong Bum; Kim, Tae Kyun

    2015-01-01

    Background It is important to identify the reasons or factors preventing patients from participating in sports activities after total knee arthroplasty (TKA) to improve patient satisfaction and general health that can be gained from regular sports activities. Purpose To determine the reasons for lack of participation in regular sports activities after TKA as perceived by patients and to identify specific factors involved. Study Design Case series; Level of evidence, 4. Methods A total of 369 patients with a follow-up longer than 1 year after TKA were included in this retrospective study. A postal survey regarding sports activities was conducted using a questionnaire gathering information such as sociodemographic data, activity levels, and sports activities after TKA. The reasons perceived by patients for not participating in sports activities were determined. Patients unable to participate in sports activities were compared with patients able to do so in terms of sociodemographic data and pre- and postoperative outcomes. Results Of the 369 patients, 88 (24%) replied that they could not participate in a sports activity. Among the perceived reasons, reasons not related to the replaced knee were more frequent than those related to the replaced knee (76% vs 24%). Symptoms related to the spine or other joints composed 25% of the total perceived reasons. The presence of medical comorbidities accounted for 16%, while symptoms in the nonreplaced knee represented 8% of the reasons. In terms of patient factors, multivariate logistic regression revealed that male sex, a floor-based (ie, non-Western) lifestyle with greater demands on knee flexion, and worse postoperative University of California at Los Angeles activity scale were associated with nonregular sports activity levels. Conclusion The perceived reasons and patient factors hindering regular sports activities after TKA were not restricted to problems with the replaced knee. Nonetheless, orthopaedic surgeons may have a

  6. Homologous structural graft for treatment of bone defect during knee revision arthroplasty

    Directory of Open Access Journals (Sweden)

    Hugo Alexandre de Araujo Barros Cobra

    2013-08-01

    Full Text Available OBJECTIVE: Obtaining stable bone-implant interface, correct alignment of the components, proper balance of soft tissues' tension, maintenance of proper joint interline are fundamental principles for success in surgical revision total knee arthroplasty, which are only obtained with management bone deficiency. However, proper treatment of large defects remains unclear. The aim of this study was to evaluate the clinical and radiographic results of patients that had underwent revision surgery for total knee arthroplasty with use of structural grafts of musculoskeletal tissue bank in the period between January 2002 to December 2010 by the Knee Surgery Center of National Institute of Traumatology and Orthopaedics (INTO. The study included 26 revision arthroplasties with homologous structural bone grafting in 25 patients. Thirty-four structural bone grafts were used during the 26 revision total knee arthroplasty surgeries studied. The proximal tibia and distal femur were the grafts most frequently used. Six patients developed deep infection and in one of them with damage to the extensor mechanism associated. The average score on the WOMAC was 24,9. In the assessment of functional capacity in the SF-36, the average was 52.5. In radiographic evaluation, resorption of the graft occurred in three patients and no cases were observed of osteolysis, fracture of the graft, migration or subsidence of the components. Bone grafting of a musculoskeletal tissue bank is a satisfactory option to the handling of the bone defect in the setting of revision surgery for total knee arthroplasty.

  7. Outcomes of Varus Valgus Constrained Versus Rotating-Hinge Implants in Total Knee Arthroplasty.

    Science.gov (United States)

    Malcolm, Tennison L; Bederman, S Samuel; Schwarzkopf, Ran

    2016-01-01

    The stability of a total knee arthroplasty is determined by the ability of the prosthesis components in concert with supportive bone and soft tissue structures to sufficiently resist deforming forces transmitted across the knee joint. Constrained prostheses are used in unstable knees due to their ability to resist varus and valgus transformative forces across the knee. Constraint requires inherent rigidity, which can facilitate early implant failure. The purpose of this study was to describe the comparative indications for surgery and postoperative outcomes of varus valgus constrained knee (VVK) and rotating-hinge knee (RHK) total knee arthroplasty prostheses. Seven retrospective observational studies describing 544 VVK and 254 RHK patients with an average follow-up of 66 months (range, 7-197 months) were evaluated. Patients in both groups experienced similar failure rates (P=.74), ranges of motion (P=.81), and Knee Society function scores (P=.29). Average Knee Society knee scores were 4.2 points higher in VVK patients compared with RHK patients, indicating minimal mid-term clinical differences may exist (Puniversal indication for RHK implantation vs VVK. Constrained device implantation is routinely guided by inherent stability of the knee, and, when performed, similar postoperative outcomes can be achieved with VVK and RHK prostheses. PMID:26730689

  8. Modern perceptions and expectations regarding total knee arthroplasty.

    Science.gov (United States)

    Meneghini, Robert Michael; Russo, Glenn S; Lieberman, Jay R

    2014-04-01

    It is established that patients and surgeons share different perceptions regarding total knee replacement (TKA). This study's objective was to determine patient perceptions regarding TKA as well as the influence of the various information sources in shaping these perceptions. All patients presenting with knee pain for evaluation of TKA were offered a questionnaire. Multivariate statistical analysis correlated response and demographic variables. Approximately 81% of patients felt the main reason for TKA was to alleviate pain, whereas only 19% felt return to sports-related activities was the main reason. Approximately 37% of patients felt TKAs should last for 20 years or more, which was strongly correlated with TV, newspaper, or Internet exposure (p ≤ 0.01). Approximately 38% of respondents had heard of partial knee replacement, whereas relatively few had received information regarding patient-specific, gender-specific, mobile-bearing, or high-flexion TKA designs. Men were likelier than women to get their information from friends, family, or another patient (p = 0.04). Although most respondents perceived pain relief as the primary goal, patients getting information from the media are likelier to expect TKA to last longer than 20 years. This suggests direct-to-patient marketing with such claims as 30-year durability may influence patient perceptions regarding TKA. PMID:23775544

  9. Pre-Operative Patient Education is Associated With Decreased Risk of Arthrofibrosis After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Livbjerg, Anna Emilie; Frøkjær, Sara; Simonsen, Ole;

    2013-01-01

    The purpose was to investigate risk factors for postoperative stiffness and long-term outcome following manipulation under anaesthesia (MUA). In one of the five Danish regions, all patients in a 4-year period who received MUA following total knee arthroplasty (N=36) were included in two case......-control studies. Data on potential risk factors were extracted from the Danish Knee arthroplasty Register and from a postal questionnaire including long-term outcome measures regarding pain, function and quality of life (Oxford Knee Score and EQ-5D). Previous knee surgery and a high preoperative Knee Society...... Function Score were significant risk factors, whereas attending a preoperative information meeting was associated with a significantly decreased risk of postoperative stiffness requiring MUA (P<0.001). The long-term results following MUA (1-5 years) were equivalent to patients without postoperative...

  10. Effects of Tourniquet Release on Total Knee Arthroplasty.

    Science.gov (United States)

    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

  11. Clinical experience with fondaparinux in antiaggregate patients undergoing total hip and knee arthroplasty

    OpenAIRE

    Guido Grappiolo; Marco Scardino; Giuseppe Mazziotta; Stefano Quaini; Corrado Lodigiani; Matteo Carlo Ferrari

    2013-01-01

    Patients undergoing total hip arthroplasty or total knee arthroplasty have a high risk for post-operative venous thromboembolism. The current study addressed the use of fondaparinux post-operatively in 556 patients with antiplatelet therapy in order to prevent deep vein thrombosis as well as demonstrate efficacy in preventing arterial thrombotic events. Results provided evidence for a safe and effective prophylaxis strategy, involving the change from low molecular weight heparin pre-operative...

  12. Adductor canal block for postoperative pain treatment after revision knee arthroplasty

    DEFF Research Database (Denmark)

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Schrøder, Henrik M;

    2014-01-01

    arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an adductor canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT......BACKGROUND: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total...... difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. TRIAL REGISTRATION: Clinicaltrials.gov NCT01191593....

  13. Are both the knees of the same size? Analysis of component asymmetry in 289 bilateral knee arthroplasties

    Directory of Open Access Journals (Sweden)

    Venkata Gurava Reddy

    2011-01-01

    Full Text Available Background: Variations in the anatomy of knee are well described, however the true incidence of component asymmetry in bilateral total knee arthroplsties is rarely reported. Incidence of component asymmetry in bilateral total knee arthroplasties (TKA was retrospectively analysed in 289 cruciate retaining total knee arthroplasties. Materials and Methods: Medical records of these 289 patients were evaluated for the incidence of asymmetry of either femoral or tibial components. Clinical outcomes were compared between the cases of asymetrical components to that of symmetrical components. Results: Incidence of femoral component asymmetry was found to be 9.2% and tibial component asymmetry to be 8.7%. Of 289 cases, TKA 178 were done in a single day (group A, while 111 were done at 2- to 3-day intervals (group B. Asymmetric and symmetric knees were equally distributed among both groups, male and female patients in both groups, and the incidence of component asymmetry was similar between all four different implants - Optetrak-CR (Exactech, Gainesville, FL, USA, Nexgen-CR (Zimmer, Warsaw, IN, USA, PFC-Sigma CR (DePuy, Warsaw, IN, USA, Genesis II CR (Smith and Nephew, Memphis, TN, USA we used. The pre- and postoperative range of motion and pre- and postoperative knee society scores were compared between the symmetric and asymmetric cases in both the groups and the difference was found to be insignificant. Conclusion: We conclude that incidence of component asymmetry in bilateral total knee arthroplasty is around 9 % and independent sizing of both knees during bilateral arthoplasty is recommended rather than simply relying on the contralateral knee measurements.

  14. Normalized knee-extension strength or leg-press power after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Aalund, Peter K; Larsen, Kristian; Hansen, Torben Bæk;

    2013-01-01

    OBJECTIVE: (s): To investigate which of the two muscle-impairment measures for the operated leg, normalized knee extension strength or leg press power, is more closely associated to performance-based and self-reported measures of function shortly following total knee arthroplasty (TKA). DESIGN...... dynamic leg presses to determine their body-mass normalized knee extension strength and leg press power, respectively. The 10-m fast speed walking and 30-s chair stand tests were used to determine performance-based function, while the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and...

  15. The Correlation between Posterior Tibial Slope and Maximal Angle of Flexion after Total Knee Arthroplasty

    OpenAIRE

    Kim, Keong-Hwan; Bin, Seong-Il; Kim, Jong-Min

    2012-01-01

    Purpose The purpose of this study was to evaluate the correlation between the posterior tibial slope and the maximal angle of flexion after total knee arthroplasty. Materials and Methods Seventy nine cases (63 patients, 60 females and 3 males), which received total knee arthroplasty with the Nexgen LPS system from Jan 2001 to Jan 2004, were enrolled. We divided all cases into two subsets in two ways. Firstly, group A (up to 10°, 44 cases) and group B (over 10°, 35 cases) were divided accordin...

  16. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... of articular cartilage lining the bone within the joint. That compares and contrasts to the arthritic knee ... swelling in and around her knee. The damaged joint was caused by bones grinding against each other, ...

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... in this outline here, where on the inner aspect of her knee, what we call the medial ... injection to try and re-lubricate the inner aspect of the knee. However, this failed to provide ...

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... the arthritic knee that we see on the right where the cartilage is starting to break down ... different patient who underwent that procedure where the right opaque portion of the knee shows the partial ...

  19. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... glossy layer of cartilage that's intact without any evidence of arthritis in other aspects of the knee. ... have in their knee from rupturing this ligament, evidence has shown that most of these patients do ...

  20. Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients

    DEFF Research Database (Denmark)

    Jensen, Claus Hjorth; Rofail, S

    1999-01-01

    The prevalence of obesity and previous knee injury was assessed in a retrospective study of 115 patients under-going total knee replacement due to osteoarthritis. Obesity was considered a contributing factor in the development of osteoarthritis in 37% of the patients, and 33% of the patients had...... had an injury to the knee in question. Unilateral osteoarthritis was significantly more frequent than bilateral osteoarthritis among patients with a history of previous knee injury. The association of previous injury to the knee and unilateral osteoarthritis was stronger in men than women. Aggressive...... treatment of patients with knee injuries seems warranted....

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

    Science.gov (United States)

    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

  2. The Patient’s Perspective of in-Home Telerehabilitation Physiotherapy Services Following Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    the Telage Researchers

    2013-08-01

    Full Text Available This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1 improving access to services with reduced need for transportation; (2 developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3 complementing telerehabilitation with in-person visits; (4 providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5 perceived ease-of-use of telerehabilitation equipment; and (6 feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented.

  3. Criteria used when deciding on eligibility for total knee arthroplasty - Between thinking and doing

    DEFF Research Database (Denmark)

    Skou, Søren T; Roos, Ewa M; Laursen, Mogens B;

    2016-01-01

    BACKGROUND: Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (O...... highlights the complexity of the decision-making with some overlap between the criteria that OSs think they apply and what is actually applied in clinical practice.......BACKGROUND: Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (OA...

  4. 全膝关节置换治疗晚期骨性关节炎%Treatment of osteoarthritis of the knee by total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    张永明; 范久庆; 张德光; 马东印

    2009-01-01

    目的 探讨全膝关节置换(total knee arthroplasty,TKA)在膝关节骨性关节炎治疗中的疗效,手术要点及注意事项.方法 对35例(41膝)晚期骨性关节炎患者行初次人工全膝关节置换术,采用膝前正中纵形切口和内侧髌旁入路,术后进行随访,对比术前术后膝关节功能评分(the Hospital for Special Surgery Knee Score,HSS)及膝关节活动度( range of motion,ROM)以观察疗效.结果 全部病例均得到平均24个月的随访,均未出现感染、下肢静脉血栓等并发症.HSS评分由术前平均(69±7)分提高到术后平均(91±4.6)分.膝关节活动范围由术前平均95°提高到术后平均115°.结论 全膝关节置换是治疗晚期膝关节骨关节炎的最佳治疗手段.选择恰当的病例,良好的假体设计,精确的手术技术,术后积极的康复锻炼是影响术后结果的主要因素.%Objective To explore the efficacy,operation points and points for attention of total knee replacement in the treatment of osteoarthritis of the knee. Methods We reviewed the results of 35 cases (41 knees)with initial total knee arthroplasty at our hospital,including 26 females(32 knees)and 9 males(9 knees)with age range from 50 to 78 years(mean,64.9-year-old),from January 2004 to January 2006.All knees were varus deformity mean,(12.8±3°).Results A 11 cases were followed up with a mean period of 24 months without infections and deep vein thrombosis.According to the HSS knee scoring system,the scores were from 69±7 preoperation to 91±4.6 postoperation.The knee ROM increased from 95°to 115°too. Conclusions Total knee arthroplasty is the best treatment for advanced knee osteoarthritis.Selecting appropriate cases,a good Prosthesis design,precise surgical technique,postoperative rehabilitation exercise can result in the best functional results.

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

    OpenAIRE

    Saibaba, Balaji; Dhillon, Mandeep S.; 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 us...

  6. New Instrumentation Reduces Operative Time in Medial Unicompartmental Knee Arthroplasty Using the Oxford Mobile Bearing Design

    OpenAIRE

    Keith Berend; Jason Hurst; Michael Morris; Joanne Adams; Adolph Lombardi

    2015-01-01

    Redesigned instrumentation has become available for implantation of the Oxford Mobile Bearing Medial unicompartmental knee arthroplasty. To assess the benefit of these changes, we compared operative time of 200 Phase III and 176 Microplasty UKA done 2008-2011. An average time savings of 8.6 minutes was seen with the Microplasty design.  Additionally, the standard deviation in operative times, minimum and maximum operatives were lower in knees in which Microplasty instrumentation was utilized....

  7. Do clinical foot and ankle assessments improve the prediction of patient reported outcomes in knee arthroplasty?

    OpenAIRE

    Gates, Lucy

    2015-01-01

    Knee arthroplasty (KA) has been considered to be a successful and cost-effective intervention for individuals with severe end stage Osteoarthritis (OA). A number of clinically important predictors of outcomes following KA have been established, however there are still other factors to be identified to improve our ability to recognise patients at risk of poor KA outcomes. Although the relationship between foot, ankle and knee kinematics has become widely accepted, it is not known whether foot ...

  8. Preoperative screening for venous thromboembolism in total knee arthroplasty

    International Nuclear Information System (INIS)

    The purpose of this study is to investigate the availability of the D-dimer as a screening marker, the factors affecting on the value of the D-dimer, and the patient's background with the deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) before total knee arthroplasty (TKA) prospective trial. The total of 85 patients scheduled for TKA from March 2004 to Aril 2007 were enrolled under the criteria excluding the revison surgery and the medication of anticoagulant. There were 20 men and 65 women with a mean age of 73 years-old (range, 52-89). All patients were measured the D-dimer preoperatively. If the value was more than 1.0 μg/ml, the multidetector-CT (MD-CT) examination was followed to determined the diagnosis for DVT and/or pulmonary embolism (PE). In addition, six clinical factors including the age, sex, body mass index (BMI), disease, heart function, and walking ability were examined in order to analyze their influences on the value of D-dimer and the formation of DVT/PE. The mean value of D-dimer was 2.5±2.7 μg/ml and 71 patients (83.5%) had the value more than 1.0 μg/ml. The incidence of DVT/PE was 9.4% (1.2-15.0 μg/ml). There were no symptomatic cases. No clinical factors had significant differences in the occurrence of DVT/PE. Our findings demonstrated that the preoperative screening for DVT/PE using the MD-CT selectively in patients with a high value of D-dimer was not always available. Additional anticoagulant treatment, therefore, may be necessary for the prevention of DVT/PE after TKA. (author)

  9. Strength training to contraction failure increases voluntary activation of the quadriceps muscle shortly after total knee arthroplasty

    DEFF Research Database (Denmark)

    Mikkelsen, Elin Karin; Jakobsen, Thomas Linding; Holsgaard-Larsen, Anders; Andersen, Lars L.; Bandholm, Thomas

    2016-01-01

    OBJECTIVE: The objective of this study was to investigate voluntary activation of the quadriceps muscle during one set of knee extensions performed until contraction failure in patients shortly after total knee arthroplasty. DESIGN: This was a cross-sectional study of 24 patients with total knee ...

  10. Strength Training to Contraction Failure Increases Voluntary Activation of the Quadriceps Muscle Shortly After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Mikkelsen, Elin Karin; Jakobsen, Thomas Linding; Holsgaard-Larsen, Anders; Andersen, Lars Louis; Bandholm, Thomas

    2016-01-01

    OBJECTIVE: The objective of this study was to investigate voluntary activation of the quadriceps muscle during one set of knee extensions performed until contraction failure in patients shortly after total knee arthroplasty. DESIGN: This was a cross-sectional study of 24 patients with total knee ...

  11. Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    SHEN Hui-liang; LI Zheng; FENG Ming-li; CAO Guang-le

    2011-01-01

    Background Total knee arthroplasty (TKA) is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin (HB) counts postoperatively, which are significantly inconsistent with the measured blood loss. Although the concept of hidden blood loss has been presented in 2000, very little clinical attention has been paid since then. In this study, we investigated the characteristics and influential factor of hidden blood loss after TKA in treating knee osteoarthritis.Methods One hundred and eight patients, with 42 males and 66 females, were retrospectively analyzed. The perioperative blood loss and the hidden blood loss following TKA were calculated by Gross formula. Potential factors affecting perioperative and hidden blood loss included gender, surgical time, tourniquet time, hemostasis (during operation with deflating tourniquet), and reinfusion of salvaged blood.Results The average perioperative blood loss was found to be (1553±356) ml and the average hidden blood loss was (793±223) ml. The hidden blood loss of the male was significantly higher than that of the female, and was reduced by hemostasis during the operation with a deflating tourniquet. Hidden blood loss was not affected by postoperative blood salvage and reinfusion, surgical time, or tourniquet time.Conclusions When calculating the value of hidden blood loss by Gross formula, the lowest value of hematocrit should be chosen as the parameter so that hidden blood loss would not be underestimated. No significant differences could be found in hidden blood loss for males compared to females. Hidden blood loss can be reduced by hemostasis during operation with a deflating tourniquet. Although reinfusion of salvaged blood could not reduce the perioperative blood loss or hidden blood loss, it was still an effective method to reduce transfusion rate.

  12. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jenstrup, M T; Jæger, P; Lund, J; Fomsgaard, J S; Bache, S; Mathiesen, O; Larsen, T K; Dahl, J B

    2012-01-01

    Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We...

  13. Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Villadsen, Allan; Overgaard, Søren; Holsgaard-Larsen, Anders;

    2014-01-01

    supervised neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier...

  14. Physiotherapy Exercise After Fast-Track Total Hip and Knee Arthroplasty: Time for Reconsideration?

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Kehlet, Henrik

    2012-01-01

    Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Major surgery, including total hip arthroplasty (THA) and total knee arthroplasty (TKA), is followed by a convalescence period, during which the loss of muscle strength and......-track methodology or enhanced recovery programs. It is the nature of this methodology to systematically and scientifically optimize all perioperative care components, with the overall goal of enhancing recovery. This is also the case for the care component "physiotherapy exercise" after THA and TKA. The 2 latest...... meta-analyses on the effectiveness of physiotherapy exercise after THA and TKA generally conclude that physiotherapy exercise after THA and TKA either does not work or is not very effective. The reason for this may be that the "pill" of physiotherapy exercise typically offered after THA and TKA does...

  15. Heart rate response during sleep in elderly patients after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Sørensen, Gertrud Laura; Kehlet, Henrik; Jennum, Poul

    2015-01-01

    postoperative period after fast-track hip and knee arthroplasty. Determination of autonomic function was gained from polysomnographic evaluation of 10 patients >60 years undergoing either hip or knee arthroplasty (mean age 69.9 years) evaluating HRR during the different sleep phases. Sleep monitoring took place...... major arthroplasty surgery in elderly patients may reflect a functional change in sympathetic nervous system potentially relevant for postoperative sleep changes, fatigue and cognitive function.......Variability in heart rate response (HRR) can be used as a measure for autonomic nervous system function, which may influence sleep disturbances and the recovery phase after major surgery. The aim of this study was to evaluate autonomic function by assessment of HRR during sleep arousals in the...

  16. 全膝关节置换治疗严重膝关节疾病%Total knee arthroplasty for the treatment of severe knee disease

    Institute of Scientific and Technical Information of China (English)

    李广伟; 王红军; 孙晓智

    2013-01-01

    . Through patel ar medial approach and correct osteotomy, selective soft tissue release was performed to restore normal knee alignment and soft tissue balance to harvest knee stability. The targeted rehabilitation training was performed after replacement and the knee range of motion and maximum knee flex degree were detected regularly. The Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score were performed. RESULTS AND CONCLUSION: Al patients were fol owed-up for 25 to 84 months, 35.5 months in average. The knee range of motion, maximum knee flex degree, Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score of al the patients were significantly increased after replacement compared with those before replacement (P < 0.01). The wound was in stage Ⅰ recovery. No knee joint rigidity, blood vessel and nerve injury, patel a fracture, patel a low-site and prosthesis loosening were observed after replacement. The lower limb alignment was restored to normal level. The adult severe knee deformity can be corrected through total knee arthroplasty, and the function is improved significantly with satisfactory clinical results.

  17. Getting Active After Knee Replacement Might Raise Hip Fracture Risk

    Science.gov (United States)

    ... exact reason for the increase in hip and spine fractures isn't clear, it's most likely due "to ... Osteoporosis International . "The increasing risk for hip and vertebral fracture in the 10 years after knee replacement may ...

  18. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Lau Rick L

    2012-12-01

    Full Text Available Abstract Background A number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes. Methods We performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language. Results Studies were variable in defining surgeon volume (‘low’: 5 to >70 total knee arthroplasty per year. Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection (0.26% - 2.8% higher, procedure time (165 min versus 135 min, longer length of stay (0.4 - 2.13 days longer, transfusion rate (13% versus 4%, and worse patient reported outcomes. Conclusions Findings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution.

  19. Effect of Posterior Femoral Condylar Offset and Posterior Tibial Slope on Maximal Flexion Angle of the Knee in Posterior Cruciate Ligament Sacrificing Total Knee Arthroplasty

    OpenAIRE

    Kim, Jong-Heon

    2013-01-01

    Purpose To evaluate the effect of femoral condylar offset and posterior tibial slope on maximal flexion angle of the knee in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA, Medial-Pivot Knee System). Materials and Methods Forty-five knees in 35 patients who could be followed up more than 1 year after PCL-sacrificing TKA were evaluated retrospectively. We measured and analyzed the preoperative and postoperative maximal flexion angle, posterior femoral condylar offse...

  20. The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty

    OpenAIRE

    Pongcharoen, Boonchana; Reutiwarangkoon, Chaivet

    2016-01-01

    In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arth...

  1. Sleep disturbances after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, L; Jennum, P; Kehlet, H

    2012-01-01

    normalized on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern. CONCLUSIONS: /st>Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost......BACKGROUND: /st>Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement...... the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated. RESULTS: /st>The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a...

  2. Sex,age,and annual incidence of primary total knee arthroplasty:a university affiliated hospital survey of 3118 Chinese patients

    Institute of Scientific and Technical Information of China (English)

    YANG Bo; YU Jia-kuo; GONG Xi; CHEN Lian-xu; WANG Yong-jian; WANG Jian; MA Dong

    2012-01-01

    Background In recent years,the number of patients undergoing primary total knee arthroplasty in China has rapidly increased.However,the incidence of primary total knee arthroplasty is unknown.The purpose of this study was to investigate the sex,age and,annual incidence of primary total knee arthroplasty based on 3118 Chinese patients who underwent the procedure during the period of 2000-2011.Methods Total knee arthroplasties were performed on 511 males and 2607 females in our hospital during the period of 2000-2011.The sex,age,and annual incidence of primary total knee arthroplasty were evaluated.Results The annual incidence of primary total knee arthroplasty increased from 35 knees in 2000 to 681 knees in 2011.The average annual percentage increase in incidence was 33.2%.Females accounted for 83.2% of the patients who underwent primary total knee arthroplasty.In both males and females,the highest incidence was observed in the group aged 65-74 years.Conclusions This study demonstrated a rapid increase in the incidence of primary total knee arthroplasty in our Chinese study population.The sex and age incidence of primary total knee arthroplasty in our study population differed from those reported in Western populations.

  3. Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach

    OpenAIRE

    Verdonk, Peter C. M.; PERNIN, Jérôme; PINAROLI, Alban; AIT SI SELMI, Tarik; Neyret, Philippe

    2009-01-01

    We present an algorithmic release approach to the varus knee, including a novel pie crust release technique of the superficial MCL, in 359 total knee arthroplasty patients and report the clinical and radiological outcome. Medio-lateral stability was evaluated as normal in 97% of group 0 (deep MCL), 95% of group 1 (pie crust superficial MCL) and 83% of group 2 (distal superficial MCL). The mean preoperative hip-knee angle was 174.0, 172.1, and 169.5 and was corrected postoperatively to 179.1, ...

  4. [Evolution of total knee arthroplasty : From robotics and navigation to patient-specific instruments].

    Science.gov (United States)

    Haaker, R

    2016-04-01

    In this article the evolution beginning with the robotics of total knee arthroplasty to CT-based and kinematic navigation and patient-specific instruments is described. Thereby it is pointed out that in the early 1990s, CT imaging solely for the planning of a knee endoprosthesis was considered as obsolete radiation exposure and this led to the widespread development of kinematical systems.Also a patient specific planning tool based on CAD built acryl harz blocs existed at the time. There is an ongoing process of implanting total knee arthroplasties in a more exact position. Nowadays the new evolution of soft tissue balancing by using a kinematic alignment has put these efforts into perspective. PMID:27025867

  5. Weight loss intervention before total knee arthroplasty-feasibility and safety

    DEFF Research Database (Denmark)

    Liljensøe, A.; Laursen, J. O.; Bliddal, H.;

    2015-01-01

    implement an intensive weight loss program in order to reduce preoperative body weight of obese patients before TKA surgery. The primary aim of the Weight Loss Intervention before Total Knee Arthroplasty (WITKA) study is to investigate whether weight loss interventions before total knee arthroplasty (TKA......) will improve QoL and physical function 1 year after surgery. Methods: We conducted a single-blind, randomized study. Eligible patients were scheduled for TKA due to osteoarthritis (OA) of the knee and obesity (BMI >30kg/m2). Participants were randomized to either a control group that followed the...... standard care or a weight loss group that followed a low-energy diet (810 kcal/day) 8 weeks before surgery. Outcomes were assessed before intervention for the weight loss group, and within 1 week preoperatively for both the weight loss group and the control group. The primary outcome in the WITKA study was...

  6. Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty.

    Science.gov (United States)

    Milandt, Nikolaj; Nymark, Tine; Jørn Kolmos, Hans; Emmeluth, Claus; Overgaard, Søren

    2016-08-01

    Background and purpose - Iodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolonization. A greater number of viable bacteria in the surgical field of an arthroplasty, and surgery in general, may increase the infection risk. We investigated whether IIID use increases bacterial recolonization compared to no drape use under conditions of simulated total knee arthroplasty (TKA). Methods - 20 patients scheduled for TKA were recruited. Each patient had 1 knee randomized for draping with IIID, while the contralateral knee was left bare. The patients thus served as their own control. The operating room conditions and perioperative procedures of a TKA were simulated. Cylinder samples were collected from the skin of each knee prior to disinfection, and again on 2 occasions after skin preparation-75 min apart. Quantities of bacteria were estimated using a spread plate technique under aerobic conditions. Results - We found similar quantities of bacteria on the intervention and control knees immediately after skin disinfection and after 75 min of simulated surgery. These quantities had not increased at the end of surgery when compared to baseline, so no recolonization was detected on the draped knees or on the bare knees. Interpretation - The use of IIIDs did not increase bacterial recolonization in simulated TKA. This study does not support the hypothesis that IIIDs promote bacterial recolonization and postoperative infection risk. PMID:27168308

  7. Former Male Elite Athletes Have a Higher Prevalence of Osteoarthritis and Arthroplasty in the Hip and Knee Than Expected.

    OpenAIRE

    Tveit, Magnus; Rosengren, Björn; Nilsson, Jan-Åke; Karlsson, Magnus

    2012-01-01

    BACKGROUND: Intense exercise has been reported as one risk factor for hip and knee osteoarthritis (OA). PURPOSE: This study aimed to evaluate (1) whether this is true for both former impact and nonimpact athletes, (2) if the risk of a hip or knee arthroplasty due to OA is higher than expected, and (3) if joint deterioration is associated with knee injuries. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The prevalence of OA and arthroplasty in the hip and knee were registered in 7...

  8. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... 10 hospitals in America by "US News and World Report." New York Presbyterian is affiliated with two ... implant itself. And again, this is when only one part of the knee, what we call a ...

  9. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Today we're going to be discussing several topics. First, we're going to introduce our patient. ... and go over some questions of some common topics that come up when talking about partial knee ...

  10. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... knee. The damaged joint was caused by bones grinding against each other, leading to pain, stiffness and ... smaller hospitals with lower volume. It's fairly demanding technology surgery that you were just doing there. Don' ...

  11. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... patient. She's a 42-year-old female, a mother of two young children who had several years ... is gone through the skin and we're working our way down to the knee joint capsule ...

  12. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... diagnosed based on a doctor taking a medial history, physical exam, and other modalities such as x- ... Jeff, just to remind the audience, you're operating on the left knee. And so, your incision ...

  13. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... is a younger woman who's had many different treatments attempted on her knee. She started out simply ... and anti-inflammatories, as well as some physical therapy. Continuing with other non-operative treatment modalities, she ...

  14. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... younger patients this can be caused by either fractures or just natural wear and tear and excessive ... prior surgery on the knee, any sort of fracture surgery or any sort of osteotomy, which is ...

  15. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... but very often they have a local visiting nurse service or something take out the clips and ... reconstruction. What about the overall knee alignment? How critical do you think that is in choosing your ...

  16. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... the medial compartment of her knee, she's got bone-on-bone arthritis. What makes her a good candidate for ... full healthy layer of articular cartilage lining the bone within the joint. That compares and contrasts to ...

  17. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... year-old female, a mother of two young children who had several years worth of debilitating left ... the arthritic knee that we see on the right where the cartilage is starting to break down ...

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... Jeff, just to remind the audience, you're operating on the left knee. And so, your incision ... soon. What's your rationale for that? In this system, the way the guides are for the distal ...

  19. Arthritic Pain Relief through Partial Knee Replacement

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    Full Text Available ... diagnosed based on a doctor taking a medial history, physical exam, and other modalities such as x- ... to get back to a normal way of life with the partial knee. And most of my ...

  20. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... do these with as little exposure to the muscles and to the ligaments as possible. And so, ... the inner aspect of the knee. The quadriceps muscle is just to the top left aspect of ...

  1. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... patient. We're going to go into the definition of arthritis. We're going to talk a ... the arthritic knee that we see on the right where the cartilage is starting to break down ...

  2. Recovery after short-stay total hip and knee arthroplasty. Evaluation of a support program and outcome determination

    NARCIS (Netherlands)

    Akker-Scheek, Inge van den

    2007-01-01

    As a result of the increasing demand for total hip arthroplasties (THA) and total knee arthroplasties (TKA), waiting lists are growing. To cope with this problem, many hospitals have introduced short-stay programs; a consequence is increased responsibility of the patient regarding his own rehabilita

  3. A systematic review investigating the relationship between efficacy and stimulation parameters when using transcutaneous electrical nerve stimulation after knee arthroplasty

    OpenAIRE

    Beckwée, David; Bautmans, Ivan; Swinnen, Eva; Vermet, Yorick; Lefeber, Nina; Lievens, Pierre; Vaes, Peter

    2014-01-01

    Objective: To evaluate the clinical efficacy of transcutaneous electric nerve stimulation in the treatment of postoperative knee arthroplasty pain and to relate these results to the stimulation parameters used. Data Sources: PubMed, Pedro and Web of Knowledge were systematically screened for studies investigating effects of transcutaneous electric nerve stimulation on postoperative knee arthroplasty pain. Review Methods: Studies were screened for their methodological and therapeutical quality...

  4. Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty

    DEFF Research Database (Denmark)

    Madsen, Majbritt; Larsen, Kristian; Madsen, Inger Kirkegård; Søe, Hanne; Hansen, Torben Bæk

    2013-01-01

    This study aimed to test whether group-based rehabilitation focusing on strength training, education and self-management is more effective than individual, supervised home-training after fast-track total knee arthroplasty (TKA).......This study aimed to test whether group-based rehabilitation focusing on strength training, education and self-management is more effective than individual, supervised home-training after fast-track total knee arthroplasty (TKA)....

  5. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

    Science.gov (United States)

    Tilbury, Claire; Holtslag, Maarten J; Tordoir, Rutger L; Leichtenberg, Claudia S; Verdegaal, Suzan H M; Kroon, Herman M; Fiocco, Marta; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-01-01

    Background and purpose There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model. Results Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations. Interpretation The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA. PMID:26484651

  6. Influence of Bicompartmental Knee Replacement on Stand-to-Sit Movement

    Science.gov (United States)

    Wang, He; Frame, Jeff; Rolston, Lindsey

    2012-01-01

    Knee osteoarthritis often occurs in medial and patellofemoral compartments. A bicompartmental knee replacement system replaces these two affected knee compartments and keeps the lateral compartment and cruciate ligaments intact. It is yet to be determined whether limbs with bicompartmental knee systems can demonstrate frontal-plane knee mechanics…

  7. Opinions among Danish knee surgeons about indications to perform total knee replacement showed considerable variation

    DEFF Research Database (Denmark)

    Troelsen, Anders; Schrøder, Henrik; Husted, Henrik

    2012-01-01

    During the past decade, the incidence of primary total knee replacement (TKA) surgery in Denmark has approximately doubled. This increase could be due to weakened indications to perform TKA surgery. We aimed to investigate variation in opinions about indications to perform TKA among Danish knee...

  8. Psychiatric disease as a risk factor in fast-track hip and knee replacement

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Jørgensen, Christoffer Calov; Fink-Jensen, Anders;

    2016-01-01

    Recent studies suggest that patients with psychiatric disorders tend to do worse than patients without a psychiatric diagnosis when undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Whether this is due to their psychiatric condition, pharmacological treatment, a combinatio...

  9. Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Aasvang, Eske Kvanner

    2015-01-01

    Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding...... randomized controlled trials comparing modern general anesthesia and spinal anesthesia for knee and hip arthroplasty prevents final recommendations and calls for prospective detailed studies in this clinically important field....

  10. A compression bandage improves local infiltration analgesia in total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse; Husted, Henrik; Otte, Niels Kristian Stahl Kri; Kristensen, Billy Bjarne; Kehlet, Henrik

    2008-01-01

    BACKGROUND: High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated. METHODS: 48 patients undergoing fast-track total knee replacement with high-volume (170 mL) 0.2% rop...

  11. Mid- term results of stryker® scorpio plus mobile bearing total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Kobayashi Hideo

    2012-10-01

    Full Text Available Abstract Background The mobile bearing knee system was introduced to lessen contact stress on the articular bearing surface and reduce polyethylene wear. The purpose of the current study was to investigate the mid-term results of patients undergoing total knee arthroplasties (TKAs using Scorpio Plus Mobile Bearing Knee System (Stryker, Mahwah, NJ, and compare the outcomes between patients with osteoarthritis and osteonecrosis (OA·ON group and patients with rheumatoid arthritis (RA group. Methods Eight males and 58 females were followed up for a period of 4.4- 7.6 years from June 1, 2003 to December 31, 2005. There were 53 knees with osteoarthritis, 17 knees with rheumatoid arthritis, and 6 knees with osteonecrosis. Clinical and radiographic follow- up was done using The Japanese Orthopedic Association knee rating score (JOA score and Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Results With regard to the JOA score, there was significant improvement in both groups. The postoperative range of motion was between 0.8°and 116.8° in OA·ON group, and between 0.0° and 113.7° in RA group. There were no significant differences with the radiographic evaluation between two groups. Spontaneous dislocation of a polyethylene insert occurred in one patient, and deep infection was occurred in one patient. Conclusion There was significant improvement with regard to the clinical and radiographic results of patients undergoing TKAs using the model. The risk of polyethylene insert dislocation related to the mobile bearing TKA is a cause for concern.

  12. A biomechanical evaluation of hinged total knee replacement prostheses.

    Science.gov (United States)

    Long, Robin; Gheduzzi, Sabina; Bucher, Thomas A; Toms, Andrew D; Miles, Anthony W

    2013-08-01

    The number of total knee replacements being performed worldwide is undergoing an unprecedented increase. Hinged total knee replacements, used in complex salvage and revision procedures, currently account for a small but growing proportion of prostheses implanted. Modern hinged prostheses share the same basic configuration, allowing flexion-extension and tibial rotation. One aspect on which designs differ is the anteroposterior location of the hinge. A more posterior hinge is designed to increase the patellar tendon moment arm, reducing the quadriceps force required for a given activity and benefiting the patient. Five commonly used total knee replacements were evaluated in terms of quadriceps force and patellar tendon moment arm using a laboratory-based rig. Significant differences were identified between the five prostheses in quadriceps force and patellar tendon moment arm. Analysis of the correlation between these two parameters indicates that while patellar tendon moment arm influences quadriceps force, it is not the only factor. Also important is the lever function of the patella, and it is suggested here that the non-physiological nature of the prosthetic patellofemoral geometry may result in unnatural joint function. Thus, a thorough understanding of the resulting kinematic function of hinged total knee replacements is becoming increasingly important in complex revision total knee replacement to meet rising patient expectations and functional demands. PMID:23722496

  13. Risk factors for lower limb swelling after primary total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    GAO Fu-qiang; LI Zi-jian; ZHANG Ke; David Huang; LIU Zhong-jun

    2011-01-01

    Background Total knee arthroplasty (TKA) is a successful surgical technique for patients with advanced knee osteoarthritis; however,some peri-operative complications can not be predicted or avoided completely.This study aimed to investigate the factors affecting limb swelling after primary total knee arthroplasty,to guide and improve patient rehabilitation.Methods Using a hospital database,we retroactively analyzed the mean changes in limb circumferences of 286 consecutive patients who underwent primary unilateral total knee arthroplasty between October 2007 and August 2009.The lower limb circumference change was calculated and analyzed statistically.The influence of age,gender,body mass index,the presence of deep vein thrombosis,methods of anti-coagulation,operation time,hidden blood loss,and type of prosthesis on post-operative lower limb swelling was studied.Results Swelling was most pronounced from the third to the fifth post-operative day and usually occurred in both lower limbs.Swelling was significantly more pronounced in the operated limb than in the non-operated limb.The swelling above the knee was also significantly greater than that below the knee.The change in limb circumference at 10 cm above the knee was significantly different between the patients with body mass index <25 kg/m2 and those with body mass index >25 kg/m2.However,the change in limb circumference at 10 cm below the knee was not significantly different between the two groups.There was no statistically significant difference in limb swelling between different age groups (P >0.05).Similarly,gender,methods of anti-coagulation,the presence of deep vein thrombosis,the type of prosthesis,and operation time did not significantly affect post-operative limb swelling.Multivariate linear regression showed that the factors affecting post-operative limb swelling were body mass index and hidden blood loss.Conclusions Lower limb swelling after total knee arthroplasty is related to early post

  14. Ten-Year Comparison of Oxidized Zirconium and Cobalt-Chromium Femoral Components in Total Knee Arthroplasty

    Science.gov (United States)

    Roe, Justin; Vioreanu, Mihai; Salmon, Lucy; Waller, Alison; Pinczewski, Leo

    2016-01-01

    Objective: The purpose of this study was to determine if oxidized zirconium femoral components had better outcomes than cobalt-chromium in vivo at medium and long term and if the use of oxidized zirconium components had clinical adverse effects. Methods: Forty consecutive patients (eighty knees) underwent simultaneous bilateral cruciate-retaining total knee arthroplasty for primary osteoarthritis from January 2002 to December 2003. For each patient, the knees were randomized to receive the oxidized zirconium femoral component, with the contralateral knee receiving the cobalt-chromium component. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, Knee Society score, and British Orthopaedic Association patient satisfaction scale. Radiographic outcomes include the Knee Society total knee arthroplasty roentgenographic evaluation and scoring system and measurement of radiographic wear. Patients and assessors were blinded to the treatment groups and results. Results: There were no significant differences in clinical, subjective, and radiographic outcomes between the two implants at ten years postoperatively. Ten years following surgery, 36% of the patients preferred the cobalt-chromium knee compared with 11% who preferred the oxidized zirconium knee (p = 0.02) and 53% had no preference. Conclusions: Ten-year outcomes after total knee arthroplasty with oxidized zirconium and cobalt-chromium femoral components showed no significant differences in clinical, subjective, and radiographic outcomes. Patients had no preference or preferred the cobalt chromium prosthesis to the oxidized zirconium prosthesis. There were no adverse effects associated with the use of oxidized zirconium femoral implants.

  15. Finite element assessment of block-augmented total knee arthroplasty.

    Science.gov (United States)

    Frehill, B; Crocombe, A D; Agarwal, Y; Bradley, W N

    2015-01-01

    Loosening and migration of tibial prostheses have been identified as causes of early total knee replacement (TKR) failure. The problem is made more complex when defects occur in the proximal tibia compromising fixation and alignment. Clinical studies using metal augments have shown these to be an alternative to other means of defect treatment. Finite element (FE) analysis can be used to identify regions that may be prone to loosening and migration. In the current work, 3D FE models of TKR uncontained type-2 defects treated with block augments have been constructed and analysed. It has been shown that a metal augment is the most suitable. The use of bone cement (PMMA) to fill proximal defects is not considered suitable as stresses carried by the cement block exceed those of the fatigue limit of bone cement. It has been shown that the stresses in the proximal cancellous bone of block-augmented models are significantly below levels likely to cause damage due to overloading. Furthermore, the use of stem extensions has been shown to reduce the cancellous bone stresses in the proximal region thus increasing the likelihood of bone resorption. Given this, it is recommended that stem extensions are not required unless necessary to mitigate some other problem. PMID:25204616

  16. Who should have knee joint replacement surgery for osteoarthritis?

    DEFF Research Database (Denmark)

    Dieppe, Paul; Lim, Keith; Lohmander, Stefan

    2011-01-01

    Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10-20% of peo...... percentage of the variance with this technique. Finally, we propose use of the 'capacity to benefit framework' to attempt providing guidance to both patients and healthcare professionals....

  17. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... like you said, they have to be the right candidate. Turns out that probably fewer than 10 or 15 percent of the knee surgery candidates that come into my office are real good patients who are good candidates for this ...

  18. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... or just natural wear and tear and excessive exercise, ultimately leading to arthritis. Again, this is just ... maybe what we would have appreciated with our physical exam during the office ... to more high impact activities, what do you tell them about partial knee ...

  19. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... left knee pain. She had arthritis on her x-rays, as you can see in this outline here, ... history, physical exam, and other modalities such as x-rays, MRI's or CAT scans. And again, operative treatment ...

  20. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... than 10 or 15 percent of the knee surgery candidates that come into my office are real good patients who are good candidates for this particular ... essentially the fixation of these implants are as good on the first day of the surgery as they'll ever be, right? So you ...

  1. Elongation of the collateral ligaments after cruciate retaining total knee arthroplasty and the maximum flexion of the knee.

    Science.gov (United States)

    Park, Kwan Kyu; Hosseini, Ali; Tsai, Tsung-Yuan; Kwon, Young-Min; Li, Guoan

    2015-02-01

    The mechanisms that affect knee flexion after total knee arthroplasty (TKA) are still debatable. This study investigated the elongation of the superficial medial (sMCL) and lateral collateral ligaments (LCL) before and after a posterior cruciate retaining (CR) TKA. We hypothesized that overstretching of the collateral ligaments in high flexion after TKA could reduce maximal flexion of the knee. Three-dimensional models of 11 osteoarthritic knees of 11 patients including the insertions of the collateral ligaments were created using MR images. Each ligament was divided into three equal portions: anterior, middle and posterior portions. The shortest 3D wrapping length of each ligament portion was determined before and after the TKA surgery along a weight-bearing, single leg flexion path. The relationship between the changes of ligament elongation and the changes of the maximal knee flexion after TKAs was quantitatively analyzed. The sMCL showed significant increases in length only at low flexion after TKA; the LCL showed decreases in length at full extension, but increases with further flexion after TKA. The amount of increases of the maximum flexion angle after TKA was negatively correlated with the increases of the elongations of the anterior portion (p=0.010, r=0.733) and middle portion (p=0.049, r=0.604) of the sMCL as well as the anterior portion (p=0.010, r=0.733) of the LCL at maximal flexion of the knee. The results indicated that the increases of the length of the collateral ligaments at maximal flexion after TKA were associated with the decreases of the maximal flexion of the knee. Our data suggest that collateral ligament management should also be evaluated at higher knee flexion angles in order to optimize maximal flexion of the knee after TKAs. PMID:25555307

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

    Science.gov (United States)

    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

  3. Anti-inflammatory effect of peripheral nerve blocks after knee surgery: clinical and biologic evaluation. : Postoperative peripheral nerve blocks reduce clinical inflammation after total knee arthroplasty

    OpenAIRE

    Martin, Frédéric; Martinez, Valéria; Mazoit, Jean Xavier; Bouhassira, Didier; Cherif, Kamel; Gentili, Marc Edouard; Piriou, Philippe; Chauvin, Marcel; Fletcher, Dominique

    2008-01-01

    BACKGROUND: Nerve blocks provide analgesia after surgery. The authors tested whether nerve blocks have antiinflammatory effects. METHODS: Patients had combined sciatic (single-shot) and continuous femoral block (48 h) (block group) or morphine patient-controlled analgesia after total knee arthroplasty. Pain at rest and upon movement was monitored at 1 (D1), 4 (D4), and 7 days (D7) and 1 (M1) and 3 months (M3) after surgery. Knee inflammation was evaluated (skin temperature, knee circumference...

  4. Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kristensen, Billy Bjarne; Valentiner, Lotte;

    2007-01-01

    -5200 mL) compared with restrictive (median 1740 mL, range 1100-2165 mL) intravascular fluid administration led to improved pulmonary function 6 h postoperatively, significant hypercoagulability 24-48 h postoperatively, and reduced incidence of vomiting. There were no overall differences in the other......BACKGROUND: There are few data describing the relationship between amount of perioperative fluid and organ function. In this study we investigated the effects of two levels of intravascular fluid administration ("liberal" versus "restrictive") in knee arthroplasty on physiological recovery as the...... primary outcome variable. METHODS: In a double-blind study, 48 ASA I-III patients undergoing fast-track elective knee arthroplasty were randomized to restrictive or liberal perioperative intravascular fluid administration. Patients received a fixed rate infusion of Ringer's lactate solution with a...

  5. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique.

    Science.gov (United States)

    Dillon, John P; Brennan, Louise; Mitchell, David

    2012-04-01

    The optimal form of post-operative analgesia in hip and knee arthroplasty is still debated. Traditionally, patient-controlled analgesia and epidural anaesthesia were used. Potential side-effects such as nausea, confusion, urinary retention, hypotension and immobility have resulted in the emergence of newer techniques that limit opioid use. Peripheral nerve blockade provides excellent analgesia but limits patient ability to ambulate in the immediate post-operative period. Local infiltrative analgesia (LIA) is an emerging technique that has shown to provide superior analgesia, higher patient satisfaction and earlier discharge from hospital when compared to some of the more traditional methods. This review article highlights the advantages of LIA in hip and knee arthroplasty surgery. We describe the technique used, including additional measures that aid early ambulation and discharge from hospital in this cohort of patients. PMID:22696983

  6. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Jens Ulrik; Mathiesen, Ole; Lind, T;

    2014-01-01

    category compared with placebo. METHODS: Fifty patients with severe pain, defined as having a visual analogue scale (VAS) pain score of >60 during active flexion of the knee on the first or the second postoperative day after TKA, were included in this randomized, double-blind, placebo-controlled trial. All......BACKGROUND: Total knee arthroplasty (TKA) is associated with varying degrees of pain. A considerable proportion (25-40%) of patients experience severe pain, despite a comprehensive multimodal analgesic regimen. We hypothesized that adductor canal block (ACB) would reduce pain in this patient...... moderate, movement-related pain. Clinical trial registration www.clinicaltrials.gov, NCT01549704....

  7. Safety of Early Application of Continuous Passive Motion in Patients after Total Knee Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    顾晓园; 陈文红; 等

    2002-01-01

    Objective This research aimed to study the effect of early application of continuous passive motion(CPM) on the drainage volume of knee joints post total knee arthroplasty (TKA).Methods The drainage volume was measured 1h before,during and after CPM on the day and next day of the operation.Results There was no significant difference in the drainage volume before,during and after CPM(P>0.05).Conclusion Early application of CPM is safe for TKA patients.

  8. Safety of Early Application of Continuous Passive Motion in Patients after Total Knee Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    顾晓园; 陈文红; 张中南; 励建安

    2002-01-01

    ObjectiveThis research aimed to study the effect of early application of continuous passive motion (CPM) on the drainage volume of knee joints post total knee arthroplasty (TKA).MethodsThe drainage volume was measured 1 h before,during and after CPM on the day and next day of the operation.ResultsThere was no significant difference in the drainage volume before,during and after CPM(P >0.05).ConclusionEarly application of CPM is safe for TKA patients.``

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

    Science.gov (United States)

    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. PMID:22556326

  10. Patient-matched instruments versus standard instrumentation in total knee arthroplasty: a prospective randomized study

    OpenAIRE

    Molicnik, Andrej; Naranda, Jakob; Dolinar, Drago

    2015-01-01

    Summary Background Optimal positioning of implants and restoration of neutral mechanical axis are two primary surgical goals in total knee arthroplasty (TKA). Despite modern instruments and improved surgical techniques, malalignment remains an important cause of early failure after TKA. The aim of this prospective randomized study was to compare the value of a new patient-matched instrument system (PMI) (SignatureTM; Biomet, Inc, Warsaw, Indiana) to that of standard TKA surgical instrumentati...

  11. Fabella Fractures after Total Knee Arthroplasty with Correction of Valgus Malalignment

    Science.gov (United States)

    Heggelman, Ben; Gaasbeek, Robert; Nix, Maarten

    2016-01-01

    The incidence of fabella fractures is considered to be extremely low. This report presents two patients with femorotibial osteoarthritis and considerable preoperative valgus malalignment, who developed a fracture of the fabella (as demonstrated by radiography) after total knee arthroplasty with intraoperative correction of the valgus malalignment. Special attention should be paid to the fabella for not missing a fabella fracture in these patients. PMID:27340579

  12. Targeted Preoperative Autologous Blood Donation in Total Knee Arthroplasty Reduces the Need for Postoperative Transfusion

    OpenAIRE

    Bou Monsef, Jad; Buckup, Johannes; Mayman, David; Marx, Robert; Ranawat, Amar; Boettner, Friedrich

    2013-01-01

    Background Preoperative donation of autologous blood has been widely used to minimize the potential risk of allogeneic transfusions in total knee arthroplasty. A previous study from our center revealed that preoperative autologous donation reduces the allogeneic blood exposure for anemic patients but has no effect for non-anemic patients. Questions/Purposes The current study investigates the impact of a targeted blood donation protocol on overall transfusion rates and the incidence of allogen...

  13. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jaeger, Pia; Zaric, Dusanka; Fomsgaard, Jonna Storm; Hilsted, Karen Lisa; Bjerregaard, Jens; Gyrn, Jens; Mathiesen, Ole; Larsen, Tommy; Dahl, J�rgen Berg

    2013-01-01

    Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps...... muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, adductor muscle strength, morphine-related complications, and mobilization ability....

  14. Pain Management for Total Knee Arthroplasty: Single-Injection Femoral Nerve Block versus Local Infiltration Analgesia

    OpenAIRE

    Moghtadaei, Mehdi; Farahini, Hossein; Faiz, Seyed Hamid-Reza; Mokarami, Farzam; Safari, Saeid

    2014-01-01

    Background: Pain is one of the major concerns of patients underwent Total Knee Arthroplasty (TKA); appropriate pain management is a key factor in patient's early physical fitness to move, physiotherapy, and most importantly, patient satisfaction. Objectives: In this study the analgesic effect of single injection femoral nerve block (SFNB) was compared with local infiltration analgesia (LIA). Patients and Methods: Forty patients who underwent TKA under spinal anesthesia were randomized to rece...

  15. Homologous structural graft for treatment of bone defect during knee revision arthroplasty

    OpenAIRE

    Hugo Alexandre de Araujo Barros Cobra; Mario Correa Netto Pacheco Junior; Alan de Paula Mozella

    2013-01-01

    OBJECTIVE: Obtaining stable bone-implant interface, correct alignment of the components, proper balance of soft tissues' tension, maintenance of proper joint interline are fundamental principles for success in surgical revision total knee arthroplasty, which are only obtained with management bone deficiency. However, proper treatment of large defects remains unclear. The aim of this study was to evaluate the clinical and radiographic results of patients that had underwent revision surgery fo...

  16. Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study

    OpenAIRE

    Pichonnaz, Claude; Bassin, Jean-Philippe; Lécureux, Estelle; Currat, Damien; Jolles, Brigitte M.

    2015-01-01

    Background The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TK...

  17. Fabella Fractures after Total Knee Arthroplasty with Correction of Valgus Malalignment.

    Science.gov (United States)

    Kwee, Thomas Christian; Heggelman, Ben; Gaasbeek, Robert; Nix, Maarten

    2016-01-01

    The incidence of fabella fractures is considered to be extremely low. This report presents two patients with femorotibial osteoarthritis and considerable preoperative valgus malalignment, who developed a fracture of the fabella (as demonstrated by radiography) after total knee arthroplasty with intraoperative correction of the valgus malalignment. Special attention should be paid to the fabella for not missing a fabella fracture in these patients. PMID:27340579

  18. Acupuncture for postoperative pain following total knee arthroplasty: a systematic review protocol

    OpenAIRE

    Jung, Jae-Young; Cho, Jae-Heung; Chung, Seok-Hee

    2015-01-01

    Introduction Total knee arthroplasty (TKA) is a common surgical method in orthopaedics; however, pain management after TKA remains a significant challenge. This review provides a comprehensive evaluation of the effects of acupuncture for postoperative pain after TKA. Methods and analysis The following 10 databases will be searched until August 2015: MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, three Chinese databases (the China National Knowledge Infrastructure Database, the Chongqing VIP Chinese ...

  19. Navigation of total knee arthroplasty: rotation of components and clinical results in a prospectively randomized study

    OpenAIRE

    Efe Turgay; Pfeiffer Michael; Kienapfel Heino; Hauk Carsten; Schmitt Jan; Fuchs-Winkelmann Susanne; Heyse Thomas J

    2011-01-01

    Abstract Background Navigation was introduced into total knee arthroplasty (TKA) to improve accuracy of component position, function and survival of implants. This study was designed to assess the outcome of navigated TKA in comparison with conventional implantation with the focus on rotational component position and clinical mid-term results. Methods In a prospectively randomized single-blinded approach, 90 patients with primary gonarthrosis were assigned to three different groups. Thirty pa...

  20. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    Fonseca, Fernando; Rebelo, Edgar; Completo, Antonio

    2015-01-01

    Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I). Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CA...

  1. Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Paul Della Torre, MD

    2014-07-01

    Full Text Available Medial collateral ligament injury during primary total knee arthroplasty is a recognised complication potentially resulting in valgus instability, suboptimal patient outcomes and a higher rate of revision or reoperation. Options for management include primary repair with or without augmentation, reconstruction or immediate conversion to prosthesis with greater constraint, in conjunction with various postoperative rehabilitation protocols. Inconsistent recommendations throughout the orthopaedic literature have made the approach to managing this complication problematic. The objective of this study was to review the available literature to date comparing intraoperative and postoperative management options for primary total knee arthroplasty complicated by recognised injury to the medial collateral ligament. This systematic literature review was prospectively registered with PROSPERO (#CRD42014008866 and performed in accordance with PRISMA guidelines including a PRISMA flow diagram. Five articles satisfied the inclusion criteria. Each was a retrospective, observational cohort or case series with small numbers reported, inconsistent methodology and incompletely reported outcomes. Four of the five studies managing medial collateral ligament injury during total knee arthroplasty (47/84 patients with direct repair with or without autograft augmentation reported good outcomes with no revision or reoperation required for symptomatic instability over a follow-up period of 16 months to almost 8 years. The fifth study with a follow-up to 10 years and a high rate of conversion to unlinked semi constrained total knee arthroplasty implant (30/37 patients reported a greater incidence of revision due to instability, in patients in whom the medial collateral ligament injury was directly repaired without added constraint. Overall balance of evidence is in favour of satisfactory outcomes without symptomatic instability following direct repair with or without

  2. Serum Metal Ion Concentrations in Paediatric Patients following Total Knee Arthroplasty Using Megaprostheses

    Directory of Open Access Journals (Sweden)

    Jörg Friesenbichler

    2014-01-01

    Full Text Available The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163 of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P=0.002 and P<0.001 and preoperative controls (P<0.001. On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered.

  3. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Husted, Henrik; Kehlet, Henrik; Bandholm, Thomas

    2012-01-01

    Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit....... They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee...... pain, knee joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p <0.0001). Patients experienced only moderate knee pain during the strength...

  4. A rolling-gliding wear simulator for the investigation of tribological material pairings for application in total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Denkena Berend

    2010-06-01

    Full Text Available Abstract Background Material wear testing is an important technique in the development and evaluation of materials for use in implant for total knee arthroplasty. Since a knee joint induces a complex rolling-gliding movement, standardised material wear testing devices such as Pin-on-Disc or Ring-on-Disc testers are suitable to only a limited extent because they generate pure gliding motion only. Methods A rolling-gliding wear simulator was thus designed, constructed and implemented, which simulates and reproduces the rolling-gliding movement and loading of the knee joint on specimens of simplified geometry. The technical concept was to run a base-plate, representing the tibia plateau, against a pivoted cylindrical counter-body, representing one femur condyle under an axial load. A rolling movement occurs as a result of the friction and pure gliding is induced by limiting the rotation of the cylindrical counter-body. The set up also enables simplified specimens handling and removal for gravimetrical wear measurements. Long-term wear tests and gravimetrical wear measurements were carried out on the well known material pairings: cobalt chrome-polyethylene, ceramic-polyethylene and ceramic-ceramic, over three million motion cycles to allow material comparisons to be made. Results The observed differences in wear rates between cobalt-chrome on polyethylene and ceramic on polyethylene pairings were similar to the differences of published data for existing material-pairings. Test results on ceramic-ceramic pairings of different frontal-plane geometry and surface roughness displayed low wear rates and no fracture failures. Conclusions The presented set up is able to simulate the rolling-gliding movement of the knee joint, is easy to use, and requires a minimum of user intervention or monitoring. It is suitable for long-term testing, and therefore a useful tool for the investigation of new and promising materials which are of interest for application in

  5. Pre-operative quadriceps femoris neuromuscular electrical stimulation in total knee arthroplasty : a clinical and molecular analysis.

    OpenAIRE

    Walls, Raymond John

    2009-01-01

    Patients with knee osteoarthritis (OA) have asymmetrical muscle weakness due to neuromuscular activation deficits and muscle atrophy. Quadriceps muscle (QFM) strength declines after total knee arthroplasty (TKA) with associated functional impairment. The ultimate purpose of this investigation was to determine the effects of preoperative neuromuscular electrical stimulation (NMES) on quadriceps muscle strength and functional recovery after TKA. Patients undergoing TKA for advanced knee OA we...

  6. Determinants of demand for total hip and knee arthroplasty: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Mota Rubén E

    2012-07-01

    Full Text Available Abstract Background Documented age, gender, race and socio-economic disparities in total joint arthroplasty (TJA, suggest that those who need the surgery may not receive it, and present a challenge to explain the causes of unmet need. It is not clear whether doctors limit treatment opportunities to patients, nor is it known the effect that patient beliefs and expectations about the operation, including their paid work status and retirement plans, have on the decision to undergo TJA. Identifying socio-economic and other determinants of demand would inform the design of effective and efficient health policy. This review was conducted to identify the factors that lead patients in need to undergo TJA. Methods An electronic search of the Embase and Medline (Ovid bibliographic databases conducted in September 2011 identified studies in the English language that reported on factors driving patients in need of hip or knee replacement to undergo surgery. The review included reports of elective surgery rates in eligible patients or, controlling for disease severity, in general subjects, and stated clinical experts’ and patients’ opinions on suitability for or willingness to undergo TJA. Quantitative and qualitative studies were reviewed, but quantitative studies involving fewer than 20 subjects were excluded. The quality of individual studies was assessed on the basis of study design (i.e., prospective versus retrospective, reporting of attrition, adjustment for and report of confounding effects, and reported measures of need (self-reported versus doctor-assessed. Reported estimates of effect on the probability of surgery from analyses adjusting for confounders were summarised in narrative form and synthesised in odds ratio (OR forest plots for individual determinants. Results The review included 26 quantitative studies−23 on individuals’ decisions or views on having the operation and three about health professionals’ opinions-and 10 qualitative

  7. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

    DEFF Research Database (Denmark)

    Lunn, Troels; Kristensen, Billy Bjarne; Andersen, Lasse;

    2011-01-01

    Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.......Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied....

  8. Impact of an Automated Surveillance to Detect Surgical-Site Infections in Patients Undergoing Total Hip and Knee Arthroplasty in Brazil.

    Science.gov (United States)

    Perdiz, Luciana B; Yokoe, Deborah S; Furtado, Guilherme H; Medeiros, Eduardo A S

    2016-08-01

    In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty. Infect Control Hosp Epidemiol 2016;37:991-993. PMID:27072598

  9. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... completely excised and removed. It can be a source of pain in the replaced joint if it ... to our office. And we can get that information to you. Thank you. Good night. Thank you ...

  10. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... replacing. This is an artist's rendition of the prosthesis secured to the bone showing that only part ... is the bone cement, which helps secure the prosthesis into place. The real prosthesis is being tamped ...

  11. Total knee arthroplasty for treatment of severe knee joint diseases in 118 cases%人工膝关节置换治疗重症膝关节病118例

    Institute of Scientific and Technical Information of China (English)

    韩伟

    2009-01-01

    选择2000-06/2007-01贵州省人民医院骨科收治的行人工全膝关节置换患者118例(138膝),男45例,女73例;年龄52~81(61±8)岁;类风湿性关节炎28例(34膝),创伤性关节炎6例(6膝),严重骨性关节炎84例(98膝),其中合并外翻畸形14例(18膝),合并内翻畸形25例(28膝).所选假体类型Link Gemini假体38膝,Zimmer Nexgen 68膝,Depuy pfc sigma旋转平台32膝.全部患者均获得随访,随访时间10个月~6 年(平均28个月).置换前膝关节HSS评分(34.00±7.65)分,末次随访时 (81.00±6.89)分,其中优87膝(63%),良43膝(31%),可8膝(6%),优良率94%.118例患者中发生感染4例,3例单膝置换后下肢发生深静脉血栓形成,经抗凝及对症处理痊愈.3例(4膝)置换后2个月发生膝关节疼痛,检查膝关节无红肿,无压痛,活动度基本正常,摄X射线平片示假体位置良好,行股神经封闭后症状缓解.提示全膝关节置换是治疗重症膝关节疾病的有效方法.%A total of 118 patients (138 knees) who received total knee arthroplasty at the Department of Orthopedics, Guizhou Province People's Hospital between June 2000 and January 2007 were included in this study. These patients comprised 45 males and 73 females and were averaged (61±8) years old (range, 52-81 years). Of them, 28 (34 knees) suffered from rheumatoid arthritis, 6 (6 knees) from traumatic arthritis, 84 (98 knees) from severe osteoarthritis, 14 (18 knees) complicated by extraversion, and 25 (28 knees) complicated by inversion. Link Gemini knee prosthesis was used in 38 knees, Zimmer Nexgen knee prosthesis in 68 knees, and Depuy pfc sigma rotation platform knee system in 32 knees. All patients were followed up for an average of 28 months (range, 10 months-6 years). Prior to replacement, the mean knee score, according to the Hospital for Special Surgery (HSS) rating scale, was (34.00±7.65) points, and at the latest follow-up examination, it was (81.00±6.89) points. HSS score was excellent in 87

  12. Factors affecting the postoperative limb alignment and clinical outcome after Oxford unicompartmental knee arthroplasty.

    Science.gov (United States)

    Kim, Seung-Ju; Bae, Ji-Hoon; Lim, Hong Chul

    2012-06-01

    We evaluated the postoperative mechanical axis deviation and clinical outcome according to bearing size, femoral component position, and tibial resection angle after unicompartmental knee arthroplasty (UKA). A total of 104 patients with 124 knees underwent Oxford phase 3 UKA. The overall changes in mechanical axis deviation and tibiofemoral angle were significantly different according to bearing size (P = .001 and angle and femoral component position. The postoperative mechanical axis fell into the zone C or zone 2 in 108 knees (87%) and into the zone 3 or zone 4 in 16 cases (13%). One hundred eight cases, which had the mechanical axis passing the zone C or zone 2, did not show any progression of arthritis. Limb alignment is a function of the thickness of the bearing rather than alignments of femoral and tibial implant. PMID:22285234

  13. Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty?

    Science.gov (United States)

    Schnurr, Christoph; Nessler, Jochen; König, Dietmar Pierre

    2009-12-01

    Femoral malrotation in total knee arthroplasty causes flexion gap instability. Conventional instruments mostly reference the posterior condylar angle (PCA). The aim of this study was to verify whether the computer-navigated flexion gap (GAP) method produces a rectangular flexion gap and if a balanced flexion gap could also be achieved by referencing the PCA. A total of 100 knee prostheses were analysed using the navigated GAP method, and flexion gap symmetry along with femoral rotation were recorded. The GAP technique resulted in a rectangular flexion gap with adequate femoral rotational alignment. If the PCA technique had been used, only 51% of the femoral components would have been implanted in correct femoral rotation; the remaining 49% would have implanted with flexion gap instability. The GAP technique produces a rectangular flexion gap. The referencing of the PCA was shown to be less reliable. Thus, modern knee prosthesis instrumentation should not base femoral rotation solely on the PCA. PMID:18956189

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

    Science.gov (United States)

    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. PMID:26591937

  15. Mini-midvastus total knee arthroplasty in patients with severe varus deformity.

    Science.gov (United States)

    Liu, Hao-Chen; Kuo, Feng-Chih; Huang, Chung-Chen; Wang, Jun-Wen

    2015-02-01

    Patients with severe varus deformity of the knee (≥15° varus) usually are not considered good candidates for minimally invasive total knee arthroplasty (TKA). The goal of this study was to retrospectively investigate outcomes in patients with severe varus deformity after minimally invasive TKA. A study group of 52 patients with a tibiofemoral mechanical axis of 195° or greater was compared with a matched control group of 55 patients with a tibiofemoral mechanical axis of less than 195°. Clinical and radiographic evaluations according to the American Knee Society rating system were obtained preoperatively and postoperatively, and postoperative patient satisfaction in the 2 groups was compared. All patients were followed at a mean of 3 years (range, 2-5 years). Preoperatively, clinical knee and function scores and range of motion were inferior in the study group compared with the control group (Pclinical results, and no significant differences were found in the knee and function scores (P>.05). Radiographic evaluation showed no differences in the mechanical axis, femoral component valgus angle, and tibial component valgus angle, and all outliers of the radiographic parameters between the 2 groups postoperatively (P >.05). The study results showed that mini-midvastus TKA did not result in more inaccurate implant positioning in patients with severe varus deformity of the knee. The clinical outcome in the group with severe varus was comparable to that in the group with less severe varus PMID:25665115

  16. Variability of indication criteria in knee and hip replacement: an observational study

    Directory of Open Access Journals (Sweden)

    Sarasqueta Cristina

    2010-10-01

    Full Text Available Abstract Background Total knee (TKR and hip (THR replacement (arthroplasty are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. Methods The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form and the specific WOMAC (Western Ontario and Mcmaster Universities scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated. The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD, mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95, variation coefficient (CV5-95 and weighted variation coefficient (WCV5-95 for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. Results The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients

  17. Outcome of Unicompartmental Knee Arthroplasty: A Systematic Review of Comparative Studies between Fixed and Mobile Bearings Focusing on Complications

    OpenAIRE

    Ko, Young-Bong; Gujarathi, Manan Ramesh; Oh, Kwang-Jun

    2015-01-01

    The purpose of this systematic review is to collate results of studies comparing fixed and mobile bearing unicompartmental knee arthroplasty (UKA), focusing on complications and timing for reoperations. Out of 723 results derived from PubMed, EMBASE and Cochrane database search engines on bearings in arthroplasty, 10 studies comparing clinical results of fixed bearings to mobile bearings in UKA were found eligible for analysis. The reoperation rate was calculated using a novel method such as ...

  18. Role of negative pressure wound therapy in total hip and knee arthroplasty.

    Science.gov (United States)

    Siqueira, Marcelo Bp; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-18

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  19. Does knee replacement surgery lead to chronic limb ischemia?

    Science.gov (United States)

    Dawson, Alan G; Bachoo, Paul; Sutherland, Alasdair G

    2010-12-01

    Total knee replacement (TKR) may be associated with chronic limb ischemia (CLI) due to arterial injury intraoperatively. The aim of this study was to determine the incidence of CLI after TKR surgery. Patients who received a unilateral TKR in 2003-2004 were identified from our database. Patients with diabetes mellitus and preexisting peripheral arterial disease were excluded. Patient assessment was by collection of demographic details, completion of the Oxford Knee Score, Short Form-12 Health Survey, and King's College Hospital's Vascular Quality of Life Questionnaire, and measurement of the ankle brachial pressure index (ABPI). Of the 209 eligible patients, 86 (41%) participated (median age, 73 years; 50% male). Five (5.8%) patients had a reduced ABPI compared with population norms of 4.6 to 7%. Patients with reduced ABPI measurements had higher Oxford Knee Scores, but no relationships between other variables were demonstrated. TKR surgery does not appear to increase the risk of CLI. PMID:21446628

  20. Knee pain during strength training shortly following fast-track total knee arthroplasty: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Thomas Bandholm

    Full Text Available Loading and contraction failure (muscular exhaustion are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA. It is unknown how these exercise variables influence knee pain after TKA.To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA.Cross-sectional study.Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013.Seventeen patients, no more than 3 weeks after their TKA.In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM, and ended with 1 single set to contraction failure (14 RM load. The individual loadings (kilograms were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10.Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006, and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001. Resting knee pain 60 seconds after the final repetition (2.7±2.4 points was not different from that recorded before strength training (2.7±1.8 points, P = 0.88.Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived.ClinicalTrials.gov NCT01729520.

  1. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Deleuran, Thomas; Vilstrup, Hendrik; Overgaard, Søren;

    2015-01-01

    Background and purpose: The risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients and methods: Using Danish healthcare registries, we identified all Danish residents who...... underwent a THA or TKA for primary osteoarthritis in the period 1995-2011. We compared the risk of complications in patients with or without cirrhosis. Results: The surgical technique was similar in the 363 cirrhosis patients and in 109,159 reference patients, but cirrhosis patients were more likely to have...... been under general anesthesia (34% vs. 23%), were younger (median age 66 vs. 69 years), had a predominance of males (54% vs. 41%), had more comorbidity, and had had more hospitalizations preoperatively. Their risk of intraoperative complications was similar to that for reference patients (2.5% vs. 2...

  2. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate...... the analgesic efficacy of LIA for early postoperative pain treatment. In addition, the analgesic efficacy of wound catheters and implications for length of hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on...... reported to have similar or improved analgesic efficacy. In TKA, most trials reported reduced pain and reduced opioid requirements with LIA compared with a control group treated with placebo/no injection. Compared with femoral nerve block, epidural or intrathecal morphine LIA provided similar or improved...

  3. Clinical experience with fondaparinux in antiaggregate patients undergoing total hip and knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Guido Grappiolo

    2013-09-01

    Full Text Available Patients undergoing total hip arthroplasty or total knee arthroplasty have a high risk for post-operative venous thromboembolism. The current study addressed the use of fondaparinux post-operatively in 556 patients with antiplatelet therapy in order to prevent deep vein thrombosis as well as demonstrate efficacy in preventing arterial thrombotic events. Results provided evidence for a safe and effective prophylaxis strategy, involving the change from low molecular weight heparin pre-operatively to fondaparinux postoperatively. Also, fondaparinux proved effective as a unique post-operative therapy in the prevention of venous thromboembolism with no adverse effects, such as major bleeding or arterial thrombosis in patients with pre-operative antiplatelet therapy.

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

    Science.gov (United States)

    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

  5. Radiation dose reduction in digital plain radiography of the knee after total knee arthroplasty; Dosisreduktion in der digitalen Radiografie des Kniegelenkes nach endoprothetischem Gelenkersatz

    Energy Technology Data Exchange (ETDEWEB)

    Kloth, J.K.; Kauczor, H.U.; Weber, M.A. [University Hospital Heidelberg (Germany). Clinic for Diagnostic and Interventional Radiology; Tanner, M.; Ewerbeck, V. [University Hospital Heidelberg (Germany). Center of Orthopedics, Trauma and Spinal Cord Injury; Stiller, W. [German Cancer Research Center (DKFZ), Radiology (E010), Heidelberg (Germany); Burkholder, I. [Univ. of Applied Sciences of the Saarland, Dept. of Nursing and Health, Saarbruecken (Germany)

    2015-08-15

    To reduce radiation exposure of frequently performed radiographs of the knee in follow-up of total-knee arthroplasty ensuring accurate assessment by using objective quality control criteria. In this prospective randomized study 278 radiographs of the knee in follow-up of total-knee arthroplasty were performed with standard and 37 % reduced radiation dose. The evaluation of the plain-radiographs was conducted using the following criteria: bone-implant interface, implant-surface character, implant-implant discrimination and periarticular heterotopic ossification. Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score ≥ 3 or more than 2 criteria with ≥ 2 points, the radiograph was score das ''not assessable''. The study was designed as non-inferiority-trial. 100 % of examined radiographs were scored as assessable, hence no statistical inferiority between the examinations with standard and reduced dose could be observed. Singular assessment of the defined criteria was likewise dose-independent. Plain-radiography of the knee following total-knee arthroplasty can be performed with 63 % of standard dose without loss of diagnostic validity.

  6. Trends and predictors of opioid use after total knee and total hip arthroplasty.

    Science.gov (United States)

    Goesling, Jenna; Moser, Stephanie E; Zaidi, Bilal; Hassett, Afton L; Hilliard, Paul; Hallstrom, Brian; Clauw, Daniel J; Brummett, Chad M

    2016-06-01

    Few studies have assessed postoperative trends in opioid cessation and predictors of persistent opioid use after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Preoperatively, 574 TKA and THA patients completed validated, self-report measures of pain, functioning, and mood and were longitudinally assessed for 6 months after surgery. Among patients who were opioid naive the day of surgery, 8.2% of TKA and 4.3% of THA patients were using opioids at 6 months. In comparison, 53.3% of TKA and 34.7% of THA patients who reported opioid use the day of surgery continued to use opioids at 6 months. Patients taking >60 mg oral morphine equivalents preoperatively had an 80% likelihood of persistent use postoperatively. Day of surgery predictors for 6-month opioid use by opioid-naive patients included greater overall body pain (P = 0.002), greater affected joint pain (knee/hip) (P = 0.034), and greater catastrophizing (P = 0.010). For both opioid-naive and opioid users on the day of surgery, decreases in overall body pain from baseline to 6 months were associated with decreased odds of being on opioids at 6 months (adjusted odds ratio [aOR] = 0.72, P = 0.050; aOR = 0.62, P = 0.001); however, change in affected joint pain (knee/hip) was not predictive of opioid use (aOR = 0.99, P = 0.939; aOR = 1.00, P = 0.963). In conclusion, many patients taking opioids before surgery continue to use opioids after arthroplasty and some opioid-naive patients remained on opioids; however, persistent opioid use was not associated with change in joint pain. Given the growing concerns about chronic opioid use, the reasons for persistent opioid use and perioperative prescribing of opioids deserve further study. PMID:26871536

  7. System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

    Directory of Open Access Journals (Sweden)

    Mathias Worni

    Full Text Available BACKGROUND: The Hospital Acquired Condition Strategy (HACS denies payment for venous thromboembolism (VTE after total knee arthroplasty (TKA. The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. METHODS AND FINDINGS: The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. CONCLUSION: System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.

  8. Shoulder replacement - discharge

    Science.gov (United States)

    Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; ...

  9. Risk factors for renal dysfunction after total knee joint replacement.

    Science.gov (United States)

    Hassan, Basim K; Sahlström, Arne; Dessau, Ram B

    2015-12-01

    Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total knee joint replacement. A retrospective study was conducted among 702 consecutive primary knee joint replacements performed between January 2009 and December 2012 in our department. Increased postoperative serum creatinine was considered indicative of postoperative renal injury according to RIFLE criteria. Sixty three patients (9.7%) had significant moderate or severe postoperative renal dysfunction in which 8 patients (1.2%) ended with severe and permanent renal impairment. Advanced age, low intraoperative blood pressure, hypertension, general anaesthesia, and prophylactic dicloxacillin were identified as significant risk factors. Male gender and BMI were independent risk factors for postoperative increase in serum creatinine. Smoking, female gender, diabetes mellitus and duration of surgery were not identified as significant risk factors. PMID:26790786

  10. Early Progressive Strength Training to Enhance Recovery After Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Kehlet, Henrik; Husted, Henrik;

    2014-01-01

    OBJECTIVE: To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. METHODS: In total, 82 patients with a unilateral primary TKA were randomized to 2...... from baseline to the 8-week postoperative assessment (primary end point) for the 6-minute walk test with unadjusted baseline scores (mean difference between groups: -11.3 meters [95% confidence interval -45.4, 22.7]; analysis of variance P = 0.51). There were no statistically significant or clinically...

  11. Physical performance parameters during standing up in patients with unilateral and bilateral total knee arthroplasty

    OpenAIRE

    Bakirhan, Serkan; Salih ANGIN; Karatosun, Vasfi; Unver, Bayram; Gunal, Izge

    2012-01-01

    Objective: The aim of this study was to compare quadriceps femoris muscle performance parameters of patients who underwent unilateral and bilateral total knee arthroplasty (TKA). Methods: The study included 80 patients. Thirty-five underwent unilateral primary TKA (35 females; mean age: 67.11±3.97 years) and 45 underwent bilateral primary TKA (2 males, 43 females; mean age: 67.12±7.32 years). Patients were evaluated in terms of performance parameters including stand-up time, rising index,...

  12. Small Dose Ketamine Improves Postoperative Analgesia and Rehabilitation After Total Knee Arthroplasty.

    OpenAIRE

    Adam, Frédéric; Chauvin, Marcel; Manoir, Bertrand Du; Langlois, Mathieu; Sessler, Daniel I.; Fletcher, Dominique

    2005-01-01

    We designed this study to evaluate the effect of small-dose intravenous ketamine in combination with continuous femoral nerve block on postoperative pain and rehabilitation after total knee arthroplasty. Continuous femoral nerve block with ropivacaine was started before surgery and continued in the surgical ward for 48 h. Patients were randomly assigned to receive an initial bolus of 0.5 mg/kg ketamine followed by a continuous infusion of 3 μg·kg-1·min-1 during surgery and 1.5 μg·kg-1·min-1 f...

  13. Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty

    DEFF Research Database (Denmark)

    Harsten, A; Kehlet, H; Toksvig-Larsen, S

    2013-01-01

    BACKGROUND: /st>This study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA). METHODS: /st>One hundred and twenty....... Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction. RESULTS: /st>GA resulted in shorter LOS...

  14. Re-admissions, re-operations and length of stay in hospital after aseptic revision knee replacement in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, M.; Jørgensen, C. C.; Hansen, Torben Bæk; Solgaard, S.; Odgaard, A.; Kehlet, H.

    information from the Danish Knee Arthroplasty Registry. The 1218 revisions involving 1165 patients were subdivided into total revisions, large partial revisions, partial revisions and revisions of unicondylar replacements (UKR revisions). The mean age was 65.0 years (27 to 94) and the median length of......-admission. The age ranges of 76 to 80 years (p = 0.018) and the large partial revision subgroup (p = 0.073) were related to an increased risk of re-operation. The ages from 76 to 80 years (p < 0.001), age ≥ 81 years (p < 0.001) and surgical time > 120 min (p < 0.001) were related to increased length of hospital...... suggests that a length of hospital stay ≤ four days and discharge home at that time is safe following aseptic knee revision surgery in Denmark....

  15. Prolonged Epidural Infusion Improves Functional Outcomes Following Knee Arthroscopy in Patients with Arthrofibrosis after Total Knee Arthroplasty: A Retrospective Evaluation.

    Science.gov (United States)

    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 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 success postoperatively as measured by range of motion improvement. PMID:25300008

  16. Use of mid-vastus approach in less invasive primary total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    DAI Xue-song; YU Xue-zhong; WU Li-dong; HE Rong-xin; WANG Xiang-hua; YAN Shi-gui

    2008-01-01

    Background Total knee arthroplasties (TKR) combined with the concept of reduced trauma to tissue has been performed by many doctors. The aim of this study was to retrospectively assess the early results of a group of TKR with a mid-vastus approach, which was characterized as no patellar eversion, no disruption of suprapatellar pouch and extensor mechanism, and to compare the outcome with conventional operative techniques.Methods A total of 59 patients (67 knees) were followed. All patients received the same prosthesis of Genesis Ⅱ posterior-stabilized total knees. Of them, 29 consecutive patients (34 knees) had a mid-vastus approach and were operated on with less invasive instruments and techniques. The mean follow-up duration was 11.6 months. Clinical evaluations were performed according to the Hospital for Special Surgery scores; radiographic assessment followed the guidelines of the Knee Society. Postoperative recovery of quadriceps strength and the extensor mechanism was also evaluated.Results No prosthetic loosening or anterior knee pain was found at the latest follow-up; 1 patient had a superficial infection and postoperative stiffness of the knee who undertook a debridement and manipulation several months later. The angulations of tibial osteotomy were within normal range. The average preoperative and postoperative Hospital for Special Surgery scores were 57.9 points and 86.1 points respectively. The mean postoperative range of motion was 113.5(°-). Most patients regained their quadriceps strength at the third or fourth month postoperatively.Conclusions The overall early results from using the mid-vastus approach were comparable with that of using a standard approach, and the exposure did not affect the accuracy of the tibial cut. The muscle maximal contraction strength recovered gradually after operation. The approach was safe and patients of this group obtained satisfactory outcomes.

  17. Perioperative Care of a Patient with Refractory Idiopathic Thrombocytopenic Purpura Undergoing Total Knee Arthroplasty

    OpenAIRE

    Singhal, Rohit; Gudimetla, Veera; Stewart, Andrew; Luscombe, Karen L; Charalambous, Charalambos P.

    2012-01-01

    Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder leading to low platelet count and an increased risk of bleeding. Major joint replacement surgery in a patient with ITP can be associated with severe postoperative bleeding. We present our experience of perioperative management in a patient with severe refractory chronic idiopathic thrombocytopenic purpura who successfully underwent a cemented total knee replacement.

  18. Ultrasound Guided Obturator Versus Sciatic Nerve Block in Addition to Continuous Femoral Nerve Block for Analgesia After Total Knee Arthroplasty

    OpenAIRE

    Keita Sato; Seijyu Sai; Naoto Shirai; Takehiko Adachi

    2011-01-01

    Both obturator and sciatic nerve block in combination with femoral nerve block (FNB) have been suggested to be useful in relieving pain after total knee arthroplasty (TKA), compared with FNB alone. We compared their efficacy in this retrospective study. For six consecutive months, patients undergoing unilateral TKA under general anesthesia with continuous FNB plus obturator nerve block (n = 8) or continuous FNB plus sciatic nerve block (n = 8) were investigated. Knee pain was assessed using v...

  19. Sit-to-Stand 3 months after Unilateral Total Knee Arthroplasty: Comparison of Self-Selected and Constrained Conditions

    OpenAIRE

    Farquhar, Sara J.; Kaufman, Kenton R.; Snyder-Mackler, Lynn

    2009-01-01

    After unilateral total knee arthroplasty (TKA), rehabilitation specialists often constrain knee angles or foot positions during sit-to-stand, to encourage increased weight bearing through the operated limb. Biomechanical studies often constrain limb position during sit-to-stand in an effort to reduce variability. Differences between self-selecting or constraining position are unknown in persons after TKA. Twenty-six subjects with unilateral TKA participated in motion analysis. Subjects perfor...

  20. Incision Length in Small Incision Total Knee Arthroplasty: How Long of an Incision Is Needed?

    Directory of Open Access Journals (Sweden)

    Edward McPherson

    2015-03-01

    Full Text Available This prospective review studied incision length with a small incision TKA technique and compared measured incision lengths to various anatomic and clinical parameters. We prospectively reviewed 357 cases of primary total knee arthroplasty using a small paramedial incision and utilizing small incision instrumentation. By using linear regression analysis, we found that incision length was generally related to the width of the distal cut femur and the width of the proximal cut tibia. Incision length was not related to height, weight, BMI, or femoral implant width. Clinically based upon our data, a reasonable starting incision for small incision TKA (as measured in knee extension is a length that is 1.6 times the measured width of the distal femur. The surgeon should always extend the incision if he/she encounters difficulty in exposure and/or placement of instrumentation.

  1. Long-Term Survivorship and Clinical Outcomes Following Total Knee Arthroplasty.

    Science.gov (United States)

    Jauregui, Julio J; Cherian, Jeffrey J; Pierce, Todd P; Beaver, Walter B; Issa, Kimona; Mont, Michael A

    2015-12-01

    Total knee arthroplasty (TKA) is one of the most successful commonly performed orthopedic procedures; as such, the purpose was to assess the long-term outcomes and survivorship of primary TKAs with a dual-radius prosthesis. We evaluated 125-patients (145-knees), with a mean age of 63 years (37-90 years) for a mean 11-year follow-up (10-13 years). Outcomes were assessed with KSS, UCLA, SF-36, satisfaction scores, and aseptic survivorship analysis. At 10-year follow-up, the UCLA (6-points), KSS objective (84-points) and functional (73-points), SF-36 physical (41-points) and mental (51-points), and patient satisfaction (14-points) scores were reported to be good to excellent. The 10-year Kaplan-Meier survivorship rate was 99%; one TKA demonstrated radiographic loosening. At a minimum 10-year follow-up, this device demonstrated satisfactory outcomes and outstanding aseptic-survivorship rates. PMID:26100473

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

    Science.gov (United States)

    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. PMID:26488775

  3. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a meta-analysis.

    Science.gov (United States)

    Bercik, Michael J; Joshi, Ashish; Parvizi, Javad

    2013-03-01

    The objective of this meta-analysis was to compare outcomes of posterior cruciate-retaining and posterior stabilized prostheses. A computerized literature search was conducted to identify randomized controlled trials comparing the clinical outcomes of cruciate-retaining and posterior-stabilized designs. The table of contents of four major Orthopaedic journals and the references section of two arthroplasty text books were reviewed to identify other relevant studies. Ultimately, 1114 patients (1265 knees) were compared. Statistical analysis revealed a significant difference in flexion and range of motion in favor of posterior-stabilized knees, but no difference in complication rates. The clinical importance of this remains unknown. The decision to use one design versus the other should rest with the surgeon's preference and comfort with a particular design. PMID:23433255

  4. Total Knee Arthroplasty in Younger Patients Evaluated by Alternative Outcome Measures

    DEFF Research Database (Denmark)

    Klit, Jakob; Jacobsen, Steffen; Rosenlund, Signe; Sonne-Holm, Stig; Troelsen, Anders

    2014-01-01

    sexual life. Questionnaires including Oxford Knee Score (OKS) and SF-36 were evaluated preoperatively and three, six, and twelve months postoperatively. OKS and SF-36 showed significant improvements. However, patient satisfaction and fulfillment of personal expectations did not reflect these scores......In this prospective multicenter study we included subjects younger than 60 years of age and scheduled for primary total knee arthroplasty (TKA). The study assessed patients’ overall satisfaction, fulfillment of pre-operative expectations, the effect on socioeconomic parameters, and quality of....... Overall, TKA did not affect the patients’ socioeconomic status, and overall, patients did not experience impairment of sexual life, but decreased frequency and negative affection of sexual practice should be anticipated. Alternative outcome measurements of TKA surgery not focusing on implants and surgical...

  5. Clinical Evaluation of a Mobile Sensor-Based Gait Analysis Method for Outcome Measurement after Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Tilman Calliess

    2014-08-01

    Full Text Available Clinical scores and motion-capturing gait analysis are today’s gold standard for outcome measurement after knee arthroplasty, although they are criticized for bias and their ability to reflect patients’ actual quality of life has been questioned. In this context, mobile gait analysis systems have been introduced to overcome some of these limitations. This study used a previously developed mobile gait analysis system comprising three inertial sensor units to evaluate daily activities and sports. The sensors were taped to the lumbosacral junction and the thigh and shank of the affected limb. The annotated raw data was evaluated using our validated proprietary software. Six patients undergoing knee arthroplasty were examined the day before and 12 months after surgery. All patients reported a satisfactory outcome, although four patients still had limitations in their desired activities. In this context, feasible running speed demonstrated a good correlation with reported impairments in sports-related activities. Notably, knee flexion angle while descending stairs and the ability to stop abruptly when running exhibited good correlation with the clinical stability and proprioception of the knee. Moreover, fatigue effects were displayed in some patients. The introduced system appears to be suitable for outcome measurement after knee arthroplasty and has the potential to overcome some of the limitations of stationary gait labs while gathering additional meaningful parameters regarding the force limits of the knee.

  6. Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT?

    Energy Technology Data Exchange (ETDEWEB)

    Awengen, R.; Hirschmann, M.T. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Rasch, H. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Institute of Radiology and Nuclear Medicine, Bruderholz (Switzerland); Amsler, F. [Amsler Consulting, Basel (Switzerland)

    2016-04-15

    The primary purpose of this retrospective study was to evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic knees after bilateral total knee arthroplasty (TKA) and identify typical BTU patterns with regards to TKA component position and alignment. A consecutive number of 37 patients after bilateral TKA were retrospectively included. The knees were grouped into symptomatic (group A) and asymptomatic (group B) knees. All patients underwent 99m-Tc-HDP-SPECT/CT. Coronal, rotational, and sagittal TKA component position was analysed in 3D reconstructed CT. BTU was anatomically localised and quantified using a validated standardized localization scheme. Maximum BTU values for each area were recorded and normalized values calculated. Signed log-rank test, chi-square test, paired t-tests, and Pearson correlations were used (p <0.05). Symptomatic TKAs were significantly more flexed and had a tendency to be more internally rotated when compared to asymptomatic ones (p < 0.05). In all regions, the mean BTU in asymptomatic knees was lower than in symptomatic knees. In both groups the highest mean BTU was found around the tibial stem (symptomatic 7.30; asymptomatic 6.30, p = 0.061) and at the tip of the tibial stem (symptomatic 5.49; asymptomatic 4.74, p = 0.062). Superior patellar regions showed higher BTU than inferior regions. The highest patellar BTU was found in the superior medial patella (symptomatic 4.99; asymptomatic 3.98, p = 0.048). The lowest BTU was found in the posterior femoral regions (flatsp, flatip, fmedsp, fmedip) (Table 3). Tibial and patellar areas showed twice as high mean BTUs than femoral areas (Fig. 3). A significant correlation of TKA component position and BTU was demonstrated. Distribution and intensity of BTU in SPECT/CT depends on TKA component position and alignment. In addition, typical BTU patterns in symptomatic and asymptomatic knees were identified. A profound knowledge of BTU pattern, TKA component position

  7. Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT?

    International Nuclear Information System (INIS)

    The primary purpose of this retrospective study was to evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic knees after bilateral total knee arthroplasty (TKA) and identify typical BTU patterns with regards to TKA component position and alignment. A consecutive number of 37 patients after bilateral TKA were retrospectively included. The knees were grouped into symptomatic (group A) and asymptomatic (group B) knees. All patients underwent 99m-Tc-HDP-SPECT/CT. Coronal, rotational, and sagittal TKA component position was analysed in 3D reconstructed CT. BTU was anatomically localised and quantified using a validated standardized localization scheme. Maximum BTU values for each area were recorded and normalized values calculated. Signed log-rank test, chi-square test, paired t-tests, and Pearson correlations were used (p <0.05). Symptomatic TKAs were significantly more flexed and had a tendency to be more internally rotated when compared to asymptomatic ones (p < 0.05). In all regions, the mean BTU in asymptomatic knees was lower than in symptomatic knees. In both groups the highest mean BTU was found around the tibial stem (symptomatic 7.30; asymptomatic 6.30, p = 0.061) and at the tip of the tibial stem (symptomatic 5.49; asymptomatic 4.74, p = 0.062). Superior patellar regions showed higher BTU than inferior regions. The highest patellar BTU was found in the superior medial patella (symptomatic 4.99; asymptomatic 3.98, p = 0.048). The lowest BTU was found in the posterior femoral regions (flatsp, flatip, fmedsp, fmedip) (Table 3). Tibial and patellar areas showed twice as high mean BTUs than femoral areas (Fig. 3). A significant correlation of TKA component position and BTU was demonstrated. Distribution and intensity of BTU in SPECT/CT depends on TKA component position and alignment. In addition, typical BTU patterns in symptomatic and asymptomatic knees were identified. A profound knowledge of BTU pattern, TKA component position

  8. TOTAL KNEE ARTHROPLASTY WITH POSTERIOR CRUCIATE LIGAMENT RETENTION IN PATIENTS WITH SEVERE VARUS DEFORMITY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To observe the clinical outcomes of total knee arthroplasty (TKA) with posteri- or cruciate ligament (PCL) retention in patients with severe varus deformity. Methods We reviewed the clinical treatment results of primary TKA in patients with severe varus deformity ( ≥ 20°) between January 1990 and July 1995. All patients, suffered from osteoarthritis, were performed on a single surgeon using a minimal- ly constrained “Hybrid” Miller-Galante knees ( MG-I ). Cliniccal evaluation were assessed by using the Knee So- ciety clinical rating system. The Student's t test was used to analyse the data. Results At a mean follow-up of 6 years (4 ~ 9years), 56 knees in 38 patients were available for review. 5 patients ( 7 knees) lost follow-up and 3 patients ( 4 knees) died. The average knee score improved from 33 points before operation to 91 points in the latest follow-up with excellent results in 84% of all patients. The Knee Society functional score improved from 39 to 76 points. The improvements were statistically significant ( P < 0. 01 ). A functionally acceptable range of motion (ROM) of more than 90° were achieved in 86% of all patients. Most of cases (50/56) had postoperative alignment inside the normal range of 5° to 7° valgus. The other 6 cases had postoperative residual deformity of 5° ~ 10° varus. Total revision rate was 21% ( 12/56 ), the average revision time was 5.5 years af- ter surgery. Other complications included patellar subluxation in 1 case, anterior pain of knee in 4 cases, and superficial cellulitis in 1 case. No early or late infection, aseptic loosening or anterioposterior instability oc- curred in this series. Conclusion Severe varus deformity can be successfully corrected at the time of primary TKA by using PCL-retention prosthesis. There were more problems from postoperative medial-lateral instability of knee which contributed significantly to early failure after an average of 6.0 years.

  9. Patient-reported outcomes for total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Collins, Natalie J; Roos, Ewa M.

    2012-01-01

    high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need to......, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved in the...... developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind the...

  10. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact

    Directory of Open Access Journals (Sweden)

    Pinto PR

    2013-09-01

    Full Text Available Patrícia R Pinto,1–3 Teresa McIntyre,4,5 Ramón Ferrero,6 Vera Araújo-Soares,3,7 Armando Almeida1,2 1Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; 2Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal; 3Health Psychology Group, Newcastle University, Newcastle, UK; 4Texas Institute for Measurement, Evaluation and Statistics, 5Department of Psychology, University of Houston, TX, USA; 6Alto Ave Hospital Center, Orthopedics Unit, Guimarães, Portugal; 7Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK Abstract: This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA and total hip arthroplasty (THA and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4–6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post

  11. Visualization of femorotibial contact in total knee arthroplasty using X-ray fluoroscopy

    International Nuclear Information System (INIS)

    The purpose of this study was to build a visualization technique of the femorotibial contact in fixed-bearing total knee arthroplasty (TKA) using X-ray fluoroscopy, and to apply this technique to a TKA patient during dynamic motion. In vivo kinametcis of the metallic knee implant was determined using a 2D/3D registration technique, which uses computer assisted design (CAD) model of the implant to estimate the 3D pose of radiopaque metallic femoral and tibial components from a single-plane fluoroscopic image. In fixed-bearing TKA, a 3D pose of radiolucent tibial polyethylene insert can be determined from the estimated pose of the tibial component. To visualize femorotibial contact, the proximity between surfaces of femoral component and tibial insert was calculated, and mapped onto the insert surface model. For the clinical application, dynamic states of contact on the tibial insert were observed including axial rotation and unilateral loading during knee flexion, and post-cam contact of posterior stabilized TKA. The present technique provided us new information and enabled us to better understand the relationship between in vivo knee kinematics and articular shape of the implant

  12. Visualization of femorotibial contact in total knee arthroplasty using X-ray fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Takaharu E-mail: yamazaki@image.med.osaka-u.ac.jp; Watanabe, Tetsu; Nakajima, Yoshikazu; Sugamoto, Kazuomi; Tomita, Tetsuya; Maeda, Daisuke; Sahara, Wataru; Yoshikawa, Hideki; Tamura, Shinichi

    2005-01-01

    The purpose of this study was to build a visualization technique of the femorotibial contact in fixed-bearing total knee arthroplasty (TKA) using X-ray fluoroscopy, and to apply this technique to a TKA patient during dynamic motion. In vivo kinametcis of the metallic knee implant was determined using a 2D/3D registration technique, which uses computer assisted design (CAD) model of the implant to estimate the 3D pose of radiopaque metallic femoral and tibial components from a single-plane fluoroscopic image. In fixed-bearing TKA, a 3D pose of radiolucent tibial polyethylene insert can be determined from the estimated pose of the tibial component. To visualize femorotibial contact, the proximity between surfaces of femoral component and tibial insert was calculated, and mapped onto the insert surface model. For the clinical application, dynamic states of contact on the tibial insert were observed including axial rotation and unilateral loading during knee flexion, and post-cam contact of posterior stabilized TKA. The present technique provided us new information and enabled us to better understand the relationship between in vivo knee kinematics and articular shape of the implant.

  13. Relationship between retention of the posterior cruciate ligament and postoperative flexion in total knee arthroplasty.

    Directory of Open Access Journals (Sweden)

    Yokoyama,Yoshiki

    1995-12-01

    Full Text Available This study was conducted to retrospectively analyzed the outcome of 192 total knee arthroplasties in 132 patients with rheumatoid arthritis (118 women, 14 men. The Okayama Mark II prosthesis, which requires the posterior cruciate ligament (PCL to be resected, was used in 83 knees (group I, the Mark II prosthesis, which allows the PCL to be retained, was used in 68 knees (group II, and the new Okayama PCL-R prosthesis, which also allows the PCL to be retained, was used in 41 (group III. According to the Japanese Orthopaedic Association knee scoring system, the clinical outcome of groups I, II and III at 1 year after the operation were 64.9, 71.2 and 72.3 points, respectively, and the average flexion angles in each group at 1 year were 78.4, 92.6 and 101.3 degrees. Postoperative flexion in groups III was significantly greater than in groups I and II. These results suggest that postoperative flexion is greater when the posterior cruciate ligament is retained.

  14. Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach.

    Science.gov (United States)

    Verdonk, Peter C M; Pernin, Jerome; Pinaroli, Alban; Ait Si Selmi, Tarik; Neyret, Philippe

    2009-06-01

    We present an algorithmic release approach to the varus knee, including a novel pie crust release technique of the superficial MCL, in 359 total knee arthroplasty patients and report the clinical and radiological outcome. Medio-lateral stability was evaluated as normal in 97% of group 0 (deep MCL), 95% of group 1 (pie crust superficial MCL) and 83% of group 2 (distal superficial MCL). The mean preoperative hip-knee angle was 174.0, 172.1, and 169.5 and was corrected postoperatively to 179.1, 179.2, and 177.6 for groups 0, 1, and 2, respectively. A satisfactory correction in the coronal plane was achieved in 82.9% of all-comers falling within the 180 degrees +/- 3 degrees interval. An algorithmic release approach can be beneficial for soft tissue balancing. In all patients, the deep medial collateral ligament should be released and otseophytes removed. The novel pie crust technique of the superficial MCL is safe, efficient and reliable, provided a medial release of 6-8 mm or less is required. The release of the superficial MCL on the distal tibia is advocated in severe varus knees. Preoperative coronal alignment is an important predictor for the release technique, but should be combined with other parameters such as reducibility of the deformity and the obtained gap asymmetry. PMID:19290507

  15. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Parag Garg

    2011-01-01

    Full Text Available Background : Standard treatment of chronic infected total knee arthroplasty (TKA is a two-stage revision, the first step being placement of an antibiotic-impregnated cement spacer. Here we describe the results of a new technique (modification of the Goldstien′s technique for intraoperative manufacture of a customized articulating spacer at minimal cost and with relatively good conformity and longevity. Materials and Methods : Thirty-six infected knees underwent this procedure from June 2002 to May 2007. The technique consists of using the freshened femur and tibia interface as molds wrapped in a tin foil for manufacturing the two components of the spacer with antibiotic-impregnated methyl methycrylate cement. We used the spacer and the femoral component of the trial set of a TKA system to mold them to perfect articulation. We also reinforced the spacer with a K-wire scaffold to prevent fracture of the cement mantle in the last 21 cases. Results : All 36 knees showed excellent results in terms of infection control, mobility, and stability. There was significant improvement in the WOMAC and Knee Society Scores (20 and 39 points respectively. There were two fractures of the spacers in the initial 15 cases that did not have K-wire scaffolding but none in the last 21 that had reinforcement. Conclusion : This technique provides a more conforming spacer, with good range of motion and stability. The reinforcement helps in preventing the fracture of the cement mantle and is cost effective.

  16. Autologous re-transfusion drain compared with no drain in total knee arthroplasty : a randomised controlled trial

    NARCIS (Netherlands)

    Horstmann, Wieger; Kuipers, Bart; Ohanis, David; Slappendel, Robert; Kollen, Boudewijn; Verheyen, Cees

    2014-01-01

    Background. Post-operative anaemia following total knee arthroplasty is reported to impede functional mobility in the early period following surgery, whereas allogeneic blood transfusions, used to correct low post-operative haemoglobin levels, have concomitant disadvantages. The use of a post-operat

  17. Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study.

    LENUS (Irish Health Repository)

    Walls, Raymond J

    2010-01-01

    Supervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality.

  18. Rivaroxaban for the prevention of venous thromboembolism after hip or knee arthroplasty. Pooled analysis of four studies

    DEFF Research Database (Denmark)

    Turpie, A G G; Lassen, M R; Eriksson, Birgit; Gent, M; Berkowitz, S D; Misselwitz, F; Bandel, T J; Homering, M; Westermeier, T; Kakkar, A K

    2011-01-01

    Four phase III studies compared oral rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism (VTE) after total hip or knee arthroplasty (THA or TKA). A pooled analysis of these studies compared the effect of rivaroxaban with enoxaparin on symptomatic VTE plus all...

  19. Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer Calov; Kehlet, Henrik; Hip, Lundbeck Foundation Centre for Fast-track;

    2013-01-01

    Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after...

  20. Artroplastia unicompartimental no tratamento da artrose medial do joelho The unicompartmental arthroplasty in knee arthrosis treatment

    Directory of Open Access Journals (Sweden)

    Gilberto Luís Camanho

    2007-09-01

    Full Text Available OBJETIVO: Analisar a evolução de um grupo de pacientes submetido a artroplastia unicompartimental de joelho para tratamento das artroses e nas osteonecroses que comprometem exclusivamente o comportamento medial. MÉTODOS: Foram avaliados 49 pacientes portadores de artrose unicompartimental de joelho com idade variando entre 47 e 88 anos de idade, sendo 12 homens e 37 mulheres. Todos foram submetidos à artroplastia unicompartimental do tipo Miller-Galante. Após seguimento mínimo de quatro anos, os pacientes foram avaliados subjetivamente pelo exame ortopédico e objetivamente pelo sistema Hospital for Special Surgery (HSS. RESULTADOS: Apenas uma paciente necessitou de revisão para artroplastia total; quatro apresentaram dor não incapacitante; e três, queixas de instabilidade esporádica não incapacitante. Na avaliação do HSS, 30 pacientes apresentaram resultados excelentes; 18, resultados bons; e um, resultado regular. CONCLUSÃO: A artroplastia unicompartimental é uma boa opção para casos de artrose e osteonecrose do compartimento medial do joelho.OBJECTIVE:To analyze the evolution of a group of patients submitted to unicompartmental arthroplasty of the knee to treat arthrosis and in osteonecrosis that involve only the medial compartment. METHODS: 49 patients with unicompartmental knee arthrosis were evaluated. Ages ranged between 47 and 88 years, 12 of them male, and 37 female. All were submitted to the Miller-Galante type unicompartmental arthroplasty. After a minimum follow-up of four years the patients were evaluated objectively by the orthopedic exam and subjectively by the HSS system. RESULTS: Only one patient required a revision for total arthroplasty, four patients presented non-disabling pain, and three complained of sporadic instability, though not disabling. In the HSS evaluation, 30 patients had excellent results, 18 had good results, and one had a regular result. CONCLUSION: Unicompartmental arthroplasty is a good

  1. Total knee arthroplasty: indication of blood transfusion according to hematimetric variation and clinical symptoms of hypoperfusion,

    Directory of Open Access Journals (Sweden)

    Rodrigo Tavares Cardozo

    2014-10-01

    Full Text Available Objective:To analyze the relationship between hematimetric variation and the presence of clinical symptoms of hypoperfusion for indicating blood transfusion in patients undergoing total knee arthroplasty.Methods:A retrospective analysis was conducted on data gathered from the medical files of 55 patients with a diagnosis of gonarthrosis, who underwent total knee arthroplasty at a hospital orthopedics and traumatology service between February 2011 and December 2012. The patients studied presented unilateral joint degeneration and fitted into the indications for surgical treatment. All the patients underwent a preoperative cardiological evaluation, presenting a pattern of ASA I–III and absence of blood dyscrasia, and preoperative hemoglobin measurements were made. However, no minimum hematimetric value was established for the surgical treatment; there were only clinical criteria for blood perfusion.Results:Among the 55 patients, 35 were female and 20 were male, and the mean age was 68 years. Six patients underwent homologous blood transfusion, because of their clinical condition of tissue hypoperfusion, persistent hypotension, loss of consciousness, sweating and coercible vomiting. They presented postoperative hemoglobin of 7.5–8.8 g/dL.Conclusion:For patients with falls in hemoglobin counts greater than 20% and values lower than 9 g/dL after the surgery, there is a possible need for blood transfusion, which should only be indicated when accompanied by major symptoms of tissue hypoperfusion.

  2. The effect of alignment of the knee on the outcome of unicompartmental knee replacement.

    Science.gov (United States)

    Ridgeway, S R; McAuley, J P; Ammeen, D J; Engh, G A

    2002-04-01

    Many authors have recommended undercorrection of the deformity when carrying out unicompartmental knee arthroplasty (UKA). The isolated effect of alignment of the knee on the outcome of UKA has, however, received little attention. We reviewed 185 UKAs at a minimum of five years after surgery. They had been carried out by a single surgeon using metal-backed tibial components in the management of arthritis of the medial compartment. We measured the tibiofemoral angle (TFA) before and at four months after operation and at the most recent assessment. The amount of correction of the TFA and any subsequent loss were recorded. While adjusting for the effects of age, weight and gender of the patients and the type and thickness of the implants, the mean correction was significantly less for those with a Marmor rating of failure (6.8 degrees) than for those rated excellent (9.2 degrees). The mean correction was also significantly less for patients with a Marmor rating of failure (6.8 degrees) than for those rated poor (11.1 degrees). The mean correction for the UKAs which were revised (6.6 degrees) was significantly less than for those not revised (9.1 degrees). Additionally, revised UKAs had a significantly higher percentage (63%) of thinner tibial implants (TFA in UKA of the medial compartment should be avoided, particularly if a thin tibial polyethylene insert is used. PMID:12002491

  3. Knee Replacement Patients May Be Able to Hit the Shower Sooner

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_159055.html Knee Replacement Patients May Be Able to Hit the ... 26, 2016 THURSDAY, May 26, 2016 (HealthDay News) -- Knee surgery patients are usually instructed to wait two ...

  4. Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    YUE De-bo; WANG Bai-liang; LIU Kun-peng; GUO Wan-shou

    2013-01-01

    Background Multimodal cocktail periarticular injection (MCPI) with a large volume of low concentration local anesthetics,adrenaline,and anti-inflammatory agents such as non-steroidal anti-inflammatory drug or steroids have shown good pain control and improvement in range of motion after surgery.This study compares the efficacy of pain control after total knee arthroplasty,using multimodal cocktail periarticular injection with steroid or without steroid.Methods This is a prospective,double-blinded,randomized and control study.Seventy-two patients with osteoarthritis that met clinical criteria for total knee arthroplasty were recruited into the study,and were randomized to receive either multimodal cocktail periarticular injection with steroid or without steroid.Pain was assessed by visual analogue scale (VAS) at preoperative and postoperative at rest,and during activity.The range of motion was recorded preoperatively and postoperatively.The amount of daily and cumulative morphine consumption were measured by patient-controlled analgesia in the first 72 hours postoperatively.The duration of celecoxib usage was also recorded at the last follow-up.Results There were no differences between the non-steroid and steroid groups with regard to VAS at rest and during activity,or range of motion,at any postoperative observation time.The postoperative Knee Society Knee Score in the steroid group improved significantly as compared with that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; P <0.0045),three-month follow-up (90.2±16.3 and 72.5±16.6; P <0.0027),but after postoperative six-month the Knee Society Knee Score showed no significant difference between the groups.There was no significant difference in consumption of the morphine about daily or total consumption within 72 hours between the two groups.The duration of celecoxib usage in patients in the steroid group was significantly shorter than that in the non-steroid group ((7.2±0.7) compared with

  5. Design of an Advanced Bearing System for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mark L. Morrison

    2015-06-01

    Full Text Available The objective of this study was to develop an advanced-bearing couple for TKA that optimizes the balance between wear resistance and mechanical properties. The mechanical and structural properties of virgin and highly crosslinked, re-melted UHMWPE were evaluated, and tibial inserts manufactured from these UHMWPE materials were tested against either oxidized zirconium (OxZr or CoCr femoral components on a knee simulator. This study confirmed that the wear resistance of crosslinked UHMWPE improves with increasing radiation dose but is accompanied by a concomitant reduction in mechanical properties. Compared to CoCr, the ceramic surface of OxZr allows the use of a lower irradiation dose to achieve equivalent reductions in wear rates. As a result, a given wear rate can be achieved without sacrificing the mechanical properties to the same extent that is necessary with a CoCr femoral component. The advantage of ceramic counter bearing surfaces extends to both pristine and microabrasive conditions.

  6. Treating Osteoarthritis of the Knee

    Science.gov (United States)

    ... with an artificial joint made from metals and plastic. All or part of the knee joint may be replaced in this procedure. Although recovery may take a long time depending on the extent of your surgery, the results of arthroplasty are often successful. Knee ...

  7. Effect of preoperative education of patients before hip or knee replacement surgery: A systematic review

    DEFF Research Database (Denmark)

    Aydin, Dogu; Klit, Jakob; Husted, Henrik;

    2013-01-01

    Background Total hip (THA) and knee arthroplasty (TKA) are standard procedures for treatment of end stage osteoarthritis, and much is done to optimize results. It is usually hypothesized that education of patients before surgery reduces anxiety, secures more realistic patient expectations and...

  8. A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-08-01

    It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing.

  9. Unicompartmental and total knee arthroplasty for medial compartment osteoarthritis of the knee:comparison of five years of prosthesis survival rate%单髁与全膝关节置换治疗内侧间室膝骨关节炎:5年假体在位率比较

    Institute of Scientific and Technical Information of China (English)

    梁宁; Samuel Yih Shyan Wong; Nick Clement; Deborah MacDonald; Daniel E Porter

    2015-01-01

    BACKGROUND:Unicompartmental arthroplasty are more and more applied in the treatment of isolated medial compartment of knee joint osteoarthritis. OBJECTIVE:To compare the repair efficacy of unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of knee medial compartment osteoarthritis. METHODS:Total y 109 patients with isolated medial compartment of knee joint osteoarthritis were enrol ed, and then divided into unicompartmental arthroplasty group (n=41) and total knee arthroplasty group (n=68) according to the different repair methods. The average hospital stay, the incidence of complications after replacement, total scores of physical health and mental health, the Oxford knee joint scores and prosthesis survival rate after 5 years of replacement were compared. RESULTS AND CONCLUSION:The average hospital stay of patients in the unicompartmental arthroplasty group ((4.21±2.44) days) was shorter than that in the total knee arthroplasty group ((6.11±2.23) days) (P=0.001). There were no significant differences in the incidence of complications, total scores of physical health and mental health, the Oxford knee joint scores and other aspects between these two groups (P>0.05). After 5 years of replacement, the prosthesis survival rate of unicompartmental arthroplasty group (90%) was lower than that in the total knee arthroplasty group (100%) (P  目的:比较膝关节单髁置换与全膝关节置换对膝关节单纯内侧间室骨关节炎的修复效果。  方法:纳入单纯内侧间室型膝关节骨关节炎患者109例,根据修复方式分为两组,单髁置换组41例,全膝关节置换组68例。比较两组患者的平均住院时间、置换后并发症发生率、身体健康总评分、精神健康总评分、牛津膝关节评分以及置换后5年假体在位率。  结果与结论:单髁置换组患者平均住院时间(4.21±2.44) d,较全膝关节置换组(6.11±2.23) d短(P=0.001)。两组患者

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

    Science.gov (United States)

    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. PMID:27245748

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

    Science.gov (United States)

    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. PMID:26666227

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

    Science.gov (United States)

    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 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

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

    Science.gov (United States)

    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

  14. Role of integrated approach of yoga therapy in a failed post-total knee replacement of bilateral knees

    Directory of Open Access Journals (Sweden)

    John Ebnezar

    2014-01-01

    Full Text Available OA Knee is the most common arthritis. Knee replacement Surgeries are being done increasingly in the present times. This has led to the violation of the standard indications and when knees are replaced ignoring other co - musculoskeletal conditions it results in the surgery failing early. This is about a patient who encountered a failed TKR due to improper selection as patient had bilateral OA Hip that was ignored in the initial stages. To overcome the problem she was advised bilateral hip replacement which would leave her with four replacements in the lower limb. She refused surgery and was told there are no alternative treatment options. This patient underwent a 3 week integrated course of IAYT at our center and she made a remarkable recovery. IAYT is a good non-surgical treatment that can be affective both before and after knee replacement and it should be considered as the first choice of treatment before surgery.

  15. Perioperative celecoxib administration for pain management after total knee arthroplasty – A randomized, controlled study

    Directory of Open Access Journals (Sweden)

    Lin Wei-Peng

    2008-06-01

    Full Text Available Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty. Methods This was a prospective, randomized, observer-blind control study. Eighty patients that underwent total knee arthroplasty were randomized into two groups of 40 each. The study group received a single 400 mg dose of celecoxib, one hour before surgery, and 200 mg of celecoxib every 12 hours for five days, along with patient-controlled analgesic (PCA morphine. The control group received only PCA morphine for postoperative pain management. Visual analog scale (VAS pain scores, active range of motion (ROM, total opioid use and postoperative nausea/vomiting were analyzed. Results Groups were comparable for age, pre-operative ROM, operation duration and intraoperative blood loss. Resting VAS pain scores improved significantly in the celecoxib group, compared with controls, at 48 hrs (2.13 ± 1.68 vs. 3.43 ± 1.50, p = 0.03 and 72 hrs (1.78 ± 1.66 vs. 3.17 ± 2.01, p = 0.02 after surgery. Active ROM also increased significantly in the patients that received celecoxib, especially in the first 72 hrs [40.8° ± 17.3° vs. 25.8° ± 11.5°, p = 0.01 (day 1; 60.7° ± 18.1° vs. 45.0° ± 17.3°, p = 0.004 (day 2; 77.7° ± 15.1° vs. 64.3° ± 16.9°, p = 0.004 (day 3]. Opioid requirements decreased about 40% (p = 0.03 in the celecoxib group. Although patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group, this was not significant (p = 0.57. There were no differences in blood loss (intra- and postoperative between the groups. Celecoxib resulted in no significant increase in the need for blood transfusions. Conclusion Perioperative celecoxib significantly improved postoperative resting pain scores at 48 and 72 hrs, opioid

  16. Total hip arthroplasty in a patient with arthrogryphosis and an ipsilateral above knee amputation.

    LENUS (Irish Health Repository)

    Leonard, Michael

    2010-10-01

    The authors present the case of a young man with arthrogryphosis multiplex congenita and an above knee amputation who underwent an ipsilateral total hip replacement. The unique aspects of the case and technical difficulties are highlighted. Follow-up at five years revealed an excellent clinical and radiological outcome.

  17. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

    Directory of Open Access Journals (Sweden)

    Fen Wang

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group; in 24 patients, epidural analgesia was done (PCEA group. The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

  18. Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal joints: The current state

    Directory of Open Access Journals (Sweden)

    Harvinder Singh

    2011-01-01

    Full Text Available Surface replacement arthroplasty for proximal interphalangeal joint and metacarpophalangeal joints are becoming popular. Low profile, anatomically designed implants limit the amount of bone removed but need preservation of the collateral ligaments. Pyrocarbon and cobalt-chrome stemmed unconstrained implants on ultra-high molecular weight polyethylene are the two commonly available bearing surfaces. The indications for small joint arthroplasty are degenerative, post-traumatic or rheumatoid arthritis. Early results are encouraging, primarily in patient satisfaction and pain relief, but are based on low numbers. The main concerns are progressive loss of range due to implant settling, dislocation, squeaking and poor osteo-integration with the appearance of a radiolucent line at the bone-implant interface. Our experience suggests that metacarpophalangeal joint replacements consistently give good results.

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

    Science.gov (United States)

    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. PMID:26378906

  20.  MULTIMODAL ANALGESIA IN FAST TRACK HIP AND KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne;

      PURPOSE: The purpose of this project was to study the length of the hospital stay (LOS) in relation to a new multimodal pain strategy for patients undergoing elective hip and knee arthroplasty. Usual discharge criteria were used: independence in ambulation and transfers, independence in toileting...... and dressing, and pain medication with only oral analgesics. RELEVANCE: Current efforts focus to shorten the LOS and improve pain management. However, a decreased LOS has to ensure restoration of functional ability to the same level achieved with traditional LOS. Accordingly a description of the...... medication. Patients started mobilisation on the day of the operation with further physiotherapy the following days, including transfer and ambulation training, and specific joint and muscle exercises. In connection with all activities, pain scores were assessed, using a Visual Analog Scale (VAS). All...

  1. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment.

    Science.gov (United States)

    Sculco, P K; Abdel, M P; Hanssen, A D; Lewallen, D G

    2016-01-01

    The treatment of bone loss in revision total knee arthroplasty has evolved over the past decade. While the management of small to moderate sized defects has demonstrated good results with a variety of traditional techniques (cement and screws, small metal augments, impaction bone grafting or modular stems), the treatment of severe defects continues to be problematic. The use of a structural allograft has declined in recent years due to an increased failure rate with long-term follow-up and with the introduction of highly porous metal augments that emphasise biological metaphyseal fixation. Recently published mid-term results on the use of tantalum cones in patients with severe bone loss has reaffirmed the success of this treatment strategy. PMID:26733657

  2. Prevention of post-operative anaemia in hip and knee arthroplasty - a systematic review

    DEFF Research Database (Denmark)

    Khan, Nissa; Troelsen, Anders; Husted, Henrik

    2015-01-01

    , haemoglobin levels and blood transfusions. METHODS: The analysis was based on the principles of a systematic review. The literature was searched in PubMed for the period from 2004 to November 2014. The articles were reviewed with respect to blood loss, post-operative haemoglobin drop, blood transfusions and......INTRODUCTION: Patient blood management strategies for total hip and knee arthroplasty are controversial. They range from pre-operative haemoglobin optimisation to intra- and post-operative interventions. The aim of this study was to assess the various treatment modalities with respect to blood loss...... studies were found eligible which is equivalent to a total of 4,752 patients. Tranexamic acid administered either orally, topically, intravenously or in combination decreased blood loss, increased the post-operative haemoglobin level, decreased the number of patients receiving blood transfusions and...

  3. Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting

    DEFF Research Database (Denmark)

    Gromov, Kirill; Troelsen, Anders; Otte, Niels Kristian Stahl;

    2016-01-01

    Background and purpose - The safety aspects of bilateral simultaneous total knee arthroplasty (BSTKA) are still debated. In this retrospective single-center study, we investigated early morbidity and mortality following BSTKA in a modern fast-track setting. We also identified risk factors for re......-admission within 90 days and for a length of stay (LOS) of more than 5 days. Patients and methods - 284 patients were selected to receive BSTKA at our institution from 2008 through 2014 in a well-described, standardized fast-track setup (Husted 2012a, b). All re-admissions within 90 days were identified and......: 1.6-21). Higher BMI was a weak risk factor for re-admission within 90 days. Interpretation - BSTKA in selected patients without cardiopulmonary disease in a fast-track setting appears to be safe with respect to early postoperative morbidity and mortality. Surgeons should be aware that patients with...

  4. Impact of venous thromboembolism on clinical management and therapy after hip and knee arthroplasty.

    Science.gov (United States)

    Fisher, William D

    2011-10-01

    Postoperative deep vein thrombosis (DVT) occurs most often in the large veins of the legs in patients undergoing major joint arthroplasty and major surgical procedures. These patients remain at high risk for venous thromboembolic events. In patients undergoing total hip or total knee arthroplasty (THA or TKA, respectively), different patterns of altered venous hemodynamics and hypercoagulability have been found, thus the rate of distal DVT is higher than that of proximal DVT after TKA. In addition, symptomatic venous thromboembolism (VTE) occurs earlier after TKA than THA; however, most of those events occur after hospital discharge. Consequently, extended thromboprophylaxis after discharge should be considered and is particularly important after THA owing to the prolonged risk period for VTE. Evidence-based guideline recommendations for the prevention of VTE in these patients have not been fully implemented. This is partly owing to the limitations of traditional anticoagulants, such as the parenteral route of administration or frequent coagulation monitoring and dose adjustment, as well as concerns about bleeding risks. The introduction of new oral agents (e.g., dabigatran etexilate and rivaroxaban) may facilitate guideline adherence, particularly in the outpatient setting, owing to their oral administration without the need for routine coagulation monitoring. Furthermore, the direct Factor Xa inhibitor rivaroxaban has been shown to be more effective than enoxaparin in preventing VTE. PMID:21774881

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

    Science.gov (United States)

    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. PMID:23344102

  6. Smooth Pins Reinforcing Static Cement Spacers for Infected Total Knee Arthroplasty Are Not Safe.

    Science.gov (United States)

    Llado, Roald J; Banerjee, Samik; Khanuja, Harpal S

    2016-05-01

    Prosthetic joint infection is one of the most dreaded complications following elective lower extremity primary total joint arthroplasty, resulting in substantial pain, disability, and health care costs. Both static and articulating antibiotic-impregnated spacers have been used in the management of 2-stage revision for infected total knee arthroplasty, which remains the gold standard for treatment of these infections. Articulating spacers may provide theoretical benefits with regard to improved range of motion after reimplantation secondary to less scar formations and soft tissue contractures. However, static spacers may be necessary to overcome instability associated with substantial bone defects, incompetent extensor mechanisms, and collateral ligament insufficiencies. In these scenarios, static spacers are often reinforced with intramedullary rods or Steinmann pins to provide additional knee stability, improve construct strength, maintain extension, and avoid flexion contractures. This case report describes an extremely rare case of migration of smooth pins through the posterior tibia into the calf following static spacer use in a 48-year-old man. Various mechanical and systemic complications have been reported in up to 50% of patients with the use of polymethyl methacrylate spacer devices, such as acute renal failure, allergic reactions from antibiotic use, stiffness, bone loss, fractures, and dislocations. However, to the best of the authors' knowledge, this complication of hardware migration has not been reported previously in the literature. The authors believe that orthopedic surgeons should consider the use of threaded pin dowels or intramedullary rods to avoid this potential untoward complication. [Orthopedics. 2016; 39(3):e553-e557.]. PMID:27045481

  7. Mobile Application Use in Monitoring Patient Adherence to Perioperative Total Knee Arthroplasty Protocols.

    Science.gov (United States)

    Kim, Kelvin; Pham, Diep; Schwarzkopf, Ran

    2016-04-01

    The potential for using mobile applications (apps) as an effective tool to monitor patients in an outpatient setting is promising. Past studies have investigated the use of applications in preoperative and postoperative settings as well as in monitoring and treating chronic illnesses such as diabetes, congestive heart failure (CHF), and multiple sclerosis. However, there is limited data on its specific use in the context of total knee arthroplasty. Given the complicated nature and crucial role of patient adherence to protocols during the preparatory and recovery phases of the procedure, the use of an app can serve as a helpful tool in aiding patients throughout this process. We present a pilot study to assess the efficacy of using such an app in order to monitor patient adherence to total knee arthroplasty-specific preoperative and postoperative protocols. Preoperative protocols used in this study included a 5-item medication protocol and multiple activity instructions. Postoperative patient protocols included following instructions on topics such as recording responses to quality-of-life questions, when and how to contact the clinical team if patients had non-emergent concerns or questions, and carrying out daily physical therapy (PT) exercises. Patients received and recorded responses to these preoperative and postoperative instructions using the iGetBetter program application installed on an iPad Mini, provided to the participants. Patient adherence was based on the data gathered from the patient responses inputted on this app. Adherence rates were comparable to those reported in various past studies that also investigated rates of adherence to health management-related instructions communicated through mobile apps. PMID:27042789

  8. Comparison of self-reported and measured range of motion in total knee arthroplasty patients.

    Science.gov (United States)

    Unver, Bayram; Nalbant, Abdurrahman; Karatosun, Vasfi

    2015-08-01

    Total knee arthroplasty (TKA) is an established method used in the treatment of end-stage knee osteoarthritis. Range of motion (ROM) and relief from pain show success of TKA. One of the most important aims of this treatment is to achieve an adequate ROM. Numerous outcome instruments and patient-reported questionnaires are in use to evaluate of TKA patients. For this purpose, disease-specific questionnaires and self-reported ROM and function evaluation tools are also being developed. The most important criteria in musculoskeletal care is assessing the joint mobility of the patient's. Joint mobility can be measured with visual estimates, universal goniometer, X-ray radiography, digital gravity goniometers and applications found in smart phones. Apart from the reliability and validity of the method, obtaining the same results from different examiners is very important. The clinical follow-up of patients is an important part of postoperative care after TKA. The follow-up interval and duration remain dependent on the physician's anticipation of the clinical progress of the individual patient. Long-term surveillance of joint arthroplasty is necessary, but it has also become increasingly burdensome as greater numbers of TKAs are performed, and in younger populations. Patient self-reported questionnaires and self-goniometric measurement are used by many investigators to decrease this burden on the surgeon or staff, and in combination with telemedicine radiographs might be a reasonable option to routine clinic visits. They could reasonably be expected to lower the burden on both the patient and the clinician without eliminating contact and thus sacrificing quality of care. At the same time, it would reduce the financial burden too. Self-reported measured ROM can use in the routine follow-ups to reduce surgeons, physiotherapist and other staff. PMID:26417576

  9. Fraturas periprotéticas em artroplastia total de joelho Periprosthetic fractures in total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Paulo Gilberto Cimbalista de Alencar

    2010-06-01

    Full Text Available A associação do maior número de artroplastias totais de joelho com a maior expectativa de vida da população tem levado a mais complicações de longo prazo, que se somam à baixa qualidade óssea dos pacientes mais idosos e culminam, muitas vezes, em fraturas periprotéticas. Este complexo problema ortopédico tem apresentação clínica muito variável, podendo acometer quaisquer dos ossos do joelho e levar a resultados desastrosos, em virtude de sua difícil solução. O seu tratamento exige do ortopedista amplo conhecimento tanto de técnicas de artroplastia como de osteossíntese, além de elaborado arsenal terapêutico como, por exemplo, acesso a banco de ossos.The increasing number of total knee arthroplasties, in combination with the population's longer life expectancy, has led to a greater number of long-term complications. These complications are also correlated with poor bone quality in the elderly and often result in periprosthetic fractures. This complex orthopedic problem has very diverse clinical presentation, possibly afflicting periprosthetic fracture may happen in any bone that constitutes the knee and, due to the difficulty of finding a solution, may lead to disastrous outcomes. The treatment demands broad knowledge from the orthopedic surgeon, not only regarding arthroplasty techniques, but also osteosynthesis, as well as an elaborate therapeutic including, for example, access to a bone bank.

  10. Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    YU Jia-kuo; YU Chang-long; AO Ying-fang; GONG Xi; WANG Yong-jian; WANG Shu; XING Xie; CHEN Lian-xu; JU Xiao-dong

    2008-01-01

    Background Different kinds of minimally invasive surgery (MIS) procedures have now been used in total knee arthroplasty (TKA). Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing (QS) procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients' vastus medialis and if the QS procedure had some advantages in patients' early recovery.Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees (15 men and 91 women, with a mean age of 65.1±7.4 years); osteoarthritis in 97 patients (91.5%) and rheumatoid arthritis in 9 patients (8.5%). MIS TKA was performed in 49 cases (MIS TKA group), while MIS-QS TKA in 57 cases (MIS-QS TKA group). During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery (HSS) scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded.Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 (0.9%) case with a type Ⅰ insertion of the vastus medialis, 4 (3.8%) cases with type Ⅱ insertions, 101 (95.3%) cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was (53.3±12

  11. Fifteen year outcome of the ceraver hermes posterior-stabilized total knee arthroplasty: safety of the procedure with experienced and inexperienced surgeons.

    Science.gov (United States)

    Hernigou, Philippe; Manicom, Olivier; Flouzat-Lachaniete, Charles Henri; Roussignol, Xavier; Filippini, Paolo; Poignard, Alexandre

    2009-01-01

    We wished to determine whether total knee replacement (TKA) performed by young surgeons increased rates of mortality and complications compared with TKA performed by senior surgeons using the same model of arthroplasty. There were no significant pre-operative differences between the groups in terms of age, gender, height, weight, body mass index, diagnosis, comorbidity and duration of follow-up, which was a mean of 15 years in both groups. Hence, we assessed the 15 year survival of the first 150 Ceraver Posterior-Stabilized total knee arthroplasties undertaken by young surgeons (aged of less than 30 years) in formation in a single university hospital setting (Group B). We used survival curve analysis, with strict definitions regarding end-points, and evaluated a number of different endpoint criteria to assess the outcome and to compare the results with those obtained by the two seniors (aged of more than 40 years) with their 50 first implantations (Group A). The clinical results and survival rate of implants at intermediate to long-term follow-up were similar in both Groups. Kaplan-Meier survival analysis, with revision as the endpoint for failure, showed that the rate of survival at ten years was 96% (95% CI, 93 to 100) in both groups. At fifteen years the rate of survival was 91% (95% CI, 85 to 97) in group B, and 92% (95% CI, 90 to 94) in group A. The implant used in this series appears particularly safe since the usual complications observed with posterior stabilized arthroplasties were not observed even with young surgeons. PMID:19572035

  12. A study on the usefulness of total hip replacement arthroplasty using fluoroscopy

    International Nuclear Information System (INIS)

    To make a comparative analysis for clinical application of total hip replacement arthroplasty (THRA) using fluoroscopy, we have performed total hip replacement arthroplasty making 30 patients an object with general radiography and fluoroscopy respectively. The results are follows: 1) reexamination rate was 80 percent of patients and mean 3.9 sheets in the general radiography, where as it was 46.7 percent and 0.37 sheets in the fluoroscopy (p < 0.01). 2) Add examination was 2 cases in the general radiography, but fluoroscopy was no add examination. 3) The total film sheet used was mean 10.16 in the general radiography and 6.73 in the fluoroscopy. 4) In the cause of reexamination and add examination, inaccurate position of patient accounted for 72.6 percent in the general radiography and poor exposure condition accounted for 45.5 percent in the fluoroscopy. Total hip replacement arthroplasty using the fluoroscopy decreased reexamination and add examination rate, for these reasons, this method was effective abatement of pain, exposure radiation dose, and the examination time and so on. (author)

  13. Neuromuscular exercise prior to joint arthroplasty in patients with osteoarthritis of the hip or knee.

    Science.gov (United States)

    Villadsen, Allan

    2016-04-01

    Osteoarthritis (OA) is a degenerative joint disease affecting the whole joint and peri-articular structures like the muscles. The hallmark of OA is cartilage loss. The main symptoms are pain and decreased physical function leading to a reduced quality of life. OA ranks eight in leading causes of disability worldwide and it generates a heavy economic burden for society. The prevalence of OA increases with age and 10-18% aged above 60 years are affected. Currently there is no cure for OA and the various treatment modalities aim at addressing symptoms, i.e. reducing pain, improving physical function and preventing further progression of the disease. Exercise has proven to be a viable treatment option with regard to reducing pain and improving physical function in patients with mild to moderate knee OA and is today regarded a cornerstone in the treatment. The documentation is less clear for hip OA. Patients with severe OA of the hip or knee are treated with total joint arthroplasty (TJA). Although, in general, it is a very successful procedure, there are still challenges to overcome in this patient group, as approximately 10% of those having hip arthroplasty and 20% of those having knee arthroplasty have persistent symptoms. The evidence on the efficacy of exercise prior to TJA is sparse. It is based on insufficiently powered trials and with interventions of questionable validity. Two recent systematic reviews and meta-analyses reach conflicting conclusions and highlight the need for high quality trials with sufficient sample sizes. In this dissertation, I wanted to evaluate the effects of an individualised neuromuscular exercise programme (NEMEX-TJR) when administered prior to joint arthroplasty in patients with severe OA of the hip or knee joint. This intervention was previously found to be feasible with regard to pain level during exercise and it was possible to progress the training level in this patient group. The main question asked was: Does the addition of

  14. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?

    Science.gov (United States)

    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

  15. Effect of Osteoarthritis Patients' Gender on Rehabilitation after Total Knee Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Jin Lin; Bo Yang; Xi-sheng Weng; Jin Jin; Qing Zhao; Gui-xing Qiu

    2009-01-01

    To investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty (TKA).Methods We prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008. The age and body mass index of male and female patients were matched. The surgical and rehabilitation clinical factors were compared between two groups.Results There was no significant difference in postoperative hospitalization time, surgical tourniquet time, and wound drainage volume between two groups (P>0.05). The extension/flexion degrees of knee joint before operation, 1-week, 2-week and 1-year after operation for male patients were 6.0 ± 3.3 degrees/114.0 ± 10.0 degrees, 2.0 ± 1.6 degrees/93.0±7.4 degrees, 0.6 ± 0.6 degrees/104.0 ± 9.9 degrees and 0.3 ± 0.5 degrees/125.0 ± 8.8 degrees, for female patients were 7.0 ± 3.4 degrees/112.0 ± 14.0 degrees, 2.0 ± 1.3 degrees/89.0 ± 10.9 degrees, 0.9 ± 0.8 degrees/101.0 ± 11.8 degrees, 0.4 ± 0.5 degrees/124.0 ± 7.1 degrees. The range of motion before operation, 1-week, 2-week, and 1-year after operation for male patients was 108.0 ± 9.5 degrees, 91.0 ± 7.1 degrees, 103.0 ± 9.9 degrees, and 125.0 ± 8.9 degrees, for female patients was 105.0 ± 14.1 degrees, 87.0 ± 11.4 degrees, 100.0±11.9 degrees, and 124.0 ± 7.0 degrees. The preoperative and 1-year postoperative HSS scores were 55.8 ± 13.3 and 89.6 ± 6.7 for males and 54.5 ± 13.8 and 89.2 ± 4.1 for females. No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion, range of motion and HSS score (P>0.05).Conclusions Gender does not influence postoperative knee function of osteoarthritis patients. TKA significantly improves knee joint function and relieve osteoarthritis-related pain.

  16. INFLUENCE OF CONVENTIONAL POST TOTAL KNEE REPLACEMENT REHABILITATION PROTOCOL ON ANGLES OF FLAT FOOT

    OpenAIRE

    Smisha Thomas; Vinod Babu. K; Sai Kumar. N,; Vikas Kadam V

    2013-01-01

    Background and introduction:Purpose isto find the influence of conventional post total knee replacementrehabilitation protocol on angles of flat foot such as degree of navicular drop and relaxed calcaneal stancephase angles following unilateral Total Knee Replacement.Method:Pre to post test single group experimental study design. 60 subjects undergoing unilateral total kneereplacement recruited and were treated with 4 weeks of conventional post total knee replacement rehabilitationprotocol fo...

  17. Polietileno tibial móvel na artroplastia total do joelho Mobile polyethylene bearing in total knee replacement

    Directory of Open Access Journals (Sweden)

    Hugo Alexandre de Araújo Barros Cobra

    2009-01-01

    Full Text Available O desgaste do polietileno tibial utilizado nas artroplastias de joelho origina partículas que, quando fagocitadas, dão início à cascata de eventos biológicos que levam à osteólise e consequente afrouxamento dos componentes da prótese. Assim sendo, alternativas para o polietileno têm sido pesquisadas com o objetivo de minimizar o desgaste e, com isso, aumentar a durabilidade das artroplastias. Uma dessas opções é a utilização de polietilenos tibiais móveis, que apresentam maior conformidade do que os polietilenos fixos, ao mesmo tempo em que permitem autoalinhamento rotacional entre os componentes, melhorando, dessa forma, a cinética e a cinemática da prótese. São apresentados aqui, de forma resumida, porém abrangente, o conceito, os fundamentos biomecânicos, as indicações, os resultados esperados e complicações dos polietilenos tibiais móveis nas artroplastias totais do joelho.Debris of polyethylene tibial bearings have been recognized as a major cause for the onset of the cascade of biological events leading to osteolysis and loosening of prosthetic components after total knee arthroplasty. Since then, research has been focused on alternative bearing surfaces in order to minimize the amount and rate of polyethylene wear off and, in doing so, increasing the survivorship rate for knee arthroplasties. One such option is to have a mobile tibial bearing allowing more conformity and rotational self-alignment of the components, improving kinetics and kinematics of the prosthesis. The authors present a resumed but throughout and comprehensive review of the rationale, biomechanics fundamentals, indications, pitfalls, outcomes and complications for the use of mobile tibial bearings in total knee replacement.

  18. Influence of the pneumatic tourniquet on patella tracking in total knee arthroplasty: a prospective randomized study in 100 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Toftgaard Jensen, T

    2005-01-01

    One hundred consecutive patients with osteoarthritis of the knee joint and scheduled for primary total knee arthroplasty performed in a bloodless field were prospectively randomized to have the tourniquet inflated on either straight leg or maximally flexed knee. There was no difference in the...... number of lateral releases between the groups, and position of the knee in maximal flexion during inflation of the tourniquet did not decrease the number of lateral releases. There was no difference in clinical or radiological patella tracking between groups. If the patella was maltracking, tourniquet...... deflation led to better patella tracking and saved 5 (31%) of 16 releases with no difference between groups. We recommend tourniquet deflation and reevaluation of patella tracking before performing lateral release in patellar maltracking....

  19. The surveillance of surgical site infection after primary total knee replacement from 1993 to 2013

    OpenAIRE

    Ng, FY; Chiu, KY; Yan, CH; Chan, PK

    2014-01-01

    INTRODUCTION: Surgical site infection (SSI) is still the most common complication after primary total knee replacement. The surveillance of SSI after total joint replacement helps to audit the infection rate, identifies risk factors, provides trend of bacteriology. This study aims at reporting the 20-year SSI after primary total knee ...

  20. Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones

    DEFF Research Database (Denmark)

    Beckmann, Nicholas A; Mueller, Sebastian; Gondan, Matthias;

    2015-01-01

    determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased......Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases) to...... loosening rate in AORI 2 and 3 defects. The overall failure rate was also substantially lower in the porous metal group than the structural allograft group; little difference in the infection rates was noted....

  1. Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Madsbad, Sten; Kehlet, Henrik;

    2015-01-01

    when adjusting for covariates (odds ratio: 1.19 [0.93-1.54]; P = 0.172). Correspondingly, the NNH was 78 but ranged between 31 and infinity. Type 2 diabetes was not associated with 30- (1.02 [0.75-1.39]; P = 0.897) or 90-day readmissions (1.22 [0.87-1.71]; P = 0.254), and with an NNH of 957 (59-∞) and......BACKGROUND: Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early...... mobilization, and discharge to home, which improved postoperative outcome. METHODS: We performed an observational cohort study using prospective data in primary total hip and total knee arthroplasty with a standardized fast-track approach. Eight hundred ninety type 2 diabetics were successfully propensity...

  2. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial

    DEFF Research Database (Denmark)

    Toftdahl, Karen; Nikolajsen, Lone; Haraldsted, Viggo;

    2007-01-01

    BACKGROUND: Postoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome. METHODS: 80 patients undergoing TKA under spinal anesthesia were randomized...... to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these...

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

    Science.gov (United States)

    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; Pdeep 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

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

    Science.gov (United States)

    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. Total knee arthroplasty: good agreement of clinical severity scores between patients and consultants

    Directory of Open Access Journals (Sweden)

    Walley Gayle

    2006-07-01

    Full Text Available Abstract Background Nearly 20,000 patients per year in the UK receive total knee arthroplasty (TKA. One of the problems faced by the health services of many developed countries is the length of time patients spend waiting for elective treatment. We therefore report the results of a study in which the Salisbury Priority Scoring System (SPSS was used by both the surgeon and their patients to ascertain whether there were differences between the surgeon generated and patient generated Salisbury Priority Scores. Methods The Salisbury Priority Scoring System (SPSS was used to assign relative priority to patients with knee osteoarthritis as part of a randomised controlled trial comparing the standard medial parapatellar approach versus the sub-vastus approach in TKA. The operating surgeons and each patient completed the SPSS at the same pre-assessment clinic. The SPSS assesses four criteria, namely progression of disease, pain or distress, disability or dependence on others, and loss of usual occupation. Crosstabs and agreement measures (Cohen's kappa were performed. Results Overall, the four SPSS criteria showed a kappa value of 0.526, 0.796, 0.813, and 0.820, respectively, showing moderate to very good agreement between the patient and the operating consultant. Male patients showed better agreement than female patients. Conclusion The Salisbury Priority Scoring System is a good means of assessing patients' needs in relation to elective surgery, with high agreement between the patient and the operating surgeon.

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

    Directory of Open Access Journals (Sweden)

    A. Giurea

    2016-01-01

    Full Text Available 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.

  7. Revision of unicompartmental knee arthroplasty: implants used and causes of failure

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2014-04-01

    Full Text Available OBJECTIVE: to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO in the period between January 1990 and January 2013.METHODS: a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting.RESULTS: in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK.CONCLUSION: in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability.

  8. Effects of two different continuous passive motion application protocols on the functional activities of total knee arthroplasty inpatients

    OpenAIRE

    Bakırhan, Serkan; Ünver, Bayram; Karatosun, Vasfi

    2015-01-01

    Objective: The aim of this study was to compare the effects of two different continuous passive motion (CPM) application protocols (low- and high-angle) on the early phase functional activities of total knee arthroplasty inpatients.Methods: The study included 170 patients who underwent primary TKA. While 84 of the TKA patients underwent low-angle CPM application, 86 of the patients underwent high-angle CPM application. The patients’ functional activities were compared using the Iowa Level of ...

  9. Postoperative Etoricoxib versus Ketoprofen Administration for Pain Management after Total Knee Arthroplasty: A Randomized, Double-Blind Controlled Study

    OpenAIRE

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

    2015-01-01

    Objective. This randomized double-blind study compared the analgesic efficacy and tolerability of etoricoxib versus ketoprofen in 165 patients with elective total primary knee arthroplasty. Methods. After ethical committee approval, 165 patients were randomized in 3 groups: the etoricoxib group (E) receiving etoricoxib 120 mg/day, at the end of surgery and in the first postoperative day; the ketoprofen group (K) receiving ketoprofen 2 pills of 100 mg/day, the first at the end of surgery and t...

  10. After total knee arthroplasty, many people are not active enough to maintain their health and fitness: an observational study

    OpenAIRE

    Groen, Jan-Willem; Stevens, Martin; Kersten, Roel F. M. R.; Reininga, Inge H. F.; van den Akker-Scheek, Inge

    2012-01-01

    Questions: What proportion of people after total knee arthroplasty adheres to the physical activity regimen recommended for maintenance of health (moderate intensity physical activity for at least 30 min on 5 days/week)? What proportion adheres to the activity regimen recommended to improve fitness (vigorous intensity physical activity for at least 20 min on 3 days/week)? What factors are associated with adherence to these recommendations? Design: An observational study. Participants: 830 adu...

  11. Clinical Evaluation of a Mobile Sensor-Based Gait Analysis Method for Outcome Measurement after Knee Arthroplasty

    OpenAIRE

    Tilman Calliess; Raphael Bocklage; Roman Karkosch; Michael Marschollek; Henning Windhagen; Mareike Schulze

    2014-01-01

    Clinical scores and motion-capturing gait analysis are today’s gold standard for outcome measurement after knee arthroplasty, although they are criticized for bias and their ability to reflect patients’ actual quality of life has been questioned. In this context, mobile gait analysis systems have been introduced to overcome some of these limitations. This study used a previously developed mobile gait analysis system comprising three inertial sensor units to evaluate daily activities and sport...

  12. Comparative study of extended versus short term thromboprophylaxis in patients undergoing elective total hip and knee arthroplasty in Indian population

    OpenAIRE

    Velu Nair; Ratheesh Kumar; Bikram Kumar Singh; Ajay Sharma; Gururaj R Joshi; Kamal Pathak

    2013-01-01

    Background: Postoperative thromboprophylaxis with low molecular weight heparin (LMWH) for an extended period of 4 weeks is now preferred over short term thromboprophylaxis in patients undergoing total hip/knee arthroplasty (THA/TKA). However, most of the data demonstrating the efficacy and safety of extended thromboprophylaxis and short term thromboprophylaxis is from clinical trials done in the West. In India, the data of the incidence of venous thromboembolism (VTE) following THA/TKA has be...

  13. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs

    OpenAIRE

    Small, S. R.; 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 r...

  14. Which Route of Tranexamic Acid Administration is More Effective to Reduce Blood Loss Following Total Knee Arthroplasty?

    Science.gov (United States)

    Keyhani, Sohrab; Esmailiejah, Ali Akbar; Abbasian, Mohammad Reza; Safdari, Farshad

    2016-01-01

    Background: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty. Methods: One hundred twenty 120 patients were scheduled to undergo primary total knee arthroplasty. Patients were randomly allocated to three equal groups: IV tranexamic acid (500 mg), topical tranexamic acid (3 g in 100 mL normal saline) and the control. In the topical group, half of the volume was used to irrigate the joint and the other half was injected intra-articularly. The volume of blood loss, hemoglobin (Hb) level at 24 hours postoperative, and rate of transfusion was compared between groups. Results: The blood loss and Hb level were significantly greater and lower in the control group, respectively (P=0.031). Also, the rate of transfusion was significantly greater in the control group (P=0.013). However, IV and topical groups did not differ significantly in terms of measured variables. No patient experienced a thromboembolic event in our study. Conclusion: Tranexamic acid is a useful antifibrinolytic drug to reduce postoperative blood loss, Hb drop, and rate of blood transfusion in patients undergoing total knee arthroplasty. The route of tranexamic acid administration did not affect the efficacy and safety. PMID:26894222

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

    Science.gov (United States)

    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. Navigation of total knee arthroplasty: rotation of components and clinical results in a prospectively randomized study

    Directory of Open Access Journals (Sweden)

    Efe Turgay

    2011-01-01

    Full Text Available Abstract Background Navigation was introduced into total knee arthroplasty (TKA to improve accuracy of component position, function and survival of implants. This study was designed to assess the outcome of navigated TKA in comparison with conventional implantation with the focus on rotational component position and clinical mid-term results. Methods In a prospectively randomized single-blinded approach, 90 patients with primary gonarthrosis were assigned to three different groups. Thirty patients each were assigned to NexGen LPS without and with navigation (groups 1 and 2, and 30 patients to navigation with the Stryker Scorpio PS (group 3. The navigation system used was the imageless Stryker KneeTrac, version 1.0. Clinical outcome was assessed by a blinded observer applying the Knee Society Score (KSS and a visual analogue scale (VAS for pain. CT scans and radiographs were conducted prior to and 12 weeks after index surgery. Results Seventy-nine patients were available for clinical evaluation at 3 ± 0.4 years follow-up. Four implants had to be revised for early loosening or infection (4.4%. Four patients had died and three patients were not able to follow the invitation for clinical assessment. Functional results in the KSS were significantly lower after navigated TKA. Operation time and incisions with navigation were significantly longer. Significantly less radiological outliers with navigation were found for coronal alignment of the femur, only. Conclusion In this series, no beneficial effect for navigation in TKA could be shown assessing clinical data, as functional results in the presented series seemed to be lower after first generation navigated TKA. The clinical mid- to long-term value of navigation remains to be evaluated in larger patient series or meta-analyses at longer follow-up. Trial registration number DRKS 00000430

  17. Flat-on-flat, nonconstrained, compression molded polyethylene total knee replacement.

    Science.gov (United States)

    Ritter, M A; Worland, R; Saliski, J; Helphenstine, J V; Edmondson, K L; Keating, E M; Faris, P M; Meding, J B

    1995-12-01

    Flat-on-flat, posterior cruciate ligament-sparing total knee prostheses recently have shown problems of wear, loosening, and multiple design changes. Two thousand one Anatomical Graduated Components total knee arthroplasties with compression molded, nonmodular polyethylene tibial components were done between 1983 and 1991 at 3 institutions. All knees were evaluated clinically and radiographically every 2 to 3 years; 71 knees were seen in followup > 10 years. There were 8 failures secondary to revision (5 tibial failures; 2 secondary to metalosis from patellar polyethylene dissociation; and 3 femoral failures) resulting in a 98% survival rate at 10 years. The tibial design was flat-on-flat with a compression molded polyethylene that the authors believe is the primary reason for its success. PMID:7497689

  18. The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty.

    Science.gov (United States)

    Pongcharoen, Boonchana; Reutiwarangkoon, Chaivet

    2016-01-01

    In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arthritis of the lateral facet of the patella following mobile bearing UKA. We have prospectively evaluated 104 patients (114 knees) who had undergone an Oxford mobile bearing UKA. The mean follow-up was 19.05 months (range 12.30-29.70 months). The patients were divided into two groups: group I consisted of eighty patients (88 knees) who did not have severe arthritis of the lateral facet (Outerbridge grade 0-2) and group II had twenty-four patients (26 knees) who had severe arthritis of the lateral facet (Outerbridge grade 3, 4). We recorded the incidence of anterior knee pain, knee scores, pain scores, and functional scores in comparison of the two groups. The visual analog scale (VAS) and incidence of post-operative anterior knee pain had not shown any significant differences. The VAS for post-operative anterior knee pain was 0.11 (SD 0.56, range 0-3 point) versus 0.12 (SD 0.59, range 0-3 point) for group I and group II patients, respectively (P = 0.98). The incidence of post-operative anterior knee pain was 4.5 versus 3.8 % for group I and group II patients, respectively (P = 0.88). The pain scores and functional scores had not exhibited any differences. However, the knee scores of patients with severe arthritis of the lateral facet of the patella was worse than those seen in patients without severe arthritis of the lateral facet of the patella with a statistical significance. It was scored as 96.78 (SD 4.56, range 85-100) versus 94.43 (SD 4.50, range 81-100) for group I

  19. 类风湿关节炎患者全膝置换术术前评估%Preoperative evaluation of total knee arthroplasty in rheumatoid arthritis patients

    Institute of Scientific and Technical Information of China (English)

    刘大猛; 周新社

    2016-01-01

    Total knee arthroplasty ( TKA ) is developing. Rheumatoid arthritis ( RA ) patients, whose knee function is severely affected, have obtained good effects. RA can not only affect the joints, but a systemic and multi-systematic disease. When involving the cervical spine, RA can cause upper cervical instability. It is essential to pay more attention to asymptomatic patients, so as to select appropriate treatment measures. Preoperative heart function rating can assess the risk of surgery and the tolerance of patients. The pulmonary injury often slacks up lung functions too. RA patients also have higher prevalence of oral or periodontal diseases, which is related with artificial joint infection after the surgery. Anemia can lead to increased risk of infection and delayed wound healing. So for each body the comprehensive and systematic preoperative evaluation is necessary. In addition, degree of preoperative rheumatoid arthritis and inflammatory indexes such as blood sedimentation, c-reactive protein level are of controversy. The use of clinical drugs to relieve symptoms before surgery or not is worth the attention of orthopedic surgeons. Patients with long-term drug therapy, such as traditional DMARDs and biological agents, cortisol, have the risk of infection after the knee replacement. Researches on biological agents in the treatment of rheumatoid arthritis are being conducted in recent years. Foreigners also put forward the guide on the perioperative use of biological agents. Detailed preoperative evaluation and multidisciplinary cooperation are necessary to reduce the risk of surgery.

  20. Does improved instrumentation result in better component alignment in total knee arthroplasty?

    OpenAIRE

    Mo Hassaballa; Vijaya Budnar; Herbert Gbejuade; Ian Learmonth

    2011-01-01

    Accurate component alignment and joint line reproduction in total knee replacement (TKR) is crucial for successful clinical outcome. Advances in instrumentation and better understanding of the biomechanics can help to achieve better three dimensional alignments of TKR components and joint line restoration. We compared the accuracy of component alignment and joint line restoration with the use of 2 different TKR instrumentation kits (an older Gobot and a newer Xcelerate). Retrospective study o...

  1. THE IMPORTANCE OF PREOPERATIVE RISK FACTORS IN THE RECOVERY OF PATIENTS WITH DEFORMITIES FOLLOWING TOTAL KNEE ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Savin L.

    2015-08-01

    Full Text Available A retrospective observational study has been conducted on 457 patients diagnosed with advanced knee osteoarthritis and that underwent knee arthroplasty. Two groups of patients have been observed: the first group presented deformities (varus, valgus while the second group did not. There have been evaluated the prevalence of general risk factors (age, sex and local ones (obesity, muscle tone, deformities in the occurrence of advanced gonarthrosis requiring radical surgery and the influence of these factors on the evolution of patients¬ that underwent total knee arthroplasty. 53.6 % of patients had their knees correctly aligned while 39.8% presented a varus misalignment and only 6.1% a valgus misalignment. Within the group of patients included in the study, the average age of patients was 66 years and the highest frequency was found in patients aged over 70 years, both in genu varum and genu valgum. The female patients represent 74.4% of the total number of patients and more frequently affected by the occurrence of deformities. Obesity has been observed in 32 – 38% of the patients with deformities. Postoperative pain has been evaluated using the Visual Analogue Scale (VAS. In 50% of the cases, patients with varus and valgus accused early intense and severe postoperative pain (VAS 7-10. 32. 64% of the female patients accused level of pain marked as 7 – 10 VAS, while only 30.84% of the male patients accused the same levels of pain. Intense and severe pain is more frequently found in elderly patients. The deformities did not cause any important changes on early postoperative pain, obesity and muscular hypotrophy being the risk factors in increasing the level of pain. Postoperative recovery in patents with knee arthroplasty largely depends on preoperative planning, the surgical technique and, not lastly, the correct management of bleeding and pain.

  2. Analysis of Risk Factors for Lower-limb Deep Venous Thrombosis in Old Patients after Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jian Kang

    2015-01-01

    Full Text Available Background: Deep venous thrombosis (DVT is a common complication of arthroplasty in old patients. We analyzed risk factors for lower-limb DVT after arthroplasty in patients aged over 70 years to determine controllable risk factors. Methods: This was a retrospective study of 1,025 patients aged >70 years treated with knee arthroplasty at our hospital between January 2009 and December 2013. Of 1,025 patients, 175 had postoperative lower-limb DVT. We compared medical history, body mass index (BMI, ambulatory blood pressure, preoperative and postoperative fasting blood glucose (FBG, preoperative blood total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol, and preoperative homocysteine (Hcy between thrombus and non-thrombus groups. B-mode ultrasonography was used to detect lower-limb DVT before the operation and 7 days after the operation in all patients. Logistic regression analysis was used to determine risk factors for DVT. Results: Incidence of diabetes (P = 0.014, BMI (P = 0.003, preoperative FBG (P = 0.004, postoperative FBG (P = 0.012, and preoperative Hcy (P < 0.001 were significantly higher in the thrombus group. A significantly greater proportion of patients in the non-thrombus group had early postoperative activity (P < 0.001 and used a foot pump (P < 0.001. Operative duration was significantly longer in the thrombus group (P = 0.012. Within the thrombus group, significantly more patients had bilateral than unilateral knee arthroplasty (P < 0.01. Multivariate logistic analysis revealed BMI, preoperative Hcy, postoperative FBG, long operative duration, bilateral knee arthroplasty, and time to the activity after the operation to be predictive factors of DVT. At 6-month follow-up of the thrombus group, 4.7% of patients had pulmonary embolism and 18.8% had recurrent DVT; there were no deaths. Conclusions: Obesity, inactivity after operation, elevated preoperative Hcy and postoperative FBG, long operative duration, and

  3. Analysis of Risk Factors for Lower-limb Deep Venous Thrombosis in Old Patients after Knee Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Jian Kang; Xu Jiang; Bo Wu

    2015-01-01

    Background:Deep venous thrombosis (DVT) is a common complication of arthroplasty in old patients.We analyzed risk factors for lower-limb DVT after arthroplasty in patients aged over 70 years to determine controllable risk factors.Methods:This was a retrospective study of 1,025 patients aged >70 years treated with knee arthroplasty at our hospital between January 2009 and December 2013.Of 1,025 patients,175 had postoperative lower-limb DVT.We compared medical history,body mass index (BMI),ambulatory blood pressure,preoperative and postoperative fasting blood glucose (FBG),preoperative blood total cholesterol,triglyceride,high-and low-density lipoprotein cholesterol,and preoperative homocysteine (Hcy) between thrombus and non-thrombus groups.B-mode ultrasonography was used to detect lower-limb DVT before the operation and 7 days after the operation in all patients.Logistic regression analysis was used to determine risk factors for DVT.Results:Incidence of diabetes (P =0.014),BMI (P =0.003),preoperative FBG (P =0.004),postoperative FBG (P =0.012),and preoperative Hcy (P < 0.001) were significantly higher in the thrombus group.A significantly greater proportion of patients in the non-thrombus group had early postoperative activity (P < 0.001) and used a foot pump (P < 0.001).Operative duration was significantly longer in the thrombus group (P =0.012).Within the thrombus group,significantly more patients had bilateral than unilateral knee arthroplasty (P < 0.01).Multivariate logistic analysis revealed BMI,preoperative Hcy,postoperative FBG,long operative duration,bilateral knee arthroplasty,and time to the activity after the operation to be predictive factors of DVT.At 6-month follow-up of the thrombus group,4.7% of patients had pulmonary embolism and 18.8% had recurrent DVT;there were no deaths.Conclusions:Obesity,inactivity after operation,elevated preoperative Hey and postoperative FBG,long operative duration,and bilateral knee arthroplasty were risk

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

    Science.gov (United States)

    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.

  5. Clinical results of Hi-tech Knee II total knee arthroplasty in patients with rheumatoid athritis: 5- to 12-year follow-up

    Directory of Open Access Journals (Sweden)

    Yamanaka Hajime

    2012-02-01

    Full Text Available Abstract Background Total knee arthroplasty (TKA is a common form of treatment to relieve pain and improve function in cases of rheumatoid arthritis (RA. Good clinical outcomes have been reported with a variety of TKA prostheses. The cementless Hi-Tech Knee II cruciate-retaining (CR-type prosthesis, which has 6 fins at the anterior of the femoral component, posterior cruciate ligament (PCL retention, flat-on-flat surface component geometry, all-polyethylene patella, strong initial fixation by the center screw of the tibial base plate, 10 layers of titanium alloy fiber mesh, and direct compression molded ultra high molecular weight polyethylene (UHMWPE, is appropriate for TKA in the Japanese knee. The present study was performed to evaluate the clinical results of primary TKA in RA using the cementless Hi-Tech Knee II CR-type prosthesis. Materials and methods We performed 32 consecutive primary TKAs using cementless Hi-Tech Knee II CR-type prosthesis in 31 RA patients. The average follow-up period was 8 years 3 months. Clinical evaluations were performed according to the American Knee Society (KS system, knee score, function score, radiographic evaluation, and complications. Results The mean postoperative maximum flexion angle was 115.6°, and the KS knee score and function score improved to 88 and 70 after surgery, respectively. Complications, such as infection, occurred in 1 patient and revision surgery was performed. There were no cases of loosening in this cohort, and prosthesis survival rate was 96.9% at 12 years postoperatively. Conclusion These results suggest that TKA using the cementless Hi-Tech Knee II CR-type prosthesis is a very effective form of treatment in RA patients at 5 to 12 years postoperatively. Further long-term follow-up studies are required to determine the ultimate utility of this type of prosthesis.

  6. Ochronosis of the knee with secondary osteoarthritis requiring total knee replacement in a patient with cryptogenic organising pneumonia.

    Science.gov (United States)

    Jasper, Jorrit; Metsaars, Wieneke; Jansen, Joris

    2016-01-01

    Ochronosis is a rare autosomal recessive metabolic disease caused by homogentisic acid oxidase enzyme deficiency. High homogentisic acid levels will eventually result in black deposits in skin, sclerae, connective tissues and urine (alkaptonuria). It can lead to early degeneration of connective tissues and cartilage. Ochronosis can damage normal cartilage, leading to secondary osteoarthritis. The diagnosis is often delayed because of its low prevalence and non-specific early symptoms. In our patient, the secondary osteoarthritis due to ochronosis deposits in the cartilage was treated by total knee arthroplasty, with good clinical outcome. This article reports the first case of ochronosis with secondary osteoarthritis of the knee in a patient previously diagnosed with cryptogenic organising pneumonia (COP). PMID:27207988

  7. The role of low molecular weight heparin in total knee arthroplasty.

    Science.gov (United States)

    Iobst, C A; Friedman, R J

    1999-01-01

    Low-molecular-weight heparin prophylaxis is an acceptable, if not superior, alternative to heparin and warfarin prophylaxis in TKA. Considering the current popularity of pharmacologic prophylaxis after total hip and total knee arthroplasty and the advantages of low-molecular-weight heparins over traditional pharmacologic agents, these agents have the potential to become the prophylactic agent of choice against DVT in TKA. There are several practical differences between low molecular weight heparins and warfarin. Low molecular weight heparins are administered by subcutaneous injection and do not require drug-level or blood monitoring. Warfarin, although administered orally, must be maintained within an appropriate international normalized ratio (INR=2-3) with daily dose adjustments and takes 36 hours to produce a measurable effect, which may leave patients relatively unprotected during the early postoperative period. Comparative trials have demonstrated that low molecular weight heparins are more efficacious than warfarin in producing a greater overall reduction in the incidence and risk of DVT, but show similar rates of PE. Some studies suggest that bleeding may be a greater problem with low molecular weight heparin. Despite the superior efficacy of low molecular weight heparin, the prevalence of venous thromboembolism after TKA continues to be substantial compared with total hip arthroplasty, with at least a quarter of patients still affected. Additional prophylaxis strategies for this indication are needed and could include combining mechanical prophylaxis (eg, external pneumatic compression) with low molecular weight heparin. An appropriate management strategy should be established for all patients undergoing TKA. This should include identification of high-risk patients, cautious transfusion of blood products, pharmacologic prophylaxis with an acceptable agent for TKA, early mobilization, postoperative screening in high-risk patients, and continuing

  8. Type rotating hinge knee replacement treatment knee bone tumor clinical curative effect analysis%旋转铰链型膝关节置换术治疗膝部骨肿瘤临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    马伟; 于金华; 曲成明

    2015-01-01

    目的:分析旋转铰链型膝关节置换术治疗膝部骨肿瘤临床疗效。方法随机选取2011年2月至2014年2月在我院采用旋转铰链型膝关节置换术治疗膝部骨肿瘤的40例患者作为研究对象,对术后患者进行随访和Enneking肢体功能评分,分析旋转铰链型膝关节置换术治疗膝部骨肿瘤的临床治疗效果。结果40例患者经过治疗后,有2例患者出现肢体麻木,不敢行走的现象,有3例肿患者出现伤口感染现象;通过6个月的随访,所有患者的膝关节运动良好,行走时未出现跛行状况,与正常肢体无大差异;Enneking肢体功能评分,在胫骨上端行旋转铰链型膝关节置换术的患者评分为优的有29例,在股骨下端行旋转铰链型膝关节置换术的患者评分为优的有32例,对所有患者进行X片检查,未出现假体松动、下沉等异样。结论旋转铰链型膝关节置换术治疗膝部骨肿瘤效果良好,是膝部骨肿瘤保肢的良好方法。%Objective Analysis of the rotating hinge knee replacement treatment of bone tumors of the knee clinical curative effect. Methods Randomly selected from February 2011 to February 2014 in our hospital USES the rotating hinge knee replacement treatment of bone tumors of the knee of 40 patients as the research object, follow-up and Enneking limb function in patients with postoperative scores, type analysis of rotating hinge knee arthroplasty clinical treatment effect for the treatment of bone tumors of the knee. Results 40 patients after treatment, 2 cases with numbness, dare not walk phenomenon, there are 3 cases of patients with wound infection;Through six months of follow-up, all patients with knee joint movement is good, does not appear when walking limp, and normal body no big difference;Enneking limb function score, at the upper tibia type line of rotating hinge knee arthroplasty patients score for optimal in 29 cases, the bottom line of femoral

  9. Development of a Wearable Assist Robot for Walk Rehabilitation After Knee Arthroplasty Surgery

    Science.gov (United States)

    Terada, H.; Zhu, Y.; Horiguchi, K.; Nakamura, M.; Takahashi, R.

    In Japan, it is popular that the disease knee joints will be replaced to artificial joints by surgery. And we have to assist so many patients for walk rehabilitation. So, the wearable assist robot has been developed. This robot includes the knee motion assist mechanism and the hip joint support mechanism. Especially, the knee motion assist mechanism consists of a non-circular gear and grooved cams. This mechanism rotates and slides simultaneously, which has two degree-of-freedom. Also, the hip joint support mechanism consists of a hip brace and a ball-joint. This mechanism can avoid motion constraints which are the internal or external rotation and the adduction or abduction. Then, the control algorithm, which considers an assisting timing for the walk rehabilitation, has been proposed. A sensing system of a walk state for this control system uses a heel contacts sensor and knee and hip joint rotation angle sensors. Also, the prototype robot has been tested. And it is confirmed that the assisting system is useful.

  10. Good validity and reliability of the forgotten joint score in evaluating the outcome of total knee arthroplasty

    DEFF Research Database (Denmark)

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas; Barfod, Kristoffer W; Husted, Henrik; Troelsen, Anders

    strong correlation between the FJS and the OKS (intraclass correlation coefficient (ICC) = 0.81, 95% CI: 0.77-0.85;p < 0.001). The test-retest evaluation showed almost perfect reliability for the FJS total score (ICC = 0.91, 95% CI: 0.88-0.94) and substantial reliability or better for individual items of......Background and purpose - When evaluating the outcome after total knee arthroplasty (TKA), increasing emphasis has been put on patient satisfaction and ability to perform activities of daily living. To address this, the forgotten joint score (FJS) for assessment of knee awareness has been developed...... validity study and 150 in a reliability study. Correlation between the Oxford knee score (OKS) and the FJS was examined and test-retest evaluation was performed. A ceiling effect was defined as participants reaching a score within 15% of the maximum achievable score. Results - The validity study revealed a...

  11. Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Axe Michael J

    2010-05-01

    Full Text Available Abstract Background Arthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA. Although more than 400 000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA. Methods Functional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG test and the Stair Climbing Task (SCT. Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS. A logistic regression model was used to identify variables predictive of TKA use. Results Forty subjects (33% underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p 2 = 0.403. Conclusions Younger patients with full knee ROM who have a higher self-perception of function are less likely to undergo TKA. Physicians and clinicians should be aware that potentially modifiable factors, such as knee ROM can be addressed to potentially postpone the need for TKA.

  12. A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee

    Directory of Open Access Journals (Sweden)

    Takeuchi Ryohei

    2010-08-01

    Full Text Available Abstract Background The choice of surgical treatments for unicompartmental osteoarthritis (OA of the knee is still somewhat controversial. Midterm results from cases treated using unicompartmental knee arthroplasty (UKA or open wedge high tibial osteotomy (OWHTO were evaluated retrospectively. Methods Twenty-seven knees of 24 patients with varus deformities underwent OWHTO and 30 knees of 18 patients underwent UKA surgeries for the treatment of medial compartmental osteoarthritis (OA. The KSS score, FTA, range of motion and complications were evaluated before and after surgery. Results The preoperative mean KSS scores were 49 points in the OWHTO group and 62 in the UKA group which improved postoperatively to 89 (excellent; 19 knees, good; 8 knees, and 88 (excellent; 25, good; 4, fair; 1, respectively. There was no significant difference between the OWHTO and UKA scores. Seventeen patients in the OWHTO group could sit comfortably in the formal Japanese style after surgery. The preoperative mean FTA values for the OWHTO and UKA groups were 182 degrees and 184, and at follow-up measured 169 and 170, respectively. In the UKA group, the femoral component and the polyethylene insertion in one patient was exchanged at 5 years post-surgery and revision TKAs were performed in 2 cases. In the OWHTO group, one tibial plateau fracture and one subcutaneous tissue infection were noted. Conclusions Treatment options should be carefully considered for each OA patient in accordance with their activity levels, grade of advanced OA, age, and range of motion of the knee. OWHTO shows an improved indication for active patients with a good range of motion of the knee.

  13. Clinical Outcomes and Risks of Single-stage Bilateral Unicompartmental Knee Arthroplasty via Oxford Phase III

    Directory of Open Access Journals (Sweden)

    Tong Ma

    2015-01-01

    Full Text Available Background: Osteoarthritis often affects the joint bilaterally, and the single-stage (SS unicompartmental knee arthroplasty (UKA is advantageous in terms of a single anesthesia administration, a short hospital stay, lower medical costs, and enhanced patient convenience. However, the complication risk of SS UKA continues to be debated. The aim of this article was to evaluate the clinical effectiveness, complications, and functional recovery of SS and two-stage (TS UKA. Methods: From January 2008 to December 2013, we compared a series of 36 SS UKA with 45 TS UKA for osteoarthritis. The mean age was 65.4 years (range: 55-75 years. The mean body mass index was 25.2 kg/m 2 (range: 22-29 kg/m 2 . The pre- and post-operative Oxford Knee Scores (OKSs, complications, operative times, tourniquet times, the amount of drainage, and hemoglobin (Hb were evaluated. The Chi-square test, Fisher′s exact test, and paired and grouped t-tests were used in this study. Results: The mean follow-up was 50 months. No complications of death, fat embolism, deep vein thrombosis, and prosthetic infection were reported. Patients who underwent SS UKA had a shorter cumulative anesthesia time (113.5 vs. 133.0 min, P 0.05. At the final follow-up, the mean OKS improved from 39.48 ± 5.69 to 18.83 ± 3.82 (P 0.05. Patients who underwent SS UKA had a faster recovery. Conclusions: The single-staged UKA offers the benefits of a single anesthesia administration, reduced total anesthetic time, decreased overall rehabilitation time, and absence of an increase in perioperative mortality or complications compared with the TS bilateral UKA.

  14. Augmented Reality for Assistance of Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Castillo Daniel

    2016-01-01

    Full Text Available The aim of this work was the development of a surgical assistance system based on augmented reality to support joint replacement procedures and implantation of prosthetic knee. Images of the scene were captured in order to detect the visual markers located on the lateral surface of the patient’s leg for overlapping the 3D models of the prosthesis and the joint, as well as the tool used by the medical specialist. With the marker identification, it was possible to compute its position and orientation for locating the virtual models, obtaining a monitoring system for giving accurate information about the procedure. Also it can be used as training platform for surgeons, without having volunteers or patients for performing real surgeries; instead they can train in a virtual environment. The results have shown an efficient system in terms of cost-benefit relation, taking into account the materials used for developing the system; nevertheless, the accuracy of the algorithm decreases according to the distance between the markers.

  15. Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-hour clamp drain: a prospective triple-blinded randomized controlled trial

    OpenAIRE

    Paphon Sa-ngasoongsong; Thanaphot Channoom; Viroj Kawinwonggowit; Patarawan Woratanarat; Pongsthorn Chanplakorn; Bussanee Wibulpolprasert; Siwadol Wongsak; Umaporn Udomsubpayakul; Supaporn Wechmongkolgorn; Nantaporn Lekpittaya

    2011-01-01

    A high-dose local tranexamic acid has been introduced in total knee arthroplasty for bleeding control. We are not sure about the systemic absorption and side effects. The aim of this study was to evaluate the effect of low dosage of intra-articular tranexamic acid injection combined with 2-hour clamp drain in minimally bleeding computer-assisted surgery total knee replacement (CAS-TKR). A prospective randomized controlled trial was conducted in a total of 48 patients underwent CAS-TKR. The pa...

  16. Patients with knee osteoarthritis undergoing total knee arthroplasty have a lower risk of subsequent severe cardiovascular events: propensity score and instrumental variable analysis.

    Directory of Open Access Journals (Sweden)

    Wen-Yan Lin

    Full Text Available This population-based study investigated the subsequent cardiovascular risk of patients with knee osteoarthritis underwent total knee arthroplasty in Taiwan.This was a population-based follow-up study of 22931 patients diagnosed with knee osteoarthritis between 2008 and 2011. Each patient was followed for 3 years or until death. Treatment was dichotomized into conservative treatment and TKA. The association between TKA and cardiovascular disease (CVD events was analyzed using propensity score analysis and instrumental variable analysis and two-stage least-squares regression model.Patients with knee osteoarthritis who underwent TKA had a lower 3-year cumulative risk of stroke and acute myocardial infarction (AMI. After adjusting for measured risk and confounding factors, propensity score showed a 0.56 fold (adjusted OR = 0.56; 95% CI, 0.51-0.61; p<0.001 risk for CVD in those with TKA. Use of instrumental variable analysis for adjusting measured and unmeasured factors and two-stage least squares regression model revealed that the average treatment effect of TKA was statistically associated with a decreased 7% risk of CVD events (95% CI, 0.2%-13.6%.Our study revealed that patients with knee osteoarthritis who underwent TKA had a lower risk of suffering from a future severe cardiovascular event. This benefit may be attributed to an improvement in physical activity, reduction of psychosocial stress, and/or a decreased use of NSAIDs as a result of having undergone TKA.

  17. Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty- a new dimension of diagnostics?

    Directory of Open Access Journals (Sweden)

    Rasch Helmut

    2011-02-01

    Full Text Available Abstract Background The purpose of our study was to evaluate the clinical value of hybrid SPECT/CT for the assessment of patients with painful total knee arthroplasty (TKA. Methods Twenty-three painful knees in patients following primary TKA were assessed using Tc-99m-HDP-SPECT/CT. Rotational, sagittal and coronal position of the TKA was assessed on 3D-CT reconstructions. The level of the SPECT-tracer uptake (0-10 and its anatomical distribution was mapped using a validated localization scheme. Univariate analysis (Wilcoxon-Mann-Whitney, Spearmean`s-rho test, p Results SPECT/CT imaging changed the suspected diagnosis and the proposed treatment in 19/23 (83% knees. Progression of patellofemoral OA (n = 11, loosening of the tibial (n = 3 and loosening of the femoral component (n = 2 were identified as the leading causes of pain after TKA. Patients with externally rotated tibial trays showed higher tracer uptake in the medial patellar facet (p = 0.049 and in the femur (p = 0.051. Patients with knee pain due to patellofemoral OA showed significantly higher tracer uptake in the patella than others (p Conclusions SPECT/CT was very helpful in establishing the diagnosis and guiding subsequent management in patients with painful knees after TKA, particularly in patients with patellofemoral problems and malpositioned or loose TKA.

  18. Efficacy of Intra-articular Local Anesthetics in Total Knee Arthroplasty.

    Science.gov (United States)

    Fang, Rui; Liu, Zhenfeng; Alijiang, Asila; Jia, Heng; Deng, Yingjie; Song, Yucheng; Meng, Qingcai

    2015-07-01

    Pain management after total knee arthroplasty (TKA) remains among the most important challenges for patients with TKA. Intra-articular local anesthetic has been shown to reduce postoperative pain following TKA. However, studies report conflicting results. This meta-analysis evaluated the efficacy and safety of single-dose intra-articular local anesthetics for pain control after TKA. Databases (Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, and Chinese Biomedical Databases) were searched to identify randomized, controlled trials comparing local anesthetic with placebo in patients undergoing TKA. Data were extracted independently by 2 researchers using a standardized form. Risk of bias was assessed with the use of the Cochrane Collaboration's tool for assessing the risk of bias by 2 observers. Relative risk, standardized mean difference, and corresponding 95% confidence interval were calculated. Seventeen trials met the inclusion criteria, for a total of 1338 participants. The results showed that, compared with the placebo group, the single local anesthetic group had a significant lower pain score with rest at 4, 8, 24, and 48 hours; less opioid consumption at 24, 48, and 72 hours postoperatively; and greater range of motion at 24, 48, and 72 hours. There were no significant differences between the 2 groups in length of hospital stay, nausea and vomiting, pruritus, sedation, or deep venous thrombosis. The study findings showed that pain relief after TKA was significantly better with intra-articular local anesthetic than with placebo. PMID:26186318

  19. Three-dimensional analysis of alignment error in using femoral intramedullary guides in unicompartmental knee arthroplasty.

    Science.gov (United States)

    Ma, Burton; Long, William; Rudan, John F; Ellis, Randy E

    2006-02-01

    We used computerized simulations with 3-dimensional models of 20 cadaver femora, calculated from computed tomographic scans, and a model of a rod measuring 200 x 5 mm to study femoral alignment accuracy for unicompartmental knee arthroplasty via minimally invasive reconstruction. The anatomical axis and insertion site were identified on each femur. A simulation of all feasible flexion-extension and varus-valgus orientations was performed. The average rod orientation was 3.2 degrees flexion and 2.5 degrees valgus. The range of orientation was 3.2 degrees extension to 9.7 degrees flexion and 4.5 degrees varus to 8.9 degrees valgus. The study suggests that a short narrow intramedullary rod inserted according to the manufacturer's specifications does not accurately find the anatomical axis and may lead to poor alignment of the femoral prosthesis. Given our finding of consistent bias toward excessive flexion and valgus alignment, we recommend that the operating surgeon carefully plan the insertion point of the intramedullary rod during surgery to compensate for this bias. PMID:16520218

  20. Four Methods for Calculating Blood-loss after Total Knee Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Fu-Qiang Gao; Zi-Jian Li; Ke Zhang; Wei Sun; Hong Zhang

    2015-01-01

    Background:Currently,various calculation methods for evaluating blood-loss in patients with total knee arthroplasty (TKA) are applied in clinical practice.However,different methods may yield different results.The purpose of this study was to determine the most reliable method for calculating blood-loss after primary TKA.Methods:We compared blood-loss in 245 patients who underwent primary unilateral TKA from February 2010 to August 2011.We calculated blood-loss using four methods:Gross equation,hemoglobin (Hb) balance,the Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula,and Hb-dilution.We determined Pearson's correlation coefficients for the four methods.Results:There were large differences in the calculated blood-loss obtained by the four methods.In descending order of combined correlation coefficient based on calculated blood-loss,the methods were Hb-balance,OSTHEO formula,Hb-dilution,and Gross equation.Conclusions:The Hb-balance method may be the most reliable method of estimating blood-loss after TKA.

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

    Science.gov (United States)

    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

  2. New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty.

    Science.gov (United States)

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

    2016-02-01

    Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed. PMID:25892004

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

    Science.gov (United States)

    Kuntze, G; von Tscharner, V; Hutchison, C; Ronsky, J L

    2015-11-01

    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/m(2); 9 healthy control subjects, 61.4 ± 7.4 yr, BMI 25.6 ± 2.4 kg/m(2)] 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 tool for clinical neuromuscular function assessment and rehabilitation monitoring. PMID:26354313

  4. Accuracy of Implant Placement Utilizing Customized Patient Instrumentation in Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    William D. Bugbee

    2013-01-01

    Full Text Available Customized patient instrumentation (CPI combines preoperative planning with customized cutting jigs to position and align implants during total knee arthroplasty (TKA. We compared postoperative implant alignment of patients undergoing surgery with CPI to traditional TKA instrumentation for accuracy of implant placement. Twenty-five consecutive TKAs using CPI were analyzed. Preoperative CT scans of the lower extremities were segmented using a computer program. Limb alignment and mechanical axis were computed. Virtual implantation of computer-aided design models was done. Postoperative coronal and sagittal view radiographs were obtained. Using 3D image-matching software, relative positions of femoral and tibial implants were determined. Twenty-five TKAs implanted using traditional instrumentation were also analyzed. For CPI, difference in alignment from the preoperative plan was calculated. In the CPI group, the mean absolute difference between the planned and actual femoral placements was 0.67° in the coronal plane and 1.2° in the sagittal plane. For tibial alignment, the mean absolute difference was 0.9° in the coronal plane and 1.3° in the sagittal plane. For traditional instrumentation, difference from ideal placement for the femur was 1.5° in the coronal plane and 2.3° in the sagittal plane. For the tibia, the difference was 1.8° in the coronal plane. CPI achieved accurate implant positioning and was superior to traditional TKA instrumentation.

  5. Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of four different concepts of prosthetic fixation

    International Nuclear Information System (INIS)

    In a prospective study, micromotion between tibial components and bone was analysed using roentgen stereophotogrammetric analysis (RSA), the potential of which was assessed. The patient material consisted of 96 arthrotic knees subjected to arthroplasty with six types of prosthese representing four different fixation concepts with and without bone cement. Provided stable conditions of the objects studied, RSA proved to have an accuracy (=resolution) of 0.3 degrees for rotation and 0.2 mm for translation (3 S.D.). This resolution was 10 times better than conventional radiography and sufficient for the study of micromotion. Micromotion, both gradual over time (migration) and instant, in response to applied forces (inducible displacement), was found for all tibial components studied. For conventional cemented prostheses the mean migration was 1-1.5 mm for the different groups. Most of the migration occurred during the first 6 months. Inducible displacement of 0.2-1.0 mm was found in most cases. Metal support did not improve the prosthetic fixation. For the non-cemented cases both migration and inducible displacement was significantly larger than in cemented cases. All prostheses proved to be bonded to the bone in a semi-rigid way permitting micromotion. The newer fixation concept did not prove superior to conventional cementing of all-polyethylene prostheses. The micromotion occurred wihtin the soft tissue layer constituing the radiolucent zone, which in some cases was of tensile origin. Other radiographic of clinical variables did not correlate with the micromotion. (Author)

  6. The Evolution of Image-Free Robotic Assistance in Unicompartmental Knee Arthroplasty.

    Science.gov (United States)

    Lonner, Jess H; Moretti, Vincent M

    2016-01-01

    Semiautonomous robotic technology has been introduced to optimize accuracy of bone preparation, implant positioning, and soft tissue balance in unicompartmental knee arthroplasty (UKA), with the expectation that there will be a resultant improvement in implant durability and survivorship. Currently, roughly one-fifth of UKAs in the US are being performed with robotic assistance, and it is anticipated that there will be substantial growth in market penetration of robotics over the next decade. First-generation robotic technology improved substantially implant position compared to conventional methods; however, high capital costs, uncertainty regarding the value of advanced technologies, and the need for preoperative computed tomography (CT) scans were barriers to broader adoption. Newer image-free semiautonomous robotic technology optimizes both implant position and soft tissue balance, without the need for preoperative CT scans and with pricing and portability that make it suitable for use in an ambulatory surgery center setting, where approximately 40% of these systems are currently being utilized. This article will review the robotic experience for UKA, including rationale, system descriptions, and outcomes. PMID:27327917

  7. Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature

    Directory of Open Access Journals (Sweden)

    Ziętek, Paweł

    2014-10-01

    Full Text Available The rapid progress in knee implants technology and operational techniques go together with more and more modern medical programs, designed to optimize the patients’ care and shorten their stay in hospital. However, this does not guarantee any elimination of perioperative 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 the final result of the treatment of patients after big joints arthroplastics.

  8. Postoperative radiologic imaging of joint arthroplasty

    International Nuclear Information System (INIS)

    With increased life expectancy in industrialised countries, improvement of implant design and operative technique, arthroplasty has become a routine procedure. The hip and knee joints are treated by arthroplasty most frequently. Nowadays joint replacement can be performed in many other joints. Radiologic imaging is an important tool for evaluation of the operative results and for detection of early and late complications. In the following article we describe the relevance of different imaging modalities as well as their systematic application in patients with joint arthroplasty. (orig.)

  9. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Jørgensen, Christoffer; Kehlet, Henrik;

    2014-01-01

    BACKGROUND: Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast......-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission. STUDY...... national databases and patient charts. Adjusted risk estimates for transfusion, prolonged LOS, and all-cause readmission according to preoperative anemia status were obtained by multivariate logistic regression. RESULTS: A total of 5.165 THA or TKA procedures were included with a mean patient age of 67...

  10. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement.

    LENUS (Irish Health Repository)

    Monaghan, Brenda

    2010-01-01

    Total knee replacement has been demonstrated to be one of the most successful procedures in the treatment of osteoarthritis. However quadriceps weakness and reductions in function are commonly reported following surgery. Recently Neuromuscular Electrical Stimulation (NMES) has been used as an adjunct to traditional strengthening programmes. This review considers the effectiveness of NMES as a means of increasing quadriceps strength in patients before and after total knee replacement.

  11. Non-Traumatic Anterior Dislocation of a Total Knee Replacement Associated with Neurovascular Injury

    OpenAIRE

    Aderinto, Joseph; Gross, Allan E.; Rittenhouse, Bryan

    2009-01-01

    Prosthetic total knee replacements rarely dislocate. When dislocation does occur, it is usually in a posterior direction in association with a posterior stabilised, cruciate-sacrificing prosthesis. Neurovascular injury is unusual. In this report, we describe a case of anterior dislocation of a cruciate-retaining total knee replacement in a 67-year-old woman. The dislocation occurred in the absence of overt trauma and resulted in severe neurovascular injury.

  12. Unique combination of patellofemoral joint arthroplasty with Osteochondral Autograft Transfer System (OATS) - a case series of six knees in five patients.

    Science.gov (United States)

    Unnithan, A; Jimulia, T; Mohammed, R; Learmonth, D J A

    2008-06-01

    Patellofemoral arthroplasty (PFA) is an accepted procedure for the treatment of isolated patellofemoral osteoarthritis. However its failure rate has been attributed to progressive femorotibial arthritis. Autologous osteochondral transplantation is an established procedure for the repair of focal cartilaginous defects on the medial and lateral femoral condyles. We present our case series of six knees in five patients where we combined the two procedures and extended the indication for PFA and delayed the need for total knee arthroplasty (TKA) in all but one patient over a mean follow up period of 3.8 years. PMID:18372179

  13. Outcome of unicompartmental knee arthroplasty in octogenarians with tricompartmental osteoarthritis: A longer followup of previously published report

    Directory of Open Access Journals (Sweden)

    Sanjiv KS Marya

    2013-01-01

    Full Text Available Background: Unicompartmental knee arthroplasty (UKA has specific indications, producing excellent results. It, however, has a limited lifespan and needs eventual conversion to total knee arthroplasty (TKA. It is, therefore, a temporizing procedure in select active young patients with advanced unicompartmental osteoarthritis (UCOA. Being a less morbid procedure it is suggested as an alternative in the very elderly patients with tricompartmental osteoarthritis (TCOA. We performed UKA in a series of 45 octogenarians with TCOA predominant medial compartment osteoarthritis (MCOA and analyzed the results. Materials and Methods: Forty five octogenarian patients with TCOA predominant MCOA underwent UKA (19 bilateral from January 2002 to January 2012. All had similar preoperative work-up, surgical approach, procedure, implants and postoperative protocol. Clinicoradiological assessment was done at 3-monthly intervals for the first year, then yearly till the last followup (average 72 months, range 8-128 months. Results were evaluated using the knee society scores (KSS, satisfaction index [using the visual analogue scale (VAS] and orthogonal radiographs (for loosening, subsidence, lysis or implant wear. Resurgery for any cause was considered failure. Results: Four patients (six knees died due to medical conditions, two patients (three knees were lost to followup, and these were excluded from the final analysis. Barring two failures, all the remaining patients were pain-free and performing well at the final followup. Indications for resurgery were: medial femoral condyle fracture needing fixation subsequent conversion to TKA at 2 years (n=1 and progression of arthritis and pain leading to revision TKA at 6 years (n=1. Conclusion: UKA has shown successful outcomes with regards to pain relief and function with 96.4% implant survival and 94.9% good or excellent outcomes. Due to lower demands, early rehabilitation, less morbidity, and relative short life

  14. Unique relationship between osteophyte and femoral-tibia component size mismatch in determining polyethylene wear in primary total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Ramappa Manjunath

    2009-02-01

    Full Text Available Abstract Introduction Knee pain is a complex problem that can occur after total knee arthroplasty. One cause of knee pain may be due to a retained osteophyte, but it is not clear if the retained osteophyte is sufficient explanation of the pain, as not all patients with retained osteophytes are symptomatic. In fact, the literature shows that excised osteophytes can also recur over a period of time, without any symptoms. Therefore a retained osteophyte alone is probably not sufficient to cause symptoms. Case presentation We present a case of intermittent medial knee pain occurring post-primary total knee arthroplasty, in a patient who underwent several investigations over a period of 5 years. Radiographs showed an osteophyte in the postero-medial femur along with slight tibial component overhang which was normal for that knee implant design. The symptoms eventually settled with excision of only the osteophyte, without altering the tibial component. Conclusion A retained osteophyte alone, or tibial component overhang alone, did not seem to cause significant symptoms in our patient whose symptoms completely settled with excision of the osteophyte alone, without changing the tibial component. Therefore, it seems that the combination of retained osteophyte and tibial component overhang (tibia-femoral component size mismatch are detrimental and therefore best avoided. This report also emphasises the importance of meticulous osteophyte excision and avoiding tibial component overhang during knee arthroplasty.

  15. Application of mobile bearing total knee system In the total knee arthroplasty%旋转平台假体在全膝关节置换术中的应用及早期疗效观察

    Institute of Scientific and Technical Information of China (English)

    冯贵喜; 阚世廉

    2011-01-01

    [ Objective ] To investigate the clinical effects of mobile bearing total knee arthroplasty (TKA) . [ Methods]Seventy - nine patients ( ninety - three knees) received TKA midline incision and medial parapatella approaches, the patella was treated with denervation and reparation, and then the prosthesis was inserted without replacements of patella. The fixation of prosthesis was observed by X-ray, the knee score and knee function score were evaluated by KSS scoring, and the complications were observed. [ Results ] The patients were followed up for 33.61 ± 7.34 months (24 to 48 months) . At final follow -up examination, the average total range of knee motion improved from 68.76° (0° ~ 100°) preoperatively to 107.53°(90°~120°) postoperatively. The average Knee Society knee scores improved from 37.53 scores (20 ~ 55 scores) preoperatively to 91.87 points (75 to 100 scores), and the average Knee Society function scores improved from 32. 96 scores ( 15 ~65 scores) preoperatively to 80.84 (75 to 95 scores) . X - rays showed no prosthesis loosening or patella dislocation. Six of the fifty - eight knees with OA and four of the thirty - five knees with RA had lucencies around the tibial prosthesis (P >0. 05), but the radiolucencies were < 2 mm and were nonprogressive. [ Conclusion ] The short term effect of TKA by mobile bearing total knee replacement is definite, but the long term effect needs further follow up studies.%[目的]观察旋转平台人工膝关节置换术的临床疗效.[方法]对79例患者93膝行TKA,采用正中切口髌旁内侧入路,安装假体,膝关节均未进行髌骨置换.术后复查X线片观察假体固定情况,采用美国膝关节学会评分(KSS评分)评定膝评分及膝功能评分,观察并发症发生情况.[结果]本组平均随访时间(33.61±7.34)个月(24~48个月).末次随访时,关节总活动度明显增加,由术前68.76°增加至术后107.53°(P

  16. Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review.

    Science.gov (United States)

    Arnold, John B; Walters, Julie L; Ferrar, Katia E

    2016-06-01

    Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative

  17. Muscle strength, physical performance and physical activity as predictors of future knee replacement

    DEFF Research Database (Denmark)

    Skou, Søren T; Wise, Barton L; Lewis, Cora E;

    2016-01-01

    OBJECTIVE: To investigate associations between lower levels of muscle strength, physical performance and physical activity and the risk of knee replacement (KR) in older adults with frequent knee pain. METHOD: Participants from the Multicenter Osteoarthritis Study (MOST) with knee pain on most of...... the past 30 days at baseline were included (n=1,257; mean (SD) age of 62.2 (8.2)). We examined the association between 1) baseline peak isokinetic knee extensor strength, (60°/sec, maximum out of 4 trials), 2) best time to stand in timed chair stand (2 trials of 5 repetitions), and 3) baseline...... Physical Activity Scale for the Elderly score with incident KR between baseline and the 84-month follow-up. RESULTS: 1,252 (99.6%) participants (1,682 knees) completed the follow-up visits. 331 participants (394 knees) underwent a KR during the 84 months (229 women and 102 men). The crude analysis...

  18. Total knee arthroplasty for knee varus deformity:follow-up evaluation of femorotibial angle and range of motion%全膝关节置换修复膝内翻畸形:胫股角及膝关节活动度随访评价

    Institute of Scientific and Technical Information of China (English)

    李广伟; 王红军; 孙晓智; 陈林斌; 高宇亮; 白忠旭; 程新胜

    2015-01-01

      结果与结论:所有患者均获得随访,随访时间为12-96个月,随访方式为门诊复查随访。胫股角由置换前平均内翻17.69°(5°-30°)纠正至置换后的5.66°(2°-8°),膝关节活动度由置换前的74.29°(60°-95°)提高到置换后119.46°(105°-130°);HSS评分由置换前的26.60分(14-42分)提高到置换后89.03分(82-95分),优28膝,良7膝;WOMAC评分由42.83分(28-54分)提高到置换后90.17分(85-95分)。结果经统计学分析提示,所有病例置换后胫股角、膝关节活动度、HSS及WOMAC评分均较置换前显著改善(P OBJECTIVE:To observe the femorotibial angle and range of knee joint motion of adults patients with knee varus deformity during 1-year fol ow-up after total knee arthroplasty. METHODS:A total of 31 patients (35 knees) with knee varus deformity were treated with posterior stabilized prosthesis replacement from June 2006 to June 2013. Using patel ar medial approach, the correct osteotomy and selective soft tissue release were performed to restore normal knee alignment and soft tissue balance. Posterior stabilized prosthesis in total knee arthroplasty was applied to achieve knee stability. Postoperative targeted rehabilitation training was also fol owed. The femorotibial angle was measured before and after surgery. The range of knee joint motion was determined during postoperative fol ow-up. Patients were evaluated with the Hospital for Special Surgery (HSS) score and the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. RESULTS AND CONCLUSION:Al patients were fol owed up for 12-96 months through out-patient clinic. The femorotibial angle was corrected from preoperative varus 17.69° (5°-30°) to postoperative 5.66° (2°-8°);the range of knee joint motion was improved from preoperative 74.29° (60°-95°) to 119.46° (105°-130°);the HSS score increased from preoperative 26.60 points (14-42 points) to postoperative 89.03 points (82-95 points

  19. Biomechanical behavior of a cemented ceramic knee replacement under worst case scenarios

    Science.gov (United States)

    Kluess, D.; Mittelmeier, W.; Bader, R.

    2010-03-01

    In connection with technological advances in the manufacturing of medical ceramics, a newly developed ceramic femoral component was introduced in total knee arthroplasty (TKA). The motivation to consider ceramics in TKA is based on the allergological and tribological benefits as proven in total hip arthroplasty. Owing to the brittleness and reduced fracture toughness of ceramic materials, the biomechanical performance has to be examined intensely. Apart from standard testing, we calculated the implant performance under different worst case scenarios including malposition, bone defects and stumbling. A finite-element-model was developed to calculate the implant performance in situ. The worst case conditions revealed principal stresses 12.6 times higher during stumbling than during normal gait. Nevertheless, none of the calculated principal stress amounts were above the critical strength of the ceramic material used. The analysis of malposition showed the necessity of exact alignment of the implant components.

  20. Risk Factors for Moderate and Severe Persistent Pain in Patients Undergoing Total Knee and Hip Arthroplasty: A Prospective Predictive Study

    OpenAIRE

    Pinto, Patrícia R.; McIntyre,Teresa; Ferrero, Ramón; Almeida, Armando; Araújo-Soares, Vera

    2013-01-01

    Persistent post-surgical pain (PPSP) is a major clinical problem with significant individual, social and health care costs. The aim of this study was to examine the joint role of demographic, clinical and psychological risk factors in the development of moderate and severe PPSP after Total Knee and Hip Arthroplasty (TKA and THA, respectively). This was a prospective study wherein a consecutive sample of 92 patients were assessed 24 hours before (T1), 48 hours after (T2) and 4–6 months (T3) af...