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Total knee arthroplasty

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https://www.readbyqxmd.com/read/29691180/multimodal-clinical-pathway-with-adductor-canal-block-decreases-hospital-length-of-stay-improves-pain-control-and-reduces-opioid-consumption-in-total-knee-arthroplasty-patients-a-retrospective-review
#1
Terry A Ellis, Hassan Hammoud, Philip Dela Merced, Nishankkumar P Nooli, Farhad Ghoddoussi, Joshua Kong, Sandeep H Krishnan
BACKGROUND: Total knee arthroplasty volume is increasing significantly in the United States. Reducing hospital length of stay may represent the best method for accommodating expanding volume and reducing costs. We hypothesized that tailoring a clinical pathway to facilitate early ambulation would decrease costs and resource utilization. METHODS: We conducted a sequential before-and-after study of total knee arthroplasty patients after a phased implementation of a clinical pathway that includes multimodal oral analgesic protocols, adductor canal nerve block, and standardized day of surgery ambulation protocols...
March 27, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691176/anthropometric-measurements-of-knee-joints-in-the-hispanic-population
#2
Colin A McNamara, Amer A Hanano, Jesus M Villa, Gustavo M Huaman, Preetesh D Patel, Juan C Suarez
BACKGROUND: Total knee arthroplasty (TKA) systems provide a set of incrementally sized tibial and femoral components intended to accommodate most knee parameters. However, the most commonly used systems in the United States were developed using data from Caucasian patients which might not lead to the best fit in non-Caucasians. Therefore, we wanted to evaluate whether these TKA systems proportionally match femoral and tibial measurements in Hispanics. METHODS: All lower extremity magnetic resonance imaging performed at our institution between January 2007 and October 2015 were screened...
March 27, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691175/correlation-between-intraoperative-anterior-stability-and-flexion-gap-in-total-knee-arthroplasty
#3
Shinichiro Nakamura, Shinichi Kuriyama, Kohei Nishitani, Hiromu Ito, Koichi Murata, Shuichi Matsuda
BACKGROUND: Instability is a common failure mode after total knee arthroplasty. There have been only a few methods to quantify anterior translation with fixed forces applied during surgery. The purpose of the study was to measure the anterior translation with a new device and to analyze the relationships between the amount of anterior translation and the joint gaps. METHODS: Fifty knees with medial osteoarthritis underwent surgery using a posterior-stabilized implant...
March 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691174/ten-year-mortality-and-revision-after-total-knee-arthroplasty-in-morbidly-obese-patients
#4
Mina Tohidi, Susan B Brogly, Katherine Lajkosz, Heather J Grant, Elizabeth G VanDenKerkhof, Aaron R Campbell
BACKGROUND: Although morbid obesity has been associated with early surgical complications after total knee arthroplasty (TKA), evidence of long-term outcomes is limited. We conducted a population-based study to determine the association between morbid obesity and 10-year survival and revision surgery in patients undergoing primary TKA. METHODS: A cohort study of 9817 patients aged 18-60 years treated with primary TKA from April 1, 2002 to March 31, 2007 was conducted using Ontario administrative health-care databases of universal health-care coverage...
April 4, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691173/cruciate-retaining-vs-posterior-stabilized-primary-total-arthroplasty-clinical-outcome-comparison-with-a-minimum-follow-up-of-10-years
#5
Ricardo Serna-Berna, Alejandro Lizaur-Utrilla, Maria F Vizcaya-Moreno, Francisco A Miralles Muñoz, Blanca Gonzalez-Navarro, Fernando A Lopez-Prats
BACKGROUND: Controversy continues regarding whether the posterior cruciate ligament should be retained or removed during total knee arthroplasty (TKA) procedure. The objective was to compare the clinical outcomes with a minimum follow-up of 10 years between patients who received contemporary cruciate-retaining or posterior-stabilized primary TKA. METHODS: Case-control study of 268 patients who underwent cruciate-retaining TKA vs 211 to posterior-stabilized design, with the same arthroplasty system, and a minimum follow-up of 10 years...
March 17, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691172/revision-of-unicompartmental-knee-arthroplasty-to-total-knee-arthroplasty-is-it-as-good-as-a-primary-result
#6
Adolph V Lombardi, Mark T Kolich, Keith R Berend, Michael J Morris, David A Crawford, Joanne B Adams
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is touted as a more conservative, bone- and tissue-sparing procedure than total knee arthroplasty (TKA). Similarly, revision of UKA to TKA is generally a simpler procedure than revision of TKA to TKA and can be accomplished with primary TKA components in most cases. The purpose of this study was to review a consecutive series of patients undergoing revision of failed UKA to TKA to determine if etiology is similar to that reported in recent literature and evaluate if the results align more with primary TKA vs revision of TKA to TKA...
March 17, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691171/risk-adjustment-is-necessary-in-medicare-bundled-payment-models-for-total-hip-and-knee-arthroplasty
#7
P Maxwell Courtney, Daniel D Bohl, Edmund C Lau, Kevin L Ong, Joshua J Jacobs, Craig J Della Valle
BACKGROUND: Concerns exist that high-risk patients in alternative payment models may face difficulties with access to care without proper risk adjustment. The purpose of this study is to identify the effect of medical and orthopedic specific risk factors on the cost of a 90-day episode of care following total hip (THA) and knee arthroplasty (TKA). METHODS: We queried the Medicare 5% Limited Data Set for all patients undergoing primary THA and TKA from 2010 to 2014...
March 17, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691170/outcomes-of-articulating-spacers-with-autoclaved-femoral-components-in-total-knee-arthroplasty-infection
#8
Daniel E Goltz, E Grant Sutter, Michael P Bolognesi, Samuel S Wellman
BACKGROUND: In 2-stage revision of total knee arthroplasty (TKA) infection, articulating antibiotic spacers show similar eradication rates and superior range of motion compared with static spacers. This study evaluated infection control and other outcomes in articulating spacers with an autoclaved index femoral component. METHODS: We reviewed 59 patients who underwent 2-stage treatment of TKA infection using articulating antibiotic spacers with an autoclaved femoral component with at least 2-year follow-up (mean: 5...
March 30, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691169/treatment-success-following-joint-arthroplasty-defining-thresholds-for-the-oxford-hip-and-knee-scores
#9
David F Hamilton, Fanny L Loth, Deborah J MacDonald, Karlmeinrad Giesinger, James T Patton, A Hamish Simpson, Colin R Howie, Johannes M Giesinger
BACKGROUND: Patient-reported outcome scores are the mainstay method for quantifying success following arthroplasty. However, it is unclear when a "successful outcome" is achieved. We calculated threshold values for the Oxford Hip and Knee Score (OHS and OKS) representing achievement of a successful treatment at 12-month follow-up. METHODS: Questionnaires were administered to patients undergoing total hip (THA) or knee (TKA) arthroplasty before and 12 months after surgery alongside questions assessing key aspects of treatment success...
March 30, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691167/press-ganey-outpatient-medical-practice-survey-scores-do-not-correlate-with-patient-reported-outcomes-after-primary-joint-arthroplasty
#10
Jessica M Kohring, Christopher E Pelt, Mike B Anderson, Christopher L Peters, Jeremy M Gililland
BACKGROUND: Patient delivery of care satisfaction surveys have emerged as instruments to assess the quality of health care at both the hospital and provider levels. We evaluated the correlation between these care satisfaction surveys and patient-reported outcomes (PROs). METHODS: We reviewed secondary data on 540 patients with 540 random visits who underwent primary total joint arthroplasty between January 2014 and February 2017. The Press Ganey Outpatient Medical Practice Survey was collected from outpatient clinical encounters to measure patient satisfaction with their experience and matched to PRO measures from the same encounter...
March 27, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691166/improved-perioperative-care-of-elective-joint-replacement-patients-the-impact-of-an-orthopedic-perioperative-hospitalist
#11
Steven J Fitzgerald, Terrence C Palmer, Matthew J Kraay
BACKGROUND: We developed an orthopedic hospitalist fellowship program for our total joint replacement program at a large urban academic medical center. The goal of the program was to improve patient outcomes, quality, and healthcare value through collaborative perioperative care and improved care coordination. This study evaluates the implementation and impact of our modified Hospitalist-Orthopaedic Team Co-management model on quality and performance metrics. METHODS: We reviewed our Quality Institute data using 3 databases for the 16 months before (PreOH) and 18 months after (PostOH) implementation...
March 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29690729/-clinical-study-of-a-new-wearable-device-for-rehabilitation-after-total-knee-arthroplasty
#12
K Kang, Q Geng, H T Xu, X Z Zheng, J T Dong, T Li, Z G Zhao, S J Gao
Objective: To evaluate the effect of promoting knee joint rehabilitation after total knee arthroplasty (TKA) with a rehabilitation training instrument NEO-GAIT. Methods: Sixty patients who received TKA from January 2017 to July 2017 in the Third Hospital of Hebei Medical University were randomly assigned to receive rehabilitation training with continuous passive motion (CPM) or NEO-GAIT with random number (30 cases in CPM group, included 8 males and 22 females; 30 cases in NEO-GAIT group, included 6 males and 24 females)...
April 17, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29688961/does-total-intravenous-anesthesia-with-short-acting-spinal-anesthetics-in-primary-hip-and-knee-arthroplasty-facilitate-early-hospital-discharge
#13
Derek M Klavas, Azim Karim, Bradley S Lambert, Marley Sam Ferris, Domenica Delgado, Stephen J Incavo
INTRODUCTION: Our study assessed the effect of total intravenous anesthesia (TIVA) with short-acting spinal anesthesia and aggressive day-of-surgery postoperative day 0 physical therapy (POD#0 PT) on hospital length of stay (LOS) in patients who underwent primary total joint arthroplasty. METHODS: A retrospective chart review compared the hospital LOS of 116 patients who underwent primary total hip arthroplasty and total knee arthroplasty with TIVA and short-acting spinal blockade ("Updated protocol group") with that of the control group of 228 patients who were under standard anesthesia ("Traditional protocol group")...
April 23, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29687360/suspected-periprosthetic-joint-infection-after-total-knee-arthroplasty-under-propofol-versus-sevoflurane-anesthesia-a-retrospective-cohort-study
#14
Miwa Kishimoto, Hayato Yamana, Satoki Inoue, Tatsuya Noda, Manabu Akahane, Yusuke Inagaki, Hiroki Matsui, Hideo Yasunaga, Masahiko Kawaguchi, Tomoaki Imamura
PURPOSE: Periprosthetic joint infection is a serious complication of total knee arthroplasty. Though there are many factors that might increase its risk, the use of propofol for maintaining general anesthesia could theoretically increase the incidence of infection because of its lipid component that supports bacterial growth. Nevertheless, the relationship between anesthetic maintenance agents and the occurrence of periprosthetic joint infection remains uncertain. The purpose of this study was to compare the incidence of suspected early-onset periprosthetic joint infection between patients undergoing total knee arthroplasty under propofol vs sevoflurane anesthesia...
April 23, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29686970/why-total-knees-fail-a-modern-perspective-review
#15
REVIEW
Zachary C Lum, Alvin K Shieh, Lawrence D Dorr
Historically, the most common mechanism of total knee arthroplasty (TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. Clinical database and worldwide national registries confirm these reports...
April 18, 2018: World Journal of Orthopedics
https://www.readbyqxmd.com/read/29685836/narcotics-and-knee-arthroscopy-trends-in-use-and-factors-associated-with-prolonged-use-and-postoperative-complications
#16
Samuel R H Steiner, Jourdan M Cancienne, Brian C Werner
PURPOSE: To (1) examine trends in the prevalence of preoperative and prolonged postoperative narcotic use in patients undergoing knee arthroscopy, (2) characterize factors associated with prolonged narcotic use after knee arthroscopy, and (3) explore the association of preoperative and prolonged postoperative narcotic use with complications after knee arthroscopy. METHODS: The PearlDiver database was reviewed for patients who underwent knee arthroscopy from 2007 to 2015 with a minimum of 6 months' follow up...
April 20, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29685710/excellent-survival-and-good-outcomes-at-15-years-using-the-press-fit-condylar-sigma-total-knee-arthroplasty
#17
William M Oliver, Calum H C Arthur, Alexander M Wood, Robert A E Clayton, Ivan J Brenkel, Philip Walmsley
BACKGROUND: We report 15-year survival, clinical, and radiographic follow-up data for the Press-Fit Condylar Sigma total knee arthroplasty. METHODS: Between October 1998 and October 1999, 235 consecutive TKAs were performed in 203 patients. Patients were reviewed at a specialist nurse-led clinic before surgery and at 5, 8-10, and 15 years postoperatively. Clinical outcomes, including Knee Society Score, were recorded prospectively at each clinic visit, and radiographs were obtained...
March 27, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29685500/evidence-of-generalised-mechanical-hyperalgesia-in-patients-with-advanced-knee-osteoarthritis-undergoing-total-knee-arthroplasty
#18
Khalid Jaber, Shaun O'Leary, Ashley Pedler, Michele Sterling, Michael McAuliffe
BACKGROUND AND OBJECTIVE: Persistent pain is reported in up to 34% of patients following total knee arthroplasty (TKA) for management of knee osteoarthritis (KOA). Persistent pain in this group is thought to be at least partly reflective of pain sensory hypersensitivity. The objective of this study was to evaluate sensory hypersensitivity, using mechanical and thermal quantitative sensory testing, in patients about to undergo TKA. DESIGN AND METHODS: Pressure pain thresholds (PPT) and cold pain thresholds (CPT) were recorded from 30 participants prior to their TKA, and compared with recordings taken from 30 healthy control participants of similar age and gender...
April 20, 2018: Knee
https://www.readbyqxmd.com/read/29684539/fewer-complications-after-uka-than-tka-in-patients-over-85-years-of-age-a-case-control-study
#19
Quentin Ode, Romain Gaillard, Cécile Batailler, Yannick Herry, Philippe Neyret, Elvire Servien, Sébastien Lustig
INTRODUCTION: Implanting a knee prosthesis in patients aged over 85 years is not without risk. Unicompartmental knee arthroplasty (UKA) is reputed to show lower morbidity and mortality than total knee arthroplasty (TKA). Elderly patients with isolated unicompartmental osteoarthritis without specific contraindications are thus good candidates for this procedure. The present retrospective case-control study compared complications rates in elderly patients receiving UKA versus TKA. The study hypothesis was that UKA incurs fewer complications, with equivalent functional results...
April 20, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/29682602/acute-perioperative-comparison-of-patient-specific-instrumentation-versus-conventional-instrumentation-utilization-during-bilateral-total-knee-arthroplasty
#20
Jerrod A Steimle, Michael T Groover, Brad A Webb, Brian J Ceccarelli
Utilizing patient-specific instrumentation during total knee arthroplasty has gained popularity in recent years with theoretical advantages in blood loss, intraoperative time, length of stay, postoperative alignment, and functional outcome, amongst others. No study has compared acute perioperative measures between patient-specific instrumentation and conventional instrumentation in the bilateral total knee arthroplasty setting. We compared patient-specific instrumentation versus conventional instrumentation in the setting of bilateral total knee arthroplasty to determine any benefits in the immediate perioperative period including surgical time, blood loss, pain medication use, length of stay, and discharge disposition...
2018: Surgery Research and Practice
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