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Total knee arthroplasty

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https://www.readbyqxmd.com/read/28828882/medication-equipment-and-supply-costs-for-common-interventions-providing-extended-postsurgical-analgesia-following-total-knee-arthroplasty-in-us-hospitals
#1
Shelby Corman, Nishant Shah, Simon Dagenais
AIMS: To estimate the cost to hospitals of materials (ie, medications, equipment, and supplies) required to administer common interventions for postsurgical analgesia after TKA, including single-injection peripheral nerve block (sPNB), continuous peripheral nerve block (cPNB), periarticular infiltration of multi-drug cocktails, continuous epidural analgesia, intravenous patient-controlled analgesia (IV PCA), and local infiltration of bupivacaine liposome injectable suspension (BLIS). MATERIALS AND METHODS: This analysis was conducted using a mixed methods approach combining published literature, publicly available data sources, and administrative data, to first identify the materials required to administer these interventions, and then estimate the cost to the hospital of those materials...
August 22, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28827053/bilateral-simultaneous-unicompartmental-knee-arthroplasty-versus-unilateral-total-knee-arthroplasty-a-comparison-of-the-amount-of-blood-loss-and-transfusion-perioperative-complications-hospital-stay-and-functional-recovery
#2
Ji Hyun Ahn, Dong Mo Kang, Kug Jin Choi
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a good alternative treatment option to total knee arthroplasty (TKA) for single compartment knee osteoarthritis.Several recent reports suggest that UKA results in more rapid functional recovery than TKA, together with fewer complications.Few performed a comparison of bilateral simultaneous UKA and unilateral TKA. HYPOTHESIS: Bilateral simultaneous UKA would result in fewer perioperative complications, less blood loss, less transfusion and faster recovery of short-term clinical outcomes, compared with unilateral TKA patients...
August 4, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28822634/development-and-efficacy-testing-of-a-hollow-awl-that-leads-to-patent-bone-marrow-channels-and-greater-mesenchymal-stem-cell-mobilization-during-bone-marrow-stimulation-cartilage-repair-surgery
#3
Byoung-Hyun Min, Minh-Dung Truong, Hyung Keun Song, Jae Ho Cho, Do Young Park, Heon Ju Kweon, Jun Young Chung
PURPOSE: To investigate whether microfracture with a cannulated hollow awl can yield more patent marrow channels and allow greater mobilization of the reparable cells to the defect compared to the conventional awl with blunt end in human knee joints. METHODS: Patients who were planned for 1-stage bilateral total knee arthroplasty due to degenerative osteoarthritis with well-preserved lateral femoral condylar cartilage were retrospectively included. A 10-mm × 20-mm, rectangular, full-thickness chondral defect was made on the lateral femoral condyle on each knee joint...
August 16, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28822068/polyethylene-damage-increases-with-varus-implant-alignment-in-posterior-stabilized-and-constrained-condylar-knee-arthroplasty
#4
Zhichang Li, Christina I Esposito, Chelsea N Koch, Yuo-Yu Lee, Douglas E Padgett, Timothy M Wright
BACKGROUND: Implant malalignment in primary TKA has been reported to increase stresses placed on the bearing surfaces of implant components. We used a longitudinally maintained registry coupled with an implant retrieval program to consider whether preoperative, postoperative, or prerevision malalignment was associated with increased risk of revision surgery after TKA. QUESTIONS/PURPOSES: (1) What is the relative polyethylene damage on medial and lateral compartments of the tibial plateaus from revised TKAs? (2) Does coronal TKA alignment affect implant performance, such that TKAs aligned in varus are predisposed to experience increased polyethylene damage? (3) Does TKA alignment differ between postoperative and prerevision radiographs, and if so, what does this difference suggest about the mechanical contact load placed on a knee with a TKA? METHODS: Between 2007 and 2012, we performed 18,065 primary TKAs at our institution...
August 18, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28821517/quality-differences-between-private-for-profit-private-non-profit-and-public-hospitals-in-norway-a-retrospective-national-register-based-study-of-acute-readmission-rates-following-total-hip-and-knee-arthroplasties
#5
Geir Hiller Holom, Terje P Hagen
OBJECTIVES: To compare the quality of care-using unplanned acute hospital readmissions as a quality measure-among patients treated at private for-profit hospitals (PFPs), private non-profit hospitals (PNPs) and public hospitals (PUBs) in Norway. DESIGN: A retrospective comparative study using the Norwegian Patient Register. Readmissions were evaluated by logistic regressions both using adjustment for various patient-level and other covariates, and a two-stage model using distance as an instrumental variable...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28819598/two-staged-bilateral-femoral-alignment-osteotomy-with-concomitant-total-knee-arthroplasty-in-an-achondroplasia-patient-a-case-report
#6
Sebastian G Walter, Tobias Schwering, Stefan Preiss
INTRODUCTION: Achondroplasia is the most common form of dwarfism in humans and is orthopedically characterized by shortened extremities and an exaggerated lumbar lordosis. The surgical challenges are maintenance of axial alignment during limb lengthening as well as joint preservation and alignment restoration. CASE REPORT: We present a 46-year-old female suffering from achondroplasia with severe pain in both knees. Severe varus deformities of both femurs and degeneration of both knee joints became apparent on clinical and radiological examination...
March 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28816906/comparison-of-liposomal-bupivacaine-with-bupivicaine-pain-pump-in-tka-patients-commentary-on-an-article-by-eric-b-smith-md-et-al-periarticular-liposomal-bupivacaine-injection-versus-intra-articular-bupivacaine-infusion-catheter-for-analgesia-after-total-knee
#7
https://www.readbyqxmd.com/read/28816893/periarticular-liposomal-bupivacaine-injection-versus-intra-articular-bupivacaine-infusion-catheter-for-analgesia-after-total-knee-arthroplasty-a-double-blinded-randomized-controlled-trial
#8
Eric B Smith, Gregory S Kazarian, Mitchell G Maltenfort, Jess H Lonner, Peter F Sharkey, Robert P Good
BACKGROUND: Intra-articular bupivacaine hydrochloride (HCl) infusion catheters and periarticular injections of liposomal bupivacaine are often used as postoperative local anesthetics. The purpose of this study was to compare the efficacies of these local anesthetics following total knee arthroplasty. METHODS: This study was a superiority trial with a randomized, controlled, double-blinded design. Patients were randomly assigned to either delivery of bupivacaine HCl by the ON-Q* Pain Relief System pump (n = 96) or by an injection of Exparel (liposomal bupivacaine) (n = 104)...
August 16, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28816892/use-of-a-tourniquet-in-total-knee-arthroplasty-causes-a-paradoxical-increase-in-total-blood-loss
#9
Timothy Schnettler, Natalie Papillon, Harold Rees
BACKGROUND: A tourniquet in total knee arthroplasty has been used in an attempt to decrease perioperative blood loss; however, questions exist regarding safety and efficacy. Tranexamic acid has also been used to decrease blood loss by stabilizing clot formation. Because of these concerns, routine tourniquet use for total knee arthroplasty was discontinued by the senior author and routine tranexamic acid administration was commenced. The purpose of this study was to examine total perioperative blood loss with tourniquet use, with tourniquet use and routine use of tranexamic acid, and with tranexamic acid use alone without tourniquet...
August 16, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28816345/errors-in-calculating-a-p-tibial-contact-locations-in-total-knee-arthroplasty-using-3d-model-to-2d-image-registration-in-radiographs-an-in-vitro-study-of-two-methods
#10
Derrick Ross, Stephen Howell, Maury Hull
Knowledge of A-P tibial contact locations provides an objective assessment of the relative motion of the tibia on the femur following total knee arthroplasty, which can be used to compare the effects of different components, surgical techniques, and alignment goals on knee function in vivo. Both the closest point method and the penetration method have been used to calculate A-P tibial contact locations using 3D model-to-2D image registration. Because the errors in calculating the A-P tibial contact locations using these two methods are unknown, the primary purpose of this study was to determine these errors...
August 17, 2017: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/28815146/quantifying-the-relative-change-in-physical-activity-after-total-knee-arthroplasty-using-accelerometer-based-measurements
#11
Vibhu Agarwal, Mathew Smuck, Nigam H Shah
Osteoarthritis is amongst the top five most disabling conditions affecting Americans over 65 years of age and imposes an annual economic burden estimated at $ 89.1 billion. Nearly half of the cost of care of Osteoarthritis is attributable to hospitalizations for total knee arthroplasties (TKA) and total hip arthroplasties (THA). The current clinical practice relies predominantly on subjective assessment of physical function and pain via patient reported outcome measures (PROM) that have proven inadequate for providing a validated, reliable and responsive measure of TKA outcomes...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28814320/intrathecal-morphine-versus-femoral-nerve-block-for-pain-control-after-total-knee-arthroplasty-a-meta-analysis
#12
Yi Tang, Xu Tang, Qinghua Wei, Hui Zhang
BACKGROUND: This meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA). METHODS: In April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cami Info. Inc., Casalini databases, EBSCO databases, Verlag database and Google database. Data on patients prepared for TKA surgery in studies that compared ITM versus FNB for pain control after TKA were collected...
August 16, 2017: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/28813550/drug-free-interventions-to-reduce-pain-or-opioid-consumption-after-total-knee-arthroplasty-a-systematic-review-and-meta-analysis
#13
Dario Tedesco, Davide Gori, Karishma R Desai, Steven Asch, Ian R Carroll, Catherine Curtin, Kathryn M McDonald, Maria P Fantini, Tina Hernandez-Boussard
Importance: There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective: To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. Data Sources: Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Web of Science (ISI database), Physiotherapy Evidence (PEDRO) database, and ClinicalTrials...
August 16, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28811109/the-risk-of-acute-infection-following-intra-articular-corticosteroid-injection-into-a-pre-existing-total-knee-arthroplasty
#14
Emily S Mills, Michael B Elman, Jared R H Foran
BACKGROUND: No previous studies have investigated the risk of infection following intra-articular corticosteroid injection (IACI) into a pre-existing total knee arthroplasty (TKA). The aim of this study is to determine the risk of acute infection following IACI into a pre-existing TKA. METHODS: A retrospective chart review identified all patients at a single institution between October 2009 and May 2015 that had an ipsilateral knee injection subsequent to a TKA...
July 25, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28811108/methylene-blue-guided-debridement-as-an-intraoperative-adjunct-for-the-surgical-treatment-of-periprosthetic-joint-infection
#15
Jeremy D Shaw, Steve Miller, Anna Plourde, Daniel L Shaw, Rosanna Wustrack, Erik N Hansen
BACKGROUND: Current methods to identify infected tissue in periprosthetic joint infection (PJI) are inadequate. The purpose of this study was (1) to assess methylene blue-guided surgical debridement as a novel technique in PJI using quantitative microbiology and (2) to evaluate clinical success based on eradication of infection and infection-free survival. METHODS: Sixteen total knee arthroplasty patients meeting Musculoskeletal Infection Society criteria for PJI undergoing the first stage of 2-stage exchange arthroplasty were included in this prospective study...
July 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28811107/local-efficacy-of-periarticular-morphine-injection-in-simultaneous-bilateral-total-knee-arthroplasty-a-prospective-randomized-double-blind-trial
#16
Kentaro Iwakiri, Yoichi Ohta, Akio Kobayashi, Yukihide Minoda, Hiroaki Nakamura
BACKGROUND: The periarticular multimodal cocktail injection including morphine is currently commonly used to reduce postoperative pain following total knee arthroplasty (TKA). Despite its analgesic effect, it frequently causes nausea, which is an adverse effect of opioids. It is inconclusive whether the intraoperative injection of periarticular morphine is effective peripherally. The aim of this study was to assess whether the addition of morphine to unilateral periarticular knee injections improves postoperative pain, range of motion, and swelling in patients undergoing simultaneous bilateral TKA...
July 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28810805/hindfoot-arthritis-progression-and-arthrodesis-risk-after-total-ankle-replacement
#17
Travis J Dekker, David Walton, Emily N Vinson, Kamran S Hamid, Andrew E Federer, Mark E Easley, James K DeOrio, James A Nunley, Samuel B Adams
BACKGROUND: The purpose of this study was to assess the radiographic progression of subtalar and talonavicular degenerative joint disease in a series of patients who had undergone TAA (total ankle arthroplasty) with minimum follow-up of 5 years. METHODS: TAA patient radiographs from a single institution were analyzed for peritalar arthritic changes by extrapolating the modified Kellgren Lawrence (KL) grades of the knee to the subtalar and talonavicular joints. Patients were included if they had a minimum of 5 years of follow-up...
August 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28807470/persistent-pulmonary-embolism-rates-following-total-knee-arthroplasty-even-with-prophylactic-anticoagulants
#18
Mark P Cote, Anthony Chen, Yue Jiang, Vincent Cheng, Jay R Lieberman
BACKGROUND: Symptomatic pulmonary embolism (PE), a significant and life-threatening complication following total knee arthroplasty (TKA), has been described as a "never event." Despite a number of advancements in care, PE continues to occur following TKA. This study evaluates symptomatic PE rates over time in TKA patients enrolled in multicenter randomized clinical trials assessing the efficacy of venous thromboembolism prophylaxis regimens. METHODS: The MEDLINE and Cochrane Central Register of Controlled Trials were searched to identify clinical trials assessing prophylactic anticoagulation in patients undergoing TKA between January 1995 and December 2016...
July 5, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28803816/midterm-adjusted-survival-comparing-the-best-performing-unicompartmental-and-total-knee-arthroplasties-in-a-registry
#19
Stefano A Bini, Guy Cafri, Monti Khatod
BACKGROUND: Recent literature suggests that the difference in revision risk between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) can be influenced by surgeon volume and other confounders. We hypothesized that implant selection might decrease the relative risk of revision in an adjusted model. METHODS: We selected the best performing (BP) primary UKAs and TKAs performed for osteoarthritis between January 2001 and December 2012 collected through a joint replacement registry...
June 8, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28803758/association-between-body-weight-and-proximal-tibial-bone-mineral-density-after-bilateral-total-knee-arthroplasty
#20
Yoshinori Ishii, Hideo Noguchi, Junko Sato, Hana Ishii, Koji Todoroki, Shin-Ichi Toyabe
BACKGROUND: Proximal tibial bone mineral density (BMD) has been studied for its potential impact on subsidence and loosening of the tibial component after total knee arthroplasty (TKA). However, no known studies of proximal tibial BMD after TKA have evaluated the effect of major impact factors such as body weight (BW), muscle strength, and level of activity. We aim to determine whether factors such as level of activity, quadriceps strength, BW, gender, age, and prosthetic design affect proximal tibial BMD over the mid- to long-term following TKA...
August 10, 2017: Knee
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