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Total knee arthroplasty

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https://www.readbyqxmd.com/read/29905628/pharmacokinetics-of-400-mg-locally-infiltrated-ropivacaine-after-total-knee-arthroplasty-without-perioperative-tourniquet-use
#1
Sietske M K Bakker, Maaike G E Fenten, Daan J Touw, Bart J F van den Bemt, Petra J C Heesterbeek, Gert-Jan Scheffer, Rudolf Stienstra
BACKGROUND AND OBJECTIVES: Local infiltration analgesia (LIA) with ropivacaine for total knee arthroplasty (TKA) is increasingly used. Despite the high doses of ropivacaine, LIA is considered safe, and this perception is sustained by pharmacokinetic data demonstrating that maximum concentrations of ropivacaine stay well below the toxic threshold in plasma. These pharmacokinetic studies all involve TKA procedures with the use of a tourniquet. Recently, performing TKA without the use of a tourniquet is gaining popularity, but no pharmacokinetic data exist when LIA is administered for TKA without the use of a tourniquet...
June 13, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29905045/-clinical-research-of-debridement-with-prosthesis-retention-for-periprosthetic-joint-infection-after-arthroplasty
#2
Xinggui Song, Xin Li, Junlei Song, Chi Xu, Rui Li, Heng Li, Jiying Chen
Objective: To investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness. Methods: A clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed...
June 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
https://www.readbyqxmd.com/read/29904433/ketamine-and-bupivacaine-attenuate-post-operative-pain-following-total-knee-arthroplasty-a-randomized-clinical-trial
#3
Jian Zhang, Kui Shi, Hongfeng Jia
Total knee arthroplasty (TKA) is highly associated with post-operative pain. The present randomized trial aimed to explore the possible post-operative pain management by a different combination of analgesics or opioids (ketamine and bupivacaine) following TKA. A total of 84 patients were randomly divided into four groups. All subjects were anesthetized for TKA surgery and received post-operative pain management via intra-articular saline (control group; n=23), ketamine (2 mg/kg) infused with saline (ket group; n=21) bupivacaine (0...
June 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29904419/value-of-procalcitonin-for-diagnosing-perioperative-pneumonia-urinary-infections-and-superficial-surgical-site-infections-in-patients-undergoing-primary-hip-and-knee-arthroplasty
#4
Lixuan Zhang, Daozhang Cai, Hanming Guo
Serum procalcitonin (PCT) levels may be helpful for the diagnosis of infections during the perioperative period of arthroplasty. However, there is much debate in the literature regarding the appropriate cut-off value for different types of surgery and local bacterial infection. The present study aimed to evaluate serum PCT levels in patients undergoing arthroplasty and to determine the cut-off value that may represent perioperative pneumonia, urinary infections and superficial surgical site infections. The present retrospective study included a total of 500 patients treated between July 2014 and August 2015...
June 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29903459/single-injection-adductor-canal-block-with-multiple-adjuvants-provides-equivalent-analgesia-when-compared-with-continuous-adductor-canal-blockade-for-primary-total-knee-arthroplasty-a-double-blinded-randomized-controlled-equivalency-trial
#5
James D Turner, Sean W Dobson, Daryl S Henshaw, Christopher J Edwards, Robert S Weller, Jon W Reynolds, Gregory B Russell, Jonathan D Jaffe
BACKGROUND: Peripheral nerve blockade is used to provide analgesia for patients undergoing total knee arthroplasty. This study compared a single-injection adductor canal block (SACB) with adjuvants to continuous adductor canal blockade (CACB). The hypothesis was that the 2 groups would have equivalent analgesia at 30 hours after neural blockade. METHODS: This was a double-blinded, randomized, controlled, equivalency trial. Sixty patients were randomized to either the SACB group (20 mL of 0...
May 24, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29903458/the-bundle-busters-incidence-and-costs-of-postacute-complications-following-total-joint-arthroplasty
#6
Andrew J Luzzi, Andrew N Fleischman, Christopher N Matthews, Meredith P Crizer, John Wilsman, Javad Parvizi
BACKGROUND: Recently, a bundled payment model was implemented in the United States to improve quality and reduce costs. While hospitals may be rewarded for lowering costs, they may be financially exposed by high cost complications, the so-called bundle busters. We aimed at determining the incidence, etiology, and costs of postacute complications after total joint arthroplasty (TJA). METHODS: A retrospective study was conducted using a prospectively collected database of patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from January 2015 to April 2016...
June 11, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29901604/skin-avulsion-injuries-caused-by-the-application-of-adhesive-drapes-during-total-knee-arthroplasty-a-case-report
#7
Bin Yang, Chuanzhi Xiong, Zhihua Lu, Jingcheng Wang
RATIONALE: The use of adhesive drapes has decreased the incidence of surgical-site infections. PATIENT CONCERNS: Despite the obvious benefits of the proper use of drapes, there remain many potential risks. DIAGNOSE: A 66-year-old man with a history of left knee osteoarthritis and varus deformity underwent total knee arthroplasty at our hospital, upon removal of the adhesive drape by delicate peeling and warm saline lavage, a large area of the skin avulsion happened...
June 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29898737/down-regulation-of-microsomal-prostaglandin-e2-synthase-1-in-the-infrapatellar-fat-pad-of-osteoarthritis-patients-with-hypercholesterolemia
#8
Manabu Mukai, Kentaro Uchida, Shotaro Takano, Dai Iwase, Jun Aikawa, Gen Inoue, Masayuki Miyagi, Masashi Takaso
BACKGROUND: While epidemiological studies have reported a potential role for hypercholesterolemia (HCE) in osteoarthritis (OA), the association between HCE and OA has yet to be clarified. Adipose tissue is a primary locus for cholesterol metabolism and the presence of HCE reportedly causes adipose dysfunction. The knee joint contains adipose tissue in the form of the infrapatellar fat pad (IPFP), which has been shown to contribute to the pathophysiology of OA in the knee via the secretion of inflammatory mediators...
June 13, 2018: Lipids in Health and Disease
https://www.readbyqxmd.com/read/29898707/comparison-of-intravenous-and-topical-tranexamic-acid-in-total-knee-arthroplasty
#9
Wenbo Wei, Shajie Dang, Dapeng Duan, Ling Wei
BACKGROUND: To investigate the clinical effectiveness of intravenous (IV) and topical tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA) by comparing safety, efficacy and patient-reported outcomes. METHODS: In this prospective single-blind clinical trial, 64 patients were randomized into two groups (n = 32 each). The Intravenous Group was administered TXA 10 mg/kg IV (Reyong, Shandong, China) 10 min prior to tourniquet deflation. In the Topical Group, 1...
June 13, 2018: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29896563/early-femoral-condyle-insufficiency-fractures-after-total-knee-arthroplasty-treatment-with-delayed-surgery-and-femoral-component-revision
#10
George L Vestermark, Susan M Odum, Bryan D Springer
Background: Periprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction. Methods: We retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896562/proximal-tibial-resorption-in-a-modern-total-knee-prosthesis
#11
Justin T Deen, Terry B Clay, Dane A Iams, MaryBeth Horodyski, Hari K Parvataneni
Background: In an effort to minimize backside polyethylene wear and osteolysis associated with titanium tibial baseplates, many manufacturers have transitioned to cobalt chromium alloys. Recent literature has implicated thicker cobalt chromium designs as a potential source of increased stress shielding and resorption. We report the incidence of proximal tibial bone resorption in a large consecutive series of patients undergoing total knee arthroplasty, with a modern total knee design...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896561/short-term-safety-and-effectiveness-of-a-second-generation-motion-guided-total-knee-system
#12
Adam I Harris, Tianyi David Luo, Jason E Lang, Branko Kopjar
Background: Modern knee prostheses are designed to more closely replicate normal knee kinematics. The JOURNEY II Bi-Cruciate Stabilized Total Knee System (Smith & Nephew Inc., Memphis, TN) is a second-generation motion-guided knee system that demonstrates axial rotation patterns during flexion, which resemble those of the normal knee. The aim of this study was to assess the short-term safety and effectiveness of this system in standard clinical practice. Methods: A total of 186 subjects (209 primary total knee arthroplasties [TKAs]) were enrolled at 12 U...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896560/single-dose-lidocaine-spinal-anesthesia-in-hip-and-knee-arthroplasty
#13
Nicholas B Frisch, Brian Darrith, Dane C Hansen, Adrienne Wells, Sheila Sanders, Richard A Berger
Background: With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896558/are-reinfusion-drains-safe-to-use-with-periarticular-liposomal-bupivacaine-an-analysis-of-systemic-bupivacaine-toxicity
#14
Marc R Angerame, Gavin P Hart, Susan M Odum, Bryan D Springer
Background: Intraoperative periarticular injection (PAI) with local anesthetic is an important component of multimodal pain control in total joint arthroplasty (TJA). A potential risk of this practice is serum anesthetic toxicity resulting from the autotransfusion of blood collected from a reinfusion drain. The purpose of this study is to evaluate the levels of bupivacaine in blood collected in an autotransfusion system after use of a PAI in TJA. Methods: In this prospective study, each TJA patient had an identical PAI consisting of 20 cc of liposomal bupivacaine, 30 cc of 0...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896557/arthroplasty-care-redesign-related-to-the-comprehensive-care-for-joint-replacement-model-results-at-a-tertiary-academic-medical-center
#15
Chancellor F Gray, Hernan A Prieto, Andrew T Duncan, Hari K Parvataneni
Background: Total joint arthroplasty (TJA) remains the highest expenditure in the Centers for Medicare and Medicaid Services (CMS) budget. One model to control cost is the Comprehensive Care for Joint Replacement (CJR) model. There has been no published literature to date examining the efficacy of CJR on value-based outcomes. The purpose of this study was to determine the efficacy and sustainability of a multidisciplinary care redesign for total joint arthroplasty under the CJR paradigm at an academic tertiary care center...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896556/are-patients-being-evaluated-for-periprosthetic-joint-infection-prior-to-referral-to-a-tertiary-care-center
#16
Matthew W Tetreault, Kenneth A Estrera, Erdan Kayupov, Caroline Brander, Craig J Della Valle
Background: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines. Methods: One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896553/the-effect-of-constraint-on-post-damage-in-total-knee-arthroplasty-posterior-stabilized-vs-posterior-stabilized-constrained-inserts
#17
Joseph Konopka, Lydia Weitzler, Daniel Westrich, Timothy M Wright, Geoffrey H Westrich
Posterior stabilized constrained (PSC) inserts are intended to provide greater varus-valgus and rotational constraint than conventional PS inserts. We determined whether the added constraint resulted in more damage to the post in PSC compared to PS inserts. Retrieved PSC inserts were matched to retrieved PS inserts from the same manufacturer according to patient age, body mass index, and length of implantation. Surface damage was visually assessed, and 3-D surface deviation from pristine was measured. Damage scores for the PSC posts were significantly greater than those of the PS posts...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896552/circular-hexapod-external-fixation-for-periprosthetic-tibial-fracture
#18
Michael J Assayag, Noam Bor, Guy Rubin, S Robert Rozbruch
A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided. Using a web-based software program, a gradual reduction in all planes was achieved...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896551/external-fixator-immobilization-after-extensor-mechanism-reconstruction-in-total-knee-arthroplasty
#19
Colin D Canham, Christopher Walsh, Stephen J Incavo
Extensor mechanism disruption after total knee arthroplasty is a complicated problem that typically requires surgical reconstruction. After extensor mechanism failure, reconstruction is typically indicated to restore active knee extension and provide a stable limb for ambulation. Immobilization of the knee in extension is vital in the initial postoperative period after extensor mechanism reconstruction. We describe a series of 4 patients who underwent extensor mechanism reconstruction followed by external fixator application to maintain the knee extended in the initial postoperative period...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896548/a-novel-use-of-a-tibial-cone-in-a-proximal-femoral-replacement
#20
Hilary Koech, Joshua M Lawrenz, Daniel R Mesko, Robert M Molloy
Revision total hip arthroplasty in the setting of severe femoral bone loss can be challenging, with salvage options often limited to modular tapered stems, allograft prosthetic composites, and megaprostheses. This case highlights a 79-year-old woman with 2 years of thigh pain who is 8 years status post a revision proximal femoral allograft prosthetic composite reconstruction. Radiographs demonstrated significant stem subsidence into the femoral condyle. In an attempt to avoid a total femoral replacement and spare her functioning native knee, a tibial cone was used in conjunction with a proximal femoral replacement to structurally fill the flaring femoral canal and serve as a stable pedestal for the megaprosthesis body and provide the potential for biologic ingrowth...
June 2018: Arthroplasty Today
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