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https://www.readbyqxmd.com/read/29352690/diagnostic-utility-of-histological-analysis-for-detecting-ongoing-infection-during-two-stage-revision-arthroplasty-in-patients-with-inflammatory-arthritis
#1
Jaiben George, Yaxia Zhang, Michael Jawad, Mhamad Faour, Alison K Klika, Thomas W Bauer, Carlos A Higuera
BACKGROUND: Surgeons often rely on intra-operative histology (frozen sections [FS]) to determine the next step in surgical management during the second stage (re-implantation surgery) of 2-stage revision arthroplasty. The purpose of the study is to assess the accuracy of permanent sections (PS) and FS in the diagnosis of persistent infection during re-implantation in patients with an inflammatory arthritis. METHODS: From 2001 to 2016, 47 planned second-stage revision total hip arthroplasty and total knee arthroplasty in patients with inflammatory arthritis were identified...
December 29, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29352687/what-influence-does-the-time-of-year-have-on-postoperative-complications-following-total-knee-arthroplasty
#2
Nipun Sodhi, Nicolas S Piuzzi, Sarah E Dalton, Jaiben George, Mitchell Ng, Anton Khlopas, Assem A Sultan, Carlos A Higuera, Michael A Mont
BACKGROUND: The time of year might influence the occurrence of surgical complications. Therefore, this study investigated correlations between the time-of-year and 30-day postoperative complication rates following primary total knee arthroplasty (TKA). Specifically, we determined (1) postoperative complication rates across all quarters; and (2) time-of-year influence on complications using univariate and multivariate regression analyses. METHODS: CPT code 27447 identified 147,473 TKAs from the NSQIP database...
December 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29352686/interobserver-and-intraobserver-reliability-of-computed-tomography-based-three-dimensional-preoperative-planning-for-primary-total-knee-arthroplasty
#3
Michiaki Miura, Shigeo Hagiwara, Junichi Nakamura, Yasushi Wako, Yuya Kawarai, Seiji Ohtori
BACKGROUND: Preoperative planning is an important factor for total knee arthroplasty (TKA). The aim of this study is to document the interobserver and intraobserver reliability of computed tomography (CT)-based 3-dimensional (3D) preoperative planning for primary TKA. METHODS: Twenty knees (10 with osteoarthritis and 10 with rheumatoid arthritis) were studied independently by 6 orthopedic surgeons using a CT-based 3D planning system. The measurements were made twice at more than 3-week intervals without any knowledge of their own previous measurements or those of the others...
December 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29352685/factors-associated-with-posterior-cruciate-ligament-tightness-during-cruciate-retaining-total-knee-arthroplasty
#4
Kazuhisa Hatayama, Masanori Terauchi, Shogo Hashimoto, Kenichi Saito, Hiroshi Higuchi
BACKGROUND: The purpose of our study was to identify factors affecting posterior cruciate ligament (PCL) tightness during cruciate-retaining total knee arthroplasty. METHODS: A total of 225 varus osteoarthritic knees that underwent cruciate-retaining total knee arthroplasty were included in this study. When the flexion gap was tighter than the extension gap after all bone resection and the lift-off sign was positive during surgery, the PCL was released. The association between PCL release and potential risk factors, such as age, gender, body mass index, preoperative range of motion, anterior cruciate ligament status, preoperative hip-knee-ankle angle (HKA), decrease in posterior condylar offset, and also change in tibial posterior slope angle (TPSA) from preoperative to postoperative measurement, was evaluated by univariate and multivariate logistic regression analyses...
December 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29352683/discharge-to-inpatient-rehab-does-not-result-in-improved-functional-outcomes-following-primary-total-knee-arthroplasty
#5
Douglas E Padgett, Alexander B Christ, Amethia D Joseph, You-Yu Lee, Stephen B Haas, Stephen Lyman
BACKGROUND: Monitored rehabilitation has long been considered an essential part of the recovery process in total knee arthroplasty (TKA). However, the optimal setting for rehabilitation remains uncertain. We sought to determine whether inpatient rehabilitation settings result in improved functional and patient-reported outcomes after primary TKA. METHODS: All patients undergoing primary TKA from May 2007 to February 2011 were identified from our institutional total joint registry...
December 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29352682/are-allogeneic-transfusions-decreasing-in-total-knee-arthroplasty-patients-national-inpatient-sample-2009-2013
#6
Jaydev B Mistry, Chukwuweike U Gwam, Qais Naziri, Robert Pivec, Roby Abraham, Michael A Mont, Ronald E Delanois
BACKGROUND: Allogeneic transfusions are commonly used for substantial blood loss in total knee arthroplasty (TKA), but have been associated with adverse effects and increased costs. The purpose of this study is to provide a detailed description of (1) trends of allogeneic blood transfusion; (2) risk factors and adverse events; and (3) discharge disposition, length-of-stay (LOS), and cost/charge analysis for primary TKA patients who received an allogeneic blood transfusion from 2009-2013...
December 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29351933/vanadium-allergy-following-total-knee-arthroplasty
#7
Fidel Peat, Ross Coomber, Adnan Rana, Alastair Vince
Allergic reactions to metals following joint arthroplasty represent a rare and poorly understood phenomenon. Much is still unknown regarding the natural history of this complication, and how it can best be prevented and managed. We present a case of a 68-year-old woman who underwent a left total knee arthroplasty for treatment of osteoarthritis. After an initial uneventful postoperative course, she developed a troublesome erythematous rash both around the incision site and over her trunk. Blood testing revealed no evidence of infection and clinically her prosthesis was functioning well...
January 18, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29351137/early-response-to-warfarin-initiation-and-the-risk-of-venous-thromboembolism-after-total-joint-arthroplasty
#8
Adam I Edelstein, Clara Terzaghi, Brandon Nudelman, Charles Qin, Mary Kwasny, David W Manning
BACKGROUND: Venous thromboembolism chemoprophylaxis with warfarin is common after total joint arthroplasty. Early response to warfarin initiation has been theorized to engender a transient increase in the risk of venous thromboembolism. We hypothesized that a rapid rise in the international normalized ratio is a risk factor for venous thromboembolism after total joint arthroplasty. METHODS: This study was a retrospective analysis of Medicare patients undergoing elective total joint arthroplasty who were given nomogram-dosed warfarin for venous thromboembolism prophylaxis...
January 18, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29349988/-comparison-of-analgesic-effects-between-multimodal-and-patient-controlled-intravenous-analgesia-in-patients-with-rheumatoid-arthritis-in-the-perioperative-period-of-total-knee-arthroplasty
#9
Hua-Li Gao, Lian-Bo Xiao, Wei-Tao Zhai, Yong He, Fei Zhu, Lin Zheng, Xiu-Wei Han
OBJECTIVE: To compare the analgesic effect between multimodal and patient-controlled intravenous analgesia(PCIA) in patients with rheumatoid arthritis(RA) in the perioperative period of knee joint replacement. METHODS: From June 2015 to June 2016, 40 RA patients undergoing total knee arthroplasty were randomly divided into two groups. There were 20 patients in PCIA group, including 3 males and 17 females, with an average age of(59.6±2.3) years old, who received controlled instillation of sufentanil analgesia controlled by an intravenous analgesia pump...
April 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/29349982/-effects-of-tranexamic-acid-combined-with-temporary-drain-clamping-on-postoperative-blood-loss-in-total-knee-arthroplasty
#10
Yi-Long Dong, Yue-Nan Qian, Xi-Qiang Zhong, Guang-Jie Shen, Chun-Yuan Cai
OBJECTIVE: To evaluate the efficacy and safety of one dose tranexamic acid combined with temporary drain lamping in primary unilateral total knee arthroplasty. METHODS: Total 160 patients undergoing unilateral primary total knee arthroplasty between January 2012 and December 2013 were randomly divided into four groups(40 cases in each group):group A (the drain was clamped for 2 hours after the operation and the patients received 20 ml physiological saline), group B(the drain was clamped for 2 hours after the operation and the patients received 10 ml tranexamic acid and 10 ml physiological saline), group C (the drain was clamped for 4 hours after the operation and the patients received 20 ml physiological saline) and group D(the drain was clamped for 4 hours after the operation and the patients received 10 ml tranexamic acid and 10 ml physiological saline)...
April 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/29349665/following-the-correction-of-varus-deformity-of-the-knee-through-total-knee-arthroplasty-significant-compensatory-changes-occur-not-only-at-the-ankle-and-subtalar-joint-but-also-at-the-foot
#11
Bi O Jeong, Tae Yong Kim, Jong Hun Baek, Hyuk Jung, Seung Hyun Song
PURPOSE: This study aimed to assess radiological changes of the ankle joint, subtalar joint and foot following the correction of varus deformity of the knee with total knee arthroplasty (TKA). It was hypothesized that following the correction of varus deformity by TKA, compensatory reactions would occur at the subtalar joint in accordance with the extent of the correction. METHODS: For this prospective study, 375 knees of patients who underwent TKA between 2011 and 2012 were enrolled...
January 18, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/29347947/efficacy-of-pre-operative-quadriceps-strength-training-on-knee-extensor-strength-before-and-shortly-following-total-knee-arthroplasty-protocol-for-a-randomized-dose-response-trial-the-quadx-1-trial
#12
Rasmus Skov Husted, Anders Troelsen, Kristian Thorborg, Michael Skovdal Rathleff, Henrik Husted, Thomas Bandholm
BACKGROUND: Patients with knee osteoarthritis (OA) report knee pain, limitation in physical activities and low quality of life. The two primary treatments for knee OA are non-surgical treatment (e.g., exercise) and surgery (total knee arthroplasty (TKA)); however, national guidelines recommend non-surgical treatment to be tried prior to surgical procedures. Patients with knee OA are characterized by decreased muscle strength, particularly in the knee-extensor muscles. Correspondingly, decreased knee-extensor strength is found to be associated with an increased risk of development, progression and severity of knee OA symptoms...
January 18, 2018: Trials
https://www.readbyqxmd.com/read/29346228/analgesia-of-combined-femoral-triangle-and-obturator-nerve-blockade-is-superior-to-local-infiltration-analgesia-after-total-knee-arthroplasty-with-high-dose-intravenous-dexamethasone
#13
Charlotte Runge, Jan Mick Jensen, Louise Clemmesen, Henriette Bach Knudsen, Carsten Holm, Jens Børglum, Thomas Fichtner Bendtsen
BACKGROUND AND OBJECTIVES: High-dose intravenous dexamethasone reduces the postoperative opioid requirement and is often included in the multimodal analgesia strategy after total knee arthroplasty (TKA). Combined obturator nerve and femoral triangle blockade (OFB) reduces the opioid consumption and pain after TKA better than local infiltration analgesia (LIA). The question is whether preoperative high-dose intravenous dexamethasone would cancel out the superior analgesic effect of OFB compared with LIA...
January 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29343449/the-comparative-efficacy-and-safety-of-topical-and-intravenous-tranexamic-acid-for-reducing-perioperative-blood-loss-in-total-knee-arthroplasty-a-randomized-controlled-non-inferiority-trial
#14
Jefferson George, Krishna Kiran Eachempati, Koushik Narayan Subramanyam, A V Gurava Reddy
BACKGROUND: Total Knee Arthroplasty (TKA) can be associated with significant perioperative blood loss and blood transfusions. This is a prospective randomised non-inferiority trial comparing intraarticular (IA) and intravenous (IV) routes of administering Tranexamic acid (TXA) with regard to efficacy and safety. METHODS: A total of 113 patients who underwent primary unilateral TKA from January to June 2017 randomly received either 1.5g TXA in 100mL normal saline solution (IA group, n=58) or 10mg/kg TXA (IV group, n=55) at 10min before the tourniquet inflation and at tourniquet release...
January 14, 2018: Knee
https://www.readbyqxmd.com/read/29343448/optimizing-the-dose-of-local-infiltration-analgesia-and-gabapentin-for-total-knee-arthroplasty-a-randomized-single-blind-trial-in-128-patients
#15
Maurik H M van Haagen, Hennie Verburg, Brechtje Hesseling, Lauri Coors, Nick T van Dasselaar, Pim N J Langendijk, Nina M C Mathijssen
BACKGROUND AND PURPOSE: Effective analgesia is essential for postoperative recovery and rehabilitation in TKA. The challenge of analgesic regimes is to obtain adequate pain relief and maximum muscle control to mobilize and rehabilitate patients early. However, the optimal dose and best composition are not known. We hypothesized that there would be no differences in reported postoperative pain on the day of the TKA surgery as well as the first day after surgery when different combinations of ropivacain for LIA and gabapentin are given...
January 14, 2018: Knee
https://www.readbyqxmd.com/read/29343282/investigation-of-perioperative-safety-and-clinical-results-of-one-stage-bilateral-total-knee-arthroplasty-in-selected-low-risk-patients
#16
Hirotaka Mutsuzaki, Arata Watanabe, Tetsuya Komatsuzaki, Tomonori Kinugasa, Kotaro Ikeda
BACKGROUND: An increased perioperative complication rate has been a concern with one-stage bilateral total knee arthroplasty (TKA). The purpose of this study was to retrospectively investigate the perioperative safety and clinical results of one-stage bilateral TKA in selected low-risk patients. METHODS: Sixty-seven patients who received one-stage bilateral TKAs for osteoarthritis who were American Society of Anesthesiology (ASA) class 1 or 2 were included in this study...
January 17, 2018: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/29342496/-adverse-events-in-the-treatment-of-periprosthetic-fractures-around-the-knee-a-clinical-and-radiological-outcome-analysis
#17
Anna Janine Schreiner, Christoph Gonser, Christoph Ihle, Max Konstantin Zauleck, Tim Klopfer, Fabian Stuby, Ulrich Stöckle, Björn Gunnar Ochs
BACKGROUND: The incidence of periprosthetic fractures associated with total knee arthroplasty (PpFxK) has been reported to be 0.3 - 5.5%. 40% of all cases are related to revision TKA. The most common localisation is the distal femur. Classification is performed according to Rorabeck (RB). RB I - II fractures are usually treated with locked plating and retrograde intramedullary nailing, whereas RB III fractures are an indication for revision arthroplasty using a hinged endoprosthesis...
January 17, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/29342059/patients-living-alone-can-be-safely-discharged-directly-home-after-total-joint-arthroplasty-a-prospective-cohort-study
#18
Andrew N Fleischman, Matthew S Austin, James J Purtill, Javad Parvizi, William J Hozack
BACKGROUND: Despite the expense and potential hazards of inpatient rehabilitation, there is a prevailing belief that patients living alone cannot be safely discharged directly home after total joint arthroplasty. The purpose of this study was to assess the safety and efficacy of direct home discharge for patients living alone during convalescence after primary total joint arthroplasty. METHODS: We prospectively studied 910 consecutive patients undergoing primary, unilateral total hip arthroplasty or total knee arthroplasty over an 8-month period...
January 17, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29342019/hot-spotting-as-a-strategy-to-identify-high-cost-surgical-populations
#19
Sarah P Shubeck, Jyothi R Thumma, Justin B Dimick, Hari Nathan
OBJECTIVE: The aim of this study was to determine the feasibility of "hot spotting" in elective surgical populations. BACKGROUND: Prospective identification of high-cost patients, known as "hot spotting," is well developed in medical populations, but has not been performed in surgical populations. Population-based management of surgical expenditures requires identification of high-cost surgical patients to allow for effective implementation of cost-saving strategies...
January 16, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29338974/usefulness-of-the-grand-piano-sign-for-determining-femoral-rotational-alignment-in-total-knee-arthroplasty
#20
Takaaki Ohmori, Tamon Kabata, Yoshitomo Kajino, Tadashi Taga, Daisuke Inoue, Takashi Yamamoto, Tomoharu Takagi, Junya Yoshitani, Takuro Ueno, Hiroyuki Tsuchiya
BACKGROUND: The "grand-piano sign" is a well-known indicator of proper rotational femoral alignment. We investigated changes in the shape of the femoral anterior cutting plane by changing the rotational alignment, anterior portion depth, and cutting plane flexion angle. METHODS: We simulated various cutting planes after cutting the anterior portion of the femur next to the distal femoral osteotomy in 50 patients with varus knee and also a femoral anterior osteotomy with four degree (S group) and seven degree (T group) flexion angles regarding the mechanical axis...
January 12, 2018: Knee
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