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João Bosco Sales Nogueira, Abrahão Cavalcante Gomes de Souza Carvalho, Edgar Marçal de Barros Filho, Leonardo Heráclio do Carmo Araújo, Marcelo José Cortez Bezerra, Marco Kawamura Demange
Objective: To evaluate the usefulness of an application when planning total knee arthroplasties (TKA), besides the accuracy when measuring the anatomical-mechanical femoral angle (AMFA), comparing, also, the time spent during planning a TKA manually and by using the application. Methods: An interdisciplinary team involving health and computer science areas established activities in order to develop the application. After development, 24 physicians underwent an application usability test...
March 2018: Revista Brasileira de Ortopedia
Sami Shalhoub, Wayne E Moschetti, Leonid Dabuzhsky, David S Jevsevar, John M Keggi, Christopher Plaskos
BACKGROUND: The traditional goal of the gap-balancing method in total knee arthroplasty is to create equal and symmetric knee laxity throughout the arc of flexion. The purpose of this study was to (1) quantify the laxity in the native and the replaced knee throughout the range of flexion in gap-balancing total knee arthroplasty (TKA) and (2) quantify the precision in achieving a targeted gap profile throughout flexion using a robotic-assisted technique with active ligament tensioning...
May 14, 2018: Journal of Arthroplasty
Hwa Sen Chua, Sarah L Whitehouse, Michelle Lorimer, Richard De Steiger, Linda Guo, Ross W Crawford
BACKGROUND: Total knee arthroplasty (TKA) is an effective procedure for relieving pain and restoring function in osteoarthritis, with a significant proportion of patients having severe disease bilaterally. However, although there are differences in patient selection criteria for bilateral procedures, there is no consensus regarding the optimal timing for bilateral TKA. The aim of this study was to compare rates and causes of revision and 30-day mortality between simultaneous and staged bilateral TKA using data from the Australian Orthopaedic Association National Joint Replacement Registry...
May 17, 2018: Journal of Arthroplasty
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
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
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
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
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
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
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
John J Callaghan, David E DeMik, Nicholas A Bedard, Andrew N Odland, William M Kane, Steven M Kurtz
Fracture of the tibial tray is a rarely observed complication of total knee arthroplasty (TKA), predominately in implants placed greater than a decade ago. This case highlights a case of baseplate fracture in a contemporary prosthesis. The patient presented 1 year after TKA with medial knee pain consistent with pes bursitis. The implant-cement-bone construct was intact and she was managed with corticosteroids. She had persistent pain, acutely developed new varus deformity, and presented with a tibial tray fracture...
June 2018: Arthroplasty Today
Kavin Sundaram, Christian M Klare, Wayne E Moschetti
Total knee arthroplasty (TKA) is a common treatment option for end-stage osteoarthritis of the tibiofemoral and patellafemoral joints. Diagnosis and treatment of the painful TKA can pose a significant challenge. In this report, we present the unusual case of a patient 12 years after total knee replacement presenting with isolated proximal tibial-fibular osteoarthritis as a cause of lateral knee pain. Proximal tibiofibular osteoarthritis is not typically on the differential diagnosis for a painful TKA but can be a rare cause of lateral knee pain...
June 2018: Arthroplasty Today
Yoshinori Ishii, Hideo Noguchi, Junko Sato, Satoshi Takayama, Yui Okada, Shin-Ichi Toyabe
Background: Venous thromboembolic events (VTE) are a common complication of total knee arthroplasty (TKA). Prior studies have discussed the utility of mechanical VTE prophylaxis as a monotherapy for low-risk TKA patients. We assess the incidence of clinically significant deep venous thrombosis (DVT) or pulmonary embolism (PE) in low-risk TKA patients who receive mechanical VTE prophylaxis and undergo spinal, epidural, or general anesthesia for their surgery. Methods: A retrospective study was performed on consecutive low-risk patients who received a TKA between July 2002 and June 2015 with spinal anesthesia ( n  = 65), epidural and general anesthesia ( n  = 154), or general anesthesia alone ( n  = 152)...
April 2018: Journal of Clinical Orthopaedics and Trauma
X Paredes-Carnero, J Escobar, J M Galdo, J G Babé
Objective: Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy). Methods: Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity...
April 2018: Journal of Clinical Orthopaedics and Trauma
Lakshmi Sudha Prasanna Karanam, Narendra Reddy Busireddy, Sridhar Reddy Baddam, Kiran Makineni, Vijaya Paidimukkala, P Raghavasarma
Aim: Acute arterial occlusions after total knee arthroplasty (TKA) are rare but very serious complication. We present a series of 9 patients who underwent endovascular recanalisation for acute thrombotic occlusion following TKA in our institution. The present series determine the importance of early diagnosis and role of early intervention for good clinical outcome in these cases. Methods: From 2013 to 2016, a total of 9 patients (3 male and 6 female) presented with acute popliteal thrombosis following TKA...
April 2018: Journal of Clinical Orthopaedics and Trauma
Shay I Warren, Taylor S Murtaugh, Akshay Lakra, Luke A Reda, Roshan P Shah, Jeffrey A Geller, H John Cooper
BACKGROUND: Soft-tissue deficiency is a potentially devastating complication of the infected total knee arthroplasty (TKA). Rotational muscle flaps are commonly used to address these defects. However, reported success rates vary widely. METHODS: We reviewed 26 consecutive patients who underwent rotational muscle flap surgery for full-thickness anterior soft-tissue defect during treatment of an infected TKA. Twenty-four cases used a medial gastrocnemius rotational flap, 1 used a lateral gastrocnemius flap, and 1 used a rectus femoris-vastus intermedius flap...
May 23, 2018: Journal of Arthroplasty
Ellen M Soffin, Melinda M Gibbons, Clifford Y Ko, Stephen L Kates, Elizabeth Wick, Maxime Cannesson, Michael J Scott, Christopher L Wu
Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surgery. These patterns have been described for patients undergoing elective total knee arthroplasty (TKA); however, adoption of ERAS to orthopedic surgery has lagged behind other surgical disciplines...
June 8, 2018: Anesthesia and Analgesia
Yukihide Minoda, Ryo Sugama, Yoichi Ohta, Mitsuhiko Ikebuchi, Hiroaki Nakamura
BACKGROUND: Patella-post impingement (PPI), contact of the patellar component with the tibial post, occurs during deep knee flexion after posterior stabilized total knee arthroplasty (TKA). In a previous pilot study, only two product lines were investigated. The aim of this study was to compare PPI between 12 contemporary posterior stabilized knee prostheses. METHODS: Twelve posterior stabilized knee prostheses were implanted in full-length sawbone models of the femur and tibia using a navigation system...
June 5, 2018: Knee
Owen J Diamond, Lisa Howard, Bassam Masri
BACKGROUND: Fracture of a polyethylene tibial post after a posterior stabilized total knee arthroplasty (PS-TKA) is an uncommon but severe complication. We report five cases of non-traumatic fracture of a tibial polyethylene post that occurred with Prolong highly cross-linked polyethylene with the NexGen LPS-Flex total knee prosthesis. METHODS: A Joint Reconstruction database for a high volume arthroplasty unit was used to identify all cases of revision of Prolong polyethylene used in PS-TKA...
June 5, 2018: Knee
Eirik Aunan, Stephan M Röhrl
Background and purpose - In the classical mechanical alignment technique, ligament balancing is considered a prerequisite for good function and endurance in total knee arthroplasty (TKA). However, it has been argued that ligament balancing may have a negative effect on knee function, and some authors advocate anatomic or kinematic alignment in order to reduce the extent of ligament releases. The effect of the trauma induced by ligament balancing on functional outcome is unknown; therefore, the aim of this study was to investigate this effect...
June 8, 2018: Acta Orthopaedica
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