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Total knee replacement

Jiri Gallo, Michal Svoboda, Jana Zapletalova, Jitka Proskova, Jarmila Juranova
BACKGROUND: The diagnosis of prosthetic joint infection (PJI) is still a challenge in some patients after total joint replacement. Interleukin-6 (IL-6) strongly participates in the arrangement of the host-bacteria response. Therefore, increased levels of IL-6 should accompany every PJI. PURPOSE: The aim of the study was to show diagnostic characteristics of serum IL-6 for the diagnosis of prosthetic joint infection (PJI). We also compared the diagnostic values of serum IL-6 with synovial IL-6 (sIL-6) and synovial C-reactive protein (sCRP)...
2018: PloS One
David F Dalury, Danielle M Chapman
An important milestone in the recovery following total knee replacement (TKR) is the ability to return to driving. With advances in pain control and the widespread introduction of rapid rehab programs, we hypothesized that the ability to drive would also return sooner than had been traditionally observed. In our group of consecutive right TKR patients, using a driving simulator, we showed that at the 2-week mark, 36 of the 40 patients tested had returned to their preoperative driving capabilities and the other 4 had reached baseline at 3 weeks...
June 20, 2018: Journal of Knee Surgery
Oommen Mathew Arikupurathu, Linda Johnston, Alasdair MacInnes, Graeme Nicol, Manhal Nassif
The NexGen legacy posterior stabilized (LPS) prosthesis was introduced in 1997 after many design changes to its predecessor, the Insall-Burstein II prosthesis. However, there have been no reported long-term studies on the performance of this implant. Prospectively, collected data from a local database comprising primary total knee replacements (TKRs) with LPS between 1997 and 2002 was analyzed. All implants were fixed with cement. Patients were followed up at 1, 3, 5, 7, and 10 years, with patient satisfaction, range of movement, and Knee Society score (KSS) assessed...
June 20, 2018: Journal of Knee Surgery
Syed Mannan, Mohammed Ali, Lukasz Mazur, Mei Chin, Ahmed Fadulelmola
Background: Incidence of infection following total elbow replacement (TER) is recognised to be higher compared to hip or knee arthroplasty. Extensive swelling following TER can complicate the wound healing which might lead to infection. Tranexamic Acid (TXA) is proven to reduce blood loss peri-operatively which might contribute to better healing outcomes. Our aim is to assess the effect of TXA in wound healing following TER. Methods: A retrospective review of a single surgeon case series. 10 patients had TER mainly for complicated elbow fractures, four of them were relatively immune-supressed...
2018: Journal of Bone and Joint Infection
Mohamed Ghanem, Christina Pempe, Dirk Zajonz, Andreas Roth, Christoph-Eckhard Heyde, Christoph Josten
Introduction: Infection of the knee joint after primary total knee arthroplasty is a serious complication. In this work, we would like to evaluate the mid-term results after two-stage revision of total knee replacement in periprosthetic infection using dynamic spacer, in particular with regard to the function of the knee joint after reimplantation. Patients and methods: In this retrospective study, we included patients who were treated in our clinic between 2005 and 2013 due to infection of the knee after total knee arthroplasty...
2018: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
Irfan Ashraf, Yasir Mohib, Obada Hasan, Amina Malik, Khabir Ahmad, Shahryar Noordin
Introduction: Surgical Site Infection (SSI) after knee arthroplasty is a major cause of morbidity and mortality that increases the hospital stay, financial burden and mental anguish of the patient. Infection Control Unit at Aga Khan University Hospital (AKUH) incorporated total knee arthroplasty in its surgical care surveillance program and started collecting data in June 2012. The purpose of this study is to review Surgical Site Infection (SSI) rates in patients undergoing primary total knee replacement (TKR) surgery...
July 2018: Annals of Medicine and Surgery
Thomas Kurien, Lars Arendt-Nielsen, Kristian K Petersen, Thomas Graven-Nielsen, Brigitte E Scammell
Preoperative pain characteristics in osteoarthritis (OA) patients may explain persistent pain after total knee replacement (TKR). Fifty patients awaiting TKR and 22 asymptomatic controls were recruited to evaluate the degree of neuropathic pain symptoms and pain sensitisation. OA patients were pain phenotyped into two groups based on the PainDETECT questionnaire: High PainDETECT group (scores ≥19) indicating neuropathic pain-like symptoms, Low PainDETECT group (scores <19) indicating nociceptive or mixed pain...
June 16, 2018: Journal of Pain: Official Journal of the American Pain Society
Gwyn N Lewis, Rosalind S Parker, Sheena Sharma, David A Rice, Peter J McNair
Objective: Many studies have provided evidence of altered brain structure in chronic pain conditions, as well as further adaptations following treatment that are coincident with changes in pain. Less is known regarding how these structural brain adaptations relate to assessments of nociceptive processing. The current study aimed to investigate brain structure in people with knee osteoarthritis (OA) before and after total knee arthroplasty (TKA) and to investigate the relationships between these findings and quantitative sensory testing (QST) of the nociceptive system...
June 15, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
K V Andersen, L Nikolajsen, V Haraldsted, N T Andersen, C F Jepsen, K Soeballe
Background/aims Optimal pain treatment with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee replacement surgery. Local infiltration analgesia (LIA) with local anaesthetic might be effective and adjuncts such as ketorolac may provide additional effects on opioid requirements and pain. We tested the hypothesis that adding ketorolac significantly improves analgesia after total knee replacement surgery. Methods Sixty patients were enrolled in this prospective double-blinded study and allocated to either group R (placebo) or Group RK (ketorolac 120 mg)...
December 29, 2017: Scandinavian Journal of Pain
E Carlos Rodriguez-Merchan, Jose A Garcia-Ramos, Norma G Padilla-Eguiluz, Enrique Gomez-Barrena
Background: The role of arthroscopic partial meniscectomy (APM) for painful degenerative meniscal tears (PDMT) is currently controversial.To define the rate of early (1 to 5 years) conversion to total knee replacement (TKR) and their predictors after APM for PDMT in patients with knee osteoarthritis and more than 50 years of age. Methods: Retrospective cohort study of patients more than 50 years of age with the diagnosis of PDMT, treated by means of APM. Patients were classified in two groups: Patients that required an early (between 1 and 5 years after APM) TKR (TKR group) after its failure and patients that did not require a TKR (non-TKR group)...
May 2018: Archives of Bone and Joint Surgery
Thiago Vivacqua, Murilo Barroso, Pedro Matos, Rodrigo Pires E Albuquerque, Naasson Cavanellas, João Maurício Barretto
Objective: Identify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery. Methods: The study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group. Results: The case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period...
March 2018: Revista Brasileira de Ortopedia
Naasson Trindade Cavanellas, Victor Rodrigues Amaral Cossich, Eduardo Becker Nicoliche, Marilena Bezerra Martins, Eduardo Branco de Sousa, José Inácio Salles
Objective: Compare the maximal isokinetic muscle strength of knee extensor and flexor muscles between patients with knee osteoarthritis and patients submitted to total knee arthroplasty. Methods: Volunteers were divided into five groups ( n  = 20): Control; Ahlbäck I and II; Ahlbäck IV; six months after total knee arthroplasty; 12 months after total knee arthroplasty. An isokinetic knee strength evaluation was conducted for the quadriceps and hamstrings at 60°/s...
March 2018: Revista Brasileira de Ortopedia
Timothy E Hereford, Kipp A Cryar, Paul K Edwards, Eric R Siegel, C Lowry Barnes, Simon C Mears
BACKGROUND: Patients taking narcotics chronically are more likely to have worse outcomes after total joint arthroplasty. These negative outcomes may be avoided when modifiable risk factors such as narcotic use are identified and improved before elective joint replacement. An accurate assessment of narcotic use is needed to identify patients before surgery. This study examines the amount of reported narcotic use in patients with hip or knee osteoarthritis and compares this with the narcotic prescriptions recorded in our state's drug prescription monitoring database...
May 29, 2018: Journal of Arthroplasty
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
Mohammad Al-Ashqar, Adeel Aqil, Hannah Phillips, Hassaan Sheikh, Simon Harrison, Sameh Sidhom, Gautam Chakrabarty, Ravinder Dimri
Introduction The 'weekend effect' is said to occur when patient outcomes are adversely affected by the day of the week on which they present to hospital or have surgery. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. We investigated whether there is a 'weekend effect' in elective orthopaedic patients. Methods Retrospectively collected data were obtained from our institution's electronic patient records. We collected demographic and International Statistical Classification of Diseases and Related Health Problems tenth revision coding data for all included patients...
June 18, 2018: Annals of the Royal College of Surgeons of England
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
Saurabh Mehta, Andrew Rigney, Kyle Webb, Jacob Wesney, Paul W Stratford, Franklin D Shuler, Ali Oliashirazi
DESIGN: Retrospective analysis of routinely collected clinical data. OBJECTIVE: This study modeled the recovery in knee flexion and extension range of motion (ROM) over 1 year after total knee replacement (TKR). BACKGROUND: Recovery after TKR has been characterized for self-reported pain and functional status. Literature describing target knee ROM at different follow-up periods after TKR is scarce. METHODS: Data were extracted for patients who had undergone TKR at a tertiary care hospital at 2, 8, 12, 26, and 52 weeks after TKR...
June 13, 2018: Physiotherapy Theory and Practice
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
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
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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