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Knee arthroplasty

Nicholas Arlas, Harry Jergesen
Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused...
2016: Journal of Health Care for the Poor and Underserved
David Gøttsche, Thomas Lind, Thorbjørn Christiansen, Henrik M Schrøder
INTRODUCTION: Revision total knee arthroplasty with a cementless metaphyseal sleeve is suggested to be used without stem in revision total knee arthroplasty (rTKA). To the best of our knowledge, no papers investigating this have been published. The purpose of this study was to evaluate clinical outcome. METHOD: In this retrospective study, 71 patients operated with rTKA with sleeves without stem in the period 2009-2011 were identified; 63 were examined. All patients with the prosthesis still in place were invited to a medical examination including X-rays...
October 19, 2016: Archives of Orthopaedic and Trauma Surgery
M Moutzouri, N Gleeson, E Billis, E Tsepis, I Panoutsopoulou, J Gliatis
PURPOSE: Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. METHODS: A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included...
October 19, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Lucas Werth, Mo Saffarini, Felix Amsler, Ashraf Abdelkafy, Martin Clauss, Michael T Hirschmann
No abstract text is available yet for this article.
October 19, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Aaron J Krych, Patrick J Reardon, Nick R Johnson, Rohith Mohan, Logan Peter, Bruce A Levy, Michael J Stuart
PURPOSE: Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction, but little is known about the natural history and outcome and for non-operative management of these lesions. The purpose of this study was to evaluate (1) the mid-term clinical and radiographic outcomes of non-operative treatment of MMPRTs and (2) risk factors for worse outcomes. METHODS: A retrospective review was performed for patients with symptomatic, unrepaired MMPRTs and a minimum 2-year follow-up for IKDC and Tegner outcome scores...
October 19, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Christian Scheele, Matthias F Pietschmann, Christian Schröder, Thomas Grupp, Melanie Holderied, Volmar Jansson, Peter E Müller
BACKGROUND: Unicompartmental total knee arthroplasty (UKA) is a well-established treatment option for unicondylar osteoarthritis, and generally leads to better functional results than tricompartimental total knee arthroplasty (TKA). However, revision rates of UKAs are reported as being higher; a major reason for this is aseptic loosening of the tibial component due to implant-cement-bone interface fatigue. The objective of this study was to determine the effects of trabecular bone preparation, prior to implantation of tibial UKAs, on morphological and biomechanical outcomes in a cadaver study...
October 16, 2016: Knee
Zhenyang Mao, Bing Yue, You Wang, Mengning Yan, Kerong Dai
BACKGROUND: Intra-articular injection of tranexamic acid (TXA) is known to be effective in controlling blood loss after total knee arthroplasty (TKA). However, this method has some disadvantages, such as TXA leakage due to soft tissue release. Peri-articular injection provides an alternative to intra-articular administration of TXA. This study aimed to evaluate the effects of peri-articular injection of TXA in reducing blood loss after TKA and compare them to those of intra-articular TXA injection...
October 19, 2016: BMC Musculoskeletal Disorders
Christoffer C Jørgensen, Henrik Kehlet
Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies. Patients and methods - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment...
October 19, 2016: Acta Orthopaedica
Olivier Borens, Pablo S Corona, Lars Frommelt, Stergios Lazarinis, Michael Richard Reed, Carlo Luca Romano
Total Joint Arthroplasty (TJA) continues to gain acceptance as the standard of care for the treatment of severe degenerative joint disease, and is considered one of the most successful surgical interventions in the history of medicine. A devastating complication after TJA is infection. Periprosthetic joint infection (PJI), represents one of the major causes of failure and remains a significant challenge facing orthopaedics today. PJI usually requires additional surgery including revision of the implants, fusion or amputations causing tremendous patient suffering but also a heavy health economics burden...
October 19, 2016: Advances in Experimental Medicine and Biology
Louis M Day, Subaraman Ramchandran, Cyrus M Jalai, Bassel G Diebo, Barthelemy Liabaud, Renaud Lafage, Themistocles Protopsaltis, Peter G Passias, Frank J Schwab, Shay Bess, Thomas J Errico, Virginie Lafage, Aaron J Buckland
STUDY DESIGN: Retrospective clinical and radiographic single-center study OBJECTIVE.: Assess simultaneous cervical spine and lower extremity compensatory changes with changes in thoracolumbar spinal alignment. SUMMARY OF BACKGROUND DATA: Full-body stereoradiographic imaging allows better understanding of reciprocal changes in cervical and lower extremity alignment in the setting of thoracolumbar malalignment. Few studies describe the simultaneous effect of alignment correction on these mechanisms...
October 17, 2016: Spine
Atsushi Minatani, Kentaro Uchida, Gen Inoue, Shotaro Takano, Jun Aikawa, Masayuki Miyagi, Hisako Fujimaki, Dai Iwase, Kenji Onuma, Toshihide Matsumoto, Masashi Takaso
BACKGROUND: Calcitonin gene-related peptide (CGRP) is a 37-amino-acid vasodilatory neuropeptide that binds to receptor activity-modifying protein 1 (RAMP1) and the calcitonin receptor-like receptor (CLR). Clinical and preclinical evidence suggests that CGRP is associated with hip and knee joint pain; however, the regulation mechanisms of CGRP/CGRP receptor signaling in synovial tissue are not fully understood. METHODS: Synovial tissues were harvested from 43 participants with radiographic knee osteoarthritis (OA; unilateral Kellgren/Lawrence (K/L) grades 3-4) during total knee arthroplasty...
October 17, 2016: Journal of Orthopaedic Surgery and Research
Morad Chughtai, Anil Bhave, Sabahat Z Khan, Anton Khlopas, Osman Ali, Steven F Harwin, Michael A Mont
The use of a pneumatic unloader brace has been shown in pilot studies to decrease pain and increase muscle strength in patients with knee osteoarthritis (OA). Therefore, we analyzed patients who had knee OA, and either received a pneumatic unloader brace and conventional treatment or conventional treatment alone. Specifically, we assessed: (1) use of pain relieving injections; (2) opioid consumption; and (3) the eventual need for total knee arthroplasty (TKA) in the above-mentioned cohort. We performed an analysis of a longitudinally maintained database of patients from a prospective, randomized, single center study...
October 17, 2016: Journal of Knee Surgery
Anton Khlopas, Michael A Mont, Morad Chughtai, Robert Molloy, Prem N Ramkumar, Steven F Harwin
Revision total knee arthroplasty (TKA) can be challenging in the setting of bone loss. Previously, severe bone loss was managed with impaction grafting and structural allografts; however, these had limited success. Recently, metaphyseal cones have been developed as useful adjuncts with good early outcomes. Presently, there are no published guidelines on how to preoperatively predict the need for metaphyseal cone implantation radiographically. Therefore, the purpose of this study was to evaluate how well preoperative radiographs were able to predict the use of cones in a small series of patients undergoing revision TKA...
October 17, 2016: Journal of Knee Surgery
Stephen Choi, Turlough O'Hare, Jeffrey Gollish, James E Paul, Hans Kreder, Kevin E Thorpe, Joel D Katz, Muhammad Mamdani, Peter Moisiuk, Colin J McCartney
BACKGROUND: This randomized trial compared (1) continuous femoral nerve block (cFNB), (2) single femoral nerve block (sFNB), and (3) local infiltration analgesia (LIA) with respect to analgesic and functional outcomes after primary tricompartmental knee arthroplasty (TKA). METHODS: One hundred twenty patients undergoing primary tricompartmental knee arthroplasty were randomly assigned to 1 of 3 interventions for postoperative analgesia: (1) cFNB-preoperative bolus of ropivacaine 0...
October 3, 2016: Anesthesia and Analgesia
Michael P Palmer, Rachael Melton-Kreft, Laura Nistico, N Louisa Hiller, Leon H J Kim, Gregory T Altman, Daniel T Altman, Nicholas G Sotereanos, Fen Z Hu, Patrick J De Meo, Garth D Ehrlich
BACKGROUND: Preliminary studies have identified known bacterial pathogens in the knees of patients with osteoarthritis (OA) before arthroplasty. AIMS: The current study was designed to determine the incidence and types of bacteria present in the synovial fluid of native knee joints from adult patients with diagnoses of septic arthritis and OA. PATIENTS AND METHODS: Patients were enrolled between October 2010 and January 2013. Synovial fluid samples from the affected knee were collected and evaluated with both traditional microbial culture and polymerase chain reaction-electrospray ionization-time-of-flight mass spectrometry (molecular diagnostics [MDx]) to prospectively characterize the microbial content...
October 17, 2016: Genetic Testing and Molecular Biomarkers
Panna Sanga, Nathaniel Katz, Elena Polverejan, Steven Wang, Kathleen M Kelly, Juergen Haeussler, John Thipphawong
OBJECTIVE: To evaluate long-term safety and efficacy of fulranumab in patients with moderate-to-severe chronic osteoarthritis (OA) knee or hip pain. METHODS: In this placebo-controlled, phase-2 double-blind (DB) extension study, patients who were equally randomized to 1mgQ4wk, 3mgQ8wk, 3mgQ4wk, 6mgQ8wk, or10mgQ8wk fulranumab (s.c.) or placebo in the 12-week DB efficacy phase, and completed this DB efficacy phase, were eligible to continue the dose throughout a 92-week extension phase followed by a 24-week posttreatment follow-up (PFTU)...
October 16, 2016: Arthritis & Rheumatology
Nicolas Reina, Etienne Cavaignac, Régis Pailhé, Aymeric Pailliser, Nicolas Bonnevialle, Pascal Swider, Jean-Michel Laffosse
Overweight is a risk factor for osteoarthritis on the knees. Subchondral trabecular bone (SCTB) densification has been shown to be associated with cartilage degeneration. This study analyzed the microarchitectural changes in the SCTB of tibial plateaus to validate the hypothesis that the degree of remodeling is correlated with a patient's body weight. Twenty-one tibial plateaus were collected during total knee arthroplasty from 21 patients (15 women and 6 men). These patients had a mean age of 70.4 years (49-81), mean weight of 74...
October 17, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Jai Thilak, Melvin J George
BACKGROUND: The correct sizing of the components in both anteroposterior and mediolateral (ML) dimensions is crucial for the success of a total knee arthroplasty (TKA). The size of the implants selected is based on the intraoperative measurements. The currently used TKA implants available to us are based on morphometric measurements obtained from a Western/Caucasian population. Hence, the risk of component ML mismatch is more common in Asian sub-population, as they are of a smaller built and stature...
September 2016: Indian Journal of Orthopaedics
Emanuele Maiorano, Bruno Dino Bodini, Francesca Cavaiani, Catia Pelosi, Valerio Sansone
BACKGROUND: To identify variables influencing length of stay (LOS) and short-term functional outcome in patients undergoing total knee arthroplasty (TKA). A secondary aim was to verify the effect of the same variables on blood management and the rate of postoperative infection. METHOD: We retrospectively reviewed 353 patients, 258 females and 85 males, who underwent primary TKA in a single specialist orthopaedic centre. Anamnestic and anthropometric data and the Modified Barthel Index Score (MBI) at admission were recorded, and entered as covariates in four longitudinal regression models, separately carried out for female and male groups...
October 11, 2016: Knee
Daniel Pérez-Prieto, María E Portillo, Lluís Puig-Verdié, Albert Alier, Carlo Gamba, Pau Guirro, Santos Martínez-Díaz, Juan P Horcajada, Andrej Trampuz, Joan C Monllau
BACKGROUND: Culture negative prosthetic joint infections (PJI) still remain an issue even with the advantages of the new diagnostic tools for PJI. This is why some orthopedic surgeons have reservations relative to the use of preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis on intraoperative cultures. MATERIAL AND METHODS: An enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI that were seen in a university hospital...
September 23, 2016: Diagnostic Microbiology and Infectious Disease
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