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Knee arthroplasty

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https://www.readbyqxmd.com/read/27932196/a-mini-volume-loading-test-mvlt-using-2-5-mlkg-1-boluses-of-crystalloid-for-indication-of-perioperative-changes-in-hydration-status
#1
Audrius Andrijauskas, Christer H Svensen, Narūnas Porvaneckas, Jūratė Šipylaitė, Edgaras Stankevičius, Darius Činčikas, Valentinas Uvarovas, Saulė Švedienė, Igoris Šatkauskas, Saulius Vosylius, Giedrius Kvederas
BACKGROUND AND OBJECTIVE: A mini volume loading test (mVLT) evaluating hemodilution during step-wise crystalloid infusion has established that the arterio-capillary plasma dilution difference is inversely correlated to the body hydration level of subjects. This observational study aimed to test whether this can be replicated in a perioperative setting using a 2.5-mLkg(-1) boluses. MATERIALS AND METHODS: The mVLT was performed before induction of regional anesthesia and 24h later...
November 25, 2016: Medicina
https://www.readbyqxmd.com/read/27932045/serum-and-knee-synovial-fluid-matrixmetalloproteinase-13-and-tumor-necrosis-factor-alpha-levels-in-patients-with-late-stage-osteoarthritis
#2
Kenan Özler, Erdem Aktaş, Çiğdem Atay, Barış Yılmaz, Murat Arıkan, Şafak Güngör
OBJECTIVE: To compare the levels of MMP-13 and TNF-α in late stage osteoarthritis, define their predominant pathways and investigate their correlation with McMaster Universities Arthritis Index scores. PATIENTS AND METHODS: A total of 42 patients (mean age 64 ± 8.8) with grade 3 and grade 4 knee osteoarthritis according to Kellegren- Lawrence criteria and who were scheduled for total knee arthroplasty were enrolled in the study. TNF-alpha and MMP-13 levels were measured preoperatively from venous blood samples and intraoperatively from knee synovial fluid via ELISA...
December 5, 2016: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/27931954/younger-patients-have-less-severe-radiographic-disease-and-lower-reported-outcome-scores-than-older-patients-undergoing-total-knee-arthroplasty
#3
Jacob Haynes, Adam Sassoon, Denis Nam, Loren Schultz, James Keeney
BACKGROUND: Total knee arthroplasty (TKA) has been successful for many younger patients, but some experience residual symptoms or dissatisfaction. We performed this study to assess the relationship between radiographic disease severity and patient demographic features on patient reported TKA outcome scores. METHODS: We compared 100 TKAs performed for 82 patients ≤55years old with 100 gender-matched TKAs performed for 85 patients between 65 and 75years old. These study cases represented 25% and 21%, respectively, of TKAs performed between January 2006 and June 2011...
December 5, 2016: Knee
https://www.readbyqxmd.com/read/27931702/peripheral-nerve-blocks-causing-increased-risk-for-fall-and-difficulty-in-ambulation-for-the-hip-and-knee-joint-replacement-patient
#4
Bonnie L Crumley Aybar, Michael J Gillespie, Sean F Gipson, Caitlin E Mullaney, Melissa Tommasino-Storz
A systematic review of the literature was completed by the Evidence-Based Practice Group for the Patient population, Intervention/Issue, Comparison Intervention, Outcomes, Timing (PICOT) question: "Does the use of a peripheral nerve block increase the risk for falls and difficulty ambulation in patients after lower extremity surgery through postoperative day 2?" A search of multiple databases using specified key terms resulted in 258 articles for total knee arthroplasty or total hip arthroplasty. These were reduced to 13 with exclusion criteria and became primary evidence...
December 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/27926687/an-initiative-to-standardize-the-identification-of-and-acute-response-to-postoperative-lower-extremity-neurological-deficits-effects-on-provider-knowledge-confidence-and-communication-skills
#5
Peter B Derman, Sravisht Iyer, Matthew Garner, Steven Orr, Karla J Felix, Allison Goldberg, Titilayo Ologhobo, Minlun Wu, Laura Robbins, Charles Cornell
BACKGROUND: Although relatively uncommon, neurological deficits following hip and knee arthroplasty can have permanent and debilitating consequences. This study was conducted to quantify the effectiveness of an educational curriculum aimed at standardizing the identification of and acute response to postoperative neurological deficits in the inpatient setting, specifically with respect to improvements in clinician knowledge, confidence levels, and communication skills. METHODS: A multidisciplinary committee at a single, high-volume academic institution created an algorithm delineating the appropriate clinical actions and escalation procedures in the setting of a postoperative neurological deficit for each clinical practitioner involved in care for patients who undergo arthroplasty...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27926677/transfemoral-amputation-after-failure-of-knee-arthroplasty-a-nationwide-register-based-study
#6
Tinne B Gottfriedsen, Henrik M Schrøder, Anders Odgaard
BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27924199/in-plane-three-step-needle-insertion-technique-for-ultrasound-guided-continuous-femoral-nerve-block-after-total-knee-arthroplasty-a-retrospective-review-of-488-cases
#7
Hyeon Ju Shin, Jung Sub Soh, Hyong Hwan Lim, Bumjoon Joo, Hye Won Lee, Hae Ja Lim
BACKGROUND: Continuous femoral nerve block (CFNB) improves postoperative analgesia after total knee arthroplasty (TKA). The aim of this study was to investigate the clinical efficacy and complications of our in-plane three-step needle insertion technique that was devised to reduce the risk of direct femoral nerve injury during CFNB in anesthetized patients. METHODS: This retrospective study included 488 patients who had undergone TKA. Ultrasound (US)-guided CFNB was performed under general or spinal anesthesia using an in-plane, three-step needle insertion technique...
December 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27924167/reduction-of-falls-and-factors-affecting-falls-a-year-after-total-knee-arthroplasty-in-elderly-patients-with-severe-knee-osteoarthritis
#8
T Tsonga, M Michalopoulou, S Kapetanakis, E Giovannopoulou, P Malliou, G Godolias, P Soucacos
BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical treatment for severe knee Osteoarthritis (OA), which generally improves pain, physical function, quality of life and possibly fall risk. Fall risk increases for older adults with severe knee OA; however it has not been studied extensively whether this parameter is improved after TKA. OBJECTIVE: To investigate: a) the history and frequency of falls, including mechanism or causes of falls, injuries sustained from falls reported, activity during falling and location of falls and, b) the factors affecting falls, a year after TKA in elderly patients with severe knee OA...
2016: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/27923627/outcomes-of-cementless-unicompartmental-and-total-knee-arthroplasty-a-systematic-review
#9
REVIEW
Jelle P van der List, Dana L Sheng, Laura J Kleeblad, Harshvardhan Chawla, Andrew D Pearle
BACKGROUND: Aseptic loosening is a common failure mode in cemented unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This led to the development of cementless designs but the historical outcomes were poor. Recent developments in cementless designs have improved outcomes, but the current status is unknown. Therefore, a systematic review was performed to assess recent outcomes of cementless knee arthroplasty. METHODS: A search was performed using PubMed, Embase and Cochrane systems and national registries for studies reporting outcomes since 2005...
December 3, 2016: Knee
https://www.readbyqxmd.com/read/27923623/staged-total-knee-arthroplasty-for-bilateral-complex-knee-deformities-from-kashin-beck-disease-and-skeletal-dysplasia
#10
Ming Ling, Xueyuan Wu, Yanhai Chang, Xianghui Dong, Zhengming Sun, Li Ling, Shixun Wu, Bo Yang
This study reported two cases of patients with Grade III Kashin-Beck disease (KBD) with skeletal dysplasia concomitant with complex knee deformity and functional limitation treated by staged total knee arthroplasty (TKA). Detailed pre-operative planning, bone resection, and soft tissue balancing in affected knees were performed in the surgeries in this report. The results demonstrated that TKA could correct lower limb alignment, alleviate knee pain, improve function, and provide good quality of life in people with KBD...
December 3, 2016: Knee
https://www.readbyqxmd.com/read/27923598/the-use-of-routine-postoperative-microscopy-and-culture-screening-following-elective-hip-and-knee-arthroplasty-an-unnecessary-cost-with-no-effect-on-clinical-management
#11
Mark A Kemp, Ka Martina, Claire L Collins, Lucy J Salmon, Benjamin R Gooden, Matthew C Lyons
BACKGROUND: The use of microscopy and culture screening to detect pathogenic microorganisms followed by a decolonization protocol is a widely performed practice prior to elective hip and knee arthroplasty. In our center, the routine care of hip and knee arthroplasty also involves postoperative screening including direct culture of the surgical site. The aim of this study was to assess the frequency of pathogen detection following these tests and to determine whether routine postoperative screening, with particular reference to postoperative surgical site culture, led to any change in clinical management of these patients...
November 15, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27923404/combined-femoral-and-sciatic-nerve-block-versus-femoral-and-local-infiltration-anesthesia-for-pain-control-after-total-knee-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#12
Jian Li, Xinlian Deng, Tao Jiang
BACKGROUND: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of combined femoral and sciatic nerve block (SNB) versus femoral and local infiltration anesthesia (LIA) after total knee arthroplasty (TKA). METHODS: The electronic databases PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to 15 June 2016. Articles comparing combined femoral and SNB versus femoral and LIA for pain control were eligible for this meta-analysis...
December 7, 2016: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/27923169/primary-stability-of-unicompartmental-knee-arthroplasty-under-dynamic-flexion-movement-in-human-femora
#13
Thomas M Grupp, Melanie Holderied, Matthias F Pietschmann, Christian Schröder, Angélica P Islas Padilla, Christoph Schilling, Volkmar Jansson, Peter E Müller
BACKGROUND: The objective of our study was to evaluate the impact of a trabecular stem fixation versus a cortical teeth fixation technique on the primary stability of cemented unicompartmental femoral components under dynamic flexion movement loading conditions in human femora. METHODS: Ten fresh-frozen human knees of a mean donor age of 73.9years were used to perform medial unicompartmental knee arthroplasty under a less invasive parapatellar surgical approach...
November 26, 2016: Clinical Biomechanics
https://www.readbyqxmd.com/read/27922947/microbiology-and-antimicrobial-challenges-of-prosthetic-joint-infection
#14
Douglas R Osmon
Research that leads to better strategies to diagnose and treat prosthetic joint infection (PJI) is critical because PJI is a devastating complication of total knee arthroplasty. A key to the diagnosis and management of PJI is defining the microbiology of PJI and improving the medical management of PJI utilizing both systemic and local antimicrobial therapy. In this review, the author will present his opinions on future research needs as they relate to the microbiology of PJI, including antimicrobial resistance and the antimicrobial treatment of PJI...
December 5, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27922946/patient-reported-outcome-measurement-for-patients-with-total-knee-arthroplasty
#15
Stephen Lyman, Kaitlyn L Yin
Total knee arthroplasty is a large contributor to Medicare costs. In an effort to lower costs and improve outcomes, the Centers for Medicaid and Medicare Services has implemented the Comprehensive Care for Joint Replacement model, which incentivizes surgeons to submit both general health and joint-specific patient-reported outcome measures (PROMs). However, in addition to using PROMs for reporting purposes, surgeons should also consider incorporating PROMs into clinical practice. Currently, PROMs are not widely implemented in the clinical setting despite their value in measuring factors such as patients' expectations and mental state, which impact outcomes...
December 5, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27922945/staphylococcal-biofilms-and-immune-polarization-during-prosthetic-joint-infection
#16
Casey M Gries, Tammy Kielian
Staphylococcal species are a leading cause of community- and nosocomial-acquired infections, where the placement of foreign materials increases infection risk. Indwelling medical devices and prosthetic implants are targets for staphylococcal cell adherence and biofilm formation. Biofilm products actively suppress proinflammatory microbicidal responses, as evident by macrophage polarization toward an anti-inflammatory phenotype and the recruitment of myeloid-derived suppressor cells. With the rise in prosthetic hip and knee arthroplasty procedures, together with the recalcitrance of biofilm infections to antibiotic therapy, it is imperative to better understand the mechanism of crosstalk between biofilm-associated bacteria and host immune cells...
December 5, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27921130/-does-the-certification-according-to-endocert-lead-to-a%C3%A2-better-quality-of-treatment
#17
P Weber, A C Paulus, D Hallmen, A Steinbrück, F Schmidutz, V Jansson
BACKGROUND: Certification according to EndoCert in the field of arthroplasty in Germany aims at standardization of treatment and with this optimization of its quality. However, huge capital investment and efforts are necessary. There are currently more than 400 certified centres in Germany. Our Department of Orthopaedics at a German medical school was certified in the pilot phase. The aim of this study was to analyse whether there was a difference in the quality in the year after the certification...
December 5, 2016: Der Orthopäde
https://www.readbyqxmd.com/read/27921128/-total-knee-arthroplasty-in-the-elderly
#18
M Weber, F Völlner, A Benditz, T Schwarz, M Wörner, B Craiovan, T Renkawitz, J Grifka
BACKGROUND: The number of total knee arthroplasties in elderly patients is increasing in accordance with the demographic shift in the population. OBJECTIVE: Analysis of the special situation in the elderly, conservative treatment options, perioperative risk factors, preoperative preparation, special intraoperative features and outcome. METHODS: Analysis of currently available scientific data and presentation of own scientific study results...
December 5, 2016: Der Orthopäde
https://www.readbyqxmd.com/read/27920813/densitometric-evaluation-of-bone-prosthetic-counterface-in-hip-and-knee-arthroplasty-with-modern-implants
#19
Andrea Cozzi Lepri, Marco Giorgini, Carla Signorini, Christian Carulli, Roberto Civinini, Maria Luisa Brandi, Massimo Innocenti
INTRODUCTION: Recent acquisitions of the complex mechanisms of osseointegration between implants and host bone have gained attention, accordingly to the methods of evaluation of these interactions. DEXA analysis is considered an useful tool to assess such phenomena, in order to analyse in a quantitative manner the local metabolic activity of the bone, and to evaluate over the time the integration between host bone and prosthetic components. The purpose of the present study is to report about a preliminary experience in the analysis of osseointegration processes of patients undergoing a primary Total Hip Arthroplasty (THA) or a revision Total Knee Arthroplasty (rTKA)...
May 2016: Clinical Cases in Mineral and Bone Metabolism
https://www.readbyqxmd.com/read/27919672/a-study-of-pre-operative-presence-of-micro-organisms-in-affected-knee-joints-of-rheumatoid-arthritis-patients-who-need-total-knee-arthroplasty
#20
Jiang-Ming Luo, Lin Guo, Hao Chen, Peng-Fei Yang, Ran Xiong, Yang Peng, Liu Yang
BACKGROUND: To evaluate, by way of intraoperative tissue culture and pathological study, the pre-operative presence of micro-organisms in knee joints of patients with rheumatoid arthritis (RA) who need total knee arthroplasty (TKA). METHODS: From November 2012 to January 2014, 47 patients with RA (53 knees) who needed TKA were included in this study. Patients received routine pre-operative examination and joint fluid routine and culture. Each RA patient was match-paired with one osteoarthritis (OA) patient...
December 2, 2016: Knee
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