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Revision knee replacement

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
Zaheed Damani, Gail MacKean, Eric Bohm, Brie DeMone, Brock Wright, Tom Noseworthy, Jayna Holroyd-Leduc, Deborah A Marshall
BACKGROUND: Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba...
October 18, 2016: Health Research Policy and Systems
B Fink, R Lass
Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1...
October 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Miguel Ortega-Andreu, Gloria Talavera, Norma G Padilla-Eguiluz, Hanna Perez-Chrzanowska, Reyes Figueredo-Galve, Carlos E Rodriguez-Merchán, Enrique Gómez-Barrena
PURPOSE: To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA). PATIENTS AND METHODS: A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol...
2016: Open Orthopaedics Journal
S Singh, S Reddy, Raj Shrivastva
This study compared the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) data for total hip replacements (THRs) and total knee replacements (TKRs) from Hospital A [with laminar airflow (LAF)] and Hospital B (without LAF). These hospitals were originally managed by two different trusts that subsequently merged. Consequently, the theatres in Hospital A have always had LAF and those in Hospital B had only conventional ventilation systems. As this merger happened before the establishment of the NJR, it puts us in a unique position, enabling direct comparison of the revision rates for infected hip and knee replacements between the two hospitals that follow similar infection protocols...
September 29, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Ingrid Milošev, Vesna Levašič, Janja Vidmar, Simon Kovač, Rihard Trebše
BACKGROUND: Due to degradation and metal dissolution during articulation of metal joint replacements the chemical periprosthetic environment may change. The aim was to establish whether metal replacements cause the local changes in pH and elevated metal concentrations. METHODS: pH was measured on samples from 167 patients: native hip and knee osteoarthritic joints, joints with hip and knee replacements revised for aseptic or septic reasons. pH of synovial fluid and periprosthetic tissue was measured perioperatively using a microelectrode and pH indicator papers for removed metal components...
September 23, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Amaia Ormaza, Jesús Moreta, Javier Mosquera, Oskar Sáez de Ugarte, José Luis Martinez-de Los Mozos
Tear of the quadriceps tendon after revision or primary total knee arthroplasty is a rare complication, but when it occurs, this injury has serious functional consequences. In complete tears, the outcome of direct repair is unpredictable, and several authors recommend that the suture should be reinforced. Several techniques have been described, including the use of autografts, allografts, and synthetic mesh. The goal of this study was to assess the outcomes of a reconstruction technique augmented with synthetic mesh...
September 19, 2016: Orthopedics
Kuang-Ming Liao, Hsueh-Yi Lu
The incidence and prevalence of chronic obstructive pulmonary disease (COPD) is associated with increasing age. Osteoarthritis is also a growing problem in the aging population, and total knee replacement (TKR) is a common surgical procedure for this population. An increasing number of COPD patients are receiving TKR, but few studies have examined the complications and outcomes after TKR in COPD patients. The purpose of this study was to investigate the complications, including mortality, wound infections, hospitalization readmission, pneumonia (PN), and cerebrovascular accidents (CVAs) in patients with COPD after receiving TKR...
September 2016: Medicine (Baltimore)
Mansur Halai, Andrew Ker, Iain Anthony, Graeme Holt, Bryn Jones, Mark Blyth
AIM: To determine outcomes using the Femoro-Patella Vialla (FPV) arthroplasty and if there is an ideal patient for this implant. METHODS: A total of 41 FPV patellofemoral joint replacements were performed in 31 patients (22 females, 9 males, mean age 65 years). Mean follow-up was 3.2 years (minimum 2 years). Radiographs were reviewed preoperatively and postoperatively. We assessed whether gender, age, previous surgery, patella atla or trochlear dysplasia influenced patient satisfaction or patient functional outcome...
August 18, 2016: World Journal of Orthopedics
Alexandra I Stavrakis, Nelson F SooHoo
BACKGROUND: This study provides an updated comparison of the reoperation rates following primary ankle arthrodesis and total ankle replacement on the basis of observational, population-based data from California. We previously reported data from 1995 to 2004, and our current study includes new data from 2005 to 2010. Our hypothesis was that total ankle replacement would demonstrate increasing utilization and lower complication rates given advances in implant design and growth in surgeon experience...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
Diego A Orozco Villaseñor, Markus A Wimmer
The aim of this study was to determine how representative wear scars of simulator-tested polyethylene (PE) inserts compare with retrieved PE inserts from total knee replacement (TKR). By means of a nonparametric self-organizing feature map (SOFM), wear scar images of 21 postmortem- and 54 revision-retrieved components were compared with six simulator-tested components that were tested either in displacement or in load control according to ISO protocols. The SOFM network was then trained with the wear scar images of postmortem-retrieved components since those are considered well-functioning at the time of retrieval...
2016: BioMed Research International
Ben Parkinson, Nicholas Smith, Laura Asplin, Peter Thompson, Tim Spalding
BACKGROUND: Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined...
August 2016: Orthopaedic Journal of Sports Medicine
Albrecht Encke, Sylvia Haas, Ina Kopp
BACKGROUND: Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008...
August 8, 2016: Deutsches Ärzteblatt International
Sohrab S Virk, Frank M Phillips, Safdar N Khan
BACKGROUND: A bundled payment represents a single payment for services during an episode of care for a surgical procedure. Anterior cervical discectomy and fusion (ACDF) and associated 90-day costs have been suggested as a bundle amenable to such a payment structure; however, to our knowledge, there are limited available data with regard to costs related to this procedure and subsequent care. METHODS: The Medicare 5% National Sample Administrative Database was used to catalog clinical and financial data associated with the day of the surgical procedure and the 90-day postoperative period for patients undergoing a one to two-level ACDF procedure from 2005 to 2012...
August 17, 2016: Journal of Bone and Joint Surgery. American Volume
P J C Heesterbeek, A B Wymenga, G G van Hellemondt
BACKGROUND: In revision total knee arthroplasty (TKA), the femoral component and tibial baseplate are usually cemented. However, stems can be fixed either with cement or with a press-fit technique, with the latter resulting in hybrid fixation. There is no consensus on the preferred stem fixation technique. Therefore, we compared the stability of cemented TKA implants with the stability of TKA implants fixed with the hybrid technique in a prospective randomized trial using radiostereometric analysis (RSA)...
August 17, 2016: Journal of Bone and Joint Surgery. American Volume
Nader Naouar, Hamdi Kaziz, Thabet Mouelhi, Karim Bouattour, Mohamed Mseddi, Mohamed Laziz Ben Ayeche
BACKGROUND: The treatment of isolated internal tibiofemoral knee osteoarthritis on young and active patients is controversial. This treatment can be a high tibial osteotomy or a joint replacement that can be a partial unicompartmental knee arthroplasty (UKA) or total knee replacement (TKR). The aim of our study is the long-term evaluation of functional outcome of partial unicompartmental knee arthroplasty (UKA) in elderly patients under than 60 years. METHODS: This is a retrospective study of 25 unicompartmental knee arthroplasties in 22 patients, collected between1993 and 2003 whose age was less than 60 years...
January 2016: La Tunisie Médicale
Zaid Saffo, Anthony Ognjan
The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis...
2016: IDCases
Nael Hawi, Jochen Plutat, Daniel Kendoff, Eduardo M Suero, Michael B Cross, Thorsten Gehrke, Mustafa Citak
PURPOSE: The aim of this study was to determine the survival rate, the causes of failure, and the functional outcomes of an all-polyethylene tibial unicompartmental knee prosthesis. METHODS: One hundred (100) nonselected, consecutive patients indicated for unicompartmental knee replacement for isolated medial knee compartment osteoarthritis by a single surgeon at a single institution from 2000 to 2004 were included in this study. Data was collected retrospectively at final follow-up from the hospital electronic database, including progress notes, demographic information, Hospital for Special Surgery (HSS) Knee Score, details on the surgical procedure, reoperations/revisions, and mortality...
September 2016: Archives of Orthopaedic and Trauma Surgery
Jas Singh, Angelos Politis, Lynda Loucks, David R Hedden, Eric R Bohm
BACKGROUND: National joint replacement registries outside North America have been effective in reducing revision risk. However, there is little information on the role of smaller regional registries similar to those found in Canada or the United States. We sought to understand trends in total hip (THA) and knee (TKA) arthroplasty revision patterns after implementation of a regional registry. METHODS: We reviewed our regional joint replacement registry containing all 30 252 cases of primary and revision THA and TKA performed between Jan...
September 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Christopher B Knowlton, Priyanka Bhutani, Markus A Wimmer
Recently developed techniques have enabled volume loss measurements on surgically retrieved total knee replacements (TKR). However, it is not well understood how volume loss relates to polyethylene surface damage appearance. Sixty-four fixed bearing cruciate retaining components retrieved from revision and postmortem surgeries were analyzed for penetration and volume loss on the topside articular surface. An autonomous reconstruction method was used to approximate the original unworn surfaces. Surface damage patterns were also mapped using a video microscope, and each pattern's contribution to volume loss was calculated...
July 12, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
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