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Knee replacements

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
Vikash Kapoor, Daipayan Chatterjee, Sutanu Hazra, Anirban Chatterjee, Parag Garg, Kaustav Debnath, Soham Mandal, Sudipto Sarkar
INTRODUCTION: Patient satisfaction after total knee replacement (TKR) depends on the amount of pain relief and the functional activities achieved. An important criterion of good functional outcome is the amount of flexion achieved and whether the patient can manage high flexion activities. In order to increase the amount of safe flexion, various implant designs have been developed. This study aims to compare the outcome after TKR using two contemporary high flexion knee designs: Sigma CR150 High Flex Knee prosthesis (Depuy, Warsaw, Indiana) and NexGen High Flex Knee prosthesis (Zimmer, Warsaw, Indiana)...
2016: SICOT-J
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
Terry K Morgan, Emilie Jensen, Jeong Lim, Russell Riggs
BACKGROUND: Intra-articular hyaluronic acid (HA) injection is an intermediate option between analgesics and knee joint replacement in patients with osteoarthritis (OA). Our objective was to test whether image-guided HA injections may improve knee OA outcomes after 6 months of treatment independent of potential covariates. METHODS: This is a retrospective case series with multivariate outcome-based analysis of 207 consecutive adult patients with mild to severe knee OA treated at a single out-patient clinic employing fluoroscopy-guided HA injections...
December 2015: Sports Medicine—Open
Takamasa Tanaka, Norihiko Terada, Yoshiki Fujikawa, Takushi Fujimoto
Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder with diverse clinical presentations. A 79-year-old man was bedridden for six months due to flexion contractures of the bilateral hips and knees, along with hyponatremia. He was diagnosed with IAD based on the results of endocrine tests. After one month of corticosteroid replacement, he recovered and was able to stand up by himself. Although flexion contracture is a rare symptom of IAD, steroid replacement therapy may be effective, even for seemingly irreversibly bedridden elderly patients...
2016: Internal Medicine
Qing-Hang Zhang, Andrew Cossey, Jie Tong
Periprosthetic bone strain distributions in some of the typical cases of total knee replacement (TKR) were studied with regard to the selection of material, design and the alignments of tibial components to examine which conditions are more forgiving than the others to stress shielding post a TKR. Four tibial components with two implant designs (cruciate sacrificing and cruciate retaining) and material properties (metal-backed (MB) and all-polyethylene (AP)) were considered in a specimen-specific finite element tibia bone model loaded in a neutral position...
October 10, 2016: Medical Engineering & Physics
Julia R Dahlqvist, Christoffer R Vissing, Gitte Hedermann, Carsten Thomsen, John Vissing
PURPOSE: The aim of this study was to investigate the age-related changes in fatty replacement and cross sectional area (CSA) of cervical, thoracic and lumbar paraspinal muscles vs. leg muscles in healthy adults, and to test for association between muscle fat fraction and lifestyle factors. METHODS: Fifty-three healthy adults (24-76 years) were included. Dixon MRI technique was used to determine CSA and quantify fat fraction of paraspinal and leg muscles. Muscle CSA and fat fractions were tested for association with age and muscle strength...
October 13, 2016: Medicine and Science in Sports and Exercise
Yongcai Chen, Zhuo Chen, Shuo Cui, Zhiyang Li, Zhengjiang Yuan
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug widely used to reduce blood loss during joint replacements, including total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, there is no final consensus regarding the composition of an optimal administration of TXA regime between topical and systemic (intravenous). The purpose of our study was to compare the efficacy of topical and intravenous (IV) regimen of TXA during TKA and THA. METHODS: Five relevant electronic online databases, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Chinese Biomedical Database were systematically searched in November 2015...
October 2016: Medicine (Baltimore)
Rebecca N Howie, Timothy L Foutz, Curtis C Cathcart, Jeff S Burmeister, Steve C Budsberg
OBJECTIVE: To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro. ANIMALS: Eight canine hemipelves. METHODS: A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage...
October 14, 2016: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
C Belvedere, A Ensini, M d'Amato, P Barbadoro, A Leardini
PURPOSE: Physiological elongation and orientation of patellar tendon fibres are among the scopes of total knee arthroplasty, but little is known in the three dimensions. The study aims to assess in vitro these variations at the intact and replaced knee, with and without patellar resurfacing. It was hypothesised that fibre patterns differ before and after prosthesis implantation, and between specific prosthesis designs. It was also expected that patellar resurfacing would affect relevant results...
October 13, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Robert Gabriel Coumine Riis, Henrik Gudbergsen, Ole Simonsen, Marius Henriksen, Nasir Al-Mashkur, Mikkel Eld, Kristian Kjær Petersen, Olga Kubassova, Anne C Bay Jensen, Janus Damm, Henning Bliddal, Lars Arendt-Nielsen, Mikael Ploug Boesen
OBJECTIVES: To investigate the association between MRI, macroscopic and histological assessments of synovitis in end-stage knee osteoarthritis (KOA). METHODS: Synovitis of end-stage osteoarthritic knees was assessed using non-contrast-enhanced (CE), CE-MRI and dynamic-CE (DCE)-MRI prior to total knee replacement and correlated with microscopic and macroscopic assessments of synovitis obtained intraoperatively. Multiple bivariate correlations were used with a pre-specified threshold of 0...
October 10, 2016: Osteoarthritis and Cartilage
Jamshed J Dalal, Anil Dhall, Abhay Bhave
Oral vitamin K antagonists (VKA) such as warfarin have been the mainstay of therapy for stroke prevention in patients with non valvular atrial fibrillation (NVAF) while low-molecular-weight heparin, fondaparinux and adjusted-dose warfarin or aspirin have been routinely used for thromboembolism (VTE) prophylaxis in patients undergoing total hip or knee replacement. However, VKAs are associated with considerable limitations, including increased risk of bleeding and narrow therapeutic window. Novel oral anticoagulants (NOACs, now referred as Non Vit K dependent oral anticoagulants), including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban and apixaban are now approved alternatives to warfarin for prophylaxis of stroke and systemic embolic events (SEE) in patients with NVAF and treatment and prophylaxis of VTE...
April 2016: Journal of the Association of Physicians of India
Daan Botje, Guus Ten Asbroek, Thomas Plochg, Helen Anema, Dionne S Kringos, Claudia Fischer, Cordula Wagner, Niek S Klazinga
BACKGROUND: Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management activities. METHODS: We conducted a qualitative interview study among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. Concentrating on orthopaedic and oncology departments, our goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery...
October 13, 2016: BMC Health Services Research
Ran Schwarzkopf, Erik Schnaser, Taiki Nozaki, Yasuhito Kaneko, Michael J Gillman
INTRODUCTION: Patient-specific implants and instruments (PSI) have been used in both knee and shoulder replacements due to the perceived benefits of improved surgical accuracy and efficiency. The proposed benefits of using a PSI in total hip arthroplasty (THA) are numerous and include reduction of operative time and improved mechanical and anatomical alignment leading to increased implant longevity, increased stability, and clinical outcomes. We describe a novel patient-specific instrumentation and a surgical method that may improve directed resection of acetabular bone and accurate cup placement during THA...
October 6, 2016: Surgical Technology International
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
Oriana Ciani, Nicola Antonio Pascarelli, Chiara Giannitti, Mauro Galeazzi, Michela Meregaglia, Giovanni Fattore, Antonella Fioravanti
OBJECTIVE: To perform a cost-effectiveness analysis of mud-bath therapy (MBT) in addition to usual treatment compared to usual treatment alone in patients with bilateral knee osteoarthritis (OA). METHODS: An economic evaluation alongside a randomized controlled trial was conducted. Patients were randomly assigned to receive either a 2 weeks cycle of MBT in addition to their usual treatment or to continue routine care alone. The European Quality-of-Life Questionnaire-5 Dimensions (EQ-5D) questionnaire was administered at baseline, 2 weeks, 3, 6, 9, and 12 months...
October 9, 2016: Arthritis Care & Research
Laura A Wyatt, Bryan J Moreton, Paul I Mapp, Deborah Wilson, Roger Hill, Eamonn Ferguson, Brigitte E Scammell, David A Walsh
OBJECTIVE: Osteoarthritis (OA) is a heterogeneous, multi-tissue disease. We hypothesised that different histopathological features characterise different stages during knee OA progression, and that discrete subgroups can be defined based on validated measures of OA histopathological features. DESIGN: Medial tibial plateaux and synovium were from 343 post-mortem (PM) and 143 OA arthroplasty donations. A `chondropathy/osteophyte' group (n=217) was classified as PM cases with osteophytes or macroscopic medial tibiofemoral chondropathy lesions ≥ grade 3 to represent pre-surgical (early) OA...
October 6, 2016: Osteoarthritis and Cartilage
Yaxia Zhang, Michael Joyce, Jean Schils, Thomas W Bauer
Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas, predominantly involving lung, mediastinal lymph nodes and other organs. Synovium involvement is infrequent, and as far as we know, involvement of a periprosthetic membrane has not been reported in the English literature. Intra-articular diffuse tenosynovial giant cell tumor ("conventional diffuse pigmented villonodular synovitis") is an uncommon, locally aggressive neoplasm with few previous case reports in which it arose in periprosthetic tissues after knee arthroplasty...
October 7, 2016: Skeletal Radiology
Olivier Malaise, Biserka Relic, Edith Charlier, Mustapha Zeddou, Sophie Neuville, Céline Deroyer, Philippe Gillet, Edouard Louis, Michel G Malaise, Dominique de Seny
BACKGROUND: Glucocorticoid-induced leucine zipper (GILZ) is a mediator of the anti-inflammatory activities of glucocorticoids. However, GILZ deletion does not impair the anti-inflammatory activities of exogenous glucocorticoids in mice arthritis models and GILZ could also mediate some glucocorticoid-related adverse events. Osteoarthritis (OA) is a metabolic disorder that is partly attributed to adipokines such as leptin, and we previously observed that glucocorticoids induced leptin secretion in OA synovial fibroblasts...
October 4, 2016: Arthritis Research & Therapy
Anna Koskinen-Kolasa, Katriina Vuolteenaho, Riku Korhonen, Teemu Moilanen, Eeva Moilanen
BACKGROUND: Previous studies provide evidence that adipokine leptin increases production of catabolic and proinflammatory factors in chondrocytes and serves as a link between obesity and osteoarthritis (OA). However, the magnitude of the response to leptin treatment varies greatly between chondrocytes from different donor patients. In the present study, we investigated the regulatory role of suppressor of cytokine signaling-3 (SOCS-3) in the leptin-induced responses in OA cartilage. METHODS: Cartilage and synovial fluid samples from 97 patients with OA undergoing knee replacement surgery were collected...
October 3, 2016: Arthritis Research & Therapy
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