Latest & greatest articles for knee replacement

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Top results for knee replacement

1. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. (PubMed)

The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Late-stage isolated medial knee osteoarthritis can be treated with total knee replacement (TKR) or partial knee replacement (PKR). There is high variation in treatment choice and little robust evidence to guide selection. The Total or Partial Knee Arthroplasty Trial (TOPKAT) therefore aims to assess (...) the clinical effectiveness and cost-effectiveness of TKR versus PKR in patients with medial compartment osteoarthritis of the knee, and this represents an analysis of the main endpoints at 5 years.Our multicentre, pragmatic randomised controlled trial was done at 27 UK sites. We used a combined expertise-based and equipoise-based approach, in which patients with isolated osteoarthritis of the medial compartment of the knee and who satisfied general requirements for a medial PKR were randomly assigned (1:1

2019 Lancet

2. The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling

The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation (...) or try a website search above to find the information you need. >> >> >> >> Issue {{metadata .Issue }} Toolkit 1)"> 0)"> 1)"> {{metadata.Title}} {{metadata.Headline}} The Oxford hip and knee scores can be used to assess individuals' suitability for surgery, and this study showed that surgery nearly always costs less than £20,000 per QALY. {{author}} {{($index , , , , , , , , , , , , , , , , , , , , , , , , & . Andrew Price 1, * , James Smith 1 , Helen Dakin 2 , Sujin Kang 1 , Peter Eibich 2

2019 NIHR HTA programme

3. Addition of Adductor Canal Block to Periarticular Injection for Total Knee Replacement: A Randomized Trial

Addition of Adductor Canal Block to Periarticular Injection for Total Knee Replacement: A Randomized Trial Periarticular injection is a popular method to control postoperative pain after total knee replacement. An adductor canal block is a sensory block that can also help to alleviate pain after total knee replacement. We hypothesized that the combination of adductor canal block and periarticular injection would allow patients to reach discharge criteria 0.5 day faster than with periarticular

2019 EvidenceUpdates

4. Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up Refractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA (...) , and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.This was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA

2019 EvidenceUpdates

5. Diagnostic Accuracy of Serum, Synovial, and Tissue Testing for Chronic Periprosthetic Joint Infection After Hip and Knee Replacements: A Systematic Review

Diagnostic Accuracy of Serum, Synovial, and Tissue Testing for Chronic Periprosthetic Joint Infection After Hip and Knee Replacements: A Systematic Review Chronic periprosthetic joint infection (PJI) is a devastating complication that can occur following total joint replacement. Patients with chronic PJI report a substantially lower quality of life and face a higher risk of short-term mortality. Establishing a diagnosis of chronic PJI is challenging because of conflicting guidelines, numerous (...) involving the diagnosis of chronic PJI in patients with hip or knee replacement. Eligible studies were assessed for quality and bias using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analyses were performed on tests with sufficient data points. Summary estimates and hierarchical summary receiver operating characteristic (HSROC) curves were obtained using a bivariate model.A total of 12,616 citations were identified, and 203 studies met the inclusion criteria

2019 EvidenceUpdates

6. Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial

Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited.To compare the effectiveness of later-stage exercise (...) germane to knee replacement and additional surveys of physical function. Data were analyzed by linear mixed models and responder analysis.A total of 240 participants (mean [SD] age, 70 [7] years; 61.7% female) were allocated to physical therapy (n = 96), community exercise (n = 96), or control (n = 48). All 3 arms demonstrated clinically important improvement. At 3 months, between-arm analyses for the WOMAC-PF demonstrated no differences between physical therapy and community (-2.2; 98.3% CI, -4.5

2019 EvidenceUpdates

7. Perioperative Dietary Restriction of Carbohydrates in the Management of Blood Glucose Levels in Patients Undergoing Total Knee Replacement

Perioperative Dietary Restriction of Carbohydrates in the Management of Blood Glucose Levels in Patients Undergoing Total Knee Replacement Approximately 75% of the US population over 65 years has prediabetes or diabetes. Despite current evidence for the efficacy of carbohydrate restriction in managing blood glucose, this practice has not been implemented as part of routine perioperative blood sugar management. We hypothesize that a carbohydrate reduced hospital diet (CRD) of 135 g/d may improve (...) blood sugar levels following total knee arthroplasty (TKA) compared to a non-carbohydrate reduced hospital diet (NCRD).We randomized non-insulin-dependent prediabetic and diabetic patients undergoing TKA to either an NCRD or a CRD. Sixty-four patients were enrolled in the study and 2 were excluded, leading to 62 patients in the final analysis. The NCRD group included 14 females (47%) and 16 males (53%), with mean age of 68.5 years (±6.3 years). The CRD group included 16 females (50%) and 16 males

2019 EvidenceUpdates

8. What is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis

What is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis Total knee replacement (TKR) patients participate in early supervised exercise therapy programs, despite a lack of evidence for such programs or the optimal type, duration or frequency to provide the best clinical outcomes. As hospital stay rates decrease worldwide, the first days after joint replacement surgery are of increasing clinical importance (...) postoperatively, and the Modified Quadriceps Setting group showed greater hamstring and gluteal muscle strength. Results of the methodological quality assessment showed included studies were of moderate quality. The meta-analysis included 3 of the 4 trials and found no significant differences between groups in maximum knee flexion (MD = 1.34; 95% CI, - 5.55-8.24) or knee society scores (MD = - 1.17; 95% CI, - 4.32-1.98) assessed at 6 weeks post-operatively.The paucity and heterogeneity of existing studies

2019 EvidenceUpdates

9. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. (PubMed)

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making.Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large

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2019 BMJ

10. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. (PubMed)

How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Knee replacements are the mainstay of treatment for end-stage osteoarthritis and are effective. Given time, all knee replacements will fail and knowing when this failure might happen is important. We aimed to establish how long a knee replacement lasts.In this systematic review and meta-analysis, we searched MEDLINE and Embase for case (...) series and cohort studies published from database inception until July 21, 2018. Articles reporting 15 year or greater survival of primary total knee replacement (TKR), unicondylar knee replacement (UKR), and patellofemoral replacements in patients with osteoarthritis were included. Articles that reviewed specifically complex primary surgeries or revisions were excluded. Survival and implant data were extracted, with all-cause survival of the knee replacement construct being the primary outcome. We

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2019 Lancet

11. One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements

One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements Discover Portal Discover Portal One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements Published on 30 August 2016 doi: A one-stage knee replacement procedure to treat an infected prosthetic knee may offer similar outcomes for most people as the more commonly used two (...) replacement surgery. Using one-stage revision surgery to treat suitable patients would reduce hospital time and improve patient experience. Patient selection will remain important and patient registries could be used to monitor outcomes. Share your views on the research. Why was this study needed? Knee replacement surgery (arthroplasty) replaces a damaged or diseased knee with an artificial joint. More than 70,000 knee replacements are carried out in England and Wales each year, and the number is rising

2019 NIHR Dissemination Centre

12. Nexgen found to be best value for total knee replacement

Nexgen found to be best value for total knee replacement Nexgen found to be best value for total knee replacement Discover Portal Discover Portal Nexgen found to be best value for total knee replacement Published on 28 June 2016 doi: This economic analysis, using routinely collected National Joint Registry data from 2003 to 2012, found that Nexgen was the most cost-effective brand of prosthesis for total knee replacement. The cheapest brand was AGC Biomet, but Nexgen gave greater quality (...) of life improvement, and the additional cost for the benefit - £2,300 per quality-adjusted life-year - was well within usual willingness to pay thresholds. Nexgen also had the lowest rates of revision surgery. The study is the first to compare commonly-used prostheses for patient outcomes, costs and revision rates (how soon the replacement knee needed replacing). The comparisons relied on non-randomised, routinely collected data, and although the authors made every effort to correct for possible bias

2019 NIHR Dissemination Centre

13. Partial knee replacements may save costs compared with total knee replacements

Partial knee replacements may save costs compared with total knee replacements Partial and total knee replacement costs compared Discover Portal Discover Portal Partial knee replacements may save costs compared with total knee replacements Published on 27 November 2018 doi: Partial knee replacements, when performed by experienced surgeons, can save costs and improve quality of life compared with total knee replacements. Partial replacements for selected patients improve quality of life and save (...) between £600 and £2,000 over the patient’s lifetime, depending on age and gender. Knee replacements are commonly performed for people with ongoing pain and poor function. If the damage is limited to one side of the knee, it may be suitable to replace just the affected side (unicompartmental replacement) rather than replacing the entire knee joint. This study compared costs and quality of life associated with both procedures using the National Joint Registry for England and Wales, with patients matched

2019 NIHR Dissemination Centre

14. Two types of anaesthesia are safe for hip and knee replacements but one may reduce the time spent in hospital by a few hours

Two types of anaesthesia are safe for hip and knee replacements but one may reduce the time spent in hospital by a few hours Two types of anaesthesia are safe for hip and knee replacements but one may reduce the time spent in hospital by a few hours Discover Portal Discover Portal Two types of anaesthesia are safe for hip and knee replacements but one may reduce the time spent in hospital by a few hours Published on 15 March 2016 doi: Neuraxial anaesthesia, administered around the nerves (...) in the spine, was found to be as safe as general anaesthesia for people undergoing total hip or knee replacements. This review found a similar risk of dying, infection, nerve damage and blood clots in people regardless of the type of anaesthesia. Hospital stay was reduced on average by 0.4 days in the neuraxial anaesthesia group, though the significance to patients or impact on costs was not explored. Using neuraxial anaesthesia took no longer to perform than general anaesthesia. Hip and knee replacements

2019 NIHR Dissemination Centre

15. The Effect of Prosthetic Design and Polyethylene Type on the Risk of Revision for Infection in Total Knee Replacement: An Analysis of 336,997 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry

The Effect of Prosthetic Design and Polyethylene Type on the Risk of Revision for Infection in Total Knee Replacement: An Analysis of 336,997 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry Periprosthetic infection following total knee replacement remains alarmingly frequent, is devastating for patients, and is an increasingly substantial public health burden. While both the prosthetic design elements and type of polyethylene used in total knee (...) replacement can independently affect survivorship of the prosthesis, their influence on the risk of revision for infection is unknown. Therefore, we examined the effects of total knee prosthetic design and type of polyethylene bearing on the long-term revision risk for nonacute infection following total knee replacement by comparing 4 different cohorts: patients who had minimally stabilized total knee prostheses with crosslinked polyethylene (XLPE) bearing surfaces, minimally stabilized total knee

2019 EvidenceUpdates

16. A comparison of the clinical outcomes of cemented and cementless knee replacements

A comparison of the clinical outcomes of cemented and cementless knee replacements Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email

2019 PROSPERO

17. The determinants of aseptic loosening following a primary total hip or knee replacement: a systematic review and meta-analysis

The determinants of aseptic loosening following a primary total hip or knee replacement: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any

2019 PROSPERO

18. What pre-operative factors predict discharge destination following total knee replacement surgery? A systematic review and meta-analysis

What pre-operative factors predict discharge destination following total knee replacement surgery? A systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration

2019 PROSPERO

19. KNee Implant Prostheses Study. The choice between implants in total knee replacement: a systematic review and network meta-analysis

KNee Implant Prostheses Study. The choice between implants in total knee replacement: a systematic review and network meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record

2019 PROSPERO

20. Comparison of direct oral anticoaugulants and enoxaparin for preventing major vascular events after total hip or knee replacement: a network meta-analysis

Comparison of direct oral anticoaugulants and enoxaparin for preventing major vascular events after total hip or knee replacement: a network meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO