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Latest & greatest articles for knee replacement
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No radiological and clinical advantages with patient-specific positioning guides in total kneereplacement Background and purpose - Although the use of patient-specific positioning guides (PSPGs) in total kneereplacement (TKR) in theory is promising, the technique has not yet proven its superior- ity compared with the conventional method. We compared radio- logical alignment and clinical outcome between TKR performed with the use of PSPGs and the conventional operation method. Patients (...) and methods - 3 hospitals participated in a prospec- tive trial. 109 patients were randomized to either the conventional method or to the use of PSPGs. Postoperatively a full-length standing anteroposterior radiograph and a postoperative CT scan were taken. On the CT scan the alignments were measured for both the femoral and tibial components in the frontal, sagit- tal, and axial plane. The Knee injury and Osteoarthritis Outcome Score (KOOS), the Eurocol-5D-3L (Eq5D) descriptive system and visual analogue
A Meta-Analysis of Patellar Replacement in Total Knee Arthroplasty for Patients With Knee Osteoarthritis This meta-analysis (MA) aims at comparing the clinical outcomes of resurfacing and nonresurfacing the patella in patients undergoing total knee arthroplasty in the treatment of knee osteoarthritis.Randomized controlled trials were included by retrieving data from electronic English databases. Both fixed and random-effects models were employed, and standardized mean difference and 95 (...) % confidence intervals were calculated. Stata13.1 software was used for statistical analysis for all the studies included to compare the differences in improving Knee Society Clinical Score and Knee Society Function Score as well as the reduction in rates of infection, reoperation, and anterior knee pain.A total of 394 studies were initially included in this MA. About 20 randomized controlled trials which met the inclusion criteria were finally enrolled in this MA. The results of our MA showed
Does standing a patient on the day of surgery following a primary unilateral total hip or kneereplacement reduce the length of hospital stay? Recently Reviewed and Updated CAT: May 2018 Previous CAT Lead: Alison Morris Updated CAT Lead Greg Bicker Date CAT to be reviewed: Insert date Date CAT completed: May 2018 e mail of CAT Lead firstname.lastname@example.org 1 1 Short Question: Specific Question: Does standing a patient on the day of surgery following a primary unilateral total hip or knee (...) replacement reduce the length of hospital stay? Clinical bottom line There is limited, low quality evidence to support reduction in length of stay (LOS) following same day mobilisation in patients undergoing primary Total Hip Replacements (THR) and primary Total KneeReplacements (TKR). However, as the previous CAT concluded, there is evidence to support same day mobilisation as part of a multidisciplinary enhanced recovery protocol, to reduce LOS Clinical bottom line CAT 2010: “There is evidence to show
Effect of bisphosphonates on kneereplacement surgery Bone remodelling as a therapeutic target in knee osteoarthritis (OA) has gained much interest, but the effects of antiresorptive agents on knee OA have been conflicting, with no studies to date examining the effects of bisphosphonate use on the clinically relevant endpoint of kneereplacement (KR) surgery.We used data from The Health Improvement Network (THIN), a general practitioner electronic medical records representative of the general (...) UK population. We identified older women who had initiated bisphosphonate use after their incident knee OA diagnosis. Each bisphosphonate initiator was propensity score-matched with a non-initiator within each 1-year cohort accrual block. The effect of bisphosphonates on the risk of KR was assessed using Cox proportional hazard regression. Sensitivity analyses to address residual confounding were also conducted.We identified 2006 bisphosphonate initiators, who were matched to 2006 non-initiators
Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or KneeReplacement Surgery: A Randomized Controlled Trial Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or kneereplacement surgery.In a randomized, double-blind, 2-center trial (...) , patients of 60 years or older who underwent elective total hip or kneereplacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline). All patients received combined spinal-epidural anesthesia during surgery and IV morphine for postoperative analgesia. The primary outcome was the incidence of delirium within 5 days after surgery.Between January 2011 and May 2013, 620 patients were enrolled and were
The Main Cause of Death Following Primary Total Hip and KneeReplacement for Osteoarthritis: A Cohort Study of 26,766 Deaths Following 332,734 Hip Replacements and 29,802 Deaths Following 384,291 KneeReplacements Patients undergoing primary total joint replacement are selected for surgery and thus (other than having a transiently increased mortality rate postoperatively) have a lower mortality rate than age and sex-matched individuals do. Understanding the causes of death following joint (...) replacement would allow targeted strategies to reduce the risk of death and optimize outcome. We aimed to determine the rates and causes of mortality for patients undergoing primary total hip or kneereplacement compared with individuals in the general population who were matched for age and sex.We compared causes and rates of mortality between age and sex-matched individuals in the general population (National Joint Registry for England, Wales and Northern Ireland; Hospital Episode Statistics; and Office
Impact of total kneereplacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. Objectives To evaluate the impact of total kneereplacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms.Design Marginal structural modeling and cost effectiveness analysis based on lifetime predictions for total kneereplacement and death (...) from population based cohort data.Setting Data from two studies-Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST)-within the US health system.Participants 4498 participants with or at high risk for knee osteoarthritis aged 45-79 from the OAI with no previous kneereplacement (confirmed by baseline radiography) followed up for nine years. Validation cohort comprised 2907 patients from MOST with two year follow-up.Intervention Scenarios ranging from current practice
The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing (...) for surgery.We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total kneereplacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery.We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total kneereplacement between Jan 1
Kneereplacement in chronic post-traumatic cases Post-traumatic knee arthritis is a challenging condition. Prosthetic surgery is demanding and the risk of complications is relatively high.Planning is an essential element of this surgery; correct diagnosis (to exclude latent infection) and adequate considerations regarding approach, axis, bone loss, choice of implant and level of constraint are indispensable.There are two main categories of post-traumatic arthritis: extra-articular deformities (...) and articular deformities.Use of an algorithms can support the surgeon's choice of implant.Correct implant positioning and limb alignment restoration is associated with very good results, similar to those achieved with standard total knee arthroplasty. Cite this article: Benazzo F, Rossi SMP, Combi A, Meena S, Ghiara M. Kneereplacement in chronic post-traumatic cases. EFORT Open Rev 2016:1:211-218. DOI: 10.1302/2058-5241.1.000025.
Guided Imagery for Total KneeReplacement: A Randomized, Placebo-Controlled Pilot Study. To determine the effect of guided imagery (GI) on functional outcomes of total kneereplacement (TKR), explore psychological and neuroimmune mediators, and assess feasibility of study implementation.Investigator-blinded, randomized, placebo-controlled pilot study.Hospital, surgeon's office, participant's home.82 persons undergoing TKR.Audiorecordings of TKR-specific GI scripts or placebo-control (...) audiorecordings of audiobook segments.Gait velocity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Function scale.Outcomes for 58 participants (29 receiving GI and 29 controls) were analyzed at 6 months after surgery. The most frequent reason for noncompletion was protocol-driven exclusion at 6 months for having the contralateral kneereplaced before the study endpoint (n = 15). With imaging ability as a moderator, gait velocity, but not WOMAC Function score, was significantly improved
Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or kneereplacement or hip fracture repair. The optimal duration of thromboprophylaxis after total hip or kneereplacement, or hip fracture repair remains controversial. It is common practice to administer prophylaxis using low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) until discharge from hospital, usually seven to 14 days after surgery. International guidelines recommend (...) undergoing elective hip or kneereplacement surgery, or hip fracture repair.The Cochrane Vascular Information Specialist searched the Specialised Register (last searched May 2015) and CENTRAL (2015, Issue 4). Clinical trials databases were searched for ongoing or unpublished studies.Randomised controlled trials assessing extended-duration thromboprophylaxis (five to seven weeks) using accepted prophylactic doses of LMWH, UFH, vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) compared
Outcome of total kneereplacement following explantation and cemented spacer therapy Infection after total kneereplacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two (...) -setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation.A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient's group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging
A Randomized, Controlled Trial of Total KneeReplacement. More than 670,000 total kneereplacements are performed annually in the United States; however, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking.In this randomized, controlled trial, we enrolled 100 patients with moderate-to-severe knee osteoarthritis who were eligible for unilateral total kneereplacement. Patients were randomly assigned to undergo total knee (...) replacement followed by 12 weeks of nonsurgical treatment (total-knee-replacement group) or to receive only the 12 weeks of nonsurgical treatment (nonsurgical-treatment group), which was delivered by physiotherapists and dietitians and consisted of exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the change from baseline to 12 months in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, activities
Prophylactic Tranexamic Acid Administration for Patients Undergoing Hip and KneeReplacement Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid (...) Administration for Patients Undergoing Hip and KneeReplacement: Clinical Effectiveness, Cost-Effectiveness, and Guidelines DATE: 16 June 2015 RESEARCH QUESTIONS 1. What is the clinical effectiveness of the administration of tranexamic acid for blood conservation in patients who are undergoing hip or kneereplacement surgery? 2. What is the cost-effectiveness of the administration of tranexamic acid for blood conservation in patients who are undergoing hip or kneereplacement surgery? 3. What
Smith & Nephew Journey II Oxinium Total KneeReplacement System Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic review s. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts w ithin the time allow ed. Rapid responses should be considered (...) Replacement Systems: Clinical and Cost- Effectiveness and Guidelines DATE: 19 March 2015 RESEARCH QUESTIONS 1. What is the clinical effectiveness of Smith & Nephew Journey total kneereplacement systems in patients requiring total kneereplacement? 2. What is the cost-effectiveness of Smith & Nephew Journey total kneereplacement systems in patients requiring total kneereplacement? 3. What are the evidence-based guidelines associated with the use of Smith & Nephew Journey total kneereplacement systems
Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: A systematic review To systematically review the effect of early mobilization after hip or knee joint replacement surgery on length of stay in an acute hospital.Randomized controlled trials were selected from electronic databases based on inclusion criterion requiring an experimental group mobilizing (sitting out of bed/walking) earlier than a comparison group post joint replacement (...) 48 hours post operatively. Individual trials reported benefits in range of motion, muscle strength and health-related quality of life in favor of the experimental group. There were no differences in discharge destinations, incidence of negative outcomes or adverse events attributable to early mobilization when compared to the comparison groups.Early mobilization post hip or knee joint replacement surgery can result in a reduced length of stay of about 1.8 days. Trials that reported these positive
Appraisal of evidence base for introduction of new implants in hip and kneereplacement: a systematic review of five widely used device technologies. To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare.Systematic review of clinical trials, comparative observational studies (...) ) and two in total kneereplacement (high flexion kneereplacement and gender specific kneereplacement). All clinical studies of primary total hip or kneereplacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors
Adverse outcomes after total and unicompartmental kneereplacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales. Total kneereplacement (TKR) or unicompartmental kneereplacement (UKR) are options for end-stage osteoarthritis. However, comparisons between the two procedures are confounded by differences in baseline characteristics of patients undergoing either procedure and by insufficient reporting of endpoints other than revision. We
45-day mortality after 467 779 kneereplacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Understanding the risk factors for early death after kneereplacement could help to reduce the risk of mortality after this procedure. We assessed secular trends in death within 45 days of kneereplacement for osteoarthritis in England and Wales, with the aim of investigating whether any change that we recorded could be explained by alterations (...) in modifiable perioperative factors.We took data for kneereplacements done for osteoarthritis in England and Wales between April 1, 2003, and Dec 31, 2011, from the National Joint Registry for England and Wales. Patient identifiers were used to link these data to the national mortality database and the Hospital Episode Statistics database to obtain details of death, sociodemographics, and comorbidity. We assessed mortality within 45 days by Kaplan-Meier analysis and assessed the role of patient