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Latest & greatest articles for knee replacement
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Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement Update on physiotherapy rehabilitation after total knee or hip replacement Update on physiotherapy rehabilitation after total knee or hip replacement Ontario Health Technology Advisory Committee Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Ontario Health (...) Technology Advisory Committee. Update on physiotherapy rehabilitation after total knee or hip replacement. Toronto: Health Quality Ontario (HQO). OHTAC Recommendation. 2014 Authors' conclusions OHTAC recommends the health system support the move towards community-based physiotherapy after primary total knee or hip replacement and discharge from acute care. In regards to location of physiotherapy within the community, the health system should allow for flexibility, depending on the local care context
Functional outcome and alignment in computer-assisted and conventionally operated total kneereplacements: a multicentre parallel-group randomised controlled trial We performed a randomised controlled trial comparing computer-assisted surgery (CAS) with conventional surgery (CONV) in total kneereplacement (TKR). Between 2009 and 2011 a total of 192 patients with a mean age of 68 years (55 to 85) with osteoarthritis or arthritic disease of the knee were recruited from four Norwegian hospitals (...) . At three months follow-up, functional results were marginally better for the CAS group. Mean differences (MD) in favour of CAS were found for the Knee Society function score (MD: 5.9, 95% confidence interval (CI) 0.3 to 11.4, p = 0.039), the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for 'pain' (MD: 7.7, 95% CI 1.7 to 13.6, p = 0.012), 'sports' (MD: 13.5, 95% CI 5.6 to 21.4, p = 0.001) and 'quality of life' (MD: 7.2, 95% CI 0.1 to 14.3, p = 0.046). At one-year follow-up, differences
Aspirin for VTE prophylaxis in hip and kneereplacement surgery Aspirin for VTE prophylaxis in hip and kneereplacement surgery Aspirin for VTE prophylaxis in hip and kneereplacement surgery Mitchell MD, Williams K Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mitchell MD, Williams K. Aspirin for VTE prophylaxis in hip and kneereplacement surgery (...) . Philadelphia: Center for Evidence-based Practice (CEP). 2014 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Aspirins; Venous Thromboembolism Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market St. Suite 50, Philadelphia PA 19104
Preoperative education for hip or kneereplacement. Hip or kneereplacement is a major surgical procedure that can be physically and psychologically stressful for patients. It is hypothesised that education before surgery reduces anxiety and enhances clinically important postoperative outcomes.To determine whether preoperative education in people undergoing total hip replacement or total kneereplacement improves postoperative outcomes with respect to pain, function, health-related quality (...) trials of preoperative education (verbal, written or audiovisual) delivered by a health professional within six weeks of surgery to people undergoing hip or kneereplacement compared with usual care.Two review authors independently assessed trial quality and extracted data. We analysed dichotomous outcomes using risk ratios. We combined continuous outcomes using mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). Where possible, we pooled data using
Femoral nerve blocks for acute postoperative pain after kneereplacement surgery. Total kneereplacement (TKR) is a common and often painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia.To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web (...) , number needed to treat for an additional harmful outcome (NNTH) four, high-quality evidence), greater knee flexion (11 RCTs, 596 participants, MD 6.48 degrees, 95% CI 4.27 to 8.69 degrees, moderate-quality evidence) and greater patient satisfaction (four RCTs, 180 participants, SMD 1.06, 95% CI 0.74 to 1.38, low-quality evidence) compared with PCA.We could not demonstrate a difference in pain between FNB (any type) and epidural analgesia in the first 72 hours post operation, including pain at 24
Increased risk of revision for high flexion total kneereplacement with thicker tibial liners The outcome of total kneereplacement (TKR) using components designed to increase the range of flexion is not fully understood. The short- to mid-term risk of aseptic revision in high flexion TKR was evaluated. The endpoint of the study was aseptic revision and the following variables were investigated: implant design (high flexion vs non-high flexion), the thickness of the tibial insert (≤ 14 mm vs (...) > 14 mm), cruciate ligament (posterior stabilised (PS) vs cruciate retaining), mobility (fixed vs rotating), and the manufacturer (Zimmer, Smith & Nephew and DePuy). Covariates included patient, implant, surgeon and hospital factors. Marginal Cox proportional hazard models were used. In a cohort of 64 000 TKRs, high flexion components were used in 8035 (12.5%). The high flexion knees with tibial liners of thickness > 14 mm had a density of revision of 1.45/100 years of observation, compared
Computer assisted surgery for unicondylar and total kneereplacement Computer assisted surgery for unicondylar and total kneereplacement Computer assisted surgery for unicondylar and total kneereplacement Malaysian Health Technology Assessment (MaHTAS) Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Malaysian Health Technology (...) Assessment (MaHTAS). Computer assisted surgery for unicondylar and total kneereplacement. Putrajaya: Malaysian Health Technology Assessment (MaHTAS). 2014 Authors' objectives To review evidence on the effectiveness, safety and costeffectiveness of computer assisted surgery for unicondylar and total kneereplacement in patients with osteoarthritis. Authors' conclusions Computer assisted surgery or computer image-based navigation or robotic-assisted procedure has the potential to be used as alternative
Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement: OHTAC Recommendation. March 2014; pp. 1–9 Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement: OHTAC Recommendation Ontario Health Technology Advisory Committee March 2014 Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement: OHTAC Recommendation. March 2014; pp. 1–9 Suggested Citation This report (...) should be cited as follows: Ontario Health Technology Advisory Committee (OHTAC). Update on physiotherapy rehabilitation after total knee or hip replacement: OHTAC recommendation [Internet]. Toronto: Queen's Printer for Ontario; 2014 March. 9 p. Available from: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/ontario-health- technology-assessment-series/physiotherapy-rehabilitation-after-total-knee-or-hip-replacement. Permission Requests All inquiries regarding permission
A systematic review and meta-regression of mobile-bearing versus fixed-bearing total kneereplacement in 41 studies Mobile-bearing (MB) total kneereplacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical advantages of mobile- over fixed-bearing (FB) TKR have been found. In this study we evaluated whether mobile bearings have an advantage over fixed bearings with regard to revision rates and clinical outcome scores (...) . Furthermore, we determined which modifying variables affected the outcome. A systematic search of the literature was conducted to collect clinical trials comparing MB and FB in primary TKR. The primary outcomes were revision rates for any reason, aseptic loosening and wear. Secondary outcomes included range of movement, Knee Society score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score and radiological parameters. Meta-regression techniques were used to explore factors modifying the observed
Improved fixation in cementless unicompartmental kneereplacement: five-year results of a randomized controlled trial When used for appropriate indications, unicompartmental kneereplacement is associated with fewer complications, faster recovery, and better function than total kneereplacement. However, joint registries demonstrate a higher revision rate for unicompartmental kneereplacement. Currently, most unicompartmental kneereplacements are cemented; common reasons for revision include (...) aseptic loosening and pain. These problems could potentially be addressed by using cementless implants, with coatings designed to improve fixation. The objectives of this study were to compare the quality of fixation as well as clinical outcomes of cemented and cementless unicompartmental kneereplacements at five years of follow-up.A randomized controlled trial was established with sixty-three knees (sixty-two patients) receiving either cemented (thirty-two patients) or cementless Oxford
Is there reduced polyethylene wear and longer survival when using a mobile-bearing design in total kneereplacement? A meta-analysis of randomised and non-randomised controlled trials The purpose of this study was to undertake a meta-analysis to determine whether there is lower polyethylene wear and longer survival when using mobile-bearing implants in total kneereplacement when compared with fixed-bearing implants. Of 975 papers identified, 34 trials were eligible for data extraction and meta (...) -analysis comprising 4754 patients (6861 knees). We found no statistically significant differences between the two designs in terms of the incidence of radiolucent lines, osteolysis, aseptic loosening or survival. There is thus currently no evidence to suggest that the use of mobile-bearing designs reduce polyethylene wear and prolong survival after total kneereplacement.
Do modern total kneereplacements offer better value for money? A health economic analysis Do modern total kneereplacements offer better value for money? A health economic analysis Do modern total kneereplacements offer better value for money? A health economic analysis Hamilton DF, Clement ND, Burnett R, Patton JT, Moran M, Howie CR, Simpson AH, Gaston P Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract (...) replacements offer better value for money? A health economic analysis. International Orthopaedics 2013; 37(11): 2147-2152 PubMedID DOI Indexing Status Subject indexing assigned by NLM MeSH Aged; Arthroplasty, Replacement, Knee /economics /instrumentation /methods; Cost-Benefit Analysis; Disability Evaluation; Female; Health Care Costs /statistics & Humans; Knee Joint /physiology /surgery; Knee Prosthesis /economics; Life Expectancy; Male; Middle Aged; Osteoarthritis, Knee /surgery; Quality of Life; Quality
Analgesia after total kneereplacement: local infiltration versus epidural combined with a femoral nerve blockade: a prospective, randomised pragmatic trial In a randomised controlled pragmatic trial we investigated whether local infiltration analgesia would result in earlier readiness for discharge from hospital after total kneereplacement (TKR) than patient-controlled epidural analgesia (PCEA) plus femoral nerve block. A total of 45 patients with a mean age of 65 years (49 to 81) received
Does exercise reduce pain and improve physical function before hip or kneereplacement surgery? A systematic review and meta-analysis of randomized controlled trials Does exercise reduce pain and improve physical function before hip or kneereplacement surgery? A systematic review and meta-analysis of randomized controlled trials Does exercise reduce pain and improve physical function before hip or kneereplacement surgery? A systematic review and meta-analysis of randomized controlled trials (...) Gill SD, McBurney H CRD summary The review concluded that exercise-based interventions can reduce pain and improve physical function for people awaiting hip replacement surgery but not kneereplacement surgery. A lack of evidence regarding sustained preoperative improvements, coupled with some review limitations, means the authors' conclusions appear somewhat over-optimistic. Authors' objectives To investigate the effect of exercise-based interventions on pain and physical function prior to joint
Five-year results of a randomised controlled trial comparing mobile and fixed bearings in total kneereplacement There is conflicting evidence about the merits of mobile bearings in total kneereplacement, partly because most randomised controlled trials (RCTs) have not been adequately powered. We report the results of a multicentre RCT of mobile versus fixed bearings. This was part of the knee arthroplasty trial (KAT), where 539 patients were randomly allocated to mobile or fixed bearings (...) difference between trial groups in OKS at five years (-1.12 (95% confidence interval -2.77 to 0.52) or any of the other outcome measures. Furthermore, there was no significant difference in the proportion of patients with knee-related re-operations or in total costs. In this appropriately powered RCT, over the first five years after total kneereplacement functional outcomes, re-operation rates and healthcare costs appear to be the same irrespective of whether a mobile or fixed bearing is used.
Steroid modulation of cytokine release and desmosine levels in bilateral total kneereplacement: a prospective, double-blind, randomized controlled trial The perioperative inflammatory response as measured by elevated levels of interleukin-6 (IL-6) has been linked to acute respiratory distress syndrome, postoperative confusion, and fever. Because of the extent of surgery,patients undergoing bilateral total knee arthroplasty may be at high risk of complications. We had found a significant (...) decrease in IL-6 in patients having bilateral total kneereplacement who received two doses of 100 mg of hydrocortisone eight hours apart; however, by twenty-four hours, IL-6 levels were equal to those in the group that received a placebo. In the present study, we investigated whether the administration of three doses would reduce IL-6 levels at twenty-four hours and affect other outcomes such as desmosine level, a marker of lung injury.After institutional review board approval, a total of thirty-four
Does Exercise Reduce Pain and Improve Physical Function Before Hip or KneeReplacement Surgery? A Systematic Review and Meta-Analysis of Randomized Controlled Trials To investigate the preoperative effects of exercise-based interventions on pain and physical function for people awaiting joint replacement surgery of the hip or knee.Four computer databases (CINAHL, MEDLINE, Embase, and Cochrane Library) were searched until July 4, 2012. Search terms included knee, hip, joint replacement (...) , arthroplasty, physiotherapy, physical therapy, exercise, hydrotherapy, rehabilitation, and preoperative. Reference lists of retrieved articles were also screened.Randomized or quasi-randomized studies comparing an exercise-based intervention with a no-intervention group for people awaiting hip or knee joint replacement surgery were included. Outcomes were pain and physical function including self-reported function, walking speed, and muscle strength. One of 2 reviewers determined that 18 studies met
Cryotherapy Machines versus Ice Packs for the Post-Operative Management of Anterior Cruciate Ligament Replacement Surgery or Total Knee Arthroplasty: Clinical Evidence and Guidelines 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 (...) by the owners’ own terms and conditions. TITLE: Cryotherapy Machines versus Ice Packs for the Post-Operative Management of Anterior Cruciate Ligament Replacement Surgery or Total Knee Arthroplasty: Clinical Evidence and Guidelines DATE: 28 November 2012 RESEARCH QUESTIONS 1. What is the clinical evidence for the use of cyrotherapy machines versus ice packs for the post-operative management of anterior cruciate ligament replacement surgery or total knee arthroplasty? 2. What are the evidence-based guidelines
Does a mobile-bearing, high-flexion design increase knee flexion after total kneereplacement? This prospective randomised controlled double-blind trial compared two types of PFC Sigma total kneereplacement (TKR), differing in three design features aimed at improving flexion. The outcome of a standard fixed-bearing posterior cruciate ligament-preserving design (FB-S) was compared with that of a high-flexion rotating-platform posterior-stabilised design (RP-F) at one year after TKR. The study (...) group of 77 patients with osteoarthritis of the knee comprised 37 men and 40 women, with a mean age of 69 years (44.9 to 84.9). The patients were randomly allocated either to the FB-S or the RP-F group and assessed pre-operatively and at one year post-operatively. The mean post-operative non-weight-bearing flexion was 107° (95% confidence interval (CI) 104° to 110°)) for the FB-S group and 113° (95% CI 109° to 117°) for the RP-F group, and this difference was statistically significant (p = 0.032