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Latest & greatest articles for knee replacement
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Cancellation of Hip and KneeReplacement Surgeries: 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 that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along (...) . It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions. TITLE: Cancellation of Hip and KneeReplacement Surgeries: Guidelines
Rationing of total kneereplacement: a cost-effectiveness analysis on a large trial data set Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
The blood-saving effect of tranexamic acid in minimally invasive total kneereplacement: Is an additional pre-operative injection effective? Tranexamic acid (TEA), an inhibitor of fibrinolysis, reduces blood loss after routine total kneereplacement (TKR). However, controversy persists regarding the dosage and timing of administration of this drug during surgery. We performed a prospective randomised controlled study to examine the optimum blood-saving effect of TEA in minimally invasive TKR
Review: Factor Xa inhibitors reduce DVT more than LMWH in total knee or hip replacement. 22910959 2012 10 19 2012 08 22 1539-3704 157 4 2012 Aug 21 Annals of internal medicine Ann. Intern. Med. ACP Journal Club: review: factor Xa inhibitors reduce DVT more than LMWH in total knee or hip replacement. JC2-5 10.7326/0003-4819-157-4-201208210-02005 Bona Robert R Frank H. Netter School of Medicine at Quinnipiac University Hamden, Connecticut, USA. eng Comment Journal Article United States Ann Intern
Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic review, meta-analysis, and indirect treatment comparisons Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic review, meta-analysis, and indirect treatment comparisons Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic (...) review, meta-analysis, and indirect treatment comparisons Gomez-Outes A, Terleira-Fernandez AI, Suarez-Gea L, Vargas-Castrillon E CRD summary This generally well-conducted review concluded that higher efficacy in prevention of symptomatic venous thromboembolism in new anticoagulants following total knee or hip replacement was associated with a higher risk of bleeding. This conclusion accurately reflects the evidence and is likely to be reliable. Authors' objectives To assess clinical outcomes
Do we need a gender-specific total kneereplacement? A randomised controlled trial comparing a high-flex and a gender-specific posterior design The purpose of this study was to investigate whether a gender-specific high-flexion posterior-stabilised (PS) total kneereplacement (TKR) would offer advantages over a high-flex PS TKR regarding range of movement (ROM), 'feel' of the knee, pain and satisfaction, as well as during activity. A total of 24 female patients with bilateral osteoarthritis (...) entered this prospective, blind randomised trial in which they received a high-flex PS TKR in one knee and a gender-specific high-flexion PS TKR in the other knee. At follow-up, patients were assessed clinically measuring ROM, and questioned about pain, satisfaction and daily 'feel' of each knee. Patients underwent gait analysis pre-operatively and at one year, which yielded kinematic, kinetic and temporospatial parameters indicative of knee function during gait. At final follow-up we found
Apixaban versus enoxaparin for thromboprophylaxis after hip or kneereplacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials In order to compare the effect of oral apixaban (a factor Xa inhibitor) with subcutaneous enoxaparin on major venous thromboembolism and major and non-major clinically relevant bleeding after total knee and hip replacement, we conducted a pooled analysis of two previously reported double-blind (...) randomised studies involving 8464 patients. One group received apixaban 2.5 mg twice daily (plus placebo injection) starting 12 to 24 hours after operation, and the other received enoxaparin subcutaneously once daily (and placebo tablets) starting 12 hours (± 3) pre-operatively. Each regimen was continued for 12 days (± 2) after knee and 35 days (± 3) after hip arthroplasty. All outcomes were centrally adjudicated. Major venous thromboembolism occurred in 23 of 3394 (0.7%) evaluable apixaban patients
Long-Term Comparison of Fixed-Bearing and Mobile-Bearing Total KneeReplacements in Patients Younger Than Fifty-one Years of Age with Osteoarthritis There is limited information comparing the results of fixed-bearing total kneereplacement and mobile-bearing total kneereplacement in patients with osteoarthritis who are younger than fifty-one years and who have a fixed-bearing implant in one knee and a mobile-bearing implant in the other. The purpose of this study was to compare our long-term (...) clinical and radiographic results of fixed-bearing total kneereplacement and mobile-bearing total kneereplacement in a group of patients from this population.We prospectively compared the results of 108 patients with osteoarthritis who were younger than fifty-one years (mean age, forty-five years) who had received a fixed-bearing prosthesis in one knee and a rotating platform mobile-bearing prosthesis in the other. The mean follow-up was 16.8 years (range, fifteen to eighteen years). The patients
Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic review, meta-analysis, and indirect treatment comparisons. To analyse clinical outcomes with new oral anticoagulants for prophylaxis against venous thromboembolism after total hip or knee replacement.Systematic review, meta-analysis, and indirect treatment comparisons.Medline and CENTRAL (up to April 2011), clinical trials registers, conference proceedings, and websites (...) of regulatory agencies.Randomised controlled trials of rivaroxaban, dabigatran, or apixaban compared with enoxaparin for prophylaxis against venous thromboembolism after total hip or kneereplacement. Two investigators independently extracted data. Relative risks of symptomatic venous thromboembolism, clinically relevant bleeding, deaths, and a net clinical endpoint (composite of symptomatic venous thromboembolism, major bleeding, and death) were estimated using a random effect meta-analysis. RevMan and ITC
Oral direct factor Xa inhibitors versus low-molecular-weight heparin to prevent venous thromboembolism in patients undergoing total hip or kneereplacement: a systematic review and meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Oral Direct Factor Xa Inhibitors Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Patients Undergoing Total Hip or KneeReplacement: A Systematic Review and Meta-analysis. Thromboembolic disease is the most frequent medical complication of arthroplasty.To evaluate the benefits and harms of oral direct factor Xa inhibitors versus low-molecular-weight heparin (LMWH) in patients undergoing total hip or knee replacement.MEDLINE (1966 to December 2011), EMBASE (1980 (...) to December 2011), and the Cochrane Central Register of Controlled Trials (up to December 2011), without language restrictions. References of reviews and abstracts of conferences were hand-searched.Randomized trials in patients undergoing hip or kneereplacement that evaluated factor Xa inhibitors versus LMWH.Two reviewers independently evaluated eligibility, abstracted the data, and assessed risk for bias.In 22 trials, high-quality evidence indicated that the absolute effect of factor Xa inhibitors
Kneereplacement. Knee-replacement surgery is frequently done and highly successful. It relieves pain and improves knee function in people with advanced arthritis of the joint. The most common indication for the procedure is osteoarthritis. We review the epidemiology of and risk factors for kneereplacement. Because replacement is increasingly considered for patients younger than 55 years, improved decision making about whether a patient should undergo the procedure is needed. We discuss (...) assessment of surgery outcomes based on data for revision surgery from national joint-replacement registries and on patient-reported outcome measures. Widespread surveillance of existing implants is urgently needed alongside the carefully monitored introduction of new implant designs. Developments for the future are improved delivery of care and training for surgeons and clinical teams. In an increasingly ageing society, the demand for knee-replacement surgery will probably rise further, and we predict
Tranexamic acid in total kneereplacement: A systematic review and meta-analysis We conducted a systematic review and meta-analysis of randomised controlled trials evaluating the effect of tranexamic acid (TXA) upon blood loss and transfusion in primary total kneereplacement. The review used the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. A total of 19 trials were eligible: 18 used intravenous administration, one also evaluated oral dosing and one
Patellar resurfacing in primary total kneereplacement: a meta-analysis Treatment of the patella during total kneereplacement is an area of continuing debate. We performed a meta-analysis of randomized controlled trials to address the hypothesis that patellar resurfacing in primary total kneereplacement improved patient outcome.Randomized controlled trials comparing patellar resurfacing with nonresurfacing in primary total kneereplacement were included. The primary outcomes analyzed were (...) knee scores, anterior knee pain, and patient satisfaction. We also investigated the prevalence of complications, revision surgery related specifically to the patellofemoral joint, the infection rate, operative time, and radiographic appearance.Sixteen randomized controlled trials assessing 3465 kneereplacements were eligible; 1710 procedures included patellar resurfacing and 1755 did not. The knee component of the Knee Society Score was significantly higher in the resurfacing group (p = 0.005
Partial replacement of the meniscus of the knee using a biodegradable scaffold (IPG430) Overview | Partial replacement of the meniscus of the knee using a biodegradable scaffold | Guidance | NICE Partial replacement of the meniscus of the knee using a biodegradable scaffold Interventional procedures guidance [IPG430] Published date: July 2012 Share Save Guidance The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland (...) and Northern Ireland on partial replacement of the meniscus of the knee using a biodegradable scaffold. Description The meniscus is a crescent-shaped cartilage inside either side of the knee. It acts as a shock absorber between the long bones of the leg. It can be damaged by injury or overuse, causing pain, swelling and locking of the knee. In this procedure, a biodegradable implant is placed into the meniscus by ‘keyhole’ knee surgery. The implant works as a scaffold to support re-growth and repair
Apixaban for the prevention of venous thromboembolism after total hip or kneereplacement in adults (TA245) Overview | Apixaban for the prevention of venous thromboembolism after total hip or kneereplacement in adults | Guidance | NICE Apixaban for the prevention of venous thromboembolism after total hip or kneereplacement in adults Technology appraisal guidance [TA245] Published date: 25 January 2012 Share Guidance on apixaban (Eliquis) for preventing venous thromboembolism after total hip (...) or kneereplacement in adults. Guidance development process Is this guidance up to date? . We found nothing new that affects the recommendations in this guidance. Next review : This guidance will be reviewed if there is new evidence that is likely to change the recommendations. Your responsibility The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take
Joint line position correlates with function after primary total kneereplacement: a randomised controlled trial comparing conventional and computer-assisted surgery The role of computer-assisted surgery in maintaining the level of the joint in primary knee joint replacement (TKR) has not been well defined. We undertook a blinded randomised controlled trial comparing joint-line maintenance, functional outcomes, and quality-of-life outcomes between patients undergoing computer-assisted
A randomised, controlled trial of circumpatellar electrocautery in total kneereplacement without patellar resurfacing The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total kneereplacement in the absence of patellar resurfacing. Patients (...) requiring kneereplacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery