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Latest & greatest articles for knee replacement
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Effect of the Referencing System on the Posterior Condylar Offset and Anterior Flange-Bone Contact in Posterior Cruciate-Substituting Total Knee Arthroplasty The effect of referencing system on posterior condylar offset (PCO) after total knee arthroplasty (TKA) is still controversial. Moreover, there is a lack of concern about the anterior flange-bone contact according to the referencing system.One hundred four TKAs using the anterior referencing (AR) system and 107 TKAs using the posterior (...) referencing (PR) system were analyzed with 2-year follow-up. The PCO, PCO ratio (PCOR), and contact at the anterior flange-bone interface were compared between the 2 groups. The flexion and extension gaps and the degree of medial release were measured, and clinical outcomes were evaluated. Finally, the correlation between changes in PCO and knee flexion angle was analyzed.The mean postoperative PCO and PCOR were significantly larger in the PR group than in the AR group. Incomplete contact between
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
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
In adult patients immediately post primary total kneereplacement (TKR) for osteoarthritis (OA) is group therapy more clinically effective than an individual programme for pain and function? Musculoskeletal Research Facilitation Group (Cat Group) Critically appraised topic and clinical bottom line Date: April 2016 CAT Lead: Mark Buckley Date CAT completed: April 2016 Email: firstname.lastname@example.org Date CAT to be reviewed: April 2018 Specific Question: In adult patients immediately post primary (...) total kneereplacement (TKR) for osteoarthritis (OA) is group therapy more clinically effective than an individual programme for pain and function? Clinical bottom line After TKR, group rehabilitation is not more effective than individual rehabilitation. Individual rehabilitation appears similarly effective if undertaken as a package of 2 initial individual face-to-face treatment sessions followed by telephone support for a home exercise programme or as a package of 12 individual treatment sessions
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
interest are provided in the appendix. OVERALL SUMMARY OF FINDINGS Five non-randomized studies 1-5 were identified regarding Smith & Nephew Journey total kneereplacement systems in patients requiring total kneereplacement. One study 1 reported high complication rates (e.g., 1.65 complications requiring major revision surgery per 100 component years) with the Journey bicruciate substituting total kneereplacement. Two studies 2,3 comparing Journey Bicruciate Stabilised kneereplacement systems (...) KneeReplacement System 3 REFERENCES SUMMARIZED Health Technology Assessments No literature identified. Systematic Reviews and Meta-analyses No literature identified. Randomized Controlled Trials No literature identified. Non-Randomized Studies 1. Christen B, Neukamp M, Aghayev E. Consecutive series of 226 journey bicruciate substituting total kneereplacements: early complication and revision rates. BMC Musculoskelet Disord [Internet]. 2014 [cited 2015 Mar 17];15:395. Available from: http
Comparison of highly cross-linked and conventional polyethylene in posterior cruciate-substituting total knee arthroplasty in the same patients We are not aware of any information on in vivo clinical results at a minimum of five years after posterior cruciate-substituting total knee arthroplasties performed with a highly cross-linked polyethylene insert. The purpose of the study was to evaluate whether the clinical and radiographic results of posterior cruciate-substituting total knee (...) prostheses, including the prevalences of fracture of the polyethylene post, failure of the locking mechanism of the tibial polyethylene insert, and osteolysis, would be similar between patients treated with conventional polyethylene and those treated with highly cross-linked polyethylene.Three hundred and eight patients with a mean age of 60.3 years (range, twenty-two to sixty-five years) received a posterior cruciate-substituting total knee prosthesis with a conventional polyethylene tibial insert
Elective unilateral total kneereplacement using continuous femoral nerve blockade versus conventional patient-controlled analgesia: perioperative patient management based on a multidisciplinary pathway. OBJECTIVES. To evaluate the effectiveness of our new multidisciplinary pathway for total kneereplacement patients and compare outcomes after continuous femoral nerve blockade versus conventional patient-controlled analgesia for postoperative pain. DESIGN. Randomised controlled trial (...) in a routine clinical setting. SETTING. Acute orthopaedic wards and operating theatres, Yan Chai Hospital, Hong Kong. PATIENTS. Sixty patients underwent elective unilateral total kneereplacement under spinal anaesthesia from May 2009 to September 2011 and were randomly assigned to continuous femoral nerve blockade or conventional patient-controlled analgesia (30 patients in each group). MAIN OUTCOME MEASURES. Quality of pain control was evaluated by pain scores at rest and during mobilisation, opioid
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
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
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