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Latest & greatest articles for knee replacement
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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
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
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
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
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
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
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
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
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
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
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