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Palanisamy Y, Prasad AR, Seetharaman K, Ganesan K, Kavitha M, Rajan DV. Does Proprioception-Based Rehabilitation Enhance Functional Outcome in Total Knee Arthroplasty? A Prospective Randomised Study. Indian J Orthop 2024; 58:1375-1387. [PMID: 39324093 PMCID: PMC11420428 DOI: 10.1007/s43465-024-01218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/24/2024] [Indexed: 09/27/2024]
Abstract
Introduction Rehabilitation after Total Knee Arthroplasty (TKA) often includes proprioceptive exercises to prevent falls, but studies on proprioceptive training have yielded conflicting findings. This study aims to explore impact of proprioceptive training on functional performance after TKA. Methods Eighty patients who underwent unilateral TKA were randomly assigned to a proprioceptive exercise (PE) group or a routine exercises (RE) group. The PE group received proprioceptive exercises in addition to routine physiotherapy. Osteoarthritis Research Society Internal (OARSI) recommended tests and Oxford Knee Score (OKS) were used to assess performance and outcome at 3 and 6 months. Results In the 30-s chair sits test, the PE group outperformed the RE group at 3 months (13.69 vs. 9.17) and 6 months (21.07 vs. 18.63) (p < 0.001 and p = 0.030). Stair climbing favoured PE group at 3 months (8.86 vs. 16.66, p = 0.037) and 6 months (0.556 vs. 1.133, p = 0.001). At 6 months in the 40-m fast-paced walk test, the PE group had a significantly shorter time (0.308 min vs. 0.557 min, p < 0.001). Timed up and go test at 6 months favoured PE group (0.204 min vs. 0.377 min). In the 6-min walk test, the PE group covered significantly greater distances than the RE group at 3 months (589.59 vs. 346.53 m, p < 0.001) and 6 months (649.60 vs. 448.32 m, p < 0.001). OKS at 3 months was 38 ± 2.0 for PE group and 38 ± 4 for RE group (p = 1). OKS at 6 months was 42 ± 4 for PE group and 40 ± 2 for RE group (p = 0.94). Conclusion This study highlights the importance of proprioception-based rehabilitation in improving functional performance for TKA patients, surpassing traditional rehabilitation programmes.
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Affiliation(s)
| | - Arjun R. Prasad
- Ortho-One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu 641005 India
| | - Karthik Seetharaman
- Ortho-One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu 641005 India
| | - K. Ganesan
- Department of Physiotherapy, Ortho-One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu 641005 India
| | - M. Kavitha
- Department of Physiotherapy, Ortho-One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu 641005 India
| | - David V. Rajan
- Ortho-One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu 641005 India
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Pander P, Fransen BL, Hagemans FJA, Keijser LCM. Functional outcome of total knee arthroplasty following tibial plateau fractures: a systematic review. Arch Orthop Trauma Surg 2023; 143:1265-1274. [PMID: 34800157 DOI: 10.1007/s00402-021-04188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) following a tibial plateau fracture (TPF) is a debilitating disease which often affects a young and active patient population for whom good knee function is essential. Frequently, total knee arthroplasty (TKA) is the only surgical option. The aim of this systematic review was to evaluate functional outcome for TKA in PTOA patients, together with several secondary outcome parameters. METHODS A systematic review according to the PRISMA guidelines was conducted. Studies were included that reported on patient-reported outcome measures, range of motion or objective functional analysis after TKA because of PTOA following TPF. RESULTS After analyzing 105 studies, 5 were included for the final review. In total, 162 patients with a TKA for PTOA were included of whom 125 (77%) were managed operatively for their TPF. All studies reported improvements in functional outcome after TKA, with two studies showing no significant differences between PTOA patients and a matched cohort of primary OA patients. Reported complication and re-intervention rates were higher for TKA patients with PTOA. CONCLUSION The results of this review indicate the TKA for PTOA after a TPF provides satisfactory functional outcome, with results similar to those of matched primary OA patients. TKA should, therefore, be considered a viable treatment option to improve function, but both patients and orthopedic surgeons should be aware of the higher complication rates in this patient population.
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Affiliation(s)
- Pieter Pander
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - Bas Lennart Fransen
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Frans Johan Alexander Hagemans
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Lucien Cornelis Marie Keijser
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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Prill R, Kayaalp ME, Królikowska A, Becker R, Ayeni O, Langaufová A, Klugar M. Effects of physiotherapy interventions for home-based rehabilitation on physical function after primary total knee arthroplasty: a systematic review protocol. JBI Evid Synth 2022; 20:3017-3024. [PMID: 35976230 DOI: 10.11124/jbies-21-00355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to provide a systematic and transparent overview of the effects of common physiotherapy techniques and exercises for the rehabilitation of patients following total knee arthroplasty. INTRODUCTION Many protocols exist for the rehabilitation of patients after total knee arthroplasty, but there is a lack of systematic evidence on rehabilitation components, including precise exercise descriptions and their parameters. This review will fill in some of the gaps in reporting on scientific rehabilitation protocol components and the evaluation of their effectiveness. INCLUSION CRITERIA We will include randomized controlled trials investigating active and passive physiotherapy techniques and exercises employed after primary total knee arthroplasty, and which report concrete parameters, such as dosage, duration, frequency, intensity, and function-related measurements. We will exclude other study types and randomized controlled trials reporting on techniques and exercises without precise descriptions. METHODS This review will aim to find both published and unpublished studies. The key information sources to be searched are MEDLINE (PubMed), Embase (Ovid), CINAHL (EBSCO), PEDro, Cochrane CENTRAL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two independent reviewers will screen titles, abstracts, and full texts; assess the methodological quality; and extract the data. We will perform narrative synthesis, followed by meta-analyses for pooled studies, where possible. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022309185.
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Affiliation(s)
- Robert Prill
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, University of Brandenburg an der Havel Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mahmut Enes Kayaalp
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, University of Brandenburg an der Havel Theodor Fontane, Brandenburg an der Havel, Germany
- Istanbul Taksim Training and Research Hospital, Istanbul, Turkey
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Roland Becker
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, University of Brandenburg an der Havel Theodor Fontane, Brandenburg an der Havel, Germany
| | - Olufemi Ayeni
- Division of Orthopedics, McMaster University, Hamilton, ON, Canada
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Bohm ER, Kirby S, Trepman E, Hallstrom BR, Rolfson O, Wilkinson JM, Sayers A, Overgaard S, Lyman S, Franklin PD, Dunn J, Denissen G, W-Dahl A, Ingelsrud LH, Navarro RA. Collection and Reporting of Patient-reported Outcome Measures in Arthroplasty Registries: Multinational Survey and Recommendations. Clin Orthop Relat Res 2021; 479:2151-2166. [PMID: 34288899 PMCID: PMC8445553 DOI: 10.1097/corr.0000000000001852] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are validated questionnaires that are completed by patients. Arthroplasty registries vary in PROM collection and use. Current information about registry collection and use of PROMs is important to help improve methods of PROM data analysis, reporting, comparison, and use toward improving clinical practice. QUESTIONS/PURPOSES To characterize PROM collection and use by registries, we asked: (1) What is the current practice of PROM collection by arthroplasty registries that are current or former members of the International Society of Arthroplasty Registries, and are there sufficient similarities in PROM collection between registries to enable useful international comparisons that could inform the improvement of arthroplasty care? (2) How do registries differ in PROM administration and demographic, clinical, and comorbidity index variables collected for case-mix adjustment in data analysis and reporting? (3) What quality assurance methods are used for PROMs, and how are PROM results reported and used by registries? (4) What recommendations to arthroplasty registries may improve PROM reporting and facilitate international comparisons? METHODS An electronic survey was developed with questions about registry structure and collection, analysis, reporting, and use of PROM data and distributed to directors or senior administrators of 39 arthroplasty registries that were current or former members of the International Society of Arthroplasty Registries. In all, 64% (25 of 39) of registries responded and completed the survey. Missing responses from incomplete surveys were captured by contacting the registries, and up to three reminder emails were sent to nonresponding registries. Recommendations about PROM collection were drafted, revised, and approved by the International Society of Arthroplasty Registries PROMs Working Group members. RESULTS Of the 25 registries that completed the survey, 15 collected generic PROMs, most frequently the EuroQol-5 Dimension survey; 16 collected joint-specific PROMs, most frequently the Knee Injury and Osteoarthritis Outcome Score and Hip Disability and Osteoarthritis Outcome Score; and 11 registries collected a satisfaction item. Most registries administered PROM questionnaires within 3 months before and 1 year after surgery. All 16 registries that collected PROM data collected patient age, sex or gender, BMI, indication for the primary arthroplasty, reason for revision arthroplasty, and a comorbidity index, most often the American Society of Anesthesiologists classification. All 16 registries performed regular auditing and reporting of data quality, and most registries reported PROM results to hospitals and linked PROM data to other data sets such as hospital, medication, billing, and emergency care databases. Recommendations for transparent reporting of PROMs were grouped into four categories: demographic and clinical, survey administration, data analysis, and results. CONCLUSION Although registries differed in PROM collection and use, there were sufficient similarities that may enable useful data comparisons. The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample. CLINICAL RELEVANCE By collecting PROMs, registries can provide patient-centered data to surgeons, hospitals, and national entities to improve arthroplasty care.
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Affiliation(s)
- Eric R. Bohm
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Kirby
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Elly Trepman
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Brian R. Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ola Rolfson
- Department of Orthopaedics at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J. Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Sheffield, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Learning and Research, University of Bristol, Southmead Hospital, Bristol, UK
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of South Denmark, Odense, Denmark
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephen Lyman
- Hospital for Special Surgery, New York, NY, USA
- Kyushu University School of Medicine, Fukuoka, Japan
| | - Patricia D. Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Geke Denissen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, the Netherlands
| | - Annette W-Dahl
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lina Holm Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ronald A. Navarro
- Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center, Harbor City, CA, USA
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Louwerens JKG, Hockers N, Achten G, Sierevelt IN, Nolte PA, van Hove RP. No clinical difference between TiN-coated versus uncoated cementless CoCrMo mobile-bearing total knee arthroplasty; 10-year follow-up of a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:750-756. [PMID: 32367201 DOI: 10.1007/s00167-020-05997-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Improvement of biomechanical properties of cobalt-chromium-molybdenum (CoCrMo) implant surface and reduction of adhesive wear is achieved by titanium-nitride (TiN) coating in vitro. Less pain, higher postoperative outcome scores and a lower revision rate after TKA with a TiN-coated CoCrMo TKA compared with uncoated CoCrMo TKA after 10-year follow-up was hypothesized. METHODS In a double-blinded RCT, 101 patients received a cementless mobile-bearing CoCrMo TKA, either TiN-coated or uncoated. The primary outcome measure was the visual analogue scale (VAS) score for pain and secondary outcome measures were the Knee Society Score (KSS), Oxford Knee Score (OKS), revision rate and adverse events. Patients were assessed at 6 weeks, 6 months, 1 year, 5 years and 10 years, postoperatively. RESULTS 68 patients (67%) were available for 10-year follow-up. No difference was found in any of the assessed outcome measures with a mean decrease in VAS score (31.6 ± 22.9) and a mean increase in OKS (10.9 ± 8.4), KSS (29.3 ± 31.4), KSSK (26.4 ± 18.2) and KSSF (4.1 ± 22.9). Overall revision rate was 7% (coated 6% vs uncoated 8%) without additional revision procedures between 5 and 10-year follow-up. CONCLUSIONS The in vitro potential benefits of TiN coating did not result in better clinical outcome when compared to an uncoated cementless TKA. Pain, functional outcome and revision rates were comparable after 10-year follow-up. TiN-coated cementless TKA provides comparable good long-term results, similar to uncoated cementless CoCrMo TKA. LEVEL OF EVIDENCE Level 1, Therapeutic Study NETHERLANDS TRIAL REGISTER: NL2887/NTR3033.
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Affiliation(s)
- Jan K G Louwerens
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.
| | - Niels Hockers
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Gijs Achten
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Ruud P van Hove
- Department of Orthopaedic Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Vissers LCM, van Hove RP, van der Zwaard BC. Predicting self-reported functional improvement one year after primary total knee arthroplasty using pre- and postoperative patient-reported outcome measures. Knee 2020; 27:683-689. [PMID: 32563423 DOI: 10.1016/j.knee.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/25/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Approximately 20% of patients do not perceive functional improvement after a primary total knee arthroplasty (TKA). This study aims to assess which patient-related and clinical determinants at baseline and six months postoperative can predict lack of self-reported functional improvement at 12 months after primary TKA. METHODS In a retrospective cohort study of 569 patients who received a primary TKA between 2015 and 2018, self-reported functional improvement, measured as ≥7 points increase in Oxford Knee Score (OKS) from baseline to 12 months postoperative, was assessed. Patient characteristics and patient-reported variables at baseline and six months postoperative were entered in a logistic regression model with manual backward elimination. RESULTS Incidence of functional improvement in this study was 73%. Preoperative variables were no strong predictors of the outcome. An increase in pain between baseline and six months postoperative was a risk factor for not functionally improving (odds ratio (OR) 1.13 (95% confidence interval (CI) 1.03-1.23)). An improvement in knee pain and function was a protective factor for lacking functional improvement (OR 0.78 (95% CI 0.74-0.82)). The prediction model explained 44% of variance and showed good calibration and discrimination. Sensitivity and specificity were 82% and 76%, respectively. CONCLUSIONS Using pre- and postoperative variables, a prediction model for self-reported functional improvement one year after TKA was developed. This prediction tool was easy to use at six months postoperative and allowed identification of patients at high risk for not functionally improving one year after TKA. This could facilitate early interventions directed at functional improvement after TKA.
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Affiliation(s)
- Lieke C M Vissers
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands; Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Ruud P van Hove
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands
| | - Babette C van der Zwaard
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands.
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Nha KW, Oh SM, Ha YW, Patel MK, Seo JH, Lee BH. Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2019; 27:2021-2029. [PMID: 30151721 DOI: 10.1007/s00167-018-5121-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the classification scheme for osteoarthritis severity grading that most closely correlates with postoperative clinical outcomes and to identify the positive and negative prognostic factors for medial open-wedge high-tibial osteotomy (OWHTO). METHODS Seventy-nine consecutive patients with primary varus osteoarthritis were treated using OWHTO. Arthritic grading was determined by arthroscopic assessment according to the modified Outerbridge classification and by radiographic classification according to the Kellgren-Lawrence (KL) grading scale on standing anteroposterior (AP) and 45° posteroanterior (PA) flexion weight-bearing radiography. Clinical outcome was assessed using the Oxford Knee Score (OKS), which was evaluated both preoperatively and at the postoperative 2-year follow-up after OWHTO. Multivariate regression analyses were used to explore and quantify the influence of baseline patient demographics, variables related to arthroscopic and radiological grades of arthritis, as well as postoperative alignment changes on the OKS. RESULTS At the 2-year follow-up, the mean OKS had improved from 20 ± 4 to 39 ± 5 points (p < 0.001). The average mechanical femorotibial and mechanical medial proximal tibial angle (MPTA) changed from 6.9° ± 3.4° to valgus 2.7° ± 2.8° and from 85.6° ± 2.4° to 92.9° ± 3.7° (all p < 0.001). The osteoarthritis severity grade based on the KL scale was 2.4 ± 0.9 on standing AP radiography, 2.8 ± 0.9 on 45° PA flexion weight-bearing radiography (p = 0.003), and 3.4 ± 0.7 according to the modified Outerbridge classification. In the multivariate analyses, the KL grade on 45° PA flexion weight-bearing radiography (p = 0.01) and postoperative MPTA (p = 0.01) showed significant negative correlations with postoperative OKS at the 2-year follow-up. CONCLUSION The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest significant negative correlation with postoperative OKS after the OWHTO procedure using three different common OA classification schemes, which should be considered to determine the surgical indication of HTO. The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest correlation with high-tibial osteotomy-surgical indications and the counselling of patients with advanced osteoarthritis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Seung Min Oh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Yoon Won Ha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Manoj Kumar Patel
- Department of Orthopaedic Surgery, St. Stephens Hospital, New Delhi, India
| | - Ji Hyun Seo
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, South Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, South Korea.
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Fröschen FS, Gravius N, Lau JF, Randau TM, Kaup E, Friedrich MJ, Gravius S. A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy. INTERNATIONAL ORTHOPAEDICS 2018; 43:2323-2331. [PMID: 30539218 DOI: 10.1007/s00264-018-4273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The contact allergens nickel, cobalt, and chromium are often discussed as possible triggers of allergic reactions to orthopedic implants. Additionally, acrylates and polymerization additives in bone cement (e.g., benzoyl peroxide (BPO)) have been implicated as triggers of eczema, wound healing disorders, and aseptic implant loosening. We report about six patients with aseptic loosening after total knee arthroplasty (TKA), who underwent revision surgery after testing positive for BPO hypersensitivity. METHODS After clarification of possible other causes of implant failure, epicutaneous testing had been performed and the implants were replaced in a two-stage procedure with cementless, diaphyseal anchoring, hypoallergenic (TiNb-coated) revision endoprostheses. RESULTS Epicutaneous testing revealed a BPO allergy in all six patients and an additional nickel allergy in three of the six patients. There was no histopathological or microbiological evidence for a periprosthetic infection. The clinical follow-up showed a low level of pain with good function, a stable knee joint, and proper implant position. The Knee Society Score (KSS) with its subscales Knee Score and Functional Score improved post-operatively from 43 to 70 points and from 47.5 to 68.3 points, respectively. Two implant-specific complications occurred: femoral stress shielding two years post-operatively with no further need for action and aseptic loosening of the tibial stem with the need of revision three years post-operatively. CONCLUSIONS The regression of complaints after replacement with cementless and nickel-free revision implants suggests allergic implant intolerance. Implantation of a cementless, hypoallergenic endoprosthesis might, therefore, be a surgical treatment strategy in patients with evidence of allergies.
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Affiliation(s)
- Frank S Fröschen
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Nadine Gravius
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Jan-Frederic Lau
- Department of Pathology, University Hospital Bonn, Bonn, Germany
| | - Thomas Martin Randau
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Eva Kaup
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Max J Friedrich
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Sascha Gravius
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
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Liao CD, Xie GM, Tsauo JY, Chen HC, Liou TH. Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2018; 19:278. [PMID: 30068324 PMCID: PMC6090995 DOI: 10.1186/s12891-018-2204-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/20/2018] [Indexed: 12/26/2022] Open
Abstract
Background Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84–6.12, P < 0.0001), pain reduction (SMD: − 1.49, 95% CI: − 2.11 to − 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43–2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being − 3.13 (95% CI: − 5.70 to − 0.56; P = 0.02) and − 1.80 (95% CI: − 2.52 to − 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12891-018-2204-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chun-De Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Guo-Min Xie
- Department of Neurology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University, Zhejiang, China
| | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan. .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan.
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Abdullah HR, Tan SR, Lee SJ, Bin Abd Razak HR, Seet RH, Ying H, Sethi E, Sim EY. Protocol for a single-centre prospective observational study of postoperative delirium following total joint arthroplasties among South East Asians. BMJ Open 2018; 8:e019426. [PMID: 29511014 PMCID: PMC5855196 DOI: 10.1136/bmjopen-2017-019426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Postoperative delirium is a serious and common complication in older adults following total joint arthroplasties (TJA). It is associated with increased risk of postoperative complications, mortality, length of hospital stay and postdischarge institutionalisation. Thus, it has a negative impact on the health-related quality of life of the patient and poses a large economic burden. This study aims to characterise the incidence of postoperative delirium following TJA in the South East Asian population and investigate any risk factors or associated outcomes. METHODS AND ANALYSIS This is a single-centre prospective observational study recruiting patients between 65 and 90 years old undergoing elective total knee arthroplasty or total hip arthroplasty. Exclusion criteria included patients with clinically diagnosed dementia. Preoperative and intraoperative data will be obtained prospectively. The primary outcome will be the presence of postoperative delirium assessed using the Confusion Assessment Method on postoperative days 1, 2 and 3 and day of discharge. Other secondary outcomes assessed postoperatively will include hospital outcomes, pain at rest, knee and hip function, health-related quality of life and Postoperative Morbidity Survey-defined morbidity. Data will be analysed to calculate the incidence of postoperative delirium. Potential risk factors and any associated outcomes of postoperative delirium will also be determined. ETHICS AND DISSEMINATION This study has been approved by the Singapore General Hospital Institutional Review Board (SGH IRB) (CIRB Ref: 2017/2467) and is registered on the ClinicalTrials.gov registry (Identified: NCT03260218). An informed consent form will be signed by all participants before recruitment and translators will be made available to non-English-speaking participants. The results of this study will be presented at international conferences and submitted to a peer-reviewed journal. The data collected will also be made available in a public data repository. TRIAL REGISTRATION NUMBER NCT03260218.
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Affiliation(s)
- Hairil Rizal Abdullah
- Department of Anesthesiology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Si Jia Lee
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | | | | | - Hao Ying
- Health Services Research Unit, Division of Medicine, Singapore General Hospital, Singapore
| | - Ervin Sethi
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Eileen Yilin Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore
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Periarticular joint infection: Survey of the European Knee Associates (EKA) of ESSKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:3047-3049. [PMID: 27704191 DOI: 10.1007/s00167-016-4308-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Choi YJ, Ra HJ. Patient Satisfaction after Total Knee Arthroplasty. Knee Surg Relat Res 2016; 28:1-15. [PMID: 26955608 PMCID: PMC4779800 DOI: 10.5792/ksrr.2016.28.1.1] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/12/2015] [Accepted: 09/12/2015] [Indexed: 12/11/2022] Open
Abstract
Total knee arthroplasty (TKA) is one of the most successful and effective surgical options to reduce pain and restore function for patients with severe osteoarthritis. The purpose of this article was to review and summarize the recent literatures regarding patient satisfaction after TKA and to analyze the various factors associated with patient dissatisfaction after TKA. Patient satisfaction is one of the many patient-reported outcome measures (PROMs). Patient satisfaction can be evaluated from two categories, determinants of satisfaction and components of satisfaction. The former have been described as all of the patient-related factors including age, gender, personality, patient expectations, medical and psychiatric comorbidity, patient's diagnosis leading to TKA and severity of arthropathy. The latter are all of the processes and technical aspects of TKA, ranging from the anesthetic and surgical factors, type of implants and postoperative rehabilitations. The surgeon- and patient-reported outcomes have been shown to be disparate occasionally. Among various factors that contribute to patient satisfaction, some factors can be managed by the surgeon, which should be improved through continuous research. Furthermore, extensive discussion and explanation before surgery will reduce patient dissatisfaction after TKA.
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Affiliation(s)
- Young-Joon Choi
- Department of Orthopedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Ho Jong Ra
- Department of Orthopedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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