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Tsushima T, Sasaki E, Sasaki S, Oishi K, Sakamoto Y, Kimura Y, Otsuka H, Yamamoto Y, Tsuda E, Ishibashi Y. Mobile bearing shows larger rollback motion than fixed bearing in total knee arthroplasty using a medial stabilising technique with a navigation system. J Exp Orthop 2024; 11:e12053. [PMID: 38868126 PMCID: PMC11167407 DOI: 10.1002/jeo2.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose This study aimed to investigate the intraoperative knee kinematics of cruciate-retaining total knee arthroplasty with a medial stabilising technique (MST-TKA) and compare the kinematics between mobile- and fixed-bearing MST-TKAs. We hypothesised that mobile-bearing MST-TKA would result in greater physiological kinematic motion than fixed-bearing MST-TKA. Methods Twenty-one and 20 knees underwent mobile- and fixed-bearing MST-TKAs using a navigation system (Orthopilot® ver. 6.0; B. Braun Aesculap), respectively. In the preoperative and postoperative kinematic analysis, the knee was moved manually from 0° to 120°, and femoral anteroposterior translations of the medial femoral condyle (MFC) and lateral femoral condyle (LFC) were recorded every 0.1 s from 0° to 120°. Data were subsequently extracted from the software every 10° of flexion and compared between the two groups, and the correlation coefficients between preoperative and postoperative kinematics were calculated. Results In the postoperative analysis, the MFC in the mobile-bearing group showed significant posterior translation at 100°, 110° and 120° compared to the fixed-bearing group (p < 0.01). Similarly, the LFC in the mobile-bearing group showed significant posterior translation at 100°, 110° and 120° compared to the fixed-bearing group (p < 0.05, p < 0.01 and p < 0.05, respectively). In the mobile-bearing group, the preoperative and postoperative anteroposterior translations of the MFC and LFC were correlated (p < 0.01), while in the fixed-bearing group, there was no correlation. Conclusion The femoral rollback motion in the mobile-bearing MST-TKA correlated with the preoperative kinematics and was larger than that in the fixed-bearing group. Level of Evidence Level II, therapeutic prospective cohort study.
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Affiliation(s)
- Takahiro Tsushima
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Eiji Sasaki
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Shizuka Sasaki
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Kazuki Oishi
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yukiko Sakamoto
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yuka Kimura
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hironori Otsuka
- Department of Orthopaedic SurgeryJapan Community Health Care Organization Akita HospitalNoshiroJapan
| | - Yuji Yamamoto
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Eiichi Tsuda
- Department of Rehabilitation MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
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Slade CAJ, Kruger MC, Miller MR, Mazahery H, Beck KL, Conlon CA, von Hurst PR. The Effects of GreenShell Mussel Powder (Brand-Named PERNAULTRA) on Physical Performance and Subjective Pain, Symptoms, and Function Measures in Knee Osteoarthritis: A 6-Mo Randomized, Double-Blind, Placebo-Controlled Trial. Curr Dev Nutr 2024; 8:102148. [PMID: 38645882 PMCID: PMC11026721 DOI: 10.1016/j.cdnut.2024.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Background Osteoarthritis (OA) can cause disability and reduce quality of life (QoL). Objectives This study aimed to determine whether GreenShell mussel (GSM) powder (PERNAULTRA) consumption was more effective than placebo at improving physical performance and subjective measures of symptoms and function in adults with early signs of knee OA. Methods The Researching Osteoarthritis and GSM study was a 6-mo randomized, double-blind, placebo-controlled trial in adults aged 55-80 y, screened for signs of OA (n = 120, 65.9 ± 6.43 y, 63% female). Participants consumed either 3 g of powdered whole GSM or placebo (pea protein) daily. Baseline and end data collection included 30-s chair stand, stair test, 40-m fast-paced walk test, Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire categorized into 5 subscales [pain (P), symptoms except pain (S), function in activities of daily living (ADL), function in sports/recreation (SP), and QoL], a measure of Intermittent and Constant Osteoarthritis Pain, and visual analog scale of pain and symptoms. Results Visual analog scale symptoms showed a significantly greater reduction in percentage change for GSM than that for placebo [-28.1 (-59.2, 43.2) compared with 0.00 (-28.6, 100); P = 0.03]. Further, a trend for improvement in percentage change for GSM compared with placebo was seen in 40m fast-paced walk [2.51 (-3.55, 8.12) compared with 0.20 (-6.58, 4.92); P = 0.09], KOOS-SP [11.4 (-4.48, 27.0) compared with 0.00 (-11.1, 17.7); P = 0.09], and Intermittent and Constant Osteoarthritis Pain intermittent pain scale [-27.7 (-77.3, 0.00) compared with -14.6 (-50.0, 36.4); P = 0.08]. In those with body mass index (BMI; in kg/m2) <25, GSM consumption significantly improved KOOS-S compared with placebo [6.35 (3.49, 12.7) compared with 0.00 (-4.65, 4.49); P = 0.03] and showed a trend for improvement in KOOS-ADL [3.29 (1.01, 8.79) compared with 1.01 (-5.75, 4.30); P = 0.07]. Those with BMI of ≥25, consuming GSM showed a trend for improvement in KOOS-SP [13.6 (-4.76, 33.3) compared with 0.00 (-12.5, 20.0); P = 0.07]. Conclusions This research suggests consumption of GSM has potential to alleviate symptoms and improve functionality in OA.This trial was registered at Clinical Trial Registry as ACTRN12620001112954p (https://www.anzctr.org.au/ACTRN12620001112954p.aspx).
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Affiliation(s)
| | - Marlena C Kruger
- College of Health, Massey University, Palmerston North, New Zealand
| | | | - Hajar Mazahery
- College of Health, Massey University, Auckland, New Zealand
| | - Kathryn L Beck
- College of Health, Massey University, Auckland, New Zealand
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Larrainzar-Garijo R, Molanes-López EM, Cañones-Martín M, Murillo-Vizuete D, Valencia-Santos N, Garcia-Bogalo R, Corella-Montoya F. Computer-Assisted Surgery Enables Beginner Surgeons, Under Expert Guidance, to Achieve Long-Term Clinical Results not Inferior to Those of a Skilled Surgeon in Knee Arthroplasty. Indian J Orthop 2022; 56:1439-1448. [PMID: 35923307 PMCID: PMC9283583 DOI: 10.1007/s43465-022-00666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to determine whether the use of a surgical navigation system in total knee replacement (TKR) enables beginner and intermediate surgeons to achieve clinical PROM outcomes as good as those conducted by expert surgeons in the long term. METHODS We enrolled 100 consecutive patients whose total navigated knee arthroplasty (TKA) was performed in our institution from 2008 to 2010. According to the principal surgeon's surgical experience, the patients were divided into three groups: (1) beginner surgeons, with no more than 30 previous knee replacement performances, (2) intermediate surgeons, with more than 30 but not more than 300, and (3) expert surgeons, with more than 300 knee replacements. Demographic data collected on the cohort included gender, laterality, age, and body mass index (BMI). The outcome measures assessed were Forgotten Joint Score (FJS), implant positioning, limb alignment, and prosthesis survival rate. A margin of equivalence of ± 18.5 points in the FJS scale was prespecified in terms of the minimal clinically important difference (MCID) to compare the FJS results obtained in the long period between the groups of interest. RESULTS The mean follow-up was 11.10 ± 0.78, 10.86 ± 0.66, and 11.30 ± 0.74 years, respectively, for each of the groups. The long-term FJS mean score was 80.86 ± 21.88, 81.36 ± 23.87, and 90.48 ± 14.65 for each group. The statistical analysis proved noninferiority and equivalence in terms of the FJS results reported in the long term by patients in Groups 1 or 2 compared to those in Group 3. More specifically, it has been proved that the mean difference between groups is within the interval of equivalence defined in terms of the MCID. The overall prostheses survival rate was 93.7%. CONCLUSION Navigated assisted TKA, under expert guidance, can be as effective when performed by beginner or intermediate surgeons as performed by senior surgeons regarding the accuracy of implant positioning, limb alignment, and long-term clinical outcome.
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Affiliation(s)
- Ricardo Larrainzar-Garijo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Elisa M. Molanes-López
- Unidad Departamental de BioestadísticaDepartamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Miguel Cañones-Martín
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - David Murillo-Vizuete
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | | | - Raul Garcia-Bogalo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - Fernando Corella-Montoya
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
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Stephens JD, Hurst JM, Morris MJ, Berend KR, Lombardi AV, Crawford DA. Correlation Between Patient-Reported "Happiness" With Knee Range of Motion and Objective Measurements in Primary Knee Arthroplasty. J Arthroplasty 2022; 37:S105-S109. [PMID: 35210146 DOI: 10.1016/j.arth.2022.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the correlation between objective knee range of motion (ROM) and patient "happiness" with knee ROM after total knee arthroplasty. METHODS This was a retrospective review of all primary total knee arthroplasties from June through December 2019, yielding 902 patients (1,009 knees). Records were reviewed for knee ROM preoperatively and postoperatively at 6-week follow-up as well as whether patients self-reported being "Happy with their ROM" (HWROM). Clinical records were reviewed for documents ROM as well as manipulation under anesthesia (MUA). RESULTS The mean preoperative ROM was 110 ± 16 degrees, and 40% of patients were happy with their ROM. Postoperatively, the mean ROM was 106 ± 13 degrees (P < .001), and 76% of patients were HWROM (P < .001). The mean change in knee ROM was (-) 5 ± 17 degrees. The mean postoperative ROM and change in ROM of patients who were HWROM after surgery were 109 ± 12 degrees and (-)2 ± 16 degrees. In patients not HWROM postoperatively, the mean ROM and change in ROM were 98 ± 14 degrees and (-)12 ± 18 degrees (P < .001). Patients with a lower preoperative ROM were statistically significantly more likely to have a positive change in their HWROM (f ratio = 41, P < .001). MUAs were performed in 7.2% of knees, and 28% of patients who underwent an MUA were HWROM before MUA. CONCLUSION Early postoperative knee ROM was correlated with patient HWROM. However, further longer term follow-up and more detailed analysis of patient happiness with ROM are needed.
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Affiliation(s)
- Joseph Dallis Stephens
- Department of Orthopedic Surgery, Grandview Medical Center, Kettering Health Network, Dayton, OH
| | - Jason M Hurst
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
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Sasaki E, Kasai T, Araki R, Sasaki T, Wakai Y, Akaishi K, Chiba D, Kimura Y, Yamamoto Y, Tsuda E, Ishibashi Y. Central Sensitization and Postoperative Improvement of Quality of Life in Total Knee and Total Hip Arthroplasty: A Prospective Observational Study. Prog Rehabil Med 2022; 7:20220009. [PMID: 35280325 PMCID: PMC8860666 DOI: 10.2490/prm.20220009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 12/18/2022] Open
Abstract
Background: While total knee arthroplasty (TKA) and total hip arthroplasty (THA) lead to excellent clinical outcomes, some patients experience residual surgical site pain and reduced satisfaction. This prospective observational study investigated the prevalence of preoperative and postoperative residual central sensitization (CS) after TKA and THA. The influence of residual CS on the improvement in quality of life (QOL) was also investigated. Methods: The participants were 40 patients who underwent TKA and 47 patients who underwent THA. CS was measured using the central sensitization inventory (CSI) questionnaire. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Scales (KOOS), and hip symptoms were evaluated using the Japanese Orthopedic Association Hip-disease Evaluation Questionnaires (JHEQ). General QOL was evaluated using EuroQOL (EQ-5D-5l). Regression analysis was performed to estimate factors related to low QOL after surgery. Results: Preoperatively, 47.5% of TKA patients and 66.0% of THA patients were CS positive (P=0.083), which reduced to 10.0% (P=0.042) and 25.5% (P=0.202), respectively, 3 months after surgery. Although the improvements in KOOS subscales and EQ-5D-5l scores in TKA patients with residual CS were significantly lower than in those without residual CS, residual CS status had no effect on JHEQ subscales and EQ-5D-5l scores in THA patients. Regression analysis indicated that EQ-5D-5l was negatively correlated with CSI in the TKA group (P=0.017). In contrast, CSI was not correlated with EQ-5D-5l in the THA group (P=0.206). Conclusion: Postoperative QOL improvement was achieved 3 months after THA regardless of residual CS status. In contrast, preoperative CS was negatively associated with the improvement in QOL after TKA.
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Affiliation(s)
- Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takayuki Kasai
- Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Ryo Araki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoyuki Sasaki
- Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Yuji Wakai
- Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Koichi Akaishi
- Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Influence of the Amount of Change in Quadriceps Tendon Young’s Modulus on Amount of Change in Walking Speed before and after Total Knee Arthroplasty. Medicina (B Aires) 2021; 57:medicina57121329. [PMID: 34946274 PMCID: PMC8705036 DOI: 10.3390/medicina57121329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Walking speed after total knee arthroplasty (TKA) is an important outcome. However, the effect of quadriceps tendon stiffness on walking speed remains unclear. This study aimed to clarify the influence of the amount of change in quadriceps tendon stiffness on the degree of change in walking speed before and after TKA. Materials and Methods: Sixteen patients who underwent TKA for knee osteoarthritis participated in this study (median age: 74.0 years (interquartile range: 64.5–75.8)). Shear-wave elastography was deployed to measure quadriceps tendon stiffness using Young’s modulus. A motion analysis system was used to assess kinematic parameters and walking speed. Participants’ knee circumference, range of motion, extension strength, one-leg standing time, walking pain level, and activity level were measured preoperatively and one year after TKA, and changes in values were calculated. We used path analysis to clarify the influence of the amount of change in the quadriceps tendon Young’s modulus on the change in walking speed. Results: The quadriceps tendon Young’s modulus negatively affected the knee flexion angle during swing (standardized partial regression coefficients (β) = −0.513, p = 0.042). The knee flexion angle during swing positively affected step length (β = 0.586, p = 0.017). Step length positively affected cadence (β = 0.733, p = 0.001). Step length and cadence positively affected walking speed (β = 0.563, p < 0.001, β = 0.502, p < 0.001, respectively). Conclusions: The amount of change in the quadriceps tendon Young’s modulus may affect the degree of change in walking speed after TKA through the amount of change in the knee flexion angle during swing, step length, and cadence. Clinically, reducing quadriceps tendon stiffness can be addressed in rehabilitation programs to increase walking speed after TKA.
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Posterior clearance increases the knee extension angle in cruciate retaining type total knee arthroplasty: Intraoperative evaluation using a navigation system. J Orthop Sci 2020; 25:861-867. [PMID: 31734086 DOI: 10.1016/j.jos.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/30/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Posterior osteophyte of the femur can impinge on the tibia insert in total knee arthroplasty (TKA). Although osteophyte removal [posterior clearance (PC)] improves the flexion angle, its influence on the gaps and extension angle are unclear. This study investigated the effect of PC on the gaps and range of motion (ROM) using a navigation system, as well as PC's relationship with osteophyte size. METHODS Twenty-seven knees that underwent cruciate-retaining (CR)-type TKA were examined. Before and after PC, the ROM, hip-knee-ankle (HKA) angle, and flexion and extension gaps were recorded using a navigation system. Osteophyte size was measured in the lateral view in radiographs, and in the sagittal and axial planes of computed tomography (CT) images. The effects of PC on the gaps and ROM were analysed statistically. RESULTS PC caused the extension gap to increase by 0.7 ± 0.9 mm in the medial (p < 0.001), and 0.9 ± 1.5 mm in the lateral compartment (p = 0.006). The extension angle increased by 4.9 ± 1.6°, flexion angle increased by 6.5 ± 5.0°, and HKA decreased by 0.3°. The increase in extension angle by PC was significantly correlated with the preoperative HKA angle (r = 0.594) and with the osteophyte area in radiographs and CT (r = 0.626 to 0.681). CONCLUSIONS The extension and flexion gaps increased less than 1 mm in the medial and lateral compartments. PC achieving an additional 5° extension angle could promote full extension in severely deformed knees with a large posterior osteophyte. The extension angle increase by PC was correlated with the preoperative HKA angle and osteophyte size.
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Valgus Correctability and Meniscal Extrusion Were Associated With Alignment After Unicompartmental Knee Arthroplasty. Clin Orthop Relat Res 2020; 478:1636-1644. [PMID: 32324667 PMCID: PMC7310375 DOI: 10.1097/corr.0000000000001260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Appropriate postoperative lower limb alignment is one important element of a successful unicompartmental knee arthroplasty (UKA). To predict postoperative alignment, it is important to investigate the association between preoperative imaging evaluations and lower limb alignment after medial UKA. QUESTIONS/PURPOSES (1) Do preoperative valgus stress radiographic and MRI measurements (% mechanical axis, hip-knee-ankle angle, medial meniscal extrusion distance, and osteophyte area at the medial femur and tibia) correlate with postoperative lower limb alignment after UKA; and (2) Can useful cutoffs be calculated in advance of surgery for those findings that were associated with coronal-plane overcorrection? METHODS We retrospectively analyzed 125 patients with medial knee pain who underwent UKA from January 2012 to October 2018. Valgus stress radiography and MRI were performed routinely to assess the knee. Valgus stress radiography was obtained with the patient supine with the knee in full extension and a firm manual valgus force applied to the knee. Full-length weightbearing radiography was performed 3 months after surgery. There were 12% (15) of patients who did not undergo MRI, and 4% (five) of patients who did not receive the postoperative full-length weightbearing radiograph and they were excluded, leaving 84% (105) of patients available for analysis. There were 27 men and 78 women with a mean (range) age of 77 years ± 6 years (60 to 87). The preoperative diagnosis was medial osteoarthritis in 99 patients and osteonecrosis of the medial femoral condyle in six. To investigate the associations, we routinely measured % mechanical axis using radiography, and also measured the medial meniscal extrusion distance and osteophyte area at the medial femur and tibia using MRI after surgery. Medial meniscus extrusion distance was defined as the distance from the outermost edge of the medial meniscus to a line connecting the femoral and tibial cortices. From these parameters, postoperative alignment was estimated using regression and receiver operating characteristic curve analyses. Variables with p < 0.05 were included. RESULTS The % mechanical axis on the valgus stress radiograph and medial meniscal extrusion distance were correlated with postoperative lower limb alignment after UKA (adjusted correlation coefficient 0.72; p < 0.001, adjusted correlation coefficient 0.2; p = 0.003, respectively). The estimated % mechanical axis on the postoperative weightbearing radiograph was equal to -0.27 + 0.86% (% mechanical axis on valgus stress radiograph) + 1.14 mm (medial meniscal extrusion distance). Using a cutoff point of 36%, the % mechanical axis on valgus stress radiograph was associated with overcorrection after UKA (area under the curve: 0.89; odds ratio 14 [95% CI 0.75 to 0.95]; p < 0.001, sensitivity 77.8%, specificity 80.9%). CONCLUSIONS The overcorrection of a varus knee on a valgus stress radiograph before UKA and the increased extrusion of the medial meniscus on preoperative MRI was associated with a greater likelihood of overcorrected alignment after UKA. Future studies should conduct long-term follow-up of malalignment patients to assess the possible complications. LEVEL OF EVIDENCE Level III, diagnostic study.
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Ditton E, Johnson S, Hodyl N, Flynn T, Pollack M, Ribbons K, Walker FR, Nilsson M. Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Front Psychol 2020; 11:1061. [PMID: 32670136 PMCID: PMC7326061 DOI: 10.3389/fpsyg.2020.01061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Sarah Johnson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Electrical Engineering and Computing, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicolette Hodyl
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Traci Flynn
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Humanities and Social Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Michael Pollack
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Karen Ribbons
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Ishibashi K, Sasaki E, Sasaki S, Kimura Y, Yamamoto Y, Ishibashi Y. Medial stabilizing technique preserves anatomical joint line and increases range of motion compared with the gap-balancing technique in navigated total knee arthroplasty. Knee 2020; 27:558-564. [PMID: 32035705 DOI: 10.1016/j.knee.2019.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/04/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial compartment stability is important in total knee arthroplasty. The medial stabilizing technique (MST) has been proposed to achieve medial stability without excessive medial soft tissue release in total knee arthroplasty. Herein, we compare the MST and the gap-balancing technique (GBT) in navigated total knee arthroplasty. METHODS We retrospectively analyzed 70 patients with varus knee osteoarthritis who underwent primary total knee arthroplasty using the navigation system. They were divided into MST (n = 39) and GBT (n = 31) groups. We assessed intraoperative navigation data, radiographic data, and insert thickness. Preoperative and postoperative joint line changes were measured. We also assessed range of motion and clinical instability before and after total knee arthroplasty. These parameters were statistically compared between the groups. RESULTS Compared with the GBT group, medial extension gaps were significantly smaller in the MST group (P = 0.008). The gap difference between medial and lateral extension was significantly greater in the MST group (P = 0.018). Other navigation data showed no significant differences. Insert thickness and joint line changes were significantly lower in the MST group (P = 0.001, P = 0.018, respectively). Postoperative range of motion was significantly greater in the MST group (P = 0.032). There was no objective or subjective knee instability in either group. CONCLUSION The MST could avoid knee joint line changes and might increase postoperative range of motion. Although the MST permitted a discrepancy between medial and lateral gaps, no patients felt knee instability. The MST might improve the results of total knee arthroplasty.
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Minator Sajjadi M, Keyhani S, Kazemi SM, Hanafizadeh B, Ebrahimpour A, Banasiri M. Patient Satisfaction Following Total Knee Arthroplasty: Comparison of Short-Term Results in Rheumatoid Arthritis and Osteoarthritis. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:61-66. [PMID: 30805417 PMCID: PMC6372268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Due to the obvious differences in the natural course of rheumatoid arthritis (RA) and osteoarthritis (OA), different functional outcomes might be expected after Total Knee Arthroplasty (TKA) in these distinct patients. Although several studies have reported the objective outcome of TKA in RA and OA patients, few studies have compared post-operative patient-satisfaction levels. METHODS In this clinical cohort study 171 patients (RA: n=33, OA: n=138) who underwent TKA with posterior stabilizing knee prosthesis were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) were used to evaluate and compare patients' satisfaction 6 and 12 months after TKA relative to their preoperative state and to make an assessment between two groups. RESULTS Both of patient-reported scoring systems showed a statistically significant improvement for OA and RA patients at 6 and 12 months after surgery, relative to their preoperative scores. The results of the OKS and KOOS did not show statistically significant improvement from 6 to 12 months n RA patients. Unlike RA group, OKS and KOOS revealed further improvement between 6 and 12 months for the osteoarthritic patients. CONCLUSION OA patients had continuous improvement in their satisfaction in the first year after TKA with a gentle upward curve. In contrast, in RA patients, recovery was faster and greater in the first six months after surgery and slowed down in the second six months. Patient-reported outcome scores were not significantly different between two groups at the end of the first year.
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Affiliation(s)
- Mohammadreza Minator Sajjadi
- Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani hospital, Tehran, Iran
| | - Sohrab Keyhani
- Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani hospital, Tehran, Iran
| | - Seyyed Morteza Kazemi
- Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani hospital, Tehran, Iran
| | - Behzad Hanafizadeh
- Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani hospital, Tehran, Iran
| | - Adel Ebrahimpour
- Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani hospital, Tehran, Iran
| | - Mohammad Banasiri
- Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani hospital, Tehran, Iran
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Grazette AJ, Wylde V, Dixon S, Whitehouse SL, Blom AW, Whitehouse MR. A 15 to 17-year follow-up of the Kinemax total knee replacement. Knee 2018; 25:1292-1298. [PMID: 30482640 DOI: 10.1016/j.knee.2018.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/11/2018] [Accepted: 09/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a paucity of long-term data concerning the pre- and postoperative patient reported function of total knee replacement. The aim of this study was to determine the mortality, implant survivorship, patient reported function and satisfaction in a cohort of 114 patients, from a single centre, who received a Kinemax total knee replacement more than 15 years ago. METHODS Patients completed a questionnaire incorporating validated disease- and joint-specific scores, patient satisfaction and overall health preoperatively, at three months, one year, two years and a minimum of 15 years following surgery. NHS National Strategic Tracing Service, hospital and primary care records were used to establish mortality and for implant survivorship in deceased patients. RESULTS Forty five patients were alive at final follow-up. The survivorship of the cohort with revision of the TKR as the endpoint was 84%. Four cases were revised for wear, three for loosening and one for peri-prosthetic fracture. There was a significant improvement in WOMAC Pain, Function and Stiffness Scores, Oxford Knee Score and Self-Administered Patient Satisfaction Scale between pre-operative and all post-operative time points, although patient satisfaction had decreased significantly by the time of final follow-up. CONCLUSION In this cohort, the Kinemax TKR showed survivorship of 84% at 16.3 years with functional scores demonstrating a high level of patient satisfaction at all follow-up time points. LEVEL OF EVIDENCE 2 - Prospective Cohort Study.
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Affiliation(s)
- Andrew J Grazette
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; The Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom of Great Britain and Northern Ireland.
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Samantha Dixon
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland
| | - Sarah L Whitehouse
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; Institute of Health and Biomedical Innovation, Queensland University of Technology, The Prince Charles Hospital, Brisbane, Queensland, Australia, 4032
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom of Great Britain and Northern Ireland
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Sugita T, Miyatake N, Aizawa T, Sasaki A, Kamimura M, Takahashi A. Quality of life after staged bilateral total knee arthroplasty: a minimum five-year follow-up study of seventy-eight patients. INTERNATIONAL ORTHOPAEDICS 2018; 43:2309-2314. [PMID: 30302495 DOI: 10.1007/s00264-018-4196-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/02/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Although many studies have been performed to evaluate the quality of life (QOL) and patient satisfaction after total knee arthroplasty (TKA), almost all evaluations were performed in patients after unilateral TKA or in patients after mixed unilateral and bilateral TKA. Accordingly, this study aimed to evaluate QOL after staged bilateral TKA. METHODS A total of 78 patients who underwent staged bilateral TKA for varus knee osteoarthritis were included in this study. All patients had longitudinal follow-up evaluations for at least five years. QOL was assessed by the Japanese Knee Osteoarthritis Measure (JKOM), a disease-specific and patient-derived QOL measure for Japanese patients. Conventional objective outcome scales, including the Knee Society Score and the Timed Up and Go test, were also assessed. In addition, QOL and objective outcomes were compared between the younger (≤ 80 years, average 75.8 years) and older (> 80 years, average 84.7 years) age groups at the final follow-up. RESULTS Improvements in both JKOM and objective outcomes reached a plateau one year after staged bilateral TKA. Improvements were prolonged for more than five years. There were no statistically significant differences in JKOM or objective outcomes between the younger and older age groups, despite an 8.9-year difference in the average age. CONCLUSIONS This was the first longitudinal study to evaluate QOL and objective outcomes after staged bilateral TKA for a period of at least five years. Improvements in QOL and objective outcomes reached a plateau one year after staged bilateral TKA and were prolonged for more than five years. No significant differences were observed in outcome scores between the younger and older age groups.
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Affiliation(s)
- Takehiko Sugita
- Department of Orthopaedic Surgery, Tohoku Orthopaedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city, 981-3121, Japan.
| | - Naohisa Miyatake
- Department of Orthopaedic Surgery, Tohoku Orthopaedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city, 981-3121, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city, 980-8574, Japan
| | - Akira Sasaki
- Department of Orthopaedic Surgery, Tohoku Orthopaedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city, 981-3121, Japan
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city, 980-8574, Japan
| | - Atsushi Takahashi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city, 980-8574, Japan
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Mutsuzaki H, Watanabe A, Komatsuzaki T, Kinugasa T, Ikeda K. Investigation of perioperative safety and clinical results of one-stage bilateral total knee arthroplasty in selected low-risk patients. J Orthop Surg Res 2018; 13:14. [PMID: 29343282 PMCID: PMC5772713 DOI: 10.1186/s13018-018-0720-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 01/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background An increased perioperative complication rate has been a concern with one-stage bilateral total knee arthroplasty (TKA). The purpose of this study was to retrospectively investigate the perioperative safety and clinical results of one-stage bilateral TKA in selected low-risk patients. Methods Sixty-seven patients who received one-stage bilateral TKAs for osteoarthritis who were American Society of Anesthesiology (ASA) class 1 or 2 were included in this study. Perioperative complications, blood loss, transfusion rate, blood laboratory results, and clinical results were evaluated up to 1 year after surgery. Results No major complications (deep infection, pulmonary embolism, cerebrovascular accident, myocardial infarction, death, or removal or revision of the implants) were observed. The average total blood loss was 1139.5 ml. The transfusion rate was 95.5%. Postoperative hemoglobin level and C-reactive protein level gradually improved up to postoperative day 21 (P < 0.01). Bilateral knee extension knee angles and clinical scores improved postoperatively as compared with preoperative values (P < 0.01). Conclusions Although total blood loss and transfusion rate can be high, this preliminary case series suggested that the one-stage bilateral TKA in ASA class 1 or 2 patients can have high perioperative safety levels, and good clinical results can be obtained up to 1 year after surgery. If low-risk patients are selected for bilateral TKA, a one-stage procedure can be beneficial for patients, with a minimal increase in the risk of complications.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan. .,Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan.
| | - Arata Watanabe
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Tetsuya Komatsuzaki
- Department of Anesthesiology, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Tomonori Kinugasa
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Kotaro Ikeda
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
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Sueyoshi T, Emoto G, Yato T. Correlation between Single Assessment Numerical Evaluation score and Lysholm score in primary total knee arthroplasty patients. Arthroplast Today 2017; 4:99-102. [PMID: 29560403 PMCID: PMC5859662 DOI: 10.1016/j.artd.2017.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022] Open
Abstract
Background There are numerous subjective rating scales available to evaluate outcomes of total knee arthroplasty (TKA). Single Assessment Numerical Evaluation (SANE) score was developed to reduce the burden of patients or clinicians to evaluate patients' status by asking patients to simply rate the current status of their injured body part on a scale of 0-100. The purpose of this study is to investigate the correlation between SANE score and Lysholm score in patients who underwent primary TKA. Methods Forty-nine patients who underwent primary TKA participated. Patients who underwent bilateral TKA or revision TKA were excluded from this study. They were asked to respond to SANE and Lysholm scores. Regression analysis was used to evaluate the correlation between 2 scores. Bilateral isometric quadriceps strength and limb symmetry index were also measured and recorded. Results There were a total of 49 patients in the study. The mean age of the subjects was 73.04 ± 6.63 years. The mean height and body weight were 153.37 ± 8.81 cm and 55.51 ± 8.61 kg, respectively. The mean scores for SNAE and Lysholm scores were 66.08 ± 16.77 and 71.0 ± 17.55, respectively. Pearson r correlation coefficient between SANE and Lysholm scores was 0.38 (P = .003). Regression analysis showed statistically significant correlation between 2 scores with r2 of 0.15 (P = .005). The average time from surgery was 16.02 weeks. The mean isometric quadriceps strength was 26.76 ± 11.30 kgf for the involved knee and 40.58 ± 11.55 kgf for the non-involved knee. The limb symmetry index was 66.10% ± 21.51%. Conclusions The results of the investigation showed that there was a statistically significant, however relatively weak, correlation between SANE score and Lysholm score. SANE score may serve as an alternative method to assess TKA patients' subjective post-operative outcomes to Lysholm score.
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Affiliation(s)
- Ted Sueyoshi
- Corresponding author. 1332-1 Hirokawa, Yame, Fukuoka 834-0115, Japan. Tel.: +1 943 32 1213.1332-1 HirokawaYameFukuoka834-0115Japan
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Gao JH, Chu XC, Wang LL, Ning B, Zhao CX. Effects of different anticoagulant drugs on the prevention of complications in patients after arthroplasty: A network meta-analysis. Medicine (Baltimore) 2017; 96:e8059. [PMID: 28984761 PMCID: PMC5737997 DOI: 10.1097/md.0000000000008059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND After arthroplasty treatment, some complications commonly occur, such as early revision, infection/dislocation, and venous thromboembolism (VTE). This study aims to use a network meta-analysis to compare effects of 9 anticoagulant drugs (edoxaban, dabigatan, apixaban, rivaroxaban, warfarin, heparin, bemiparin, ximelagatran, and enoxaparin) in preventing postoperative complications in arthroplasty patients. METHODS After retrieving PubMed, Embase, and Cochrane Library database from the inception to November 2016, randomized controlled trials were enrolled. The integration of direct and indirect evidences was performed to calculate odd ratios and the surface under the cumulative ranking curves. Nineteen eligible randomized controlled trials were included. RESULTS The network meta-analysis results showed that compared with warfarin, edoxaban, apixaban, and rivaroxaban had a lower incidence rate in asymptomatic deep venous thrombosis, which indicated that edoxaban, apixaban, and rivaroxaban had better effects on prevention. Similarly, in comparison to enoxaparin, edoxaban and rivaroxaban had better effect; rivaroxaban was better than ximelagatran in preventive effects. Compared with apixaban, edoxaban, dabigatan, rivaroxaban, and enoxaparin had a higher incidence rate in clinically relevant non-major bleeding, which showed that preventive effects were relatively poor. In addition, the results of the surface under the cumulative ranking curves showed that rivaroxaban and bemiparin worked best on symptomatic deep venous thrombosis and pulmonary embolism. In terms of bleeding, apixaban and warfarin had better preventive effects. CONCLUSION Our findings suggested that rivaroxaban may work better in terms of symptomatic deep venous thrombosis and pulmonary embolism, whereas apixaban had better preventive effects in bleeding.
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The Effects of Postdischarge Telephone Counseling and Short Message Service on the Knee Function, Activities of Daily Living, and Life Satisfaction of Patients Undergoing Total Knee Replacement. Orthop Nurs 2017; 36:229-236. [PMID: 28363197 PMCID: PMC5447778 DOI: 10.1097/nor.0000000000000332] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: No study comparing short message service (SMS) texts and telephone counseling for patients undergoing total knee replacement (TKR) has been reported. PURPOSE: The purpose of the study was to provide postdischarge telephone counseling and SMS texts to TKR patients and to analyze the effects of these services on their knee function (KF), activities of daily living (ADL), and life satisfaction (LS). METHODS: This study used a randomized clinical trial design. This study was conducted with 40 patients (counseling group: 21; SMS group: 19). In the telephone counseling group and the SMS group, KF, ADL, and LS were assessed before surgery and 1 and 3 months after TKR. RESULTS: Telephone counseling and SMS texts have the same effects on KF, ADL, and LS of TKR patients. CONCLUSION: Future research is needed to determine optimal frequency and duration of post-TKR SMS to support patients who have undergone TKR.
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Mutsuzaki H, Takeuchi R, Mataki Y, Wadano Y. Target range of motion for rehabilitation after total knee arthroplasty. J Rural Med 2017; 12:33-37. [PMID: 28593015 PMCID: PMC5458350 DOI: 10.2185/jrm.2923] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/10/2017] [Indexed: 11/27/2022] Open
Abstract
Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to 12 months after TKA, including intraoperative knee ROM after implantation, and to clarify a target ROM for rehabilitation after TKA. Patients and Methods: In total, 39 knee joints in 26 patients with osteoarthritis who underwent TKA (retaining the posterior cruciate ligament) were evaluated. Goniometry was used to measure the knee range of extension and flexion preoperatively; intraoperatively; at 1 and 2 weeks after TKA; and then at 1, 3, 6, and 12 months after TKA. Results: The postoperative extension range gradually improved up to a maximum at 6 months after TKA; there were no significant differences in the extension range between intraoperative and 6 months after TKA, intraoperative and 12 months after TKA, or 6 and 12 months after TKA. The postoperative flexion range gradually improved, with the maximum improvement observed at 3 months after TKA; there were no significant differences in the flexion range before TKA and 3, 6, and 12 months after TKA. There were no significant differences between flexion ROM measured at 3, 6, and 12 months after TKA. Conclusions: The changes in the knee range of extension plateaued 6 months after TKA, and those in the knee range of flexion plateaued 3 months after TKA. The target range of extension for rehabilitation from 6 months to 12 months after TKA was the intraoperative range, and the target range of flexion for rehabilitation from 3 months to 12 months after TKA was the preoperative range.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yasuyoshi Wadano
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences, Japan
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A Systematic Review of Measurement Properties of Patient-Reported Outcome Measures Used in Patients Undergoing Total Knee Arthroplasty. J Arthroplasty 2017; 32:1688-1697.e7. [PMID: 28162839 DOI: 10.1016/j.arth.2016.12.052] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/15/2016] [Accepted: 12/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND While clinical research on total knee arthroplasty (TKA) outcomes is prevalent in the literature, studies often have poor methodological and reporting quality. A high-quality patient-reported outcome instrument is reliable, valid, and responsive. Many studies evaluate these properties, but none have done so with a systematic and accepted method. The objectives of this study were to identify patient-reported outcome measures (PROMs) for TKA, and to critically appraise, compare, and summarize their psychometric properties using accepted methods. METHODS MEDLINE, EMBASE, SCOPUS, Web of Science, PsycINFO, and SPORTDiscus were systematically searched for articles with the following inclusion criteria: publication before December 2014, English language, non-generic PRO, and evaluation in the TKA population. Methodological quality and evidence of psychometric properties were assessed with the COnsensus-based standards for the selection of health Status Measurement INstruments (COSMIN) checklist and criteria for psychometric evidence proposed by the COSMIN group and Terwee et al. RESULTS One-hundred fifteen studies on 32 PROMs were included in this review. Only the Work, Osteoarthritis or joint-Replacement Questionnaire, the Oxford Knee Score, and the Western Ontario and McMaster Universities Arthritis Index had 4 or more properties with positive evidence. CONCLUSION Most TKA PROMs have limited evidence for their psychometric properties. Although not all the properties were studied, the Work, Osteoarthritis or joint-Replacement Questionnaire, with the highest overall ratings, could be a useful PROM for evaluating patients undergoing TKA. The methods and reporting of this literature can improve by following accepted guidelines.
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Kuroda Y, Matsumoto T, Takayama K, Ishida K, Kuroda R, Kurosaka M. Subjective evaluation before and after total knee arthroplasty using the 2011 Knee Society Score. Knee 2016; 23:964-967. [PMID: 27802922 DOI: 10.1016/j.knee.2016.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 05/26/2016] [Accepted: 06/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient satisfaction has been recognized as an important evaluation of total knee arthroplasty (TKA). Therefore, the 2011 Knee Society Knee Scoring System (2011 KSS) was developed in order to quantify patient satisfaction, expectations, and physical activities following TKA. However, very few reports have described subjective evaluation before TKA using the 2011 KSS, as the scoring system is still relatively new. Therefore, the degree of improvement and change over time after TKA has not been evaluated. METHODS Forty-nine consecutive patients (79 knees) with a mean age of 74.8±7.3years were prospectively included in the study and evaluated preoperatively and one year postoperatively. The following questions were assessed using the 2011 KSS: (1) Do patient-derived clinical scores improve after TKA? (2) Do patient-derived clinical scores before TKA correlate with those after TKA? and (3) Are there correlations among each category of the 2011 KSS score? RESULTS The majority of categories showed significant improvements after TKA. The preoperative functional activities score was positively correlated with the postoperative symptoms, functional activities, and objective score. Each category of the 2011 KSS score correlated with others postoperatively. CONCLUSIONS All patient-derived scores except for patient expectation significantly improved postoperatively. The more functionally active patients before receiving TKA acquired more successful objective and functional outcomes, and the postoperative knee condition was directly influenced by each subscale of the 2011 KSS.
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Affiliation(s)
- Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Qi A, Lin C, Zhou A, Du J, Jia X, Sun L, Zhang G, Zhang L, Liu M. Negative emotions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement. ACTA ACUST UNITED AC 2016; 49:e4616. [PMID: 26577843 PMCID: PMC4678652 DOI: 10.1590/1414-431x20154616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/24/2015] [Indexed: 12/17/2022]
Abstract
This study aimed to determine whether psychological factors affect health-related
quality of life (HRQL) and recovery of knee function in total knee replacement (TKR)
patients. A total of 119 TKR patients (male: 38; female: 81) completed the Beck
Anxiety Inventory (BAI), Beck Depression Inventory (BDI), State Trait Anxiety
Inventory (STAI), Eysenck Personality Questionnaire-revised (EPQR-S), Knee Society
Score (KSS), and HRQL (SF-36). At 1 and 6 months after surgery, anxiety, depression,
and KSS scores in TKR patients were significantly better compared with those
preoperatively (P<0.05). SF-36 scores at the sixth month after surgery were
significantly improved compared with preoperative scores (P<0.001). Preoperative
Physical Component Summary Scale (PCS) and Mental Component Summary Scale (MCS)
scores were negatively associated with extraversion (E score) (B=-0.986 and -0.967,
respectively, both P<0.05). Postoperative PCS and State Anxiety Inventory (SAI)
scores were negatively associated with neuroticism (N score; B=-0.137 and -0.991,
respectively, both P<0.05). Postoperative MCS, SAI, Trait Anxiety Inventory (TAI),
and BAI scores were also negatively associated with the N score (B=-0.367, -0.107,
-0.281, and -0.851, respectively, all P<0.05). The KSS function score at the sixth
month after surgery was negatively associated with TAI and N scores (B=-0.315 and
-0.532, respectively, both P<0.05), but positively associated with the E score
(B=0.215, P<0.05). The postoperative KSS joint score was positively associated
with postoperative PCS (B=0.356, P<0.05). In conclusion, for TKR patients, the
scores used for evaluating recovery of knee function and HRQL after 6 months are
inversely associated with the presence of negative emotions.
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Affiliation(s)
- A Qi
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - C Lin
- Department of Cardiology, Laiwu People's Hospital, Laiwu, China
| | - A Zhou
- The First Ward of the Surgical Department, Laiwu People's Hospital, Laiwu, China
| | - J Du
- Laiwu People's Hospital, Department of Internal Medicine, Branch of Laiwu People's Hospital, Laiwu, China
| | - X Jia
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - L Sun
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - G Zhang
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - L Zhang
- China Medical University, Department of Traumatic Orthopedics, Shengjing Hospital, Shenyang, China
| | - M Liu
- China Medical University, Department of Traumatic Orthopedics, Shengjing Hospital, Shenyang, China
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22
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Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee. INTERNATIONAL ORTHOPAEDICS 2016; 40:2289-2293. [DOI: 10.1007/s00264-016-3167-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/09/2016] [Indexed: 11/27/2022]
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23
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SHIBUKI T, SUKEZAKI F, SUZUKI T, TOYOSHIMA Y, NAGAI T, INAGAKI K. Periprosthetic Bone Mineral Density Changes after Cementless Total Knee Arthroplasty. ACTA ACUST UNITED AC 2016. [DOI: 10.15369/sujms.28.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Takashi SHIBUKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Fumio SUKEZAKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Tastuya SUZUKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Yoichi TOYOSHIMA
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Takashi NAGAI
- Department of Orthopaedic Surgery, Showa University School of Medecine
| | - Katsunori INAGAKI
- Department of Orthopaedic Surgery, Showa University School of Medecine
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24
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Oishi K, Tsuda E, Yamamoto Y, Maeda S, Sasaki E, Chiba D, Takahashi I, Nakaji S, Ishibashi Y. The Knee injury and Osteoarthritis Outcome Score reflects the severity of knee osteoarthritis better than the revised Knee Society Score in a general Japanese population. Knee 2016; 23:35-42. [PMID: 26365575 DOI: 10.1016/j.knee.2015.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were to examine population-based reference data for sex- and age-related differences between the 2011 revised Knee Society Score (KSS2011) and the Knee injury and Osteoarthritis Outcome Score (KOOS), to assess the correlation between those scores and radiographic knee osteoarthritis (OA), and to validate the use of the scores in a general Japanese population. METHODS This cross-sectional study included 963 volunteers (368 males, 595 females; mean age: 54.7years). Participants were classified into five subgroups by age: under 40, 40s, 50s, 60s, and over 70years old. The KSS2011 and KOOS were determined using self-administered questionnaires. Weight-bearing radiographs of the bilateral knee were taken and graded according to the Kellgren-Lawrence (KL) scale. The mean KSS2011 and KOOS were compared among age groups. Correlations between the severity of knee OA and each score were assessed using multiple regression analysis. RESULTS The overall KSS2011 tended to gradually decrease with age. Most subscales of the KSS2011 did not show sex-related differences. Similarly, the overall KOOS and all its subscales steadily decreased by approximately 20 points per decade with age. Most subscales of the KOOS were significantly decreased in females over 50. The KL grade was significantly related to both the overall KOOS (β=-0.42, p<0.001) and KSS2011 (β=-0.13, p=0.001), though the correlation to the KOOS was stronger. CONCLUSION The overall KSS2011 and KOOS appear to decrease with age. In this population, the KOOS reflects the severity of knee OA better than the KSS2011.
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Affiliation(s)
- Kazuki Oishi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shugo Maeda
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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25
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Valkering KP, Breugem SJ, van den Bekerom MPJ, Tuinebreijer WE, van Geenen RCI. Effect of rotational alignment on outcome of total knee arthroplasty. Acta Orthop 2015; 86:432-9. [PMID: 25708694 PMCID: PMC4513597 DOI: 10.3109/17453674.2015.1022438] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Poor outcomes have been linked to errors in rotational alignment of total knee arthroplasty components. The aims of this study were to determine the correlation between rotational alignment and outcome, to review the success of revision for malrotated total knee arthroplasty, and to determine whether evidence-based guidelines for malrotated total knee arthroplasty can be proposed. PATIENTS AND METHODS We conducted a systematic review including all studies reporting on both rotational alignment and functional outcome. Comparable studies were used in a correlation analysis and results of revision were analyzed separately. RESULTS 846 studies were identified, 25 of which met the inclusion criteria. From this selection, 11 studies could be included in the correlation analysis. A medium positive correlation (ρ = 0.44, 95% CI: 0.27-0.59) and a large positive correlation (ρ = 0.68, 95% CI: 0.64-0.73) were found between external rotation of the tibial component and the femoral component, respectively, and the Knee Society score. Revision for malrotation gave positive results in all 6 studies in this field. INTERPRETATION Medium and large positive correlations were found between tibial and femoral component rotational alignment on the one hand and better functional outcome on the other. Revision of malrotated total knee arthroplasty may be successful. However, a clear cutoff point for revision for malrotated total knee arthroplasty components could not be identified.
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Affiliation(s)
- Kars P Valkering
- Departments of Orthopaedic Surgery,Amphia Hospital, Breda, the Netherlands
| | | | | | - Willem E Tuinebreijer
- Departments of Department of General Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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26
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Unver B, Nalbant A, Karatosun V. Comparison of self-reported and measured range of motion in total knee arthroplasty patients. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:192. [PMID: 26417576 PMCID: PMC4560705 DOI: 10.3978/j.issn.2305-5839.2015.07.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Total knee arthroplasty (TKA) is an established method used in the treatment of end-stage knee osteoarthritis. Range of motion (ROM) and relief from pain show success of TKA. One of the most important aims of this treatment is to achieve an adequate ROM. Numerous outcome instruments and patient-reported questionnaires are in use to evaluate of TKA patients. For this purpose, disease-specific questionnaires and self-reported ROM and function evaluation tools are also being developed. The most important criteria in musculoskeletal care is assessing the joint mobility of the patient's. Joint mobility can be measured with visual estimates, universal goniometer, X-ray radiography, digital gravity goniometers and applications found in smart phones. Apart from the reliability and validity of the method, obtaining the same results from different examiners is very important. The clinical follow-up of patients is an important part of postoperative care after TKA. The follow-up interval and duration remain dependent on the physician's anticipation of the clinical progress of the individual patient. Long-term surveillance of joint arthroplasty is necessary, but it has also become increasingly burdensome as greater numbers of TKAs are performed, and in younger populations. Patient self-reported questionnaires and self-goniometric measurement are used by many investigators to decrease this burden on the surgeon or staff, and in combination with telemedicine radiographs might be a reasonable option to routine clinic visits. They could reasonably be expected to lower the burden on both the patient and the clinician without eliminating contact and thus sacrificing quality of care. At the same time, it would reduce the financial burden too. Self-reported measured ROM can use in the routine follow-ups to reduce surgeons, physiotherapist and other staff.
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27
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Tahmasebi MN, Bashti K, Ghorbani G, Sobhan MR. Intraarticular Administration of Tranexamic Acid Following Total Knee Arthroplasty: A Case-control Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2014; 2:141-5. [PMID: 25386572 PMCID: PMC4225016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/03/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) has received extensive attention in management of blood loss in orthopedic surgeries. However, the ideal method of TXA administration is still controversial. This study aims to determine whether intraarticular injection of TXA reduces blood loss after total knee arthroplasty (TKA). METHODS Through a retrospective case-control study consecutive TKA patients receiving intraarticular TXA (Case group) were compared with similar patients undergoing TKA using traditional blood management strategy (Control group). Hemoglobin levels (Hb) before and after the surgery, need for transfusion, and reoperation due to massive blood loss were compared between the two groups. RESULTS Fifty TXA patients were compared with 50 patients of the control group. There was no significant difference between the two groups in terms of age, gender, and preoperative Hb. Postoperative blood loss and transfusion rate were significantly reducedin TXA patients compared to the control group (P<0.05). CONCLUSIONS Our study revealed that intraarticular administration of TXA reduces postoperative blood loss as well as need for blood transfusion in patients undergoing TKA.
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Affiliation(s)
- Mohammad N Tahmasebi
- Mohammad N Tahmasebi MD, Kaveh Bashti MD, Gholamreza Ghorbani MD, Department of Orthopedic Surgery, Division of Knee Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Bashti
- Mohammad N Tahmasebi MD, Kaveh Bashti MD, Gholamreza Ghorbani MD, Department of Orthopedic Surgery, Division of Knee Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Ghorbani
- Mohammad N Tahmasebi MD, Kaveh Bashti MD, Gholamreza Ghorbani MD, Department of Orthopedic Surgery, Division of Knee Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad R Sobhan
- Mohammad N Tahmasebi MD, Kaveh Bashti MD, Gholamreza Ghorbani MD, Department of Orthopedic Surgery, Division of Knee Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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28
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Affiliation(s)
- Francesco Falez
- Orthopaedic and Traumatology, Ospedale Santo Spirito in Sassia, Luingotevere Sassia 3, 00193, Roma, Italy,
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