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Shim GY, Kim EH, Lee SJ, Chang CB, Lee YS, Lee JI, Hwang JH, Lim JY. Postoperative rehabilitation using a digital healthcare system in patients with total knee arthroplasty: a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:6361-6370. [PMID: 37129691 DOI: 10.1007/s00402-023-04894-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Digital healthcare systems based on augmented reality (AR) show promise for postoperative rehabilitation. We compared the effectiveness of AR-based rehabilitation and conventional rehabilitation after total knee arthroplasty (TKA). MATERIALS AND METHODS We randomly allocated 56 participants to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). Participants in the CR group performed brochure-based home exercises for 12 weeks, whereas those in the DR group performed AR-based home exercises that showed each motion on a monitor and provided real-time feedback. The primary outcome was change in 4-m gait speed. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, health-related quality of life [assessed by the EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire], pain [measured using a numeric rating scale (NRS)], Berg Balance Scale (BBS), range of motion (ROM), and muscle strength. Outcomes were measured at baseline (T0) and 3 (T1), 12 (T2), and 24 (T3) weeks after randomization. RESULTS There was no significant difference in baseline characteristics of participants between two groups, except age and body mass index. No group difference was observed in 4-m gait speed (0.37 ± 0.19 and 0.42 ± 0.28 for the DR and CR groups, respectively; p = 0.438). The generalized estimating equation model revealed no significant group by time interaction regarding for 4-m gait speed, WOMAC, EQ5D5L, NRS, BBS, ROM, and muscle strength score. All outcomes were significantly improved in both groups (p < 0.001). CONCLUSION The use of a digital healthcare system based on AR improved the functional outcomes, pain, and quality of life of patients after TKA. AR-based rehabilitation may be useful treatment as an alternative to conventional rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT04513353). Registered on August 9, 2020. http://clinicaltrials.gov/ct2/show/NCT04513353 .
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Affiliation(s)
- Ga Yang Shim
- Department of Physical and Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eun Hye Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea
| | - Seong Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-Gu, Seoul, Republic of Korea.
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea.
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Early Postoperative Pain After Total Knee Arthroplasty Is Associated With Subsequent Poorer Functional Outcomes and Lower Satisfaction. J Arthroplasty 2021; 36:2466-2472. [PMID: 33744080 DOI: 10.1016/j.arth.2021.02.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are few studies investigating the effects of acute postoperative pain on functional outcomes after total knee arthroplasty (TKA). The aims of this study are to identify perioperative factors associated with increased early postoperative pain and investigate the effects of acute postoperative day 1 and 2 pain on outcomes at 6 months and 2 years post-TKA. METHODS 1041 unilateral TKA patients were included in this retrospective cohort study. Patients were categorized into minor (visual analog scale: VAS <5) and major (VAS ≥5) pain groups based on postoperative day 1/2 VAS scores. Patients were assessed preoperatively, at 6 months and 2 years using Knee Society Knee Score and Function Scores (KSFS), Oxford Knee Score (OKS), SF-36 physical and mental component score (SF-36 PCS), expectation and satisfaction scores. Perioperative variables including age, gender, race, body mass index, American Society of Anesthesiologist status, type of anesthesia, and presence of caregiver were analyzed as predictors of postoperative acute pain. Wilcoxon two-sample test was used to analyze outcomes significantly associated with "major pain." Multiple logistic regression was used to identify predictors of "major pain." RESULTS Patients with "minor pain" had significantly better KSFS, Knee Society Knee Score, OKS, and SF-36 PCS scores at 6 months and significantly better KSFS, OKS, SF-36 PCS, and satisfaction at 2 years (P < .05). A significantly higher percentage of patients with "minor pain" met the minimal clinically important difference for SF-36 PCS at 6 months and KSFS at 2 years (P < .05). Women, Indian/Malay race, higher BMI, and use of general over regional anesthesia were independent predictors of getting "major pain" (P < .05). CONCLUSION Patients should be counseled about risk factors of postoperative pain to manage preoperative expectations of surgery. Patients should be managed adequately using multimodal pain protocols to improve subsequent functional outcomes while avoiding unnecessary opioid use.
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Effect of Preoperative Diabetes on the Achievement of Forgotten Knee Status in Patients with Total Knee Arthroplasty. Indian J Orthop 2021; 55:1144-1149. [PMID: 34824714 PMCID: PMC8586376 DOI: 10.1007/s43465-021-00428-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: 02/07/2021] [Accepted: 05/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Forgotten knee is the terminology which is used to describe a post-TKA patient who is completely unaware of his knee implant. The aim of the study is to determine whether preoperative diabetes negatively influences the achievement of forgotten knee status. METHODS This is a retrospective cohort study. 300 patients (240 F:60 M) were studied. Patients were evaluated by an independent observer with FJS-12 score 2 weeks preop and at 6 weeks and 12 months after the operation. The patients with a FJS-12 score of ≥ 55 were considered to have achieved forgotten knee status. Out of 240 females, 96 had diabetes and out of 60 males, 18 had diabetes. Preoperative factors such as preop HBA1c, ROM, degree of deformity, VAS score and other associated co morbidities and postoperative factors such as HBA1c, ROM and hip-knee-ankle alignment were studied. Study was started with null hypothesis. The statistical difference was measured with Binominal proportion test and comparison of means t test. RESULTS 96 out of 144 non-diabetic females (66.67%) and 51 out of 96 diabetic females (53%) achieved forgotten knee status (statistically significant, p value = 0.0336, Binominal proportion test). 27 out of 42 (65%) non-diabetic males and 12 out 18 diabetic males (66%) achieved forgotten knee status (p value = 0.9411). The FJS-12 score at 1 year for non-diabetic females and diabetic females was 58.6 mean ± 12.6 SD and 53.8 ± 17.6, respectively, which is statistically significant, p value 0.0145. The FJS-12 at 1 year in non-diabetic and diabetic males was 60.1 ± 14.8 and 59.6 ± 17.3, respectively, p value = 0.9097. CONCLUSION Diabetic females have less chance of achieving a forgotten knee status than non-diabetic females. This understanding will help the operating surgeon in the preoperative patient counseling and modify the patient expectations.
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Londhe SB, Shah RV, Doshi AP, Londhe SS, Subhedar K, Iyengar K, Mukkannavar P. Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. ARTHROPLASTY 2021; 3:10. [PMID: 35236438 PMCID: PMC8796486 DOI: 10.1186/s42836-020-00063-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.
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Affiliation(s)
- Sanjay Bhalchandra Londhe
- Orthopaedic surgeon, Criticare Hospital, Plot No 516, Besides SBI, Teli Gali, Andheri East, Mumbai, Maharashtra, 400069, India.
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Sharma S, Kumar V, Sood M, Malhotra R. Effect of Preoperative Modifiable Psychological and Behavioural Factors on Early Outcome Following Total Knee Arthroplasty in an Indian Population. Indian J Orthop 2021; 55:939-947. [PMID: 34194651 PMCID: PMC8192610 DOI: 10.1007/s43465-020-00325-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Non-surgical factors have been found to have significant impact on outcome following Total Knee Arthroplasty (TKA). The study was conducted to know the independent effect of each of the four interacting psychological factors: anxiety, depression, pain catastrophizing and kinesiophobia on early outcome following TKA in an Indian population. MATERIALS AND METHODS 104 consecutive patients undergoing TKA were included in the study and followed up at 6 weeks, 6 months and one year. Preoperatively, Hospital Anxiety and Depression Scale was used to diagnose and quantify anxiety and depression, pain catastrophizing and kinesiophobia were assessed using Pain Catastrophizing Scale and Tampa Scale for Kinesiophobia, respectively. Outcome was assessed on the basis of Knee Society Score and Knee Injury and Osteoarthritis Outcome Score. Regression analysis was done to know independent effect of each factor on outcome scores. RESULTS Nine (8.7%) patients were found to have undiagnosed psychopathology. The patients with psychopathologies were found to have significantly worse knee outcome scores on follow-up, although the rate of improvement in knee symptoms and function was not significantly different from those without psychopathology. The degree of Anxiety correlated with worse knee pain and stiffness up to 6 months while it correlated with poor knee function for a longer duration. The degree of depression and pain catastrophizing correlated with worse knee pain, stiffness and function at all visits while kinesiophobia didn't show correlation independent other factors. CONCLUSION Psychopathology was found to be associated poor knee outcome scores with degree of preoperative depression and pain catastrophizing as significant independent predictors as poor outcome, whereas the effect of degree of anxiety on knee pain and stiffness was found to wane over time. Kinesiophobia didn't show any independent correlation. SUPPLEMENTARY INFORMATION The online version of this article (10.1007/s43465-020-00325-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saurabh Sharma
- Department of Orthopaedics, Chauhan Medicity, Pathankot, Punjab India
| | - Vijay Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Klem NR, Kent P, Smith A, Dowsey M, Fary R, Schütze R, O'Sullivan P, Choong P, Bunzli S. Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100032. [DOI: 10.1016/j.ocarto.2020.100032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022] Open
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Oka T, Ono R, Tsuboi Y, Wada O, Kaga T, Tamura Y, Yamamoto Y, Mizuno K. Effect of preoperative sedentary behavior on clinical recovery after total knee arthroplasty: a prospective cohort study. Clin Rheumatol 2019; 39:891-898. [PMID: 31811412 DOI: 10.1007/s10067-019-04849-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/22/2019] [Accepted: 11/08/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Prolonged sedentary behavior (SB) may affect clinical improvements following total knee arthroplasty (TKA). We aim to assess preoperative SB effect on improvements in clinical outcomes after TKA. We hypothesized that patients with high proportion of preoperative SB have small improvements in clinical outcomes after TKA. METHODS We recruited 115 adults with knee osteoarthritis (OA), planning to undergo TKA. Knee-specific functional outcomes were assessed using the new knee society score (KSS), including total score, symptoms, patient satisfaction, patient expectations, and functional activities. Gait function was assessed using the timed up and go (TUG) test. SB was measured using a triaxial accelerometer. Multiple linear regression analysis was performed to investigate preoperative SB effect on improvements in clinical outcomes 6 months postoperatively by adjusting for several factors as potential confounders. RESULTS Of 115 patients, 82 were included. High proportion of preoperative SB had a significant negative effect on recovery at 6 months in the new KSS total score [β, -0.83, 95% confidence interval (CI), -1.53 to -0.12; p = 0.02], symptoms (-0.15, -0.28 to -0.02; p = 0.03), patient satisfaction (-0.22, -0.42 to -0.02; p = 0.03), and functional activities (-0.40, -0.76 to -0.04; p = 0.03) after adjusting for potential confounders. CONCLUSIONS A high proportion of preoperative SB was a risk factor for reduced improvements in knee-specific functional outcomes after TKA. To prevent poor functional recovery after TKA, it is essential to understand the preoperative lifestyle factors and intervene proactively during acute postoperative phase in patients with high SB proportion.Key Points• Preoperative high proportion of SB had a negative effect on improvement in new KSS total scores, symptoms, patient satisfaction, and functional activities.• When considering clinical outcomes after TKA, clinicians should closely monitor patients with high proportions of preoperative SB to prevent poor functional recovery.
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Affiliation(s)
- Tomohiro Oka
- Department of Rehabilitation, Anshin Hospital, Kobe, Japan. .,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Yamato Tsuboi
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.,Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Osamu Wada
- Department of Rehabilitation, Anshin Hospital, Kobe, Japan
| | - Takehiro Kaga
- Department of Rehabilitation, Anshin Hospital, Kobe, Japan
| | - Yoriko Tamura
- Department of Rehabilitation, Anshin Hospital, Kobe, Japan
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Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA. Functions, disabilities and perceived health in the first year after total knee arthroplasty; a prospective cohort study. BMC Musculoskelet Disord 2018; 19:250. [PMID: 30045710 PMCID: PMC6060557 DOI: 10.1186/s12891-018-2159-7] [Citation(s) in RCA: 18] [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: 12/22/2017] [Accepted: 06/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background In end-stage knee osteoarthritis total knee arthroplasty (TKA) is an effective intervention to reduce pain and improve functioning in the majority of patients. However, after TKA some patients still experience pain, loss of function, deficient muscle strength or reduced walking speed. This study systematically assesses patients’ functions, disabilities and health before TKA and at short- (3 months) and long-term (12 months) on all International Classification of Functioning, Disability and Health domains. Methods In this prospective cohort study 150 patients underwent the following tests before and at 3 and 12 months after surgery: Western Ontario and McMaster Universities Arthritis Index, Short Form 12, Knee Society Score, Patient Specific Functioning Scale, knee range of motion, quadriceps and hamstring strength, gait parameters, global perceived effect (only after surgery). All data was analyzed with repeated measures ANOVA for all measurement time points. Results Despite increased gait speed, quadriceps strength and scores on questionnaires being above pre surgical levels, patients do not reach levels of healthy persons. Walking speeds approach normal values and are higher in our study compared with the literature. Quadriceps strength stays at around 70 till 80% of norm values. However, dissatisfaction rates are below 10%, which is low compared to the literature. Conclusions Quality of life, activities, muscle strength and gait parameters improve significantly after TKA. However, some complaints regarding activities and walking speed remain. Most striking outcome is the remaining deficit in quadriceps strength.
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Affiliation(s)
- Danielle D P Berghmans
- Department of Physical therapy, Maastricht University Medical Center +, PO 5800, 6202, AZ, Maastricht, The Netherlands. .,Maastricht University/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Antoine F Lenssen
- Department of Physical therapy, Maastricht University Medical Center +, PO 5800, 6202, AZ, Maastricht, The Netherlands.,Maastricht University/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Pieter J Emans
- Department of Orthopedics, Maastricht University Medical Center +, PO 5800, 6202, AZ, Maastricht, The Netherlands.,Maastricht University/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Maastricht University/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Niemeyer P, Albrecht D, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Bosch U, Erggelet C, Fickert S, Gebhard H, Gelse K, Günther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Müller PE, Nöth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Fritz J. Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU). Knee 2016; 23:426-35. [PMID: 26947215 DOI: 10.1016/j.knee.2016.02.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/13/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. METHODS The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning therapeutic consequences of primary cartilage lesions and the suitable indication for ACI. RESULTS Based on best available scientific evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than three to four square centimetres; in the case of young and active sports patients at 2.5cm(2), while advanced degenerative joint disease needs to be considered as the most important contraindication. CONCLUSION The present review gives a concise overview on important scientific background and the results of clinical studies and discusses the advantages and disadvantages of ACI. LEVEL OF EVIDENCE Non-systematic Review.
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Affiliation(s)
- P Niemeyer
- Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Germany.
| | - D Albrecht
- Klinik im Kronprinzenbau, Reutlingen, Germany
| | - S Andereya
- Orthopädie und Unfallchirurgie, Ortho AC, Aachen, Germany
| | - P Angele
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany; Sportopaedicum, Straubing, Berlin, Regensburg, München, Germany
| | - A Ateschrang
- Berufsgenossenschaftliche Unfallklinik Tübingen, Germany
| | - M Aurich
- Kliniken Leipziger Land GmbH, Klinikum Borna, Germany
| | - M Baumann
- Kreiskliniken Esslingen, Klinik f. Unfallchirurgie - Orthopädische Chirurgie, Esslingen, Germany
| | - U Bosch
- Zentrum f. Orthopädische Chirurgie, Sporttraumatologie, INI Hannover, Germany
| | - C Erggelet
- Center of Biologie Joint Repair, Zürich, Switzerland
| | - S Fickert
- Sportopaedicum, Straubing, Berlin, Regensburg, München, Germany
| | - H Gebhard
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany
| | - K Gelse
- Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen, Germany
| | - D Günther
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH), Germany
| | - A Hoburg
- Universitätsmedizin Berlin-Charite, Klinik für Orthopädie, Unfall u. Wiederherstellungschirurgie, Germany
| | - P Kasten
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
| | - T Kolombe
- Unfallchirurgie/Orthopädie, DRK Krankenhaus Luckenwalde, Germany
| | - H Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - S Marlovits
- Universitätsklinik für Unfallchirurgie, Medizinische Universität Wien und Austrian Cluster for Tissue Regeneration, Austria
| | - N M Meenen
- Sektion Pädiatrische Sportmedizin, Kinderorthopädie, Altonaer Kinderkrankenhaus Hamburg, Germany
| | - P E Müller
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, Germany
| | - U Nöth
- Evangelisches Waldkrankenhaus Spandau, Klinik f. Orthopädie und Unfallchirurgie, Berlin, Germany
| | - J P Petersen
- Zentrum f. operative Medizin, Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - M Pietschmann
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, Germany
| | - W Richter
- Forschungszentrum für Experimentelle Orthopädie, Universitätsklinikum Heidelberg, Germany
| | - B Rolauffs
- Berufsgenossenschaftliche Unfallklinik Tübingen, Germany
| | | | - B Schewe
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
| | - A Steinert
- Orthopädische Klinik, König-Ludwig-Haus, Universität Würzburg, Germany
| | | | | | - W Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken, Germany
| | - J Fritz
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
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Thambiah MD, Nathan S, Seow BZX, Liang S, Lingaraj K. Patient satisfaction after total knee arthroplasty: an Asian perspective. Singapore Med J 2016; 56:259-63. [PMID: 26034317 DOI: 10.11622/smedj.2015074] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is an effective method for alleviating pain and restoring knee function in patients with severe osteoarthritis. However, despite the improvements in surgical technique and postoperative care, it has been reported that up to 19% of patients are dissatisfied after their operations. The aim of this study was to evaluate patient satisfaction levels after TKA in an Asian cohort, as well as assess the correlation between patient satisfaction levels and the results of traditional physician-based scoring systems. METHODS The medical data of 103 Asian patients who underwent 110 TKAs between December 2008 and June 2009 were obtained from our hospital's Joint Replacement Registry. The minimum follow-up period was one year and patient expectations were assessed before TKA. Patient satisfaction was assessed postoperatively using a 5-point Likert scale. Reasons for patient dissatisfaction were recorded. Standardised instruments (e.g. the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and the generic Short Form-36 health survey) were used to assess the patient's functional status and the severity of symptoms pre- and postoperatively. RESULTS Among the 110 TKAs performed, 92.8% resulted in patient satisfaction. Patient satisfaction correlated with postoperative WOMAC function scores (p = 0.028), postoperative WOMAC final scores (p = 0.040) and expectations being met (p = 0.033). CONCLUSION Although there was a high level of patient satisfaction following TKA in our cohort of Asian patients, a significant minority was dissatisfied. Patient satisfaction is an important outcome measure and should be assessed in addition to traditional outcome scores.
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Affiliation(s)
| | - Sahaya Nathan
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Branden Z X Seow
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Shen Liang
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Krishna Lingaraj
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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Stratford PW, Kennedy DM, Robarts SF. Modelling knee range of motion post arthroplasty: clinical applications. Physiother Can 2010; 62:378-87. [PMID: 21886379 DOI: 10.3138/physio.62.4.378] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To model change in knee range of motion (ROM) post total knee arthroplasty (TKA) and to show how this information can be incorporated into clinical decision making. METHOD We applied a variable-occasion repeated-measures study design. Patients' knee flexion and extension ROM were assessed pre- and post arthroplasty over the ensuing 60 weeks. We examined change in ROM post TKA using linear and nonlinear mixed-effects modelling, and examined whether age, body mass index, prearthroplasty ROM, and gender were determinants of recovery in post-arthroplasty ROM. RESULTS Of 93 eligible patients, 74 provided pre- and post-arthroplasty data. A random intercept nonlinear model fit the flexion data best, and a random intercept linear model fit the extension data best. Pre-arthroplasty ROM was found to be a determinant of recovery in ROM post arthroplasty. This finding was common to both flexion and extension models. CONCLUSIONS Our study showed that the greatest improvement for knee ROM took place during the first 12 weeks post arthroplasty. Of the variables examined, only pre-arthroplasty ROM was a determinant of outcome (p<0.05). The study results provide clinicians with data to determine expected rates of improvement for patients as well as the projected maximum ROM, facilitating improved clinical decision making.
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Affiliation(s)
- Paul W Stratford
- Paul W. Stratford, PT, MSc: Professor, School of Rehabilitation Science; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
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