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Thomas P, Arenberger P, Bader R, Bircher AJ, Bruze M, de Graaf N, Hartmann D, Johansen JD, Jowitz-Heinke A, Krenn V, Kurek M, Odgaard A, Rustemeyer T, Summer B, Thyssen JP. A literature review and expert consensus statement on diagnostics in suspected metal implant allergy. J Eur Acad Dermatol Venereol 2024; 38:1471-1477. [PMID: 38606660 DOI: 10.1111/jdv.20026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. OBJECTIVES To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. METHODS A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty-three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face-to-face (9/12) or virtual participation (3/12), an anonymous online voting was performed. RESULTS Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire-aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. CONCLUSIONS Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research.
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Affiliation(s)
- P Thomas
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - P Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - R Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - A J Bircher
- Department of Dermatology and Allergology, University Hospital and University of Basel, Basel, Switzerland
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - N de Graaf
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | - D Hartmann
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
- München Klinik gGmbH, Munich, Germany
| | - J D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, University of Copenhagen, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - A Jowitz-Heinke
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - V Krenn
- MVZHZMD Trier GmbH, Trier, Germany
| | - M Kurek
- Hospital MEDICAM, Gryfice, Poland
| | - A Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - T Rustemeyer
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | - B Summer
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - J P Thyssen
- Department of Dermatology and Allergy, University of Copenhagen, Herlev and Gentofte Hospital, Hellerup, Denmark
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Pua YH, Yeo SJ, Clark RA, Tan BY, Haines T, Bettger JP, Woon EL, Tan HH, Tan JWM, Low J, Chew E, Thumboo J. Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial. Osteoarthritis Cartilage 2024; 32:601-611. [PMID: 38049030 DOI: 10.1016/j.joca.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). DESIGN In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). RESULTS In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, -0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, -0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. CONCLUSIONS In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Ross Allan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia.
| | - Bryan Yijia Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore.
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Janet Prvu Bettger
- Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Hong Han Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - John Wei-Ming Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Juanita Low
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Eleanor Chew
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
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Zhou H, Zhang Y, Agarwal A, Arnold G, Wang W. A preliminary study on analysis of lower limb energy during walking in the patients with knee replacement. Heliyon 2024; 10:e27960. [PMID: 38509893 PMCID: PMC10951602 DOI: 10.1016/j.heliyon.2024.e27960] [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: 09/21/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Background Knee replacement surgeries are used to reduce pain and enhance functionality for individuals with knee arthritis. It is predicted that the annual volume of total knee replacement surgeries conducted in the US will surge by a substantial 673% by 2030. Though a lot of studies have done gait analysis on patients with knee replacement, little research is on energy changes in the lower limbs during gait. This study aimed to investigate the mechanical energy changes in the lower limbs for patients with total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), and ultimately to provide a specific tool to analyze limb energy during gait in clinical practice. Methods 10 TKA and 8 UKA patients were recruited for gait analysis. The control group consisted of 11 individuals without knee replacement surgery. Vicon motion capture system and Plug-in-Gait model were used to collect gait data to obtain marker coordinates and gait parameters. The kinetic energy, potential energy, and rotational energy for each segment in the lower limbs were calculated. The energies in the centre of pelvis were considered as the approximate to the centre of mass. The energy recovery coefficients were analysed for each segment during gait. SPSS was used to identify the differences between different groups. Results The results showed that during walking, the upper leg had the highest recovery coefficient, approximately 40%, followed by the foot at 10%, and the lowest recovery coefficient was observed in the lower leg, approximately 1-3%. However, the energy recovery coefficients at the centre of pelvis were significantly higher in the control group than the TKA and UKA groups by roughly 12%-15%. Conclusions The energy difference between the operative and non-operative sides is not significant regardless of the type of surgery. The TKA and UKA groups were more active in potential energy than control group. The upper leg has the highest recovery efficiency of kinetic and potential energy exchanges when walking. The control group used the energy for whole body is better than the patient groups. This study provides a new and useful way to analyze mechanical energy in the lower limbs during gait and could be applied in clinical practice.
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Affiliation(s)
- Haifei Zhou
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Yuying Zhang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Archit Agarwal
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
- Department of Orthopedics, S P Wahi ONGC Hospital, Dehradun, 248003, India
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
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Oka T, Wada O, Mizuno K. Comparison of time courses in postoperative functional outcomes between simultaneous bilateral and unilateral total knee arthroplasty with propensity score matching. Arch Orthop Trauma Surg 2024; 144:369-375. [PMID: 37750909 DOI: 10.1007/s00402-023-05065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/03/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION/OBJECTIVES No consensus has been reached on which is better in terms of functional outcomes between simultaneous bilateral and unilateral total knee arthroplasty (TKA). As patient characteristics, such as age, sex, and body mass index, have significant effects on functional outcomes after TKA, these factors should be matched before comparisons are made. This study aimed to compare time courses in functional outcomes between simultaneous bilateral TKA and unilateral TKA after matching the patient characteristics. MATERIALS AND METHODS In this retrospective study, the clinical records of patients admitted to a hospital were reviewed. Of 425 patients, 43 underwent simultaneous bilateral TKA, whereas 382 underwent unilateral TKA. Propensity score matching was performed for age, sex, and body mass index between simultaneous bilateral and unilateral TKA patients. Therapists measured pain intensity, knee extensor strength, and knee-specific functional outcomes by using the new knee society score, including total score, symptoms, patient satisfaction, patient expectations, and functional activities preoperatively and 3 and 12 months postoperatively. Two-way repeated analysis of variance was performed to compare the time courses in functional outcomes between simultaneous bilateral and unilateral TKA. RESULTS After propensity score matching, 40 patients each for underwent bilateral TKA and unilateral TKA were selected. Knee extensor strength in simultaneous bilateral TKA patients was significantly lower than that in unilateral TKA patients at 3 months postoperatively (p = 0.04). A significant interaction was observed between the effects of time and group on knee extensor strength (F [1, 78] = 3.338; interaction: p = 0.042; η2 = 0.052). No significant interactions were found among the other variables measured. CONCLUSIONS Patients who underwent simultaneous bilateral TKA should undergo postoperative rehabilitation focused on alleviating delayed recovery in knee extensor strength during the acute phase.
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Affiliation(s)
- Tomohiro Oka
- Department of Rehabilitation Science, Osaka Health Science University, 1-9-27, Tenma, Kita-ku, Osaka, 530-0043, Japan.
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo, Japan.
| | - Osamu Wada
- Department of Rehabilitation, Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Department of Orthopedics, Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Pua YH, Poon CLL, Seah FJT, Tan JWM, Woon EL, Chong HC, Thumboo J, Clark RA, Yeo SJ. Clinical Interpretability of Quadriceps Strength and Gait Speed Performance in Total Knee Arthroplasty: A Longitudinal Study. Am J Phys Med Rehabil 2023; 102:389-395. [PMID: 36728706 DOI: 10.1097/phm.0000000000002176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE After a total knee arthroplasty, physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function. DESIGN A sample of 2624 patients with primary total knee arthroplasty participated in this retrospective longitudinal study. Monthly, for 4 mos after surgery, quadriceps strength and gait speed were quantified. At the month-6 time point, self-reported walking and stair climbing function was measured. RESULTS All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher month-6 self-reported walking and stair climbing function ( P < 0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P < 0.001). Among female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 wks after total knee arthroplasty. CONCLUSIONS By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Understand how self-reported walking and stair climbing abilities improved from baseline before total knee arthroplasty (total knee arthroplasty) to 6 mos postoperatively; (2) Describe the time course of the 2 performance-based measures of quadriceps strength and walking speed after a total knee arthroplasty; and (3) Relate the trajectories of post-total knee arthroplasty quadriceps strength and walking speed measurements across distinct levels of self-reported walking and stair climbing function. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Yong-Hao Pua
- From the Department of Physiotherapy, Singapore General Hospital, Singapore (Y-HP, CL-LP, JW-MT, E-LW); Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore (Y-HP, JT); Department of Physiotherapy, Sengkang General Hospital, Singapore (FJ-TS); Department of Physiotherapy, Changi General Hospital, Singapore (H-CC); Department of Rheumatology and Immunology, Singapore General Hospital, Singapore (JT); Health Services Research and Evaluation, Singhealth Office of Regional Health, Singapore (JT); Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia (RAC); and Department of Orthopaedic Surgery, Singapore General Hospital, Singapore (S-JY)
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Graber J, Juarez-Colunga E, Thigpen C, Waugh D, Bade M, Stevens-Lapsley J, Kittelson A. Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty. Disabil Rehabil 2022; 44:7535-7542. [PMID: 34751608 PMCID: PMC9306324 DOI: 10.1080/09638288.2021.1995054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.
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Affiliation(s)
- Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | | | - Dawn Waugh
- ATI Physical Therapy, Greenville, SC, USA
| | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
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Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
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Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
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Klasan A, Putnis SE, Yeo WW, Myat D, Fritsch BA, Coolican MR, Parker DA. Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study. J Knee Surg 2021; 34:1579-1586. [PMID: 32450604 DOI: 10.1055/s-0040-1712100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.
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Affiliation(s)
- Antonio Klasan
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Sven Edward Putnis
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Wai Weng Yeo
- Department of Medicine, University of New South Wales, Sydney, Australia
| | - Darli Myat
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
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Sano Y, Iwata A, Wanaka H, Matsui M, Yamamoto S, Koyanagi J, Iwata H. An easy and safe training method for trunk function improves mobility in total knee arthroplasty patients: A quasi-randomized controlled trial. PLoS One 2018; 13:e0204884. [PMID: 30286130 PMCID: PMC6171877 DOI: 10.1371/journal.pone.0204884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Total knee arthroplasty (TKA) is aimed mainly at reducing pain and restoring mobility. However, mobility deficits can persist even longer than 1 year. The trunk function and movement velocity of any region have been recently recognized to be critical for determining mobility in older people. Therefore, the main goal of this quasi-randomized trial is to clarify the effectiveness of a novel training method, the seated side tapping (SST) training, for improving mobility by focusing on movement velocity of trunk function in the short term after TKA. Methods SST training consists of side trunk movements repeated as quickly as possible in a seated position. All participants after TKA were randomly assigned to the SST training group (n = 37) or control training group (n = 38). The participants in the SST group performed SST training plus the standard rehabilitation program 5 days per week for 3 weeks after TKA, while the control group performed only the standard rehabilitation programs. The primary outcome was the effect of SST training on mobility, indicated by gait speed and the timed up and go test (TUG) time. Measurements were performed before and 1, 2, and 3 weeks after surgery. Results At all-time points, the patients in the SST group showed significantly better mobility, despite that knee function, represented by muscle strength, range of motion, and degree of pain at the knee joint, was similar in both groups. The difference in gait speed between the groups was >0.1 m/s at all time points, which is clinically significant. Conclusion SST training significantly improved patients’ mobility within 3 weeks after TKA, despite that no additional benefit was observed in knee function. The findings in this study indicate that SST training may be considered as a part of the rehabilitation program after TKA, although further evaluation of its long-term effectiveness is needed. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; UMIN000027909).
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Affiliation(s)
- Yuki Sano
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Akira Iwata
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- * E-mail:
| | - Hideyuki Wanaka
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Mina Matsui
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Saki Yamamoto
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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