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Takahashi T, Hatayama K, Ae R, Saito T, Handa M, Kimura Y, Takeshita K. Association between intraoperative findings and postoperative knee range motion after cruciate-retaining total knee arthroplasty. Technol Health Care 2024; 32:1313-1322. [PMID: 37980576 DOI: 10.3233/thc-220841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) alleviates pain and improves daily living activities in individuals with end-stage osteoarthritis of the knee. However, up to 20% of patients have sub-optimal outcomes after TKA. OBJECTIVE No studies have clarified the intraoperative factors that affect postoperative range of motion (ROM) after cruciate-retaining (CR) TKA. Thus, this study aims to clarify these factors. METHODS Patients with knee osteoarthritis with varus knee deformity who underwent CR-TKA between May 2019 and December 2020 were included in this study. One year after surgery, patients were stratified into two groups based on knee flexion: Group F (over 120∘) and Group NF (below 120∘). Patient backgrounds including age, body mass index, hip knee angle, preoperative range of motion for both extension and flexion, intraoperative center joint-gap measurements of 0∘, 30∘, 45∘, 60∘, 90∘, and 120∘ of knee flexion using a tensor, intraoperative anterior-posterior (AP) laxity measurements of 30∘ and 90∘ of knee flexion using an instrumental laximeter were compared between the groups. Univariate analyses between the groups were used to construct the initial model. The receiver operating characteristic curve was also analyzed. The predictive variables included in the final model were selected by stepwise backward elimination. RESULTS Intraoperative AP laxity with 30∘ of knee flexion smaller than 10.8 mm was a significant positive prognostic factor (OR: 1.39, 95% CI: 1.08-1.79, P= 0.011) of postoperative ROM over 120∘ of knee flexion one year after surgery. The sensitivity, specificity, PPV, and NPV were 70.9%, 82.4%, 92.9%, and 46.7%, respectively. CONCLUSION Intraoperative AP laxity smaller than 10.8 mm was a significant positive predictive factor for obtaining knee flexion greater than 120∘ one year after surgery when using CR-TKA and its PPV was high up to 92.9%.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Maebashi, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Saito
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Mikiko Handa
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yuya Kimura
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Katsushi Takeshita
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Stubnya BG, Kocsis K, Váncsa S, Kovács K, Agócs G, Stubnya MP, Suskó E, Hegyi P, Bejek Z. Subvastus Approach Supporting Fast-Track Total Knee Arthroplasty Over the Medial Parapatellar Approach: A Systematic Review and Network Meta-Analysis. J Arthroplasty 2023; 38:2750-2758. [PMID: 37356465 DOI: 10.1016/j.arth.2023.06.004] [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: 01/25/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Numerous surgical approaches are being used to perform total knee arthroplasty (TKA). This systematic review and network meta-analysis aimed to compare surgical approaches used in TKA regarding postoperative outcomesat different time points. METHODS We performed a literature search from medical database inception until October 2, 2021. We searched for randomized controlled trials (RCTs) investigating patients undergoing TKA and comparing at least 2 surgical approaches regarding early postsurgical clinical outcomes (range of motion [ROM], pain on a visual analog scale, and Knee Society Score [KSS]). We included 33 RCTs in our networks. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% CIs by comparing surgical approaches to the medial parapatellar method. RESULTS The subvastus (SV) method performed the best on days 1 (MD = 6.99; CI: 1.08; 12.89), 3 (MD = 8.00; CI: 2.08; 13.92), 4 (MD = 27.01; CI: 18.09; 35.92), and 6 (MD = 27.22; CI: 18.38; 36.07) for ROM improvement. Regarding the decrease in pain, the mini SV approach offered significantly lower pain values on days 1 (MD = -1.98; CI: -2.93; -1.03), 3 (MD = -0.85; CI: -1.49; -0.22), and 7 (MD = -1.90; CI: -2.23; -1.57). The differences decreased as time passed. Furthermore, the SV and mini-SV methods performed the best regarding total, knee and function KSS. CONCLUSION Quadriceps-sparing approaches, especially the SV and mini-SV, are superior to the other approaches in the early postsurgical period, but the differences decrease as time passes.
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Affiliation(s)
- Bence G Stubnya
- Department of Orthopedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Koppány Kocsis
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopedics, Uzsoki Street Hospital, Budapest, Hungary; Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Krisztián Kovács
- Department of Orthopedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Márton P Stubnya
- Department of Orthopedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Eszter Suskó
- Department of Orthopedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Zoltán Bejek
- Department of Orthopedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Sokolovskii SE, Zykin AA, Rukina NN, Malyshev EE. Minimally Invasive (Epivastus) Approach for Total Knee Arthroplasty. Sovrem Tekhnologii Med 2023; 15:23-28. [PMID: 38434191 PMCID: PMC10902901 DOI: 10.17691/stm2023.15.4.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Indexed: 03/05/2024] Open
Abstract
The aim of the study was to assess the efficiency of a developed minimally invasive (epivastus) approach in total knee arthroplasty (TKA) by comparing its early results with those of a standard medial mediapatellar approach (MMPA). Materials and Methods A single-center, comparative randomized prospective study involved 127 patients, who underwent TKA using MMPA (n=62) and a modified minimally invasive epivastus approach (n=65) within the period from January to December, 2022. The study groups were comparable by gender, age, BMI, gonarthrosis stage, and knee joint functioning parameters. Results The surgery duration in the epivastus group was significantly lower compared to MMPA group (p<0.001). However, the interpretation of tissue trauma markers assessment appeared rather ambiguous. There were no statistically significant differences in lactate dehydrogenase (p=0.253). C-reactive protein, myoglobin, creatinine showed a significant increase in MMPA group (p<0.001; p=0.002 and p=0.048, respectively), while aspartate aminotransferase, creatine phosphokinase and ESR, in contrast, increased in the epivastus group (p<0.001; p=0.024 and p=0.010, respectively). Pain syndrome determined by VAS 3 days after the surgery was significantly lower in the epivastus group (p=0.006). The extent of blood loss appeared to be much greater in MMPA group (p=0.006). The joint function indicators on day 3 after the surgery were found to be better in the patients after TKA using an epivastus approach (p<0.001). The postoperative assessment of the endoprosthetic spatial orientation showed the indicators characterizing the correct endoprosthetic implantation to be comparable in both groups (p≥0.06). Conclusion The present study demonstrated the efficiency of the developed minimally invasive (epivastus) approach in TKA. However, it should be taken into consideration that surgeons should take a training course to be able to accomplish a high-quality approach.An ambiguous interpretation of tissue trauma markers assessment of performing minimally traumatic approaches requires terminology correction. It is probably necessary to change the approach to the approach marking and use the terms specifying minimal invasiveness and the reduction of muscle injury rather than soft tissues in general.
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Affiliation(s)
- S E Sokolovskii
- PhD Student, Department of Traumatology, Orthopedics and Neurosurgery named after M.V. Kolokoltsev; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Zykin
- Head of Traumatology and Orthopedics Department No.2, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - N N Rukina
- Senior Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - E E Malyshev
- Professor, Department of Traumatology, Orthopedics and Neurosurgery named after M.V. Kolokoltsev; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. Int J Surg 2022; 101:106616. [PMID: 35427798 DOI: 10.1016/j.ijsu.2022.106616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess the safety of minimally invasive surgery (MIS) for orthopedic spinal, upper limb and lower limb procedures, this systematic review of systematic reviews compared their complications with open procedures. MATERIALS AND METHODS A literature search was conducted electronically (PubMed, Cochrane library and Web of Science; May 8, 2021) without language restriction in the past five years. Reviews that consulted at least two databases, compared MIS with open orthopedic surgery, and reported the following: intraoperative, post-operative or total complications, function, ambulation, pain, hospital stay, reoperation rate and operation time were included. Article selection, quality assessment using AMSTAR-2, and data extraction were conducted in duplicate on predesigned forms. In each review, a subset analysis focusing on prospective cohort and randomized studies was additionally performed. PROSPERO CRD42020178171. RESULTS The search yielded 531 articles from which 76 reviews consisting of 1104 primary studies were included. All reviews were assessed as being low quality. Compared to open surgery, MIS had fewer total, postoperative and intraoperative complications in 2/10, 2/11 and 2/5 reviews of spinal procedures respectively, 1/3, 1/4 and 1/2 reviews of upper limb procedures respectively, and 4/6, 2/7 and 0/2 reviews of lower limb procedures respectively. CONCLUSIONS MIS had greater overall safety compared to open surgery in spinal procedures. In upper limb and lower limb procedures, MIS was not outright superior to open procedures in terms of safety hence a general preference of MIS is not justified on the premise of a better safety profile compared to open procedures.
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Jia Q, Chen X, Zhang J, Hu Y. Which is the better choice? A clinical cohort study protocol evaluating the differences between standard medial parapatellar and minimally invasive approaches in total knee replacement. Medicine (Baltimore) 2021; 100:e24209. [PMID: 33429813 PMCID: PMC7793439 DOI: 10.1097/md.0000000000024209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is still a lack of consensus on the best approach for total knee replacement (TKR). We carried out this present retrospective cohort study to assess the overall safety and effectiveness of a minimally invasive approach without the use of computer navigation in comparison with conventional TKR. METHODS A retrospective review of patients who receiving the primary TKR in the same institution from 2014 to 2016 was conducted. The inclusion criteria for the study indicated that the patient required a unilateral or bilateral TKR was between 18 and 80 years' old, provided informed consent, was followed up for at least 2 years, and was in stable health. There was no treatment for any condition or condition that might pose a risk of excessive surgery. The same TKR standard rehabilitation program was provided to all patients. Data were collected on patient demographics, anesthesia style, American Society of Anesthesiology scores, tourniquet duration, and surgical drainage loss. Our primary outcome measure was discharge time. Secondary outcomes included duration of surgery, incidence of postoperative complications, imaging location 6 weeks after surgery, Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index, and knee ROM. Complications were recorded and classified as surgical site, thromboembolic, systemic, or requiring reoperation. RESULTS It was assumed that there is a remarkable difference in postoperative outcomes between the 2 groups. CONCLUSION The limitations of our present research include the inherent limitations in any retrospective cohort research, including the observation bias and possibility of selection. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6349).
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Affiliation(s)
- Qiong Jia
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangdong
| | - Xin Chen
- Department of Surgical Nursing, Hunan Traditional Chinese Medical College
| | - Jun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Hunan College of traditional Chinese Medicine, Hunan, China
| | - Yang Hu
- Department of Orthopedics, The First Affiliated Hospital of Hunan College of traditional Chinese Medicine, Hunan, China
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