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Mackie M, Barton KI, Sokol-Randell D, Lanting B. The Use of Biomarkers to Quantify Clinical Response to Total Knee Arthroplasty Interventions: A Systematic Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00005. [PMID: 38547046 PMCID: PMC10977533 DOI: 10.5435/jaaosglobal-d-23-00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
The primary objective of this review was to determine whether the attenuation of the postoperative inflammatory response (PIR) after total knee arthroplasty (TKA) leads to a notable improvement in clinical outcome scores. The secondary objective of this review was to determine the optimal approach in using inflammatory biomarkers, clinical inflammatory assessments, and imaging to quantify the PIR. A systematic literature search of eight major databases was conducted using a predetermined search strategy. C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), knee surface temperature (KST), and clinical outcome data were collected and graphically displayed. Eighty-six percent of the studies that reported a statistically significant decrease in inflammatory biomarkers in their treatment group demonstrated a concordant notable improvement in clinical outcome scores. Mean CRP, IL-6, ESR, and KST values peaked on postoperative day (POD) 2, POD1, POD7, and POD 1-3, respectively. The PIR is correlated with early pain and function recovery outcomes. Future studies comparing TKA surgical methodologies and perioperative protocols should assess PIR by incorporating inflammatory biomarkers, such as CRP and IL-6, and clinical inflammatory assessment adjuncts, to provide a more comprehensive comparison.
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Affiliation(s)
- Mark Mackie
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Kristen I. Barton
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Darek Sokol-Randell
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Brent Lanting
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
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Aldanyowi SN. Novel Techniques for Musculoskeletal Pain Management after Orthopedic Surgical Procedures: A Systematic Review. Life (Basel) 2023; 13:2351. [PMID: 38137952 PMCID: PMC10744474 DOI: 10.3390/life13122351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Effective postoperative pain management is critical for recovery after orthopedic surgery, but often remains inadequate despite multimodal analgesia. This systematic review synthesizes evidence on innovative modalities for enhancing pain control following major orthopedic procedures. Fifteen randomized controlled trials and comparative studies evaluating peripheral nerve blocks, local anesthetic infiltration, cryotherapy, transcutaneous electrical stimulation, adjunct medications, and other techniques are included. Thematic analysis reveals that peripheral nerve blocks and local anesthetic infiltration consistently demonstrate reduced pain scores, opioid consumption, and side effects versus conventional analgesia alone. Oral multimodal medications also show promise as part of opioid-sparing regimens. Adjunctive approaches like cryotherapy, music, and dexmedetomidine require further research to optimize protocols. Despite promising innovations, critical knowledge gaps persist regarding comparative effectiveness, optimal interventions and dosing, combination strategies, cost-effectiveness, and implementation. High-quality randomized controlled trials using standardized protocols are essential to guide the translation of enhanced multimodal regimens into clinical practice. This review provides a framework for pursuing research priorities and advancing evidence-based postoperative pain management across orthopedic surgeries.
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Affiliation(s)
- Saud N Aldanyowi
- Orthopedic Surgery, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
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Barahona M, Barrientos C, Alegría A, Barahona MA, Navarro T, Hinzpeter J, Palet M, Zamorano Á, Catalán J, Infante C. Anterior knee pain and sit-up tests predicts patients' satisfaction and improvement in quality of life after anterior stabilized total knee replacement without patellar resurfacing. J Exp Orthop 2023; 10:73. [PMID: 37493976 PMCID: PMC10371966 DOI: 10.1186/s40634-023-00641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE The purpose of this study was to assess patient satisfaction and identify risk factors for dissatisfaction after anterior stabilised conventional total knee arthroplasty (TKA) without patellar resurfacing, using the Goodman score. METHODS We conducted a cross-sectional study using data from our institutional database from 1 January 2018 to 1 March 2021. Patients who underwent TKA with the Vanguard® Cruciate Retaining Anterior Stabilized Knee System (Zimmer Biomet, Warsaw, Indiana, USA) without patellar replacement were included. Patients with other bearing surfaces (posterior stabilised or medial congruent) or diagnosed with infection or instability were excluded. Patients' reported outcomes, body mass index (BMI), passive range of motion, the timed up-and-go test, sit-up test, and algometry were assessed. Patients were also asked if they had anterior knee pain. Satisfaction was assessed using the Goodman scale, and logistic multivariate regression was used to identify variables associated with dissatisfaction and perceived improvement in quality of life. RESULTS A total of 131 TKA patients were included in the study. The median satisfaction score was 100 (interquartile range [IQR], 87.5 to 100), with the 75-point threshold at the 90th percentile according to Section A of Goodman. Section B of Goodman showed that 113 TKA patients (86.26%) reported "great improvement" or "more than I ever dreamed." Multivariate logistic regression revealed that anterior knee pain (OR 5.16, 95% CI 1.24 to 21.39), the sit-up test (OR 0.63, 95% CI 0.49 to 0.81), and BMI (OR 0.84, 95% CI 0.70 to 0.99) were significantly associated with patient dissatisfaction and a worse perceived improvement in quality of life. The receiver operating characteristics curve for the models had areas under the curve of 0.83 (95% CI 0.69 to 0.97) and 0.82 (95% CI 0.70 to 0.94), respectively. CONCLUSION Anterior stabilised TKA without patellar resurfacing can achieve 90% satisfaction and 86% improvement in quality of life. To improve these results, it is essential to prevent and treat anterior knee pain and enhance quadriceps strength. LEVEL OF EVIDENCE Level III (retrospective cohort study).
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile.
| | - Cristian Barrientos
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Anselmo Alegría
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Macarena A Barahona
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Tomas Navarro
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Jaime Hinzpeter
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Miguel Palet
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Álvaro Zamorano
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Jaime Catalán
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Carlos Infante
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
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Mortazavi SMJ, Vosoughi F, Yekaninejad M, Ghadimi E, Kaseb MH, Firoozabadi MA, Fallah E, Toofan H, Pestehei SK. Comparison of the Effect of Intra-Articular, Periarticular, and Combined Injection of Analgesic on Pain Following Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial. JB JS Open Access 2022; 7:JBJSOA-D-22-00074. [PMID: 36226033 PMCID: PMC9536812 DOI: 10.2106/jbjs.oa.22.00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to compare the efficacy of 3 methods of intraoperative analgesic cocktail injection during total knee arthroplasty (TKA)—intra-articular (IA), periarticular (PA), and combined intra-articular and periarticular (IA+PA)—on controlling early postoperative pain.
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Affiliation(s)
- Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,Email for corresponding author:
| | - Farzad Vosoughi
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mirsaeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghadimi
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Kaseb
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Fallah
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesam Toofan
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Khalil Pestehei
- Department of Anesthesiology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Isolated effects of patellar resurfacing in total knee arthroplasty and their relation to native patellar geometry. Sci Rep 2022; 12:12979. [PMID: 35902607 PMCID: PMC9334631 DOI: 10.1038/s41598-022-16810-2] [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: 05/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
The isolated effects of patellar resurfacing on patellar kinematics are rarely investigated. Nonetheless, knowing more about these effects could help to enhance present understanding of the emergence of kinematic improvements or deteriorations associated with patellar resurfacing. The aim of this study was to isolate the effects of patellar resurfacing from a multi-stage in vitro study, where kinematics after total knee arthroplasty before and after patellar resurfacing were recorded. Additionally, the influence of the native patellar geometry on these effects was analysed. Eight fresh frozen specimens were tested successively with different implant configurations on an already established weight bearing knee rig. The patello-femoral kinematics were thereby measured using an ultrasonic measurement system and its relation to the native patellar geometries was analysed. After patellar resurfacing, the specimen showed a significantly medialized patellar shift. This medialization of the patellar tracking was significantly correlated to the lateral facet angle of the native patella. The patellar shift after patellar resurfacing is highly influenced by the position of the patellar button and the native lateral patellar facet angle. As a result, the ideal medio-lateral position of the patellar component is affected by the geometry of the native patella.
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Baghbani-Naghadehi F, Armijo-Olivo S, Prado CM, Gramlich L, Woodhouse LJ. Does obesity affect patient-reported outcomes following total knee arthroplasty? BMC Musculoskelet Disord 2022; 23:55. [PMID: 35039019 PMCID: PMC8764810 DOI: 10.1186/s12891-022-04997-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is an existing perception that obesity has a negative impact on complications following total knee arthroplasty (TKA). However, data on the impact of obesity levels on patient-reported outcomes (PROMs) is sparse. We investigated the association between different obesity classes with PROMs among patients who underwent TKA. Methods We performed retrospective secondary analyses on data extracted from the total joint replacement data repository (Alberta, Canada) managed by the Alberta Bone and Joint Health Institute (ABJHI). Patients had WOMAC and EQ5D scores measured at baseline in addition to 3 and/or 12 months following TKA. Patients were stratified according to the World Health Organization (WHO) classification, into five body mass index (BMI) groups of normal, overweight, BMI class I, BMI class II, and BMI class III. The association between BMI and mean changes in WOMAC subscales (pain, function, and stiffness) and EQ-5D-5L index over the time intervals of baseline to 3 months and 3 to 12 months following TKA was assessed. Linear mixed-effects models were used, and the models were adjusted for age, sex, length of surgery, comorbidities, year of surgery, and geographical zone where the surgery was performed. Results Mean age was 65.5 years (SD = 8.7). Postoperatively, there was a significant improvement (p < 0.001) in WOMAC subscales of patient-reported pain, function, and stiffness, as well as EQ-5D-5L regardless of BMI group. Although, patients in BMI class II and class III reported significantly improved pain 3 months after TKA compared to those with normal BMI, all BMI groups attained similar level of pain reduction at 12 months after TKA. The greatest improvement in all WOMAC subscales, as well as EQ5D index, occurred between baseline and 3 months (adjusted p < 0.0001). Conclusion The findings indicate that patients reported improved pain, function, and stiffness across all BMI groups following TKA. Patients with BMI classified as obese reported similar benefits to those with BMI classified as normal weight. These results may help health care providers to discuss expectations regarding the TKA recovery in terms of pain, function, and quality of life improvements with their TKA candidates. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-04997-4.
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Affiliation(s)
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrück, Germany.,Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carla M Prado
- Faculty of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Linda J Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Tufts University, School of Medicine, Department of Public Health & Community Medicine, Division of Physical Therapy, Boston, Massachusetts, USA
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