Bilateral Total Knee Arthroplasty Research Articles

Outcomes of Calipered Mechanically Aligned Versus Calipered Restricted Kinematically Aligned Bilateral Total Knee Arthroplasty - A Randomized Controlled Trial

Outcomes of Calipered Mechanically Aligned Versus Calipered Restricted Kinematically Aligned Bilateral Total Knee Arthroplasty - A Randomized Controlled Trial

Comparison of Early Postoperative Pain Between Same-Day Bilateral and Staggered Bilateral Total Knee Arthroplasties In Centrally Sensitized Patients

Comparison of Early Postoperative Pain Between Same-Day Bilateral and Staggered Bilateral Total Knee Arthroplasties In Centrally Sensitized Patients

Hematogenous prosthetic knee joint infection with Klebsiella pneumoniae caused by asymptomatic gallbladder abscess: a case report and literature review

Abstract Klebsiella pneumoniae has the ability to form biofilm; therefore, the treatment of prosthetic joint infection involving K. pneumoniae is often challenging. This report describes the first case of acute hematogenous prosthetic knee joint infection with K. pneumoniae that occurred as a result of an asymptomatic gallbladder abscess. The patient was a 78-year-old man who underwent bilateral total knee arthroplasty 6 years ago. He had pain and swelling in his right knee. The synovial fluid culture of the right knee revealed K. pneumoniae and prosthetic joint infection was diagnosed. Computed tomography revealed a gallbladder abscess in the absence of right upper abdominal pain. The patient underwent simultaneous debridement of the knee and open cholecystectomy. The treatment was successful and the prosthesis was retained. In cases of hematogenous prosthetic joint infection with K. pneumoniae, other sources of infection should be suspected and investigated regardless of whether they are symptomatic.

Pain management following simultaneous bilateral total knee arthroplasty: genicular nerve blockade versus periarticular injection

The aim of the present study was to investigate whether the analgesic solution prepared for periarticular injection (PAI) could be utilized as a genicular nerve blockade (GNB) agent in bilateral knee arthroplasty, and to assess the pain control efficacy of this approach in comparison with PAI. This was a retrospective cohort in which patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were evaluated. Thirty patients were enrolled. The standard PAI was used for one knee, while the PAI solution was applied in the form of GNB to the other. Visual Analog Scale (VAS) pain scores were measured and recorded separately for each knee, at rest (static) and during exercise (dynamic). Active range of joint motion (JRM) for both knee joints was measured preoperatively, at postoperatively. Compared to the PAI group, the GNB group had lower VAS scores at 2 and 8 hours (p = 0.030 and p < 0.001, respectively). The GNB group also had lower dynamic VAS scores at 2, 8, and 24 hours (p = 0.009, p <0.001 and p<0.001, respectively). Static and dynamic VAS measurements did not demonstrate any differences between groups (GNB vs. PAI) at 48 hours and 30 days (p>0.05). When the reduction in VAS scores was assessed, we found that the decrease in both scores was significantly greater in the PAI group compared to the GNB group (p<0.001, for both). There were no significant differences between the groups with regard to drainage volume, complications and JRM (p>0.05). GNB was found to be more effective for pain control throughout the first postoperative day in patients who underwent simultaneous bilateral TKA.

The use of a walking aid before surgery is not related to worse short-term outcomes after simultaneous bilateral total knee arthroplasty

Introduction: No study has been performed to compare patients’ pre- and post-operative knee disability, functional status, and length of hospital stay after surgery between patients with and without using a walking aid. Methods: One-hundred forty-five patients were enrolled and divided into four groups based on whether they used any walking aids before surgery: no walking aid, one cane, one elbow crutch, and two elbow crutches. The groups were compared for knee disability (Hospital for Special Surgery (HSS) knee score), functional status (Iowa Level of Assistance Scale (ILAS)), and length of hospital stay. Results: For the pre-operative HSS knee scores, no statistically significant differences were found between the groups ( p > 0.05). For the pre-operative ILAS scores, the patients without using walking aids had better functional status than those using any walking aids ( p < 0.05). For the post-operative outcomes, no statistically significant differences were found between the groups in the HSS knee and the ILAS scores and length of hospital stay after surgery. Conclusion: In this population, using any walking aids before surgery is related to worse pre-operative functional status but not to the pre-operative knee disability. Furthermore, it is not related to the short-term outcomes after surgery.

Prognostic Factors in Staged Bilateral Total Knee Arthroplasty-A Retrospective Case Series Analysis.

Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure. We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications. All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371). We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size.

The efficacy and safety of tranexamic acid in rheumatoid arthritis patients undergoing simultaneous bilateral total knee arthroplasty: a multicenter retrospective study

BackgroundThe efficacy and safety of tranexamic acid (TXA) in reducing blood loss following total knee arthroplasty (TKA) in patients with osteoarthritis have been widely confirmed. However, there is still a paucity of the evidences regarding the effectiveness of TXA in patients with rheumatoid arthritis (RA). The purpose of the study is to explore the efficacy and safety of intravenous TXA on blood loss and transfusion risk following simultaneous bilateral TKA (SBTKA) in patients with RA.MethodsAs a multicenter retrospective study, a total of 74 patients diagnosed with RA who underwent SBTKA were assigned into TXA group (15 mg/kg intravenous TXA before skin incision, n = 50) and control group (no TXA use, n = 24). The primary outcomes were total blood loss (TBL) and intraoperative blood loss (IBL). The secondary outcomes were hemoglobin (Hb) and hematocrit (Hct) drop on postoperative day 3, transfusion rate and volume, ambulation time, length of stay, hospitalization expenses and the incidence of complications.ResultsThe mean TBL, IBL and transfusion volume in TXA group were significantly lower than those in control group. The Hb and Hct drop on postoperative day 3 in control group were higher than those in TXA group (p<0.05). The similar trend was detected on transfusion rate, ambulation time and length of stay. The incidence of complications and hospitalization expenses did not differ significantly between the two groups (p>0.05).ConclusionsTXA could effectively reduce blood loss, decrease transfusion risk, shorten ambulation time and length of stay following SBTKA in patients with RA, without increasing the risk of complications.

Efficacy of topical tranexamic acid in bilateral cementless total knee arthroplasty

Efficacy of topical tranexamic acid in bilateral cementless total knee arthroplasty

Simultaneous bilateral TKA in the context of fast track surgery – Do patients meet discharge criteria as anticipated?

BackgroundThe efficacy and safety of enhanced recovery after surgery (ERAS) protocols for patients undergoing total knee arthroplasty (TKA) have been generally proven. Previous studies investigating patients undergoing simultaneous bilateral TKA (SBTKA) focused on complications, mortality, and pain and did not examine patients’ functional limitations. Therefore, the aim of this study was to investigate to what extent patients undergoing SBTKA are able to meet functional discharge criteria originally designed for their counterparts undergoing unilateral TKA (UTKA) in an ERAS setting. Materials and methodsAll patients who received primary SBTKA between June 2015 and December 2018 were included in this retrospective analysis. For comparison, UTKA patients were matched 1:1 to SBTKA patients using Propensity Score Matching based on age, gender, and BMI. The times to achieving the rehabilitation checkpoints of walking 150 m, walking a flight of stairs, and 90° knee flexion were evaluated. Results63 (SBTKA group) and 64 (UTKA group) patients were included. Due to the Propensity-Score-Matching there were no differences regarding age, gender, and BMI. The mean length of stay (LOS) was 9.1 days in the SBTKA and 7.6 days in the UTKA group (p = 0.003). On average, it took SBTKA patients 5.4 days to achieve an uninterrupted walking distance of at least 150 m, while it took UTKA patients 4.1 days (p < 0.001). Mean time to walking a flight of stairs was 6.3 days for SBTKA patients and 4.7 days for UTKA patients (p < 0.001). 90° flexion was achieved after 4.1 days by SBTKA patients and 3.5 days by UTKA patients (p = 0.241). ConclusionThe vast majority of SBTKA patients were able to achieve functional discharge criteria within their inpatient stay when allowed about 30% extra time. Therefore, functional discharge criteria in ERAS protocols designed for UTKA can be considered appropriate for SBTKA patients. Level of evidenceTherapeutic Level III.

Is simultaneous bilateral unicompartmental knee arthroplasty and total knee arthroplasty better than simultaneous bilateral total knee arthroplasty?

IntroductionThis retrospective study aims to clarify if there are benefits of performing unicompartmental knee arthroplasty (UKA) on just one indicated side in patients who undergo simultaneous bilateral knee arthroplasty.Materials and methodsWe compared 33 cases of simultaneous bilateral UKA/total knee arthroplasty (TKA) (S-UT) with 99 cases of simultaneous bilateral TKA (S-TT). Comparison included blood tests [C-reactive protein (CRP), albumin, and D-dimer], the incidence of deep vein thrombosis (DVT), range of motion (ROM), and clinical scores before and 1 year after surgery.ResultsClinical scores were not significantly different between the groups. The postoperative flexion angle was significantly better in UKA sides. Blood tests showed that the S-UT had a significantly higher albumin value at 4 and 7 days after surgery. The CRP value at 4 and 7 days, and the D-dimer value at 7 and 14 days after surgery were significantly lower in the S-UT. The S-UT had significantly lower incidence of DVT.ConclusionsIn cases of bilateral arthroplasty, if there is an indication on only one side, a better flexion angle can be obtained by UKA on that side, and with less surgical invasion. Moreover, the incidence of DVT is low, which is considered to be a benefit of performing UKA on just one side.

Data-driven preoperative hemoglobin thresholds in patients undergoing Bilateral simultaneous total Knee arthroplasty are similar to patients undergoing unilateral total Knee arthroplasty

IntroductionPreoperative anemia is a risk factor for transfusions and complications following total knee arthroplasty (TKA). Bilateral TKA (bTKA) is more extensive compared to unilateral TKA (uTKA) and a higher preoperative hemoglobin threshold may be warranted. We hypothesized that the optimal hemoglobin cutoff value which predicts the need for postoperative transfusion would be higher for bTKA than uTKA. MethodsWe conducted a case control study using a national database and identified patients undergoing primary TKA from 2010-2020. 1:1, nearest-neighbor propensity-score matching was used to create a cohort of patients undergoing uTKA matched with patients undergoing bTKA based on age, gender, Charlston Comorbidity Index (CCI), and American Society of Anesthesiology (ASA) classification. After 2015, NSQIP discontinued collection of the variables MI, angina, and hemiplegia. Thus, the accuracy of CCI, which was used as a matching variable, will be less accurate after 2015. To explore this limitation further, a sensitivity analysis was performed excluding data after 2015 and there was no change in the significance of our primary outcomes.Hemoglobin thresholds which maximally predict postoperative transfusion risk and 30-day complications were identified using Youden’s index. Significance was considered if 95% CI’s were non-overlapping. Results9,891 patients were included in each of the bTKA and uTKA cohorts with successful 1:1 matching (p > 0.05 for all criteria). 3.216 (16 %) of patients received a transfusion in the postoperative period. Hemoglobin values which predict postoperative transfusions were not significantly different between uTKA and bTKA for both female and male groups. In females, the preoperative hemoglobin threshold was 12.8 g/dL (95 % CI: 12.2–13.3) in patients undergoing bTKA and 12.7 g/dL (95 % CI: 12.2 – 13.2) in uTKA. In males, the threshold was 13.9 (95 % CI: 13.7–14.2) in patients undergoing bTKA and 13.1 g/dL (95 % CI: 12.5–13.8) in patients undergoing uTKA. ConclusionsPreoperative hemoglobin values which maximally predict postoperative transfusion risk following uTKA and bTKA are similar without significant differences.

No Difference in 30-day Mortality Between Patients Undergoing Bilateral Simultaneous Total Knee Arthroplasty With Technology Assistance Compared to Conventional Instrumentation.

Background: Bilateral simultaneous total knee arthroplasty (BSTKA) has decreased in frequency due to concerns about higher rates of early mortality and complications than unilateral or staged surgeries. Purpose: We sought to evaluate whether technology assistance (encompassing robotics and computer assistance) decreases early mortality following BSTKA. Methods: We conducted a retrospective cohort study using a national all-payer claims database. Patients who underwent BSTKA from October 2015 to December 2020 were identified. Univariate and multivariable analyses were conducted to compare outcomes in patients who underwent BSTKA with technology assistance compared to conventional instrumentation. The primary outcome was 30-day postoperative mortality. Secondary outcomes were respiratory failure and fat embolism. A post-hoc analysis was performed to evaluate length of stay, readmission, and other medical complications. Results: A total of 14,870 patients who underwent BSTKA were included in this study. Of these, 860 patients underwent technology-assisted BSTKA, and 14,010 patients underwent BSTKA without technology assistance. After a multivariable analysis, patients who underwent technology-assisted BSTKA had equivalent odds of 30-day mortality compared to those who underwent BSTKA without technology assistance. Technology assistance was not protective against the development of acute respiratory failure or fat embolism. Conclusion: This retrospective cohort study found no differences in the rates of 30-day mortality, respiratory failure, or fat embolism after technology-assisted BSTKA compared to conventional BSTKA. On the post-hoc analysis, technology use was associated with a decreased length of stay, lower readmission risk, and decreased rates of deep vein thrombosis, pulmonary embolism, and blood transfusion.

Venous thromboembolism is rare after total hip and knee joint arthroplasty with long thromboprophylaxis in Finnish fast-track hospitals

IntroductionPharmacological thromboprophylaxis effectively prevents venous thromboembolism (VTE) after total knee (TKA) and total hip arthroplasty (THA). Less is known about the influence of fast-track arthroplasty on VTE risk. We conducted a register-based study to determine the incidence of VTE after fast-track TKA and THA in Finland using long thromboprophylaxis.Materials and methodsAll primary TKAs and THAs operated during 2015–2016 in 3 fast-track hospitals were identified from the Finnish Arthroplasty Register. Pulmonary embolism (PE) and deep vein thrombosis (DVT) diagnosed in this patient cohort within 90 days of surgery were identified from the Finnish Hospital Discharge Register. The recommended length of thromboprophylaxis was 10 to 14 days for TKA and 28 days for THA during study period.ResultsDuring the study period, 3 831 THAs, 4 394 TKAs and 286 bilateral TKAs (BTKAs) were performed. Of all these patients, 60% were females. Venous thromboembolism (VTE) incidence within 90 days of surgery was 0.3% (95% CI 0.2–0.4). These VTEs comprised 10 PEs and 15 DVTs. None of the VTE patients´ died within the 90-day period.ConclusionVTE incidence is low in Finnish fast-track TKA and THA patients with long thromboprophylaxis.

The impact of Charlson Comorbidity Index on surgical complications and reoperations following simultaneous bilateral total knee arthroplasty

Simultaneous bilateral total knee arthroplasty (TKA) might be associated with higher postoperative morbidity and mortality rates compared with staged bilateral TKA. However, risk factors for surgical complications and reoperations following simultaneous bilateral TKA remain elusive. We conducted this retrospective, single-surgeon case series from 2010 through 2019. A total of 1561 patients who underwent simultaneous bilateral TKA procedures were included. The outcome domains included 30-day and 90-day readmission events for medical or surgical complications and 1-year reoperation events. We performed logistic regression analysis and backward stepwise selection to identify possible risk factors, including age, sex, body mass index, diabetes mellitus (DM), rheumatoid arthritis, American Society of Anesthesiologist (ASA) classification, Charlson Comorbidity Index (CCI), receiving venous thromboembolism (VTE) prophylaxis, or blood transfusion. The overall 30-day, 90-day readmission, and 1-year reoperation rates were 2.11%, 2.88%, and 1.41%, respectively. Higher CCI score (CCI = 4+) was a risk factor for 90-day readmission (aOR: 2.783; 95% CI 0.621–12.465), 90 day readmission for surgical complications (aOR: 10.779; 95% CI 1.444–80.458), and 1 year reoperation (aOR: 4.890; 95% CI 0.846–28.260). Other risk factors included older age, higher ASA level, DM, and receiving VTE prophylaxis. In conclusion, high CCI scores were associated with increased risks of surgical complications and reoperations following simultaneous bilateral TKA procedures.

Use of tranexamic acid in simultaneous bilateral total knee arthroplasty: a comparative study

Background Blood loss after total knee arthroplasty (TKA) is not something to neglect especially if it is bilateral. A lot of measures can be taken to reduce this blood loss such as tourniquets, autologous transfusion, and closed suction drains. Purpose The use of closed suction drains in TKA has downsides such as introducing a foreign body to the wound, increasing nursing care, etc. This leads to the question whether this use can be replaced by other modalities such as the use of tranexamic acid injections. Patients and methods Two groups of 13 patients undergoing bilateral TKA were compared. The first group had tranexamic acid injections while the other had closed suction drains. The number of transfusions and the hemoglobin drop 1 and 2 days postoperatively were assessed and compared between both groups. Results The hemoglobin drop both on the first and second day after the surgery were higher in the group operated with a closed suction drainage (P=0.000162 and 0.01512, respectively). The number of transfusions was also higher in the group operated with closed suction drainage (18 compared with four transfusions needed in the other group). Conclusion The use of drains may be replaced by tranexamic acid injections in bilateral TKA.

Bilateral diz protezi yapılan hastalarda postoperatif analjezi için standart intravenöz hasta kontrollü analjezi dozu yeterli olur mu?

The aim of this study is to investigate whether patients undergoing one-stage bilateral total knee arthroplasty and those undergoing unilateral total knee arthroplasty differed in their responses to a standard intravenous patient-controlled analgesia protocol. Data from patients with the physiological status I-III according to American Society of Anesthesiologists, aged 18-99 years, undergoing one-stage bilateral or unilateral total knee arthroplasty under spinal anesthesia between January 2014 and December 2017 and offered a standard intravenous patient-controlled analgesia with morphine were retrospectively reviewed. Demographic data, Visual Analogue Scale scores and postoperative complications were examined. The total dose of analgesics consumed, analgesia demands, doses delivered and the ratio of delivered doses to demands in 0- 24 hours and 24-48 hours after surgery available in the patient-controlled analgesia pump monitoring forms were recorded. &#x0D; Records about 68 patients who had one-stage bilateral total knee arthroplasty and 124 patients who had unilateral total knee arthroplasty were accessed. The analgesia demands and analgesic doses delivered and utilized by the patients with one-stage bilateral total knee arthroplasty were significantly higher in 0-24 hours and 24-48 hours after surgery. Side-effects of the analgesia were similar in both groups. Visual Analogue Scale scores in 24-48 hours after surgery were higher in the patients with unilateral total knee arthroplasty. &#x0D; Although the patients with one-stage total knee arthroplasty received significantly higher doses of morphine, side-effects due to this opioid did not differ significantly. This showed that the standard intravenous patient-controlled analgesia protocol utilized was reliable and effective in both patient groups.

Effectiveness of Intraoperative Use of Tranexamic Acid in Total Knee Arthroplasty

Background: Blood loss is among the commonly encountered problems in total knee arthroplasty (TKA) surgeries. Tranexamic acid (TXA) is commonly used intravenously to decrease the blood loss during TKA. However, it has got its own contraindications. In such patients, it can also be used locally to prevent blood loss. We assessed the effectiveness of local TXA by determining the amount of blood loss and transfusion required. Materials and Methods: A total of 60 patients with 72 TKA surgeries were included and analyzed in this observational prospective study. Three Gram of TXA was infiltrated locally into the tissues immediately after skin closure before the release of the tourniquet. The amount of blood loss was calculated by comparing the preoperative and postoperative hemoglobin (Hb) levels. Results: The mean blood loss in patients whom local TXA was used was 433.3 ml. The mean postoperative Hb loss was 1.01. Only one patient with bilateral TKA required postoperative blood transfusion. There were no issues with wound healing in any of our patients. The P value in Hb loss was 0.002 and in total blood was 0.001 and were statistically significant. Conclusion: Local use of TXA is very effective in reducing the amount of postoperative blood loss and the need for the blood transfusion. We recommend for the local use of TXA in primary knee arthroplasty surgeries.

Comparison of the effect of total knee arthroplasty and high tibial osteotomy on coronal pelvic and ankle–hindfoot alignment

BackgroundTotal knee arthroplasty (TKA) and high tibial osteotomy (HTO) are different procedures on the continuous spectrum of osteoarthritic knee treatments. TKA aims for neutral alignment and HTO aims for slight valgus. Methods2:2:2:1 propensity score matching yielded 100, 100, 100, and 50 patients with unilateral TKA, bilateral TKA, unilateral HTO, and bilateral HTO, respectively. Radiological evaluations of pelvis, knee, ankle, and hindfoot were performed. The important factors affecting the alignment change of the adjacent joints were identified, and subgroup analyses were performed using the identified parameters. The clinical outcomes were also compared. ResultsThe coronal alignments of the adjacent joints were corrected to the neutral position after TKA and HTO. The tibiotalar tilt angle (TTTA) was a common factor that affected changes in the ankle and hindfoot alignment. Patients with larger preoperative TTTA showed larger changes in TTTA in both TKA and HTO groups (P < 0.001). Patients with larger preoperative hindfoot alignment angle (HAA) showed larger changes in tibial plafond inclination, talar inclination, and HAA in both TKA and HTO groups (P < 0.001). TKA groups showed negative pelvic tilt values in the horizontal plane, and HTO groups showed a larger weight-bearing line ratio. ConclusionEven more severe deformities including adjacent joints were observed in TKA patients, both TKA and HTO patients showed improved alignment of the adjacent joints. However, HTO patients showed closer normal alignment than patients who underwent TKA. The preoperative TTTA and HAA were important factors for restoration of ankle and hindfoot alignment after knee surgery.

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) undergoing bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) are an uncommon population, and their outcomes are also difficult to predict. The purpose of this study was to evaluate whether both bilateral cementless THA and cemented posterior-stabilized TKA (PS-TKA) can provide reliable outcomes for RA patients.MethodsWe retrospectively reviewed 30 RA patients (60 hips and 60 knees) who underwent both elective bilateral cementless THA and cemented PS-TKA, with a minimum follow-up of 2 years. Clinical, patient-reported, and radiographic data were retrospectively analyzed.ResultsThe mean follow-up was 84 months (range, 24–156). By the last follow-up, the post-operative range of motion, Harris Hip Score, Knee Society Score (KSS) clinical, KSS functional, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) hip, and WOMAC knee scores were significantly improved compared to the preoperative values. All patients achieved the ability to walk. In addition, overall satisfaction scores on a 100-point scale were 92.5 after THA and 89.6 after TKA. Only one patient underwent revision surgery due to knee joint instability, and all replaced hips and knees were radiographically stable by the assessment of the radiolucent line. The proportion of implants that did not suffer loosening or require revision surgery was 99.2% during the 84-month follow-up, based on Kaplan-Meier analysis.ConclusionsOur study suggests that bilateral cementless THA and cemented PS-TKA provides reliable mid-long-term clinical, patient-reported, and radiographic outcomes in RA patients, with high survivorship and patient satisfaction.

Mid-vastus total knee arthroplasty for medial osteoarthritis recovers gait balance control better than lateral parapatellar approach three months post-surgery.

Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3months after TKA via the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body's center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA via LPPA and 12 via MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3months after surgery. The participants' kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS (p < 0.01) but less sagittal and frontal RCIA throughout the gait cycle (p < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.