Bilateral Total Knee Replacement Research Articles

Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report

BackgroundGas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.Case presentationA 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.ConclusionsThis case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.

Perioperative Intra-articular Infiltration of Tranexamic Acid and Ropivacaine Cocktail in Bilateral Total Knee Replacement

Objective: This study evaluated the efficacy and safety of perioperative intra-articular infiltration with a tranexamic acid and ropivacaine cocktail in patients undergoing bilateral total knee replacement (TKR). Methods: A randomized controlled trial was conducted involving 50 patients scheduled for elective bilateral TKR. Participants were randomly assigned to receive either intra-articular infiltration of a tranexamic acid and ropivacaine cocktail (intervention group) or standard care (control group). Outcome measures included postoperative blood loss, pain scores, range of motion, and adverse events. Results: Among the enrolled patients (n=50), the intervention group demonstrated reduced postoperative blood loss, evidenced by higher hemoglobin levels and lower drain output than the control group. Additionally, the intervention group exhibited consistently lower pain scores at various postoperative time points and greater improvements in range of motion. Conclusion: Intra-articular infiltration with a tranexamic acid and ropivacaine cocktail in bilateral TKR patients showed promising outcomes, including reduced blood loss, improved pain control, and enhanced range of motion. These findings suggest the potential of this adjunctive therapy in optimizing perioperative care for patients undergoing bilateral TKR. However, further research with larger sample sizes is warranted to validate these preliminary results and establish this intervention’s long-term efficacy and safety.

ARE GOOD OUTCOMES IN TOTAL KNEE ARTHROPLASTY PREDICTIVE OF SUCCESS IN SEQUENTIAL CONTRALATERAL TKA SURGERY?

There is little published literature to support the claim that a successful total knee replacement (TKR) is predictive of future good outcomes on the contralateral side. The objective was to identify whether outcome from the first of staged TKRs could be used to predict the outcome of the contralateral TKR.This was a retrospective cohort study of 1687 patients over a 25-year period undergoing staged bilateral TKRs in a UK arthroplasty centre. A control group of 1687 patients undergoing unilateral TKR with matched characteristics was identified. Primary outcomes were satisfaction and Knee Society Score (KSS) at one year.Preoperative status was comparable for pain, ROM and KSS (mean 41, 45, 43±14). At one year follow up, dissatisfaction was similar for all groups (4% first of staged TKR, 4% second of staged TKR, 5% controls). If the first TKR had a good outcome, the relative risk of a contralateral bad outcome was 20% less than controls (95% CI 0.6–1.2). If the first TKR had a poor outcome, the risk of a second poor outcome was 4 times higher (95% CI 2.8–6.1), increasing from 6% to 27% (absolute risk).Patients undergoing the second of staged TKRs with a previous good outcome are likely to do well in their second procedure (94 in 100 will go on to have a second good outcome). Of those with a previous poor outcome, 27 in 100 will have a second poor outcome. The trend was persistent despite correcting for gender, age, BMI, and diagnosis.

Alterations of biomarkers in assessing the prognosis of osteoarthritis in patients with total knee replacement: A cross-sectional study

Introduction: Osteoarthritis (OA) is a chronic disorder characterized by inflammation, cartilage degeneration and bone remodelling with molecular derangements followed by anatomic and physiologic elements. The aim of the study was to assess the alterations of biomarkers in patients who underwent total knee replacement (TKR) for OA. Methods: A cross-sectional retrospective analysis was carried out on 206 participants who underwent either unilateral or bilateral TKR for knee OA from January 2017 to December 2020. Data regarding medical and surgical history, demographic characteristics, X-ray findings, complete blood count (CBC), plasma glucose and high-sensitive C-reactive protein (hsCRP) were collected and analysed. Ethics approval was obtained. Based on the normality of distribution appropriate statistical tools were used. P value≤0.05 was considered statistically significant. Results: Body mass index was significantly higher in participants who underwent bilateral TKR rather than unilateral TKR. Females were affected at a younger age compared to males. Hypothyroid participants had unilateral than bilateral TKR. Neutrophil lymphocyte ratio was higher in bilateral rather than unilateral TKR (P=0.038). Males had higher monocyte lymphocyte ratio (P≤0.001), especially in individuals 61-80 years of age as well as in obese individuals. Conclusion: The use of markers such as total leukocyte count, differential count, neutrophil to lymphocyte (NLR), monocyte to lymphocyte ratios (MLR) and hsCRP are cost-effective and could predict the severity of the disease. These markers could be used to screen individuals at risk for developing OA of the knee and help in assessing the prognosis; thus allowing surgeons to decide on the appropriate management of the disease.

Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report

BackgroundTotal knee replacement is a major orthopedic procedure for severe, painful, and mobility-limiting knee arthritis. Aortic valve stenosis is the most frequent valvular heart disease and the most commonly performed valvular procedure. Stenosis of the valve may lead to left ventricular hypertrophy, ventricular dysfunction, myocardial ischemia, and a state of fixed cardiac output. Changes in hemodynamic parameters such as hypotension and bradycardia in patients with carotid artery stenosis may lead to cerebrovascular accidents, especially during anesthesia.Case presentationA 76-year-old woman with a 6-year history of bilateral knee pain. The pain was dull, aching, and severe in intensity, and it prevented her from sleeping despite optimal analgesics. A general physical examination revealed an elderly, frail woman in mild respiratory distress. She had bilateral small-volume radial pulses, positive hepatojugular reflux, and heart sounds of S1, S2, and S4 with an ejection systolic murmur, and carotid bruits were heard bilaterally. Epidural anesthesia was done by injection of 2.5 mL of 0.5% plain bupivacaine in aliquots every 5 min until the level of the block reached the suprapubic region (titrated segmental epidural anesthesia). The patient was not preloaded with intravenous fluid prior to the establishment of epidural anesthesia, and the epidural anesthesia-induced hypotension that may ensue was managed with intraoperative dopamine infusion at 5 µg/kg/min.ConclusionsTitrated segmental epidural anesthesia with intraoperative infusion of low-dose dopamine reduces the perioperative risk of myocardial infarction, cerebrovascular accident, and neurocognitive deficit in a patient with severe aortic stenosis and severe bilateral carotid stenosis.

Complications in simultaneous bilateral total knee arthroplasty, is it a safe procedure?

BackgroundThere is controversy regarding various aspects of simultaneous bilateral total knee replacement (SBTKR). We found disparity in the postoperative outcomes and complications associated with the procedure in the literature linked with the topic. ObjectiveTo retrospectively analyze the need for blood transfusion after surgery and complications associated with total knee replacement according to the type of procedure (SBTKR or unilateral). MethodsRetrospective cohort analytical study. We included 251 patients with severe knee osteoarthritis that were divided into two groups. 124 (49%) who underwent SBTKR and 127 upon whom unilateral total knee replacement (UTKR) was performed. Demographic data, days of hospitalization, complications within the first 90 days after surgery (thromboembolic events, superficial and deep infection, stiffness, death); and percentages of patients transfused with blood products during hospitalization were evaluated. ResultsThere were no statistical differences in the analysis of postoperative complications in the first 90 days after surgery. In the SBTKR group, 8 patients (6.5%) presented some thromboembolic complication during the postoperative period, while this event was observed in only 2 patients (1.5%) from the other group. The analysis showed a statistically significant drop in postoperative hemoglobin, on average that of 0.8 ​g/dl, in the SBTKR patient group compared to the UTKR group (95% CI 0.44–1.13; p ​< ​0.001). A higher proportion of patients who required transfusion were observed in the SBTKR group (40%) (OR ​= ​7.12; 95% CI 3.3–16; p ​< ​0.001).We analyzed the cause of postoperative transfusion in the patients who required transfusion taking into account two parameters: hemoglobin less than 8 ​g/dl and the clinical needs of the patients (symptoms of hypotension, decay, difficulty to rehabilitate without pain, dyspnea). 59 patients received transfusion (50 in the SBTKR group and 9 in the other group). Of these, 19 patients (32.2%) did not meet any transfusion criteria. ConclusionWe consider SBTKR a safe procedure, which does not increase postoperative complications compared to UTKR. Although there is an increase in blood loss in SBTKR, it does not generate clinical symptoms of relevance. Level of evidenceLevel III.

COMPARISON OF INTRAVENOUS VERSUS TOPICAL TRANEXAMIC ACID IN BLOOD LOSS REDUCTION IN BILATERAL TOTAL KNEE ARTHROPLASTY

AbstractIntroductionMultiple strategies, used either in isolation or combination, are available to reduce the need for post-operative blood transfusion in joint replacements. Amongst them, the use of tranexamic acid (TXA) has been rising and this study was conducted to compare the efficacy of topical and intravenous TXA in bilateral total knee replacement patients.Materials and methodsRandomised prospective study with 120 patients (male: female: 25:95) undergoing bilateral TKA. Patients were divided into two groups A and B after computer randomization, who received intravenous or topical (intra-articular) TXA respectively.ResultsThe average haemoglobin loss in intravenous group was 90.2379 g/L as compared to 39.137 g/L in topical group (p &lt; 0.005). Moreover, there was reduction in blood loss in topical (330.1602 ml) as compared to intravenous group (764.9622 ml). The blood transfusion rate was more for the intravenous group (average 1.73 units) than for the topical group (average 0.75, unit). WOMAC score at 6 weeks in the intravenous group was 12.50, and in the topical group was 7.23 (p value &lt; 0.001).ConclusionTopical TXA is better than intravenous TXA for reduction of blood loss, which also reduces the need for blood transfusion in bilateral TKA patients.

ARE GOOD OUTCOMES IN TOTAL KNEE ARTHROPLASTY PREDICTIVE OF SUCCESS IN SEQUENTIAL CONTRALATERAL SURGERY?

AbstractIntroductionThere is little published literature to support the claim that a successful total knee replacement (TKR) is predictive of future good outcomes on the contralateral side. The objective was to identify whether outcome from the first of staged TKRs could be used to predict the outcome of the contralateral TKR.MethodologyThis was a retrospective cohort study of 1687 patients over a 25-year period undergoing staged bilateral TKRs in a UK arthroplasty centre. A control group of 1687 patients undergoing unilateral TKR with matched characteristics was identified.Primary outcomes: satisfaction and Knee Society Score (KSS) at one year.ResultsPreoperative status was comparable for pain, ROM and KSS (mean 41, 45, 43±14).At one year, dissatisfaction was similar for all groups (4% first of staged TKR, 4% second of staged TKR, 5% controls). If the first TKR had a good outcome, the relative risk of a contralateral bad outcome was 20% less than controls (95% CI 0.6–1.2). If the first TKR had a poor outcome, the risk of a second poor outcome was 4 times higher (95% CI 2.8–6.1), increasing from 6% to 28% (absolute risk).ConclusionPatients undergoing the second of staged TKRs with a previous good outcome are likely to do well in their second procedure (94 in 100 will go on to have a second good outcome). Of those with a previous poor outcome, 28 in 100 will have a second poor outcome. The trend was persistent despite correcting for gender, age, BMI, and diagnosis.

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.

Physiotherapy rehabilitation in severe damaged osteoarthritis knee following surgically treated bilateral total knee replacement – A case study

This 62-year-old female patient case study describes physiotherapy rehabilitation exercises of stage 4 osteoarthritis in the post-operative phase. The patient has pain, symptoms, decreased adl activities and decreased quality of life (study measures completely done by Koos scale). Following surgical managed total knee replacement patient gets better with her symptomatically level and this study tells the importance of replacing knee joint in time as suggested by an orthopaedic surgeon, else there would be a marked functional outcome limitation of the patient. It also emphasis on the importance of physiotherapy and maintaining the operative knee joint in long term care.

COMPARISON BETWEEN INTRA-ARTICULAR AND INTRAVENOUS TRANEXAMIC ACID APPLICATION IN PRIMARY UNILATERAL KNEE JOINT ARTHROPLASTY

To compare the efficacy of intra-articular and intravenous modes of administration of tranexamic acid in primary total knee arthroplasty in terms of blood loss and fall in haemoglobin level.Study Design: Randomized controlled trial.Duration of Study: Six months, from May 2019 to Nov 2019.Seventy-eight patients were included in the study. All patients undergoing unilateral primary total knee replacement were included in the study. Exclusion criteria were patients with hepatitis B and C, history of previous knee replacement, bilateral total knee replacement, allergy to TXA, Hb less than 11g/dl in males and less than 10g/dl in females, renal dysfunction, use of anticoagulants for 7 days prior to surgery and history of thromboembolic diseases. Patients were randomly divided into group A and B. Group A patients undergoing unilateral primary total knee replacement (TKR) were given intravenous tranexamic acid (TXA) while group B were infiltrated with intra-articular TXA. Volume of drain output, fall in haemoglobin (Hb) level and need for blood transfusion were measured immediately after surgery and at 12 and 24 hours post operatively in both groups.The study included 35 (44.87%) male and 43 (55.13%) female patients. Mean age of patients was 61 ± 6.59 years. The mean drain output calculated immediately after surgery in group A was 45.38 ± 20.75 ml compared with 47.95 ± 23.86 ml in group B (p=0.73). At 24 hours post operatively, mean drain output was 263.21 ± 38.50 ml in intravenous group versus 243.59 ± 70.73 ml in intra-articular group (p=0.46). Regarding fall in Hb level, both groups showed no significant difference (p&gt;0.05). About 12.82% (n=5) patients in group A compared to 10.26% (n=4) patients required blood transfusion post operatively (p=0.72).Intra-articular and intravenous TXA are equally effective in patients undergoing primary total knee arthroplasty in reducing post-operative blood loss.

Thirty-Day Morbidity and Mortality After Total Knee Replacement in a Tertiary Care Hospital in Pakistan.

Background Total knee arthroplasty has become very popular globally as a safe surgical modality for relieving pain and improving functional outcomes in patients who fail to respond to conservative treatments; however, it may be associated with postoperative complications. The aim of this study is to determine the incidence of postoperative complications occurring within the first 30 days after total knee replacement (TKR). Materials and methods This is a prospective cross-sectional study. All consecutive patients who underwentprimary unilateral or bilateral total knee arthroplasty between November 2020 and July 2021 were included in the study. Patients were followed for a period of 30 days, and postoperative complications (if any) were documented. Continuous variables were expressed as means ±standard deviations. Categorical variables were expressed as frequency and percentages, and chi-square test was used to compare the qualitative variables. Univariate and multiple logistic regression analyses were done to analyze the magnitude of associations of the complication with other predictor variables keeping a level of significance of <0.05. Results The overall complication rate within the 30-day window was 7.0%. Postoperative surgical site infections (SSI) were noted in three patients (2.6%). Thromboembolic complications were seen in only one patient (0.9%). One patient (0.9%) was readmitted within the one-month period after initial discharge, and one patient (0.9%) expired within 12 hours postoperatively. Conclusion TKR renders satisfactory results with a low incidence of complications in general; however, wound infections, thromboembolic complications, and cardiovascular complications do occur postoperatively. Male gender, obesity, and bilateral TKRs remain the notable risk factors for the development of complications post-procedure.

Efficacy of Periarticular Local Infiltrative Analgesic Injection on Postoperative Pain Control and Functional Outcome in Sequential Bilateral Total Knee Replacement: A Prospective Controlled Trial in 120 Consecutive Patients.

One of the drawbacks of total knee replacements (TKR) is the early postoperative pain, which affects patient satisfaction and increases the duration of rehabilitation. The present study analyzes the potency of local infiltrative analgesia and its effect on rehabilitation in bilateral sequential TKRs. The present prospective observational study was conducted on 120 patients undergoing bilateral sequential TKR performed by a single surgeon using an anterior midline incision with a standard medial parapatellar approach. At the end of the surgery, a periarticular cocktail injection was administered to one knee, whereas the other knee served as the control. Postoperatively, patients were assessed for the pain level in each knee based on the visual analog scale (VAS) score and improvement in the range of motion (ROM). Intergroup and intragroup analyses were performed using the unpaired t test and analysis of variance, respectively. A p value of < 0.05 was considered significant. Of the 120 patients, 58% were women and 42% were men with a mean age of 62.14 ± 8.58years. The postoperative mean VAS score was significantly lower in the test knee group than in the control knee group (p < 0.05). The postoperative mean ROM was more in the test group as compared to the control group on days 3 and 7 (p < 0.05), whereas it was comparable on day 14 (p > 0.05). Periarticular injection of a drug combination in patients managed with bilateral TKRs that are done simultaneously reduces the early postoperative pain and improves rehabilitation during the first week after surgery.

A musculoskeletal simulation study on the biomechanics of the lower extremity during the golf swing

Purpose This study aimed to investigate the mechanisms of the human body dynamics during the golf swing through a musculoskeletal simulation for different types of subjects to better understand the biomechanical aspects of the golf sport. Methods The lower extremity model of the AnyBodyTM modeling system was adapted to a more advanced knee model to capture the large knee axial rotations during golf swing using an inverse dynamic musculoskeletal approach. Swings from three golfers, one with apparent osteoarthritis in both knee joints, one with bilateral total knee replacement, and one healthy, were captured in a motion capture laboratory and simulated. Results The golf swing generated a high axial rotation in the knee joint (approximately 25°-31°). Ball impact represented the most critical time event, near which maximum loading of the lower extremity was observed, e.g., knee compression force raised to a maximum of 329% body weight. The fast rate of knee loading by large compression forces prior to ball impact was identified as a potential cause of knee injury for golfers. Conclusions Our findings are comparable with previous experimental and computational studies, and the proposed musculoskeletal model can be employed to provide valuable information to clinicians and scientists, e.g., on the biomechanics of the lower extremities after total knee replacement for golf swing.

Comparison of Dexmedetomidine Vs Buprenorphine as Adjuvants to Intrathecal Bupivacaine for Bilateral Total Knee Replacement Surgeries - Randomised Controlled Trail

Introduction: The duration of analgesia produced by local anaesthesia is limited if administered alone. Therefore, supplementation of local anaesthetics with adjuvants helps to improve the efficacy of the sub-arachnoid block, especially in long-duration surgeries like bilateral total knee replacement. The most preferred drugs used are opioids, but due to new drug development like dexmedetomidine has been introduced and proved to be effective adjuvant. Aim: This study was conducted to evaluate and compare the characteristics of subarachnoid blockade and hemodynamic stability. The VAS was used pre-operatively, after intrathecal, immediately post-operatively, and on the basis of the need for rescue analgesia or epidural. Materials and Methods: A total of 150 patients were taken aged between 30-80 years classified as American Society of Anesthesiologists (ASA) undergoing bilateral TKR under neuraxial anaesthesia were included in the study. The patients were randomly allotted to two groups to receive 4.0 mL of 0.5% hyperbaric bupivacaine with 0.2 mL of dexmedetomidine (5 μg) intrathecally (Group D; n = 75) and another group to receive 4.0 mL of 0.5% hyperbaric bupivacaine with 0.2 mL of buprenorphine (60 μg) intrathecally (Group B; n = 75). Results: There was no significant difference between groups regarding demographic characteristics, no significant difference in hemodynamic variables. The motor, sensory, blockade, and time of rescue analgesia were significantly prolonged in Group D compared to Group B. Hence, Group D was far better than Group B in terms of duration of analgesia, time of onset of sensory block, time for maximum levels of sensory block, and modified bromage score. Conclusion: Intrathecal dexmedetomidine, compared to intrathecal buprenorphine, causes prolonged anaesthesia and analgesia with a reduced need for sedation and rescue analgesics. Also, reduced adverse effects are seen with intrathecal dexmedetomidine. Complications with Group D ............

Long Term Outcomes of Single Staged Sequential Bilateral Total Knee Replacement in Patients aged 60 years or above

Objective: To determine the long-term outcomes of single staged bilateral total knee arthroplasty in patients of geriatric age group.Methods: This single-center retrospective study was carried out at Liaquat National Hospital Karachi, Pakistan. Data of 2001 to 2010 were retrieved from the medical records. All geriatric age group patients above 60 years irrespective of comorbidity status, underwent single-stage bilateral total knee arthroplasty were consecutively included. Pre-operative diagnoses such as primary osteoarthritis, post-traumatic arthritis and rheumatoid arthritis were noted. The minimum follow-up time period was 10 years. Long term outcome such as knee society score, adverse event, and need of revision surgery were noted.Results: Of 96 patients, the median age was 69.0 (65.0-76.0) years. There were 44 (45.8%) males and 52 (54.2%) females. Primary osteoarthritis was the most common primary diagnosis, i.e., 66 (68.8%) followed by rheumatoid arthritis in 24 (25.0%), and post-traumatic arthritis in 6 (6.3%) patients. Most of the patients had moderate Charlson Comorbidity Index score, i.e., 70 (72.9%) while Knee Society Score showed that 41 (40%) reported excellent outcome. Need of revision surgery was reported by 6 (6.3%) patients. Adverse events were reported by 11 (11.5%) patients. A significant median difference of Knee Society Score was found among patients with diabetes mellitus (p-value &lt;0.001) and pre-operative diagnosis (p-value &lt;0.001).Conclusion: The long-term outcome of patients underwent bilateral total knee arthroplasty was found satisfactory. It is likely that total knee arthroplasty is widely regarded as the best option for treating end-stage knee osteoarthritis.

Pain Catastrophizing in Adult Females After Bilateral Total Knee Arthroplasty

Total Knee Arthroplasty is a procedure used to ease the pain and improve functions after degenerative joint diseases e.g. osteoarthritis. One of the complications of TKA is pain catastrophization. Pain catastrophizing is a characterized by the tendency to magnify the threat value of pain stimulus. It can be assessed through PCS which is a 13-item standardized tool for assessing pain catastrophizing. Primary objective of the study was to find the pain catastrophizing level in adult females after bilateral Total Knee Replacement. Objective: This study aims to highlight the importance of pain catastrophization in females who have undergone TKA so that it will alert the rehabilitation experts to plan the post-operative management keeping in view respective levels of pain catastrophization. Methods: This was a descriptive case series study in which 30 patients were included in study according to inclusion and exclusion criteria according to non-probability convenience sampling. All females were included in the study with same baseline characteristics. Literature was reviewed for the given study from EMBASE, MEDLINE AND PsycINFO. Questionnaire included in the study was PCS. Results: The statistical result of Rumination with the mean of 11.63, Magnification score with the mean of 1.98 and Helplessness score with the mean of 12.13 was obtained. Total mean score of pain catastrophizing was 29.500 and SD ±6.273. Conclusion: Pain catastrophizing after bilateral TKR is one major complications in females. That resulted in score of 40% Rumination, 19% Magnification and 41% Helplessness.

Does right knee behave differently from the left knee in Bilateral TKR patients: A prospective analysis

Background: Bilateral total knee arthroplasty (TKA) is one of the most common surgeries performed in patients with Osteoarthritis knee. The functional assessment in between two knees have not been in literature which is an important evaluation to help provide patients with evidence based outcome. We evaluated the functional outcomes on operated Bilateral TKA patients and compared them between the two knees.Methodology: Patients who underwent primary Bilateral sequential and staggered TKA between 1st January 2019 and 31st Dec 2019, were included and their functional outcomes were assessed at 6 weeks, 3 month, 6 months and 1 year intervals were evaluated in our study.Results: With a mean age of 66.95 years (50-82), 142 primary bilateral total knee replacements were included. In the 142 patients observed a total of 17 patients had a difference in the left and right knees where 13 patients had right knee better than left and the other 4 had left better than right based on the KSS score. In conclusion, the differences between knees were not significant over 1 year period follow-up based on the KSS scores.Conclusion: In our study, we found that functional outcomes of knees based on KSS scores were different in the early follow ups at 6 weeks and 3months interval but at a long term follow up of 1 year the differences were not significant.

Antiphospholipid antibody syndrome presenting as foot gangrene after bilateral total knee arthroplasty: A case report

Case: A 71 years old female who underwent bilateral total knee replacement, noted discolouration of toes and plantar aspect of right foot, along with cold right foot, 1 week after surgery due to thrombosis of dorsalis pedis artery in spite of adequate anticoagulation. She was eventually diagnosed with Anti phospholipid antibody (APLA) syndrome. Conclusion: APLA is not routinely investigated in preoperative workup for arthroplasty. It is also not a common condition in orthopaedic practice. Some patients may develop thrombosis after arthroplasty in spite of adequate thromboprophylaxis and a rare cause like APLA has to be kept in mind to help in ensuring appropriate treatment.

INDISCRIMINATE COAGULATION TESTING FOR BLEEDING RISK ASSESSMENT PRIOR TO ORTHOPEDIC SURGERY. IS IT A RATIONAL APPROACH?

Abstract Objective: Indiscriminative preoperative coagulation testing to identify patients at risk of bleeding is commonly practiced. However, this practice is no longer supported by current recommendations. We conducted this study with an aim to evaluate the advantage of doing screening testing for coagulation and hemostasis in unselected patients prior to elective orthopedic surgeries in our setting. Material and Methods: It was a retrospective, cross sectional study carried out at Medicare Cardiac and General Hospital, Jinnah Medical and Dental College, Karachi. All the patients admitted for elective orthopedic bilateral total knee replacement and Hip replacement surgeries from March 2016 to December 2018 were included in the study. Electronic data of patients’ pre-operative test results for Prothrombin time, activated partial Thromboplastin time was retrieved. Frequency of patients with deranged coagulation screening was calculated. Results: A total of 367 patients underwent pre-surgical coagulation testing. Male to female ratio was 1:3. Median age of patients was 61±5 years. A total of 2.9% (n=11) patients were found to have deranged coagulation profile. Out of which 3 patients did not undergo surgery and were loss to follow up. Out of total 0.54% (n=2) patients had both prolonged PT and APTT, 1.6% (n=6) patients had prolonged APTT and 0.3% (n=1) patient experienced intraoperative bleeding requiring one unit of packed cell transfusion. Only 0.3% (n=1) patient experienced post-operative bleeding and dropped her Hemoglobin and received transfusion. Conclusion: The overall results of the study suggest that indiscriminate coagulation screening does not provide any additional information unless further detailed hemostatic evaluation is carried out. It is suggested that routine screening tests should not be performed unless a medical history is indicative of bleeding tendency. Key Words: Coagulation screening, Bleeding risk, Orthopedic surgery.