Contralateral Knee Pain Research Articles

Using Two Predictive Models to Capture Two Types of Poor Outcomes in Knee Arthroplasty: A Multisite Longitudinal Cohort Study.

Poor outcome after knee arthroplasty (KA), a common major surgery worldwide, reportedly occurs in approximately 20% of patients. These patients demonstrate minimal improvement, at least moderate knee pain, and difficulty performing many routine daily activities. The purposes of our study were to comprehensively determine poor outcome risk after KA and to identify predictors of poor outcome. Data from 565 participants with KA in the Osteoarthritis Initiative and the Multicenter Osteoarthritis studies were used. Previously validated latent class analyses (LCAs) of good versus poor outcome trajectories of Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Disability were generated to describe minimal improvement and poor final outcome. The modified Escobar RAND appropriateness system was used to generate classifications of appropriate, inconclusive, and rarely appropriate. Multivariable prediction models included LCA-based good versus poor outcome, modified Escobar classifications, and evidence-driven preoperative prognostic variables. Modified Escobar appropriateness classifications were nonsignificant predictors of WOMAC Pain good versus poor outcomes, indicating the methods provide independent outcome estimates. For WOMAC Pain and WOMAC Disability, approximately 34% and 45% of participants, respectively, had a high probability of either minimal improvement via "rarely appropriate" classifications or poor outcome via LCA. In multivariable prediction models, greater contralateral knee pain consistently predicted poor outcome (eg, odds ratio 1.21, 95% confidence interval 1.10-1.33). Appropriateness criteria and LCA estimates provided combined poor outcome estimates that were approximately double the commonly reported poor outcome of 20%. Rates of poor outcome could be reduced if clinicians screened patients using appropriateness criteria and LCA predictors before surgery to optimize outcome.

Clinical affect of contralateral knee pain on patients undergoing total knee arthroplasty

To evaluate the effect of contralateral knee pain on joint dysfunction and treatment satisfaction on the operative side 1 year after total knee arthroplasty（TKA） in patients with osteoarthritis. From March 2019 to January 2021, 635 patients underwent TKA including 296 males and 339 females, with an average age of （69.33±9.38） years old, the duration of symptoms was （1.15±0.44） years. According to the degree of pain visual analogue scale（VAS） in the contralateral knee joint 12 months after operation, the patients were divided into three groups, 423 patients with no or mild pain（VAS 0 to 3）, 105 patients with moderate pain（VAS 4 to 6）, 107 patients with severe pain（VAS 7 to 10）. The related factors of knee function and satisfaction score 12 months after operation were analyzed and compared on different contralateral knee pain levels. The contralateral knee pain VAS was significantly reduced after TKA. Old age, high body mass index, high WOMAC scores of postoperative knee joint, moderate and severe pain of contralateral knee joint were the risk factors of dissatisfaction （P<0.05）, OR were 1.285, 1.665, 2.319, 1.863 respectively. The high degree of knee pain on the operation side and the ladder room in the home environment were the risk factors for the high WOMAC scores 1 year after discharge（P<0.05）. Adherence to exercise and functional training after discharge were the protective factors for patients with high WOMAC scores 1 year after discharge（P<0.05）, OR were 3.016, 1.738, 0.619, 0.574 respectively. TKA can alleviate the pain of contralateral knee joint. Contralateral knee pain does not affect the WOMAC scores after TKA, but it will reduce the treatment satisfaction of patients.

Contralateral knee pain exacerbation after total knee arthroplasty and its impact on functional activity.

The purposes of the present study were to (1) describe the prevalence of contralateral knee pain exacerbation after total knee arthroplasty (TKA), (2) explore the risk factors for pain exacerbation, and (3) verify the association of contralateral knee pain with future functional activity. We consecutively recruited outpatients with osteoarthritis of both knees who had primary TKA planned. The contralateral knee pain using a Numerical Rating Scale (NRS) and the functional activities subdomain of the new Knee Society Knee Scoring System (KSS) were assessed preoperatively and at 1, 3, and 6months postoperatively. Among patients with < 5 NRS points preoperatively, we described the frequency of the contralateral knee pain exacerbation, defined as a ≥ 2-point increase from preoperative pain at each postoperative visit. An exploratory analysis was performed to identify preoperative risk factors for contralateral knee pain exacerbation. A linear mixed model was fit to examine the association of the contralateral knee pain with KSS functional activities at subsequent visits. Among 315 patients, 14.6%, 24.1%, and 27.6% of patients experienced contralateral knee pain exacerbation at 1, 3, and 6months postoperatively, respectively. The identified preoperative risk factors were low quadriceps strength and higher Kellgren-Lawrence grade on the non-operative knee, along with severe pain on the operative knee. The magnitude of the association between contralateral knee pain and worsening KSS functional activities increased with subsequent visits (p for interaction < 0.001). The frequency and impact of pain exacerbation on the contralateral knee increase after TKA and should be carefully evaluated for a prolonged period of time.

Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option.

Failed ACL reconstruction is a common occurrence nowadays due to the increased incidence of ACL surgeries and return to full activities following the surgery. Several challenges might stand in the face of this revision surgery particularly the graft harvest and its suitability to the situation with possible widening of the tunnel and the avoidance of additional morbidity at the contralateral side or anterior knee pain as in patellar tendon harvest. The aim of this study is to evaluate the ipsilateral quadriceps tendon as a source of autograft in revision ACL surgery which constitutes a viable option that can potentially decrease the morbidity of the procedure, and meanwhile provide a graft substitute that can be tailored to suit the dilated tunnels commonly encountered in revision surgery, thus giving the patients a good potential for better functional outcome. Revision anterior cruciate ligament reconstruction was done in 30 patients using the ipsilateral quad tendon as a pure soft tissue or with a bony fragment. The mean subjective international Knee Documentation Committee score (IKDC score) at twoyears follow-up was 65.83 ± 7.20. There is statistically significant improvement of the objective as well as the subjective IKDC scores at the end of follow-up when compared to the preoperative as well as the 6-month evaluation figures. The KT1000 arthrometer recorded a mean of 4.50 ± 1.07. Significant improvement of the limb symmetry index was at twoyears duration. The quadriceps tendon can be a solution for several challenges that might appear during the revision ACL surgery with comparable results to other tendons and with minimal morbidity on the function of the harvested muscle tendon.

Obesity Severity Predicts Patient Dissatisfaction After Total Knee Arthroplasty

BackgroundPatient dissatisfaction has been reported in 15 to 20% of traditional total knee arthroplasty (TKA) procedures. While contemporary improvements may have positive effects on patient satisfaction, these may be offset by increasing obesity prevalence among patients who have knee osteoarthritis. We performed this study to determine whether obesity severity impacts patient-reported TKA satisfaction. MethodsWe compared patient demographic characteristics, preoperative expectations, preoperative and minimum 1-year postoperative patient-reported outcome measures as well as postoperative satisfaction level among 229 patients (243 TKAs) who had World Health Organization (WHO) Class II or III obesity (group A), and 287 patients (328 TKAs) who had WHO classifications of normal weight, overweight, or Class I obesity (group B). ResultsGroup A patients were younger and had more severe preoperative back and contralateral knee pain, more frequent preoperative opioid medication use, and lower preoperative and postoperative patient-reported outcome measures (P < .01). A similar proportion of patients in both groups expected at least 75% improvement (68.5 versus 73.2%, P = .27). While satisfaction was higher than traditional reporting for both groups (89.4 versus 92.6%, P = .19), group A patients were less likely to be highly satisfied (68.1 versus 78.5%, P = .04) and were more likely to be highly dissatisfied (5.1 versus 0.9%, P < .01). ConclusionsPatients who have Class II and III obesity report greater TKA dissatisfaction. Additional studies should help determine whether specific implant designs or surgical techniques may improve patient satisfaction or whether preoperative counseling should incorporate lower satisfaction expectations for patients who have WHO Class II or III obesity.

Worst pain intensity and opioid intake during the early postoperative period were not associated with moderate-severe pain 12months after total knee arthroplasty- a longitudinal study.

There are several known predictors of pain after total knee arthroplasty (TKA). However, it is unclear whether acute postoperative pain intensity and postoperative opioid intake are associated with pain 12months after TKA. Thus, the aim of this study was to assess whether worst pain intensity and opioid intake during the early postoperative period are associated with moderate-severe pain 12months after TKA. A total of 202 patients undergoing primary TKA between October 2012 and September 2014 were prospectively enrolled. Age, sex, contralateral knee pain, BMI, physical status and opioid intake were collected preoperatively. Ketamine and daily opioid intake were collected on postoperative days (POD) 0-3. Using the Brief Pain Inventory, patients' "worst pain intensity" was measured preoperatively, on POD 0-4, and 12months after TKA. Two logistic regression models evaluated the independent association of early postoperative pain intensity (model 1) and postoperative opioid intake (model 2) with moderate-severe pain 12months after TKA, adjusting for possible confounders. In total, 187 patients with data at the 12month postoperative follow-up were included in this analysis. Pain intensity on POD2 and POD3, as well as preoperative pain and BMI, were significantly associated with pain at 12months in univariate models. However, in multivariable models adjusted for preoperative pain and BMI, neither pain intensity on POD 0-4 (model 1) nor opioid intake on POD 0-3 (model 2) were associated with pain at 12months. Preoperative pain was still significant in both models, but BMI remained significant only in model 2. Worst pain intensity and opioid intake during the early postoperative period were not associated with moderate-severe pain 12months after TKA when controlling for potential confounders. More research is needed to confirm these findings.

A Comprehensive, Multidisciplinary Assessment for Knee Osteoarthritis Following Traumatic Unilateral Lower Limb Loss in Service Members.

Knee osteoarthritis (KOA) is a primary source of long-term disability and decreased quality of life (QoL) in service members (SM) with lower limb loss (LL); however, it remains difficult to preemptively identify and mitigate the progression of KOA and KOA-related symptoms. The objective of this study was to explore a comprehensive cross-sectional evaluation, at the baseline of a prospective study, for characterizing KOA in SM with traumatic LL. Thirty-eight male SM with traumatic unilateral LL (23 transtibial and 15 transfemoral), 9.5 ± 5.9 years post-injury, were cross-sectionally evaluated at initial enrollment into a prospective, longitudinal study utilizing a comprehensive evaluation to characterize knee joint health, functionality, and QoL in SM with LL. Presences of medial, lateral, and/or patellofemoral articular degeneration within the contralateral knee were identified via magnetic resonance imaging(for medically eligible SM; Kellgren-Lawrence Grade [n = 32]; and Outerbridge classification [OC; n = 22]). Tri-planar trunk and pelvic motions, knee kinetics, along with temporospatial parameters, were quantified via full-body gait evaluation and inverse dynamics. Concentrations of 26 protein biomarkers of osteochondral tissue degradation and inflammatory activity were identified via serum immunoassays. Physical function, knee symptoms, and QoL were collected via several patient reported outcome measures. KOA was identified in 12 of 32 (37.5%; KL ≥ 1) SM with LL; however, 16 of 22 SM presented with patellofemoral degeneration (72.7%; OC ≥ 1). Service members with versus without KOA had a 26% reduction in the narrowest medial tibiofemoral joint space. Biomechanically, SM with versus without KOA walked with a 24% wider stride width and with a negative correlation between peak knee adduction moments and minimal medial tibiofemoral joint space. Physiologically, SM with versus without KOA exhibited elevated concentrations of pro-inflammatory biomarker interleukin-7 (+180%), collagen breakdown markers collagen II cleavage (+44%), and lower concentrations of hyaluronic acid (-73%) and bone resorption biomarker N-telopeptide of Type 1 Collagen (-49%). Lastly, there was a negative correlation between patient-reported contralateral knee pain severity and patient-reported functionality and QoL. While 37.5% of SM with LL had KOA at the tibiofemoral joint (KL ≥ 1), 72.7% of SM had the presence of patellofemoral degeneration (OC ≥ 1). These findings demonstrate that the patellofemoral joint may be more susceptible to degeneration than the medial tibiofemoral compartment following traumatic LL.

Sit-to-Stand Weight-Bearing Symmetry Performance in Total Knee Arthroplasty: Recovery Curves, Correlates, and Predictive Validity With Gait Speed.

After total knee arthroplasty, the ability to weight bear symmetrically during the sit-to-stand task provides important information regarding altered movement patterns. Despite this, comprehensive recovery curves and validity data for sit-to-stand weight-bearing symmetry are lacking in the total knee arthroplasty population. Our study aimed to (1) develop recovery curves with reference ranges, (2) identify the correlates of standard and constrained sit-to-stand weight-bearing symmetry, and (3) evaluate their predictive validity with gait speed. We performed a retrospective longitudinal study of 706 patients with primary unilateral total knee arthroplasty. Monthly, for 4 mos after surgery, sit-to-stand weight-bearing symmetry, knee pain, knee range of motion, quadriceps strength, and gait speed were quantified. Standard and constrained sit-to-stand weight-bearing symmetry measures improved nonlinearly over time. Standard sit-to-stand weight-bearing symmetry was most strongly associated with bilateral quadriceps strength, whereas constrained sit-to-stand weight-bearing symmetry was most strongly associated with ipsilateral quadriceps strength. Knee range of motion and contralateral knee pain were additional correlates. Both standard sit-to-stand and constrained sit-to-stand weight-bearing symmetry were independently and nonlinearly associated with gait speed in multivariable models. Our study provided recovery curves and validity data to support routine clinical measurement of sit-to-stand weight-bearing symmetry in total knee arthroplasty. Our results also indicate that constrained sit-to-stand may promote greater use of the operated limb than standard sit-to-stand.

Open reduction internal fixation versus minimally invasive percutaneous fixation for calcaneus fractures: Mid-term outcomes and social consequences.

Objectives This study aims to evaluate the mid-term clinical, functional, radiological, and socioeconomic outcomes of calcaneus fractures treated with open reduction-internal fixation (ORIF) versus minimally invasive percutaneous fixation (MIPF).Patients and methods A total of 48 patients (34 males, 14 females; mean age: 44.05 years; range, 19 to 64 years) who underwent either ORIF or MIPF for calcaneus fractures between January 2010 and January 2016 were retrospectively analyzed. The patients were divided into two groups as the ORIF group (n=36) and MIPF group (n=12). The American Orthopaedic Foot & Ankle Society (AOFAS) score, Maryland Foot Score (MFS), and the Short Form-36 (SF-36) scores were assessed for the clinical assessment. The mean duration of operation, mean length of hospitalization, pedobarographic gait analysis, the incidence of contralateral knee pain, increased shoe size, and change of profession due to significant heel pain were also evaluated. The Böhler’s angle, Gissane angle, and calcaneal varus were measured for radiological assessment.Results There was a significant difference in the mean operation time (p=0.001) and length of hospitalization (p=0.001) between the two groups. There was no significant difference between the pre- and postoperative third-year Böhler’s and Gissane angles (p=0.05, p=0.07, p=0.09, respectively). There were no significant differences between the postoperative first-, second-, and third-year AOFAS, MFS, and SF-36 scores (p=0.57, p=0.55 p=0.85, p=0.64, p=0.21, p=0.51, p=0.20, p=0.15, p=0.22, respectively). Thirteen patients in the ORIF group and five patients in the MIPF group changed their job due to significant heel pain. The increased shoe size was correlated with the residual calcaneal varus (p=0.001).Conclusion Both methods have pros and cons in the treatment of calcaneal fractures. Although MIPF is more advantageous in terms of operation duration and length of hospitalization, more favorable radiological results can be obtained with ORIF. Calcaneal varus should be corrected to prevent the increased shoe size and contralateral knee pain.

Immediate Postoperative Improvement in Gait Parameters following Primary Total Knee Arthroplasty Can Be Measured with an Insole Sensor Device.

Total knee arthroplasty (TKA) improves the quality of life in those suffering from debilitating arthritis of the knee. However, little is known about the influence of TKA on restoring physical function. Prior studies have used artificial means, such as instrumented treadmills, to assess physical function after TKA. In this study an insole sensor device was used to quantify parameters of gait. The purpose of this study was to evaluate the ability of a wearable insole sensor device to measure immediate postoperative gait parameters at 2 weeks and 6 weeks following primary TKA and to determine if the device was suitable and sensitive enough to identify and measure potentially subtle changes in these measures at these early postoperative time periods. Twenty-nine patients with unilateral TKA, without contralateral knee pain, and aid-free walking before surgery were evaluated. An insole force sensor measured the postoperative parameters while walking a distance of 40 m on level ground at 2 and 6 weeks after TKA. The loading rate of the operated lower extremity was an average of 68.7% of the contralateral side at 2 weeks post-surgery and increased to 82.1% at 6 weeks post-surgery (p < 0.001). The mean gait speed increased from 0.75 to 1.02 m/s, (p < 0.001) and cadence increased from 82.9 to 99.9 steps/min (p < 0.001), while the numeric pain scale at rest decreased from 3.5/10 to 2.2/10, (p < 0.001) and the pain while walking from 3.9/10 to 2.4/10, (p < 0.001) from 2 to 6 weeks post-surgery. A significant improvement in gait parameters is detectable in the first 6 weeks after surgery with the use of a wearable insole device. As the gait speed and cadence increase and the VAS pain level decreases, the loading rate and average peak force begin to normalize. This device may allow for early gait analysis and have potential clinical utility in detecting early differences in patients' functional status following TKA.

Dependence of womac pain on radiographic knee oa status, age, sex, body mass index (BMI), race, and contralateral knee pain status

Purpose: It has been proposed that structural (e.g. radiographic) change and symptoms are highly discordant in knee osteoarthritis, although work comparing radiographic alterations with symptoms between both knees in the same patient (between knee, within-person analysis) have revealed a stronger relationship. The purpose of the current work was to analyze the impact of age, sex, body mass index (BMI), race, and contra-lateral knee pain status on the level of knee pain perception, adjusting for radiographic status, using a probabilistic index model (PIM).

Contralateral knee pain reduces the rate of patient satisfaction but does not clinically impair the change in WOMAC score after total knee arthroplasty.

The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding. According to severity there were 1,425 patients (44.8%) with minimal, 710 (22.3%) with mild, 518 (16.3%) with moderate, and 525 (16.5%) with severe pain in the contralateral knee. Patients in the severe group had a greater clinically significant improvement in their functional WOMAC score (9.8 points; p < 0.001). Only patients in the moderate (22.9 points) and severe (37.8 points) groups had a clinically significant improvement in their contralateral knee pain (p < 0.001), but they were significantly less likely to be satisfied with their TKA (moderate: odds ratio (OR) 0.64, 95% confidence interval (CI) 0.4 to 0.92, p = 0.022; severe: OR 0.57, 95% CI 0.39 to 0.82, p = 0.002). Contralateral knee pain did not impair improvement in the WOMAC score after TKA, and patients with the most severe contralateral knee pain had a clinically significantly greater improvement in their functional outcome. More than half the patients presenting for TKA had mild-to-severe contralateral knee pain, most of whom had a clinically meaningful improvement but were significantly less likely to be satisfied with their TKA. Cite this article: Bone Joint J. 2020;102-B(1):125-131.

Predicting Mobility Limitations in Patients With Total Knee Arthroplasty in the Inpatient Setting

ObjectiveTo develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA). DesignProspective cohort study. SettingInpatients in a tertiary care hospital. ParticipantsA sample of patients (N=2300) who underwent primary TKA in 2016-2017. InterventionsNot applicable. Main Outcome MeasureCandidate predictors included demographic variables and preoperative clinical and psychosocial measures. The outcome of interest was mobility limitations on post-TKA day 3, and this was determined a priori by an ordinal mobility outcome hierarchy based on the type of the gait aids prescribed and the level of physiotherapist assistance provided. To develop the model, we fitted a multivariable proportional odds regression model with bootstrap internal validation. We used a model approximation approach to create a simplified model that approximated predictions from the full model with 95% accuracy. ResultsOn post-TKA day 3, 11% of patients required both walkers and therapist assistance to ambulate safely. Our prediction model had a concordance index of 0.72 (95% confidence interval, 0.68-0.75) when evaluating these patients. In the simplified model, predictors of greater mobility limitations included older age, greater walking aid support required preoperatively, less preoperative knee flexion range of movement, low-volume surgeon, contralateral knee pain, higher body mass index, non-Chinese race, and greater self-reported walking limitations preoperatively. ConclusionWe have developed a prediction model to identify patients who are at risk for mobility limitations in the inpatient setting. When used preoperatively as part of a shared-decision making process, it can potentially influence rehabilitation strategies and facilitate discharge planning.

More than pain: pre-operative indicators of patients who progress from unilateral to bilateral total knee arthroplasty within 10 years

Purpose: Up to 40% of patients who seek knee arthroplasty (TKA) in the management osteoarthritis will progress to a second, contralateral TKA within 5-10 years of the index surgery. The aim of this study was to investigate whether the assessment of pain and function prior to and 12 months following the index TKA can be used to predict which patients will progress to contralateral TKA and those who do not. Methods: Five hundred and one patients were included and assessed (i) immediately prior to their first knee arthroplasty, (ii) 12 months following TKA, and (iii) 10 years (minimum 5 years) following TKA. Participant demographics (age, sex, BMI), pre-operative and 12 month post-operative self-reported pain and function scores (Knee Society Scores, Oxford-12, SF-12) and walking speed at 12 months were treated as factors that might be associated with progression to a subsequent contralateral knee arthroplasty. Factors with an association in univariate analyses (p<0.01) were entered into a binomial logistic regression using a hierarchical procedure in an order based on the strength of the association. Results: Three hundred and forty-nine participants were assessed at all three timepoints (70.0%). On average, at the time of their first TKA participants were 66.3 years old (SD=8.2) and had a BMI of 31.5 (SD=5.1). One hundred and ninety-nine participants (57.2%) were female. One hundred and forty participants reported the presence of pain in the contralateral knee at the time of TKA, and 162 participants (46.4%) progressed to contralateral TKA. Of the participants with contralateral knee pain at the time of TKA, only 84 (60.2%) progressed to contralateral TKA. Higher BMI, younger age, worse pre-operative Oxford-12 score, less knee flexion range, lower post-operative SF-12 Physical Component Score, and the post-operative presence of pain were all significantly associated with having a subsequent contralateral TKA. A binomial logistic regression model that included these factors explained between 24% and 32% of the variance in the progression to a contralateral TKA. Participants with worse pre-operative self-reported function scores were 1.2 times more likely to progress to contralateral TKA. Of the participants with no contralateral knee pain at the time of TKA, 60 (28.7%) progressed to contralateral TKA. Females in this cohort were 2.5 times more likely to progress to contralateral TKA than males, but this explained less than 8% of the variance in outcome. There was no difference in self-reported quality of life, pain or function at the latest assessment between participants who did not have a contralateral TKA (KOOS Quality of Life Average=99.7, SD=0.3; Oxford-12 score Average=37.93, SD=10.0, WOMAC Function Average 85.8, SD=17.6) and those who did (KOOS QOL Average=99.7, SD=0.3; p=0.562, Oxford-12 Average=38.3, SD=10.1; p=0.811, WOMAC Function Average = 85.9, SD=18.7; p=0.988). Conclusions: Forty-six percent of patients with TKA progressed to a second (or contralateral) TKA within 10 years. Patients with higher BMI and poorer self-reported function prior to an initial TKA are more likely to progress to the second TKA within 10 years. Females without pain in the contralateral knee at the time of the initial TKA are 2.5 times more likely to progress to the second TKA within 10 years than males with a similar presentation of pain. This information supports the need to maximise pre-operative function prior to TKA, and suggests that there are additional opportunities to tailor interventions towards preventing a second TKA surgery.

Younger patients with high varus malalignment of the contralateral knee may be candidates for simultaneous bilateral total knee arthroplasty.

Bilateral total knee arthroplasty (TKA) is being performed more frequently. However, a consensus on whether simultaneous or staged procedures should be performed is not available. This study reviewed the clinical course of contralateral knees in patients who underwent unilateral TKA (UTKA) to determine which patients are candidates for simultaneous bilateral TKA (BTKA). One hundred eighty-six patients with osteoarthritis who underwent UTKA at a single hospital between 2006 and 2009 (follow-up mean, 10.1years) were retrospectively investigated. Age, sex, obesity, contralateral knee pain, Hospital for Special Surgery score, femorotibial angle (FTA), and Kellgren-Lawrence grades at the time of initial surgery were used to evaluate the risk for requiring contralateral TKA. Survival analysis and receiver-operating characteristic (ROC) analysis were performed. Ninety-one patients (48.9%) underwent contralateral TKA. The FTA of the contralateral knee (CFTA) was an independent related factor (hazard ratio, 1.15; p < 0.001), and the CFTA cut-off value for the next surgery was 183° (area under the curve, 0.85; sensitivity, 80.7%; specificity, 76.2%). The 10-year Kaplan-Meier survival rates for the CFTA < 183° group and the CFTA ≥ 183° group were 79.1% and 27.0%, respectively. In the CFTA ≥ 183° group, age was the predictor of future TKA, and elderly patients tended to not require a second procedure. The age cut-off value for the next surgery was 76years. Varus deformities in the contralateral knee predicted additional contralateral TKA. Patients with CFTA ≥ 183° and aged 75years or younger are considered reasonable candidates for simultaneous BTKA. III.

Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty

Background and purpose — Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA), mainly because of pain and restricted physical function. We developed a prediction model for 6-month knee range of motion, knee pain, and walking limitations in patients undergoing TKA surgery.Patients and methods — We performed a prospective cohort study of 4,026 patients who underwent elective, primary TKA between July 2013 and July 2017. Candidate predictors included demographic, clinical, psychosocial, and preoperative outcome measures. The outcomes of interest were (i) knee extension and flexion range of motion, (ii) knee pain rated on a 5-point ordinal scale, and (iii) self-reported maximum walk time at 6 months post TKA. For each outcome, we fitted a multivariable proportional odds regression model with bootstrap internal validation.Results — At 6 months post TKA, around 5% to 20% of patients had a flexion contracture ³ 10°, range of motion < 90°, moderate to severe knee pain, or a maximum walk time £ 15 minutes. The model c-indices (the probabilities to correctly discriminate between 2 patients with different levels of follow-up TKA outcomes) when evaluating these patients were 0.71, 0.79, 0.65, and 0.76, respectively. Each postoperative outcome was strongly influenced by the same outcome measure obtained preoperatively (all p-values < 0.001). Additional statistically significant predictors were age, sex, race, education level, diabetes mellitus, preoperative use of gait aids, contralateral knee pain, and psychological distress (all p-values < 0.001).Interpretation — We have developed models to predict, for individual patients, their likely post-TKA levels of knee extension and flexion range of motion, knee pain, and walking limitations. After external validation, they can potentially be used preoperatively to identify at-risk patients and to help patients set more realistic expectations about surgical outcomes.

Worker compensation status increases the risk for presence of pain in the contralateral knee at final follow-up after arthroscopic knee surgery

ObjectivesIn patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population.MethodsAll patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery.ResultsA total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient (<1%) reported pain in the contralateral knee, which increased to 113 patients (80%) at final follow-up surgery. Of the assessed risk factors, only worker compensation status was significant for the development of contralateral knee pain (OR 2.93 95% CI 1.08 to 7.95, p=0.040).ConclusionPain in the contralateral knee is uncommon prior to arthroscopic knee surgery, but common after. The risk for the development of contralateral knee pain is increased if the index injury was workers compensation related.Level of evidenceLevel IV case series.

Is muscle strength in a painful limb affected by knee pain status of the contralateral limb? — Data from the Osteoarthritis Initiative

Contralateral knee pain has been suggested to be associated with muscle weakness in a pain-free knee, potentially through a mechanism of central nervous inhibition. Whether contralateral knee pain also affects muscle strength in a painful knee, however, is unknown. Here we study the extent to which isometric muscle strength differs between matched painful limbs of people with unilateral knee pain vs. matched painful limbs people with bilateral knee pain. To that end, 163 participants with unilateral knee pain were identified from the Osteoarthritis Initiative. Unilaterally painful (UP) limbs were defined as having numerical rating scale (NRS) ≥4/10, infrequent/frequent pain in the painful limb, while contralateral pain-free limbs were defined by NRS=0-1, no/infrequent pain and Western Ontario and McMaster Universities Arthritis Index (WOMAC) ≤1. The comparator group were matched bilaterally painful (BP) limbs. Maximum isometric muscle strength (N) was compared between 1:1 matched BP and UP limbs. Extensor strength was found to be lower in BP limbs than in UP limbs, (−2.9%; p=0.39) but this difference was not statistically significant. Extensor strength was significantly lower in the UP vs. contralateral pain-free limbs (−6.2%; p<0.001). No differences were observed between BP and contralateral painful limbs (0.6%; p=0.87). In conclusion, the current results identify a slight reduction of maximum knee extensor strength in a painful limb, when the contralateral knee is also painful. In contrast to pain-free limbs, this effect did not reach statistical significance, but the overall findings support the concept of central nervous inhibition of muscle strength by contralateral knee pain.

Avulsion Fractures In Sports

INTRODUCTION:Fractures-detached is an injury in the place where the tendon or the ligament is inserted in the bear, in the plates of growth. Thus, in the offspring, or tendons or proximal ligaments...

Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative.

Higher levels of moderate to vigorous physical activity improve all-cause mortality and cardiovascular events. However, the effect of running, a moderate to vigorous activity, in those with knee osteoarthritis (OA), a common arthritis that occurs with aging, a high-risk group for mortality and cardiovascular events, is unclear. Therefore, we aimed to evaluate the association of self-selected running on OA symptom and structure progression in people with knee OA. This nested cohort study within the Osteoarthritis Initiative (OAI) (2004-2014) included those at least 50years old with OA in at least one knee. Runners were defined using a self-administered questionnaire at the 96-month visit. At baseline and 48-months, symptoms were assessed and radiographs were scored for Kellgren-Lawrence (KL) grade (2-4) and medial Joint Space Narrowing (JSN) score (0-3). We evaluated the association of self-selected running with outcomes: KL worsening, medial JSN worsening, new knee pain, and improved knee pain over 48months, adjusting for baseline age, sex, body mass index (BMI), KL score, contralateral KL score, contralateral knee pain, and injury. If data were not available at the 48-month visit, then they were imputed from the 36-month visit. One thousand two hundred three participants had a mean age of 63.2 (7.9) years, BMI of 29.5 (4.6) kg/m2, 45.3% male, and 11.5% runners. Data from 8% of participants required imputation. Adjusted odds ratios for KL grade worsening and new frequent knee pain were 0.9 (0.6-1.3) and 0.9 (0.6-1.6) respectively. Adjusted odds ratio for frequent knee pain resolution was 1.7 (1.0-2.8). Among individuals 50years old and older with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression. Therefore, self-selected running, which is likely influenced by knee symptoms and may result in lower intensity and shorter duration sessions of exercise, need not be discouraged in people with knee OA.