Knee Joint Arthroplasty Research Articles

Hip and knee joint arthroplasty results in Lithuania

Justinas Stučinskas1, Mantas Giedraitis1, Jonas Marcinkevičius1, Kazimieras Grigaitis1, Šarūnas Tarasevičius1, Alfredas Smailys1 1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania Abstract Introduction. The hip and knee joints are most often replaced joints both in Lithuania and around the world. Demonstrating excellent results in arthroplasty surgeries, expanding the list of indications and increasing life expectancy, the need for these surgeries is constantly growing. Orthopedic surgeons must know which implants and surgical techniques provide the best treatment results for their patients. Register data is very important for evaluating results at the national level. Therefore, in this article we will review the results of Lithuanian hip and knee arthroplasty and evaluate the quality of implants used in Lithuania according to international ratings. Methodology: the results of Lithuanian hip and knee arthroplasty were evaluated using the data of the Lithuanian Arthroplasty Register. The analysis included all patients who underwent hip or knee replacement surgery in 2011-2021 period. Survival curves showing the total frequency of revisions were calculated using the life table statistics method. Also, to evaluate the quality of implants used in Lithuania according to the ODEP (Orthopedic Data Evaluation Panel) rating. Results: from 2011 to 2021 performed 36,744 primary hip and 23,865 primary knee arthroplasty surgeries. Survival of hip arthroplasty 10 m. period was 94.96 percent (95 percent, confidence interval (CI) 94.47-95.40 percent) and the road was 96.54 percent (95 percent CI 96.17-96.87 percent). About 76 percent of hip arthroplasty systems and 90 percent of knee arthroplasty systems used in Lithuania have an ODEP rating. Conclusions: the results of Lithuanian hip and knee arthroplasty are good, the survival over a 10-year period is about 95 percent and is similar to the results of other countries with extensive experience. A large part of the implants used in Lithuania have an international ODEP evaluation rating. Keywords: hip arthroplasty, knee arthroplasty, register, implant survival.

Effect of lateral wedged insole shoe in knee osteoarthritis: A 12 month randomized controlled trial

Introduction: Knee osteoarthritis (OA) is a chronic degenerative musculoskeletal condition that imposes a major healthcare burden due to considerable pain, disability and loss of quality of life especially among the older adults. Most knee OA researchers have focused on tertiary management strategies i.e pain relief with effective drug therapies (Non steroidal anti inflammatory drugs, chondroitin supplements etc). However, long-term use of NSAIDS have significant side effects and are expensive. With the exception of knee joint arthroplasty, typically reserved for end-stage disease, there is no definitive cure for osteoarthritis. Accordingly, there is an urgent need for conservative treatment modalities, that not only alleviate painful symptoms of OA, but also reduce the progression of the degenerative pathology over time. Patients with knee OA usually show major involvement in only one compartment; medial tibiofemoral compartment being more common than the lateral compartment. The lateral wedge shoe insole is an orthotic device, which is hypothesized to reduce the moment arm of the ground reaction force vector relative to the knee joint center during walking. They are an inexpensive and feasible treatment modality, that has shown to reduce medial knee load. Materials and Methods: 80 patients with bilateral medial compartment osteoarthritis of knee were included in the present study. They were randomly divided into two groups ; Group A (n = 40) included patients who were given lateral wedged insole shoes and Group B (n = 40) included those who were given normal flat soled shoes. All patients who fulfilled the inclusion and exclusion criteria were recruited for the study. The present study was carried between January 2020 to January 2021 in Krishna Institute Of Medical Sciences, “Deemed to be University” Karad. Severity of pain using WOMAC score, FTA using plain knee radiograph in AP view and frequency of intake of NSAIDS were calculated at the start of study, thereafter at each follow up every 2 months up to 12 months. Results: At the initial 2nd month follow up group A patients showed significant reduction in severity pain scale (66.74+/-19.44) as compared to group B (72.78+/-17.04), but neither of group A or group B showed any significant change in remaining variable characters (p>0.005). At the end of 12 months follow up assessment, Group A patients showed a marked reduction in severity of pain (average 46.8+/-16.24) as compared to Group B (mean 59.26+/-18.74). Patients in Group A showed significant decrease in the frequency of intake of NSAIDS for pain relief as compared to patients in Group B (p

Effects of Intravenous Lidocaine in Total Knee Joint Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Effects of Intravenous Lidocaine in Total Knee Joint Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

ХИРУРГИЧЕСКИЙ ДОСТУП ПРИ ЭНДОПРОТЕЗИРОВАНИИ КОЛЕННОГО СУСТАВА У ДЕТЕЙ С ОНКОПАТОЛОГИЕЙ: ВНЕДРЕНИЕ ЛАТЕРАЛЬНОГО ДОСТУПА ПРИ СЕГМЕНТАРНОЙ РЕЗЕКЦИИ ПРОКСИМАЛЬНОГО ОТДЕЛА БОЛЬШЕБЕРЦОВОЙ КОСТИ

The aim of the study was to analyze our own experience of using the lateral approach in knee joint arthroplasty in children with oncopathology. Materials and methods of research: the results of a retrospective nonrandomized uncontrolled single-center study are analyzed, within the framework of which 97 endoprosthetics of the knee joint were performed in children and adolescents with oncological pathology over 7 years (2012–2018). Lateral approach was used in 28 patients. The functional results were assessed using the MSTS rating scale 6 and 12 months after the surgery. Postoperative complications were analyzed according to the Henderson classification (modified by the ISOLS committee). Results: when comparing the functional outcome depending on the surgical approach, no statistically significant difference was found either after 6 months (p=0,124) or after 12 months (p=0,755). There is no more frequent development of complications detected (p=0,551). The access used also did not affect overall survival in osteosarcoma (p=0,577), in Ewing's sarcoma (p=0,493), as well as on event-free survival in osteosarcoma (p=0,829) and in Ewing's sarcoma (p=0,886). Conclusion: the use of the lateral surgical approach for knee arthroplasty in children with oncopathology does not affect the treatment results, however, it provides the surgeon with greater variability of actions during preoperative planning. This is especially true for patients whose biopsy tract is located on the lateral side.

The Incidence and Significance of Calcium Pyrophosphate Dihydrate Deposits in Histologic Examinations of Total Hip, Knee, and Shoulder Joint Arthroplasties.

The incidence, distribution, and significance of calcium pyrophosphate dihydrate deposition (CPPD) disease have not been extensively compared among various total joint resections. To investigate and define the clinical and pathologic features of CPPD in hip, shoulder, and knee arthroplasties. We retrospectively reviewed consecutive total hip, knee, and shoulder arthroplasty cases (N = 3195) confirmed pathologically between January 1, 2017, and October 10, 2018, comparing clinical and pathologic data. Among 2004 hip arthroplasties, 61 (3%) had CPPD on pathologic examination; the majority had a histologic diagnosis of osteoarthritis, followed by fracture and avascular necrosis. Of 1113 knee arthroplasties, 98 (9%) had CPPD; all had a histologic diagnosis of osteoarthritis. Among 78 shoulder arthroplasties, 10 (13%) had CPPD; all but one had a histologic diagnosis of osteoarthritis. Patients with hip and knee CPPD were significantly older than those without CPPD. Of the 169 pathologically detected CPPD cases, only 35 (21%) were documented on preoperative radiologic images or by other clinical means; radiology reports were significantly more likely to document chondrocalcinosis in the knees than in the hips. Histologically, CPPD was noted almost exclusively in the separately submitted soft tissues/joint capsule, concomitantly involving the articular cartilage surface in only 3.0% (5 of 169) of cases. Calcium pyrophosphate dihydrate deposition is more than twice as likely to occur in the knees and shoulders compared with the hips. Patients with CPPD in the knees or hips are usually not recognized preoperatively/radiologically and constitute a significantly older population. Reliably establishing the diagnosis of CPPD requires pathologic examination of the submitted soft tissue/joint capsule.

DEEP OSCILLATIONS- REDUCING EDEMA AND IMPROVING KINESIOLOGY IN THE EARLY STAGES AFTER KNEE JOINT ARTHROPLASTY

Background: Joint arthroplasty is one of the most common modern operations in orthopedics and traumatology. Physiotherapy and rehabilitation are the final phase of the endoprosthesis and are of great importance both for the rate and for the extent of functional recovery. DEEP OSCILLATION® is a patented therapeutic procedure using resonant vibrations of tissues with minimal external mechanical effect and proven analgesic, antifibrotic, anti-inflammatory and anti-inflammatory effect. Aim of the study: To investigate the effect of deep oscillations and kinesitherapy on the reduction of edema, reduction of pain syndromes and restoration of the range of motion in patients after knee joint arthroplasty. Materials and methods: The study was conducted on 106 patients -38 men and 66 women randomly assigned to 2 groups - experimental group (EG) with 56 patients and control group (CG) with 50 patients, all after knee joint arthroplasty. Results: Our preliminary results indicate that there are significant differences in the recovery of patients in EG and CG. Patients who have a deep oscillation procedure are recovering faster and better, both in terms of subjective complaints and in terms of the monitored functional parameters (p<0.001). Conclusions: The results obtained have shown that deep oscillations are an effective method for reducing swelling, suppressing pain and inflammation, and increasing the range of motion (ROM) in early rehabilitation of patients after knee joint arthroplasty.

Тренды в первичной артропластике коленного сустава в Национальном медицинском исследовательском центре травматологии и ортопедии им. Р.Р. Вредена и их сравнительный анализ с данными международных национальных регистров: схож ли наш путь?

Introduction Total joint replacement is one of the most effective and successful surgical interventions. Regular monitoring of these surgical interventions is essential and may serve as a system for early detection of defective prosthesis designs or techniques resulting in the complication rate which exceeds the estimated level. The ideal way to conduct this monitoring is a registry of joint replacements. Purpose Assessment of the structure of primary knee joint arthroplasty at the Federal State Budgetary Institution Vreden National Medical Research Centre for Traumatology and Orthopaedics named and it’s comparative analysis with the data from leading foreign registers to improve the work of orthopaedic surgeons, traumatologists and healthcare organizers by optimizing the surgical tactics in the specialized treatment of patients. Methods The authors reviewed the annual reports published by national registers of knee replacements and compared them with the data of the registry of the Vreden National Medical Research Centre for Traumatology and Orthopaedics to make conclusions that would be relevant to current orthopaedic practice. Results Several results of the survey demonstrate the most significant or unexpected conclusions as according to the registry. These include an extremely large gender imbalance and obesity as two thirds of the patients were overweight. The number of patients with tumors and rheumatological diseases in the structure of knee replacements decreased considerably in the recent years. Designs and types of implants used, patellar resurfacing in arthroplasty, time of surgical intervention and options for postoperative administrations of antibiotics at the Vreden Centre are consistent with general European trends in knee arthroplasty. Conclusions The number of primary knee replacements (including unicompartment replacements) has been increasing annually. The patients admitted for primary knee replacement are statistically very similar to patient population from other countries. The main differences are associated with an earlier age at which arthroplasty is performed, an extreme gender imbalance and a relatively low number of patellar resurfacing in primary knee replacement. The problem of overweight among the population leads to an increased number of knee replacements, complications and lower implant survival rate.

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis.

AimsTo develop and validate patient-centred algorithms that estimate individual risk of death over the first year after elective joint arthroplasty surgery for osteoarthritis.MethodsA total of 763,213 hip and knee joint arthroplasty episodes recorded in the National Joint Registry for England and Wales (NJR) and 105,407 episodes from the Norwegian Arthroplasty Register were used to model individual mortality risk over the first year after surgery using flexible parametric survival regression.ResultsThe one-year mortality rates in the NJR were 10.8 and 8.9 per 1,000 patient-years after hip and knee arthroplasty, respectively. The Norwegian mortality rates were 9.1 and 6.0 per 1,000 patient-years, respectively. The strongest predictors of death in the final models were age, sex, body mass index, and American Society of Anesthesiologists grade. Exposure variables related to the intervention, with the exception of knee arthroplasty type, did not add discrimination over patient factors alone. Discrimination was good in both cohorts, with c-indices above 0.76 for the hip and above 0.70 for the knee. Time-dependent Brier scores indicated appropriate estimation of the mortality rate (≤ 0.01, all models).ConclusionSimple demographic and clinical information may be used to calculate an individualized estimation for one-year mortality risk after hip or knee arthroplasty (https://jointcalc.shef.ac.uk). These models may be used to provide patients with an estimate of the risk of mortality after joint arthroplasty.Cite this article: Bone Joint Res 2020;9(11):808–820.

What Is the Effect of Using a Competing-risks Estimator when Predicting Survivorship After Joint Arthroplasty: A Comparison of Approaches to Survivorship Estimation in a Large Registry.

There is increasing interest in the development of statistical models that can be used to estimate risk of adverse patient outcomes after joint arthroplasty. Competing risk approaches have been recommended to estimate risk of longer-term revision, which is often likely to be precluded by the competing risk of death. However, a common approach is to ignore the competing risk by treating death as a censoring event and using standard survival models such as Cox regression. It is well-known that this approach can overestimate the event risk for population-level estimates, but the impact on the estimation of a patient's individualized risk after joint arthroplasty has not been explored. We performed this study to (1) determine whether using a competing risk or noncompeting risk method affects the accuracy of predictive models for joint arthroplasty revision and (2) determine the magnitude of difference that using a competing risks versus noncompeting risks approach will make to predicted risks for individual patients. The predictive performance of a standard Cox model, with competing risks treated as censoring events, was compared with the performance of two competing risks approaches, the cause-specific Cox model and Fine-Gray model. Models were trained and tested using data pertaining to 531,304 TKAs and 274,618 THAs recorded in the Australian Orthopaedic Association National Joint Replacement Registry between January 1, 2003 and December 31, 2017. The registry is a large database with near-complete capture and follow-up of all hip and knee joint arthroplasty in Australia from 2003 onwards, making it an ideal setting for this study. The performance of the three modeling approaches was compared in two different prediction settings: prediction of the 10-year risk of all-cause revision after TKA and prediction of revision for periprosthetic fracture after THA. The calibration and discrimination of each approach were compared using the concordance index, integrated Brier scores, and calibration plots. Calibration of 10-year risk estimates was further assessed within subgroups of age by comparing the observed and predicted proportion of events. Estimated 10-year risks from each model were also compared in three hypothetical patients with different risk profiles to determine whether differences in population-level performance metrics would translate into a meaningful difference for individual patient predictions. The standard Cox and two competing risks models showed near-identical ability to distinguish between high-risk and low-risk patients (c-index 0.64 [95% CI, 0.64 to 0.64] for all three modeling approaches for TKAs and 0.66 [95% CI 0.66 to 0.66] for THA). All models performed similarly in patients younger than 75 years, but for patients aged 75 years and older, the standard Cox model overestimated the risk of revision more than the cause-specific Cox and Fine-Gray model did. These results were echoed when predictions were made for hypothetical individual patients. For patients with a low competing risk of mortality, the 10-year predicted risks from the standard Cox, cause-specific Cox, and Fine-Gray models were similar for TKAs and THAs. However, a larger difference was observed for hypothetical 89-year-old patients with increased mortality risk. In TKAs, the revision risk for an 89-year-old patient was so low that this difference was negligible (0.83% from the cause-specific Cox model versus 1.1% from the standard Cox model). However, for THAs, where older age is a risk factor for both death and revision for periprosthetic fracture, a larger difference was observed in the 10-year predicted risks for a hypothetical 89-year-old patient (3.4% from the cause-specific Cox model versus 5.2% from the standard Cox model). When developing models to predict longer-term revision of joint arthroplasty, failing to use a competing risks modeling approach will result in overestimating the revision risk for patients with a high risk of mortality during the surveillance period. However, even in an extreme instance, where both the frequency of the event of interest and the competing risk of death are high, the largest absolute difference in predicted 10-year risk for an individual patient was just 1.8%, which may not be of consequence to an individual. Despite these findings, when developing or using risk prediction models, researchers and clinicians should be aware of how competing risks were handled in the modeling process, particularly if the model is intended for use populations where the mortality risk is high. Level III, therapeutic study.

Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty

BackgroundRacial and ethnic disparities in access to hip and knee total joint arthroplasty (TJA) and postoperative outcomes have wide-reaching implications for patients and the health care system. The aim of this study is to evaluate the effect of ethnicity on clinical outcomes and complications following revision hip and knee TJA. MethodsA single-institution, retrospective analysis of a consecutive series of 4424 revision hip and knee TJA patients was evaluated. Student’s t-test and chi-squared analysis were used to identify significant differences in patient demographics and clinical outcomes between Caucasians and various ethnic minorities, including African Americans, Hispanics, and Asians. ResultsWhen compared with white patients, African American patients demonstrated a significantly higher BMI (P = .04), ASA score (P = .04), length of hospital stay (P = .06), and postoperative infection rates (P = .04). Hispanics demonstrated a significantly higher BMI (P = .04), when compared with white patients, alongside a significantly higher risk for postoperative infection (P < .01). African American demonstrated a significantly higher ASA score (P = .02; P = .03), when compared with Hispanics and Asians, alongside a significantly increased length of stay (P = .01) and higher risk for postoperative infection (P = .02). ConclusionThe study findings demonstrate an underutilization of revision TJA by ethnic minority groups, suggesting that disparities in access to orthopedic surgery increase from primary to revision surgery despite higher failure rates of minority ethnic groups reported after primary TJA surgery. In addition, inferior postoperative outcomes were associated with African Americans and Hispanics, when compared to white patients, with African Americans demonstrating the highest risk of postoperative complications.

Risk factors of allogeneic red blood transfusion following enhanced recovery hip and knee arthroplasty

Objective: To Explore the current status and risk factors of perioperative allogenic red blood cell transfusion following enhanced recovery hip and knee joint arthroplasty. Methods: Patients who have taken their primary unilateral total hip and knee arthroplasty (THA, TKA) or simultaneous primary THA were retrospectively included from January, 2019 to December, 2019 in West China Hospital. The baseline characteristics were compared between patients with allogeneic transfusion and those without. And logistic regression were used to analyze the risk factors of perioperative allogeneic red blood cell transfusion. Results: A total of 2 034 patients (2072 arthroplasties) were included, 705 males and 1 329 females, aged (60±24) years. Of all, 1 137 patients received primary THA (38 simultaneous THA), 897 patients received primary unilateral TKA. Eleven (0.54%) patients received allogeneic red blood cell transfusion, and the mean volume was (2.6±1.2) U. Deep venous thrombosis occurred in 2 patients (0.09%) undergoing primary TKA. The transfusion rate in primary THA patients was 0.79% (9/1 137), and 0.22% (2/897) in TKA. Lower preoperative hemoglobin level (P=0.041) and more hematological comorbidities (P=0.005) were detected in transfused patients. And logistic analysis further revealed that preoperative substandard hemoglobin level was the most important risk factor for transfusion (OR=5.663, P=0.018). Conclusions: Under the intervention of enhanced recovery after surgery concept and modern blood management strategies, the transfusion requirement has been significantly reduced following primary joint arthroplasty. Pre-operative hemoglobin level should be an important threshold for perioperative blood management.

Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement

ObjectivesUnderstand the association between social determinants of health and community discharge after elective total joint arthroplasty. DesignRetrospective cohort design using Optum de-identified electronic health record dataset. Setting and ParticipantsA total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018. MethodsLogistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics. ResultsMean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76–0.85; knee: OR 0.73, 95% CI 0.69–0.77], current smoking (hip: OR 0.82, 95% CI 0.77–0.88; knee: OR 0.90, 95% CI 0.85–0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50–0.60; knee: OR 0.57, 95% CI 0.53–0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively. Conclusions and ImplicationsSocial determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.

Infection risk stratification in total knee joint arthroplasty using a new scoring system.

Periprosthetic joint infection (PJI) is a catastrophic complication of total knee arthroplasty (TKA) adding significant costs to the health care system with increasing morbidity and mortality. The goal of this study was to develop a prognostic scoring system that could risk-stratify patients undergoing TKA for the risk of PJI. The study included 150 patients who underwent primary TKA from June 2012 to February2016. There were 60 patients in group I who were not risk stratified using the scoring system, while 90 patients were assigned to group II and were prospectively assigned scores based on the scoring system. Points were assigned for each pre-op variable and a scoring chart was developed. Group II patients scoring 4 or more were counseled to optimize their modifiable risk factors before proceeding with surgery. Retrospective chart review was done for patients in group I to find out their risk score for the study purpose. Nine out of 60 patients in group I were found to have score above 4 based on the chart review, of which 4 patients got infected (P<0.05). None of the group II patients got infected after TKA. In conclusion, our scoring system is an objective scoring system for preoperative risk stratification of patients undergoing TKA, thus helping identification and optimization of the risk factors preoperatively to decrease the risk of PJI.

Body mass index and knee arthroplasty

Objectivethis study aims to evaluate the relationship between body mass index (BMI), age at which knee joint arthroplasty is performed and complications. The hypothesis is that the higher the BMI, the greater likelihood that the patient will require surgery at an earlier age.Methods: this is a cohort study with all patients who underwent a primary knee arthroplasty, between August 2013 and February 2019, in a tertiary level university hospital. Association between BMI, age and complications were analyzed. Quality of life of patients was also evaluated with the Oxford Knee Score (OKS). Results565 primary total knee replacements (TKR) were performed. A cut-off point was found in BMI of 30; 348 patients had a BMI ≤30 and 173 patients had a BMI >30. When comparing the two groups, a statistically significant difference (p = 0.0186) was found in the age at which the TKR was performed. There was a significant improvement for both groups in functional score (Oxford knee score). Additionally, intra and post-operative complications showed no statistically significant difference. Conclusionpatients with BMI greater than 30 required primary knee arthroplasty at a younger age (average: 3.5 years), compared to patients with a lower BMI. Obesity does not appear to confer and independent risk for surgery in the short and mid-term. Knee arthroplasty improves significantly quality of life in the short and mid-term, regardless of their BMI, as measured with the OKS.

Gentamycin-Loaded Bone Cement Released Time against Staphylococcus Aureus by using In Vitro Media as the Strategy for the Patient with Prostethic Joint Infection (PJI) after Hip and Knee Joint Arthroplasty

Introduction:Joint Arthroplasty is the best treatment modality to improves joint function, relieves pain, and increase the quality of life. There were about 0.5% to 0.8% of patients performed primary total knee and hip arthroplasties has been reported with Prostethic Joint Infection (PJI). Staphylococcus aureus is one of the most virulent bacteria which has identified in the isolation caused by PJI. There were increased number of primary arthroplasties. Gentamycin is an antibiotic which has a bactericidal effect for some gram positive and most aerobic and facultative anaerobic gram negative bacteria. They act by inhibiting protein synthesis.Method:This research is an experimental study.The object is Staphylococcus aureus which was treated by Gentamycin-loaded bone cement which were divided into 3 concentrations 5%,10%, and 20%. We have observed the antibacterial effect by measured how was the released time while we put it in agar plates. We controlled them every 2 weeks for observing the inhibition of ring assays which were formed. We were also calculated the diameter of ring assay.Result:Drug release profiles showed for 5%,10%,20% Gentamycin-loaded bone cement displayed a long enough drug release time about 14 weeks. The diameters of ring assay didn’t showed if they were affected by the released time.Discussion:We have been observed about Gentamycin-loaded bone cement released time with Staphylococcus aureus,we found if it can exist more than 14 weeks.There have been no study investigated about it before. In the present study by Gaoyang in 2018,they have been observed with vancomycinloaded bone cement,they had found if vancomisin loaded-bone cement provided sufficient effective antibacterial time at least 8 weeks.Conclusion:The Gentamycin-loaded bone cement released time against Staphylococcus aureus more than about 14 weeks.There is no different result between the length of released with ring assay diameters.

Arthroscopically-assisted knee joint arthrodesis by custom-made intramedullary locking nail with simultaneous femur deformity correction (case report)

Post-traumatic intra- and extra-articular deformities of the bones forming the knee joint, multiple previous surgeries, fibrous ankylosis of the knee joint is unfavorable background for performing total knee joint arthroplasty. In case of refusal to perform knee arthroplasty, the gold standard is knee arthrodesis. Standard techniques used in performing this operation are traumatic and associated with a high volume of intraoperative blood loss. Using such a surgical option as arthroscopically-assisted arthrodesis can reduce the level of surgical invasive- ness and minimize blood loss, while allowing you to perform this operation no less effectively than using traditional approaches. As a clinical example, we have presented arthroscopically-assisted arthrodesis of the knee joint in a patient with posttraumatic deformity of the femur and fibrous ankylosis of the knee joint with a good medium-term functional result.

Reduced post-operative opioid use decreases length of stay and readmission rates in patients undergoing hip and knee joint arthroplasty

BackgroundWhile adequate pain relief is central to patient recovery and satisfaction, opioid use is associated with side effects, adverse drug events and opioid use disorder and therefore is under increased scrutiny. Enhanced surgical recovery protocols include multimodal pain management as a key process, but the impact of opioid dose as an independent variable has not been examined. MethodsRetrospective analysis of 51,824 hip and knee arthroplasty encounters in a large healthcare system. ResultsOverall, patients receiving treatment with lower doses of opiates had shorter median length of stay (p < 0.001); this earlier discharge had no negative consequences on readmission rates. In particular, patients discharged on day 1 received a lower median morphine milligram equivalent (MME) per day than those who were not discharged (32.5 [IQR: 19.0–50.0] versus 45.0 [26.7–71.2], respectively, p < 0.001). The probability of discharge on day 1 was 41.2% and 19.6% for those patients on lower versus higher MME/day, respectively. Similarly, there was a reduction in odds of readmission of 15.2% (95% CI 5.8–23.6%) for patients on lower doses of MME/day. ConclusionLower MME/day following joint arthroplasty is linked to the probability of discharge on both days 1 and 2 post-surgery as well as reduced odds of readmission. These findings persisted even when adjusting for all other factors, including participation in the enhanced surgical recovery program, the use of a multi-modal analgesic regimen, the presence of complications, patient demographics, and other baseline characteristics. Efforts to reduce opioid use in the peri- and immediate post-operative period, regardless of the mechanism, demonstrated a significant effect on patient outcomes.

Responsiveness of the Turkish KOOS-PS and HOOS-PS in knee and hip joint arthroplasty patients.

Adaptation to Turkish language and validation studies of Knee Injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS) and Hip Disability and Osteoarthritis Outcome Score - Physical Function Short Form (HOOS-PS) were done previously but responsiveness to changes of these questionnaires could not be tested in these studies. The aim of this study was to assess the responsiveness of the Turkish versions of the KOOS-PS and HOOS-PS in a patient group who underwent knee or hip joint arthroplasty operation. Sixty-three patients who underwent total knee arthroplasties and sixteen patients who underwent total hip arthroplasties for primary osteoarthritis were included in this study. The preoperative and 3-month postoperative KOOS-PS, HOOS-PS, and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index hip and knee scores were collected from the hospital records, and the effect sizes (ESs) and standardized response means (SRMs) were calculated. The ESs and SRMs, respectively, were as follows: -1.954 and -2.156 for the KOOS-PS, -1.833 and -2.464 for the HOOS-PS, -4.848 and -4.210 for the WOMAC-knee, and -3.835 and -4.625 for the WOMAC-hip. The Turkish versions of the KOOS-PS and HOOS-PS exhibited strong responsiveness to change in the arthroplasty patients.

Clinical and microbiological characteristics of periprosthetic hip and knee infections

Objective. To characterize periprosthetic joint infection in patients undergoing a total hip and knee joint replacement. Materials and Methods. A total of 77 patients with periprosthetic infection following hip and knee joint replacement hospitalized in Grodno City Clinical Hospital were studied over the period of 2014-2018. Wound discharge, tissue samples, and fistula’s wall swab were used for microbiological tests. The analysis of surgical treatment of patients with deep periprosthetic knee and hip joint infection has been performed. Results. Periprosthetic infection after hip joint arthroplasty was observed in 32 (41.6%) patients, and after total knee joint arthroplasty in 45 (58.4%) patients. Surgical treatment was performed in 18 (56.3%) and 32 (71.1%) patients with periprosthetic infection following total knee and hip joint replacement, respectively. A total of 10 (31.2%) of 32 cultures from patients with periprosthetic infection after total hip joint replacement and 8 (17.8%) of 45 cultures from patients with periprosthetic infection after total knee joint replacement were positive. Overall, Staphylococcus aureus was detected in 9 (50%) of 18 positive cultures. Gram-negative aerobic bacteria (Acinetobacter baumannii, Klebsiella pneumoniae Pseudomonas aeruginosa) were detected in 4⁄10 and 5⁄8 of positive cultures from patients with periprosthetic infection of hip and knee joints, respectively. Conclusions. The most common pathogens causing periprosthetic infection of hip and knee joints were S. aureus (50%) and Gram-negative bacteria. The surgical treatment was performed in 71.4% of patients with periprosthetic joint infection.