Knee Prosthesis Surgery Research Articles

Surveillance of surgical site infections in orthopedic prosthetic surgery: a tool for identifying risk factors and improving clinical practice.

Surgical site infections (SSIs) are among the most frequently encountered complications in prosthetic surgery, and are associated with increased hospitalization, costs and in-hospital mortality. There is no national system for the comprehensive monitoring of the incidence of SSIs. All patients undergoing orthopedic prosthetic surgery from April 1 to June 30, 2023 were enrolled. Clinical evaluation of the surgical site was conducted at 30 days, and a follow-up telephone interview was carried out by means of a specially designed questionnaire at 90 days. A total of 59 patients were included. Surgery was performed on the knee in 71.19% and on the hip in 28.81%. The patients' mean BMI was 28.25 ± 2.97, and their mean ASA score was 2.67 ± 0.58. Six patients had diabetes mellitus. The incidence of SSIs was 5.08%; two infections occurred in knee prosthesis surgery and one in hip surgery. Analysis of the data revealed that diabetes was the main risk factor for the development of infection. Although based on a small number of patients, these results are encouraging, especially considering that the patients had an average ASA score of more than 2 and a high BMI. However, to further reduce the risk of infection, improved hygiene measures have now been implemented in the operating room and the antibiotic prophylaxis protocol has been updated to take into account the potential for MRSA colonization.

Rehabilitation approach in robot assisted total knee arthroplasty: an observational study

BackgroundThe purpose of this study is to evaluate the impact of total knee arthroplasty (TKA) with the aid of Navio Robot, comparing it with standard prosthetic surgery on the functional outcomes of patients after an intensive rehabilitation program.MethodA case–control observational study was conducted on patients undergoing TKA for severe KOA. All patients underwent the same intensive hospital rehabilitation program of 14 daily sessions lasting 3 h. The following rating scales were administered: Numeric Rating Scale (NRS), Knee Society Score (KSS) and 12-Item Short Form Survey scale. Patient assessments were performed 1 week post-surgery (T0), 1 month post-surgery (T2), and 3 months post-surgery (T3). The primary outcomes were active knee extension and flexion and pain severity. The secondary outcomes were functional capacity and quality of life.ResultsUsing repeated measures ANOVA, we observed at T1 a statistically different difference for the treatment group compared to the control group about KSS (p < 0.05), pain (p < 0.05), and knee flexion (p < 0.05). No statistically significant difference between the two groups was observed for knee extension (p = 0.09) and the SF-12 scale (p = 0.52). At T2 instead, we observed a statistically significant difference for the treatment group compared to the control group as regards KSS (p < 0.05) and knee flexion (p < 0.05), while no statistically significant difference was observed for pain (p = 0.83), knee extension (p = 0.60), and the SF-12 scale (0.44).ConclusionsOur study has demonstrated that robot-NAVIO assisted knee prosthesis surgery, associated with a specific intensive rehabilitation treatment, in the short and medium term, determines good pain control, better flexion recovery and a improvement of functional capacity.

MODELING OF PATELLA HEIGHT WITH DISTAL FEMUR AND PROXIMAL TIBIA REFERENCE POINTS WITH ARTIFICIAL NEURAL NETWORK

The patellofemoral joint is one of the parts of the knee extension mechanism that plays a role in the stability of the knee by enlarging the force arm of the quadriceps muscle and changing the direction of the muscle strength. For the entire knee joint to perform its task painlessly and functionally, the positions and strength of the muscles, the strength of the ligaments, and their reaction to movement must be compatible. The Insall–Salvati (Ins-Sal) index is useful for showing changes in patellar height produced by repositioning the tibial plateau, in other words, showing changes in patellar tendon length. Patella height is an important value to be taken into account in knee prosthesis surgery, tibial osteotomy, and anterior cruciate ligament reconstruction. The morphometric relationship between the reference measurements of the distal femur and proximal tibia and the position of the patella will be useful in determining the natural anatomy. In this study, we aimed to determine the relationship between patella height and distal femur and proximal tibia reference areas by using the artificial neural network method as an alternative approach method. In order to assess the performance of the estimation of the Ins-Sal index, the four ANN model with six input combinations which included age, gender and the reference measurements for the right and left sides have been constructed and tested. The MSE and [Formula: see text] values are calculated for every four models for the training and test phase. The results show that the proposed approach for modeling of relation between reference measurements and the Ins-Sal index is a powerful approach.

Knee Prosthesis in the Computer Era.

Over the past two decades, computer assistance has revolutionalized surgery and has enabled enormous advancements in knee prosthesis surgery. Total knee arthroplasty (TKA) is a hot topic of orthopaedic research. Reflecting population dynamics, its use continues to increase, especially in high demand populations. Therefore, efforts to achieve the best fit and precise alignment in TKA continue. Computer assistance is valuable for knee prosthesis surgeons in this regard. This manuscript investigated the use of computer assistance in knee prosthesis surgery. The effects of computer use on important facets of knee prosthesis surgery, such as precision, clinical aspects, and costs, were examined. Moreover, an overall review of the recent literature on the navigation and personalized cutting guides was conducted.

Total Diz Protezi Ameliyatı Planlanan Hastaların Cerrahi Korku Düzeyleri ile Ameliyat Sonrası Ağrı Düzeyleri Arasındaki İlişkinin Belirlenmesi

Total Diz Protezi Ameliyatı Planlanan Hastaların Cerrahi Korku Düzeyleri ile Ameliyat Sonrası Ağrı Düzeyleri Arasındaki İlişkinin Belirlenmesi

Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors: An observational study.

The purpose of this study was to evaluate compliance and satisfaction of adult patients to intensive rehabilitation treatment during chemotherapy cycles after surgery for bone-musculoskeletal tumours, as well as to identify possible predictive factors. An observational, prognostic, prospective study was conducted. The study enrolled 27 patients who previously had undergone modular knee prosthesis surgery in the period between October 2014 and October 2015. The outcome was compliance to intensive rehabilitation treatment during hospitalisations in the chemotherapy unit and patient satisfaction 6months' post-surgery. The variables taken into account were linked to the patient's characteristics, to the oncological pathology and to the chemotherapy treatment administered. Patients' compliance was 100% (range, 61-100). The presence of surgery complications (29.6%) produced 5% loss in compliance to treatment; likewise, chemotherapy treatment with prevalent use of ifosfamide reduced compliance to rehabilitation by 6%. The mean patient satisfaction score was 7.9 in the Likert scale from 0 to 10. Intensive physiotherapy starting during chemotherapy administration is a feasible treatment for bone tumour patients that have shown to be able to positively adhere to it. Rehabilitation treatments, within chemotherapy wards, should therefore be promoted according to satisfaction level as reported by patient.

1,25(OH)2D3 and calcipotriol, its hypocalcemic analog, exert a long-lasting anti-inflammatory and anti-proliferative effect in synoviocytes cultured from patients with rheumatoid arthritis and osteoarthritis

ObjectivesWe investigated the effects of 1,25-dihydroxy vitamin D3 (1,25(OH)2D3), i.e. biologically active vitamin D and calcipotriol, a vitamin D analog, on growth and secretion of inflammatory mediators in synovial stromal cells (SSC) of patients with rheumatoid arthritis (RA) or osteoarthritis (OA). MethodsSynovial stromal cells (SSC) isolated during knee prosthesis surgery from four patients with RA and four with OA were exposed to 1,25(OH)2D3 or calcipotriol with or without stimulation of cells with IL-1β or TNF-α. The proliferation of cells was studied by MTT assay. Levels of cytokines were analyzed by a magnetic bead–based multiplex assay (a panel of 27 important cytokines and IL-6 alone) and RT-PCR was used to validate the concentrations of the key cytokines secreted by SSC. The vitamin D receptor (VDR) was visualized by immunofluorescence in SSC and by immunohistochemistry in the synovial tissues of three RA and three OA patients. ResultsWe detected intense staining for VDR in the synovial lining and vascular endothelium in tissue sections from all our RA and OA patients. Both 1,25(OH)2D3 and calcipotriol inhibited SSC proliferation for a prolonged time (up to 23 days with calcipotriol), but dexamethasone tended to increase SSC proliferation in a 4-day culture. 1,25(OH)2D3, calcipotriol and dexamethasone reduced the secretion of most inflammatory factors. Calcipotriol and dexamethasone additively reduced the secretions of IL-6, IFN-γ, basic FGF and VEGF in TNF-α stimulated SSC. The level of IL-6 was still diminished at 10 days after exposure, emphasizing the long-term impact of calcipotriol on SSC. ConclusionsExposure for 24–48h to 1,25(OH)2D3 or calcipotriol causes a long-lasting inhibition of cell proliferation and cytokine production in SSC in vitro.

Influence of the ischaemic tourniquet in antibiotic prophylaxis in total knee replacement

ObjectiveThere is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection.There is controversy on whether the ischaemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues.The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. Material and methodA prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. ResultsThe mean concentration of antibiotic was 23.16μg/g (95% CI 19.19–27.13) in the samples at the beginning of the intervention and 15.45μg/g (95% CI 13.20–17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8μg/g. These results were statistically significant for both concentrations (P<.00001). DiscussionThe antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention.The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied.In conclusion, the use of a tourniquet does not increase the risk of infection.

Influencia del manguito de isquemia en la profilaxis antibiótica en prótesis total de rodilla

ObjectiveThere is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection.There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues.The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. Material and methodA prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. ResultsThe mean concentration of antibiotic was 23.16μg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45μg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 μg/g. These results were statistically significant for both concentrations (P<.00001). DiscussionThe antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention.The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied.In conclusion, the use of a tourniquet does not increase the risk of infection.

Cinétique du saignement en chirurgie orthopédique majeure : implications pour la prise en charge périopératoire

IntroductionManagement of the perioperative hemorrhagic risk is of major interest in patients undergoing total arthroplasty of the lower limb. Anemia in the postoperative period of that increasingly performed surgery carries its own morbidity and mortality. Better anticipation of its occurrence could be done with a refined knowledge of bleeding kinetics. Patients and methodsWe conducted a retrospective study in a single centre on 451 consecutive patients undergoing elective unilateral primary total hip or knee arthroplasty for osteoarthritis. Volume of total blood loss according to Mercuriali's formula and variations of haemoglobin levels were calculated between day 0 (D0) and postoperative day 8 (D8), and during subdivided periods between D0–D1, D1–D3 and D3–D8. Frequency and volume of autologous and homologous blood transfusions were also analyzed. Comparisons were done taking into account the use of intraoperative tranexemic acid (TA). ResultsSeventy to 75% of blood loss occurred between D0 and D1. Bleeding occurred mostly between the end of surgery and morning of D1, and tended to stop at D3. TA significantly reduced blood loss in the first 3days, mostly after knee prosthesis surgery. However, the bleeding kinetics were the same with or without TA. ConclusionLoss of haemoglobin occurred mostly in the early postoperative period. To avoid transfusion delays, haemoglobin levels should be monitored regularly until the third postoperative day after total arthroplasty, especially when D1 haemoglobin is close to the transfusion threshold. Furthermore, our results support the routine use of TA.

Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery

OBJECTIVE:There are no data adressing the prevalence of restless legs syndrome in subjects who have knee prosthesis. Therefore, we conducted a cross-sectional survey of subjects who underwent knee prosthesis surgery.METHOD:A total of 107 subjects (30 male, 77 female) were interviewed over the telephone regarding restless legs syndrome symptoms. If the patients exhibited symptoms of the syndrome, we conducted face-to-face interviews. Lastly, a therapeutic test with pramipexole was proposed for each subject.RESULTS:In our cohort, 7 males (23%) and 30 females (39%) had restless legs syndrome. Of these, 6 males and 23 females were submitted to face-to-face-interview. Of the males, 5 (83%) had restless legs after the knee surgery- exclusively in the operated leg- and reported no family restless legs history. One man had a prior case of bilateral restless legs syndrome, a positive family history and claimed exacerbation of symptoms in the operated leg. Among the females, 16 (69%) had restless legs prior to surgery. A total of 10 female patients reported bilateral symptoms, with fewer symptoms in the operated leg, while 6 displayed a worse outcome in the operated leg. The 7 females (31%) without restless legs prior to surgery and without a family history experienced symptoms only in the operated leg. All subjects responded favorably to the pramipexole therapeutic test.CONCLUSION:Our results suggest that secondary unilateral restless legs syndrome may ensue from knee prosthesis surgery and that the symptoms are generated in the peripheral nervous system.

Postoperative anemia after joint replacement surgery is not related to quality of life during the first two weeks postoperatively

Lower limb joint replacement surgery provides a considerable improvement in quality of life (QoL), but is associated with peroperative blood loss and with anemia in the direct postoperative period. General acceptance of low transfusion thresholds and shorter postoperative hospital stays will result in patients leaving hospital with low hemoglobin (Hb) levels. To evaluate the role of QoL scores as a possible alternative for Hb values to serve as a further indicator for red blood cell transfusion, we performed a secondary analysis of a previously conducted randomized clinical trial to compare QoL and fatigue scores with simultaneously measured pre- and postoperative Hb levels, in total hip and knee arthroplasty patients. QoL measurement was measured preoperatively and twice up to 14 days postoperatively using the Functional Status Index (FSI), the Visual Analogue Score (VAS)-Fatigue score, and the Functional Assessment of Cancer Therapy Anemia (FACT-Anemia) subscale. Pearson correlation coefficients between (change in) FSI, VAS-Fatigue, and FACT-Anemia subscale scores and (change in) Hb levels were calculated. Additionally, partial correlations were calculated and linear regression analysis was performed, correcting for possible confounding variables. A total of 603 patients were evaluated. All patients scored worse postoperatively, but none of the scores correlated with Hb values, neither after correcting for confounding factors. Even more, the changes between preoperative and postoperative Hb levels were not correlated with changes in fatigue scores. In hip and knee prosthesis surgery no correlation existed between postoperative Hb levels or acute postoperative decline in Hb values and QoL scores (FSI, VAS-Fatigue, or FACT-Anemia).

Mejora del acceso a la artroplastia total de rodilla: experiencia de una unidad monográfica

Introduction In May 2004 a specific program for knee prosthesis surgery was established, due to the high demand for this type of surgery. The aim of this study was to assess the outcomes of clinical and quality indicators obtained in a monographic hospitalization unit specialized in knee prosthesis surgery compared with the outcomes previously obtained in a standard orthopedic surgery hospitalization unit. Material and method The sample of this non-controlled community trial (before-after) consisted of the first 124 patients treated in the specialized unit and the last 124 patients treated in the standard unit for the same type of surgery. Age, gender, pain, length of hospital stay in days, movement at discharge, knee bending, comorbidity and complications were analyzed. Results Patients admitted to the specialized unit spent less time in the hospital (p < 0.0001) and showed better knee bending at discharge (p < 0.0001). In general the specialized unit attended patients with a greater number of comorbidities than the standard unit. Conclusions Creating a monographic unit specialized in the care of surgical patients with high prevalence could be a possible solution to this chronic problem in public hospitals. These units should follow a specific clinical pathway and should assess quality according to a group of indicators and objectives that allow continuous improvement.

Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands

Objective.To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.Design.Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.Setting.Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.Results.We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).Conclusions.For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands

To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record. Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004. We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%). For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: Gait analysis of 30 patients and 15 controls

The motions and moments in the hip and knee in female patients on the waiting list for knee prosthesis surgery with medial (n = 15) or lateral (n = 15) osteoarthritis (OA) were compared with a control group (n = 15). We hypothesized that not only the kinematics and kinetics of the knee but also of the hip would differ between patients the medial and lateral groups. At midstance, patients with lateral OA showed slightly (2 degrees) more maximal (peak) adduction (p = 0.015) of the hip joint and patients with medial OA had 7 degrees more abduction (p < 0.001) than did controls. In patients with lateral OA, the femur was positioned in about 7 degrees more maximum external rotation (p = 0.001), but femur position did not differ between medial OA and controls (p > or = 0.8). There was a tendency to higher internal hip rotation moment in lateral OA compared to controls (p = 0.021). The maximum values of the internal knee abduction moments were 52% higher in medial OA (p = 0.005) and 63% lower in lateral OA (p < 0.001) compared to controls. Cases with medial OA had 9 degrees more, whereas those with lateral OA had 6 degrees less external tibial rotation than controls (medial vs. lateral OA, p = 0.001). We found an association between presence of lateral OA of the knee and the biomechanics of the hip joint. It remains to be evaluated if the changed biomechanics of the hip joint is a reason for development of lateral OA or an observation that is a result of this disease.

Validity of echographic evaluation of cartilage in gonarthrosis. Preliminary report

We studied an echographic technique by which precise reproducible measurements of articular cartilage thickness of the knee is possible. Two groups of individuals were studied: a group of 18 patients with gonarthrosis and a control group of 10 normal individuals. The group of 18 patients with gonarthrosis was studied by ultrasound (US) before knee prosthesis surgery. The cartilage thickness was measured within the weight-bearing area. US re-evaluation and histological measurements were made on the pathological specimen following the operation. Results of pre- and post-operative US data were compared with histological data. A good correlation between these measurements was found [P(t) > 10%]. In order to have comparative reference values of the articular cartilage within the weight-bearing area of the femoral trochlea a group of 10 control subjects was also studied with US as above. We found that the articular cartilage thickness of the femoral trochlea in the weight-bearing area has a mean of 2.2 +/- 0.3 mm for the lateral condyle and 2.3 +/- 0.2 mm for the medial condyle. The intra-observer and inter-observer difference in measurements was evaluated with Student's t-test. Our data demonstrate that US measurements of articular cartilage thickness of femoral condyles is a sensitive and reproducible technique which permits early diagnosis and management of knee arthropathy as well as quantification of cartilage damage.