Knee Replacement Arthroplasty Research Articles

Oxidized LDL Accelerates Cartilage Destruction and Inflammatory Chondrocyte Death in Osteoarthritis by Disrupting the TFEB-Regulated Autophagy-Lysosome Pathway.

Osteoarthritis (OA) involves cartilage degeneration, thereby causing inflammation and pain. Cardiovascular diseases, such as dyslipidemia, are risk factors for OA; however, the mechanism is unclear. We investigated the effect of dyslipidemia on the development of OA. Treatment of cartilage cells with low-density lipoprotein (LDL) enhanced abnormal autophagy but suppressed normal autophagy and reduced the activity of transcription factor EB (TFEB), which is important for the function of lysosomes. Treatment of LDL-exposed chondrocytes with rapamycin, which activates TFEB, restored normal autophagy. Also, LDL enhanced the inflammatory death of chondrocytes, an effect reversed by rapamycin. In an animal model of hyperlipidemia-associated OA, dyslipidemia accelerated the development of OA, an effect reversed by treatment with a statin, an anti-dyslipidemia drug, or rapamycin, which activates TFEB. Dyslipidemia reduced the autophagic flux and induced necroptosis in the cartilage tissue of patients with OA. The levels of triglycerides, LDL, and total cholesterol were increased in patients with OA compared to those without OA. The C-reactive protein level of patients with dyslipidemia was higher than that of those without dyslipidemia after total knee replacement arthroplasty. In conclusion, oxidized LDL, an important risk factor of dyslipidemia, inhibited the activity of TFEB and reduced the autophagic flux, thereby inducing necroptosis in chondrocytes.

Does Perioperative use of Bisphosphonate Affect Implant Revision Rate of Total Ankle Arthroplasty?

Category: Ankle Arthritis; Other Introduction/Purpose: It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. Therefore, the purpose of this study was 1) to investigate whether there is a relationship between the use of BP and the revision rate of TAR, and (2) to determine the effect of BP medication period on the revision rate of TAR. Our hypothesis was that the use of BP would lower the revision rate of TAR. Methods: We reviewed National Health Insurance Service data based on national health insurance service claim data and health care utilization, health screening, socio-demographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP non-users, while 909 patients were BP users. The revision rate according to BP medication and co-morbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. Results: The revision rate of TAR was 7.9% for BP users and 9.5% for BP non-users, which showed no significant difference (p=0.251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 (p=0.017), while other co-morbidities such as diabetes had no effect on revision rate of TAR. Conclusion: We found that the perioperative BP use do not reduce the revision rate of TAR. Co-morbidities except hypertension did not affect the revision rate of TAR. More research regarding various factor affecting revision of TAR could be warranted.

Does Perioperative Use of Bisphosphonate Affect the Implant Revision Rate of Total Ankle Arthroplasty?

It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. We reviewed National Health Insurance Service data based on national health insurance service claims data and health care utilization, health screening, sociodemographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP nonusers, whereas 909 patients were BP users. The revision rate according to BP medication and comorbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. The revision rate of TAR was 7.9% for BP users and 9.5% for BP nonusers, which showed no significant difference (P = .251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 (P = .017), whereas other comorbidities such as diabetes had no effect on the revision rate of TAR. We found that the perioperative BP use did not reduce the revision rate of TAR. Comorbidities (except hypertension) did not affect the revision rate of TAR. More research regarding various factors affecting the revision of TAR could be warranted. Level III, retrospective cohort study.

Knee Joint Replacement: A Study Of The Patient Profile In Central India

Total knee arthroplasty (TKA) are increasing worldwide [1]. The rates have almost increased to 60% more in the last decade in theelderly. Total knee replacement or Knee arthroplasty has made a revolution the field of orthopedics as the earlier thought of painfulconditions like osteoarthritis or rheumatoid arthritis could now be solved by replacing the damaged joint with an artificial joint whichdramatically improves the pain of the patient and the person who could barely walk due to pain starts walking again pain free. Whilemost years these joint replacement surgeries were out of reach for common patients, various schemes implemented by the Govt hasmade it possible that even poor needy patients can get the total knee arthroplasty done and can live a better quality of life free of painand suffering.Methodology: This study was a record based observational study conducted retrospectively in the department of Orthopaedics in atertiary care hospital in central India from 1st March 2021 to 28th February 2022.Observation and Results: A total of 40 patients were studied in total. Out of them 22 were males and 18 were females. The mean ageof the patients was 58.2 years. Out of the 40, 15 patients had yellow ration card i.e. belonging to lower socio economic status while 15had saffron ration card and only 10 had white ration card. Majority of the population was Hindu (40%) followed by Muslims (25%),Buddhist (25%) and 10% were Christians, Sikhs and Jains. Majority of the population was educated up to 10th standard while 15%were illiterate. Osteoarthritis was the most common indication for hip joint replacement (70%).Conclusion: Knee joint replacement is being done commonly in the right candidate and helps in alleviating patients from theirsufferings.

SEE Question

Article| September 2022 SEE Question ASA Monitor September 2022, Vol. 86, 11. https://doi.org/10.1097/01.ASM.0000874208.64950.8b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation SEE Question. ASA Monitor 2022; 86:11 doi: https://doi.org/10.1097/01.ASM.0000874208.64950.8b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: atrial fibrillation, blood transfusion, deep vein thrombosis, hemorrhage, ischemic stroke, kidney diseases, knee replacement arthroplasty, renal failure, acute, seizures, venous thromboembolism You are completing a preoperative evaluation of a 66-year-old woman with a history of deep vein thrombosis who is scheduled for total knee arthroplasty. Based on a recent study, which of the following is the MOST likely outcome for this patient if you administer tranexamic acid (TXA) during the procedure, compared with a similar patient who does not receive TXA? The antifibrinolytic agent TXA is widely used in total hip and knee arthroplasties because of its proven benefit in reducing blood loss. However, there is some concern that TXA may increase the risk of thromboembolic complications, renal dysfunction, or seizure, especially in patients with known risk factors for these complications. A recent retrospective cohort study sought to evaluate the association between the use of TXA and the risk of blood transfusions and complications when used in high-risk patients. Complications were evaluated as the composite of new-onset venous thromboembolism (VTE), myocardial... You do not currently have access to this content.

Knee osteoarthritis Disease: A review

Osteoarthritis of the knee is a complex peripheral joint disorder with multiple risk factors. The molecular basis of osteoarthritis has been generally accepted; however, the exact pathogenesis is still not known. Management of patients with osteoarthritis involves a comprehensive history, thorough physical examination and appropriate radiological investigation. The relative slow progress in the disease allows a stepwise algorithmic approach in treatment. Non-surgical treatment involves patient education, lifestyle modification and the use of orthotic devises. These can be achieved in the community. Surgical options include joint sparing procedures such as arthroscopyando osteotomy or joint-replacing procedures. Joint-replacing procedures can be isolated to a single compartment such as patellofemoral arthroplasty or unicompartmental knee replacement or total knee arthroplasty. The key to a successful long-term outcome is optimal patient selection, preoperative counselling and good surgical technique.

Transfusion Trends of Knee Arthroplasty in Korea: A Nationwide Study Using the Korean National Health Insurance Service Sample Data.

Knee arthroplasties are strongly associated with blood transfusion to compensate for perioperative bleeding. The purpose of this study was to evaluate trends of transfusion associated with knee arthroplasties using nationwide data of the National Health Insurance Service-National Sample Cohort (NHIS-NSC). Using data from the nationwide claims database of the Health Insurance Review Assessment Service managed by the NHIS, 50,553 knee arthroplasties under three categories (total knee replacement arthroplasty, uni-knee replacement arthroplasty, and revision arthroplasty) from 2012 to 2018 were identified. Overall transfusion rate, transfusion count, proportion of each type of transfusion, and cost associated with each type of operation were investigated. Overall transfusion rate was 83.4% (5897/7066) in 2012, 82.7% (5793/7001) in 2013, 79.6% (5557/6978) in 2014, 75.9% (5742/7557) in 2015, 73.1% (6095/8337) in 2016, 68.2% (4187/6139) in 2017, and 64.6% (4271/6613) in 2018. The proportion of each type of transfusion was 1.8% for fresh frozen plasma, 0.5% for platelets, and 97.7% for red blood cells. The average cost of transfusion was $109.1 ($123 in 2012, $124 in 2013, $123.3 in 2014, $110.6 in 2015, $100 in 2016, $92.9 in 2017, and $90.1 in 2018). In this nationally representative study of trends in transfusion associated with knee arthroplasty, we observed significantly high rates of blood transfusion among patients undergoing knee arthroplasties. Although the overall rate of transfusion had declined, the allogeneic transfusion rate was still high from 2012 to 2018 in Korea. Thus, surgeons need to develop various patient blood management plans and minimize the use of allogeneic transfusion when performing knee arthroplasties.

Development and psychometric evaluation of the Feeling Safe During Surgery Scale.

AimThe aim of this study is to develop and psychometrically test the Feeling Safe During Surgery Scale.DesignThe study design was non‐experimental and cross‐sectional.MethodThe evaluation followed classical test theory, and the instrument was evaluated regarding reliability, construct validity and content validity. For the reliability analysis, a postal questionnaire consisting of the 16 items of the scale was dispatched in March 2020 to a consecutive sample (N = 242) of patients who had undergone hip or knee replacement arthroplasties with regional anaesthesia. Five experts in nursing care evaluated the content validity of the scale.ResultInternal consistency was 0.841. Three items were excluded due to deficits in reliability, resulting in a 13‐item scale. A principal component analysis revealed a two‐dimensional solution, labelled internal and external aspects of feeling safe. Two items were rephrased to improve clarity and content validity. The average content validity for the scale was 0.88, indicating acceptable content validity.

Q&A: Total Knee Replacement: Alignment

QUESTION: Following a total knee replacement (TKR) or total knee arthroplasty (TKA), a patient has valgus angulation of 10°. When rating the resulting impairment using Table 17-35, Rating Knee Replacement Results (5th ed, 549) of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is it correct to make an alignment deduction of 30 points (3 points for each of the 10° of valgus)?ANSWER: The answer is not as simple as it may seem. The post-TKA knee reportedly has 10° of valgus alignment (also known as knock knee); however, the question does not state whether this measurement was made on physical examination or using a radiograph. The most accurate method for measuring lower limb alignment in the frontal (coronal) plane would be a full-length, standing anteroposterior radiograph, with the patella centered between the femoral condyles to ensure the condyles are oriented parallel to the frontal plane and image.The shorter the arms on a protractor, and the higher the examinee's body mass index (and resultant limb obesity), the greater the potential discrepancy between measurements on physical examination compared with measurements from a radiograph. Hence, many measurements of knee alignment on physical examination have only moderate to poor correlation with measurements derived radiographically.Note that Table 17-35 (5th ed, 549) does not state which measurement to use, but references Insall and colleagues1 and the Knee Society Scoring System (KSS©).2 The current KSS© Licensed User Manual states that alignment is measured by the femoral tibial axis on radiographs.2 Therefore, when rating impairment, clinicians should measure the anatomic, not mechanical, axes of the femur and tibia, and preferably on a radiograph.Table 17-35 (5th ed, 549) was written when findings from long-term follow-up of knee replacement were not yet published.Modern reviews of 1-year outcomes3 and 20-year outcomes4 have not identified coronal malalignment as a cause of chronic knee pain or the need for revision. However, most published studies consider “ideal” alignment on coronal full-length lower limb radiographs as a hip-knee-ankle angle between 3° of valgus and 3° of varus. This measurement of the mechanical axes is made by drawing a line from the center of the femoral head to the center of the knee, and then a line from the center of the knee to the center of the talus. Note that mechanical axes are used in outcome studies, rather than the anatomical axes employed in the KSS.Outcome studies use a different radiographic measurement that more accurately assesses the bio-mechanical consequences of implant alignment after TKA; however, when rating impairment using the AMA Guides, Fifth Edition, Table 17-35, one should measure the femoral shaft to tibial shaft angle (anatomic axes), as the KSS specifies, because this is the basis for Table 17-35.Assuming a femoral-tibial angle has been accurately measured on a postoperative full-length lower-limb radiograph, 10° of valgus is outside the desired range for component position. A range from 0° to 4° of either valgus or varus alignment is considered the goal, with no deduction of points in the scoring system. Ten degrees of valgus would qualify for 3 points per degree beyond 4°, or 3 points each for 5°, 6°, 7°, 8°, 9°, and 10°. This sums to an 18-point deduction, not 30.As an aside, the question does not state the degree of preoperative coronal plane deformity. Correcting alignment in knees with severe valgus deformity is challenging.In a situation where different examiners provided different post-TKA impairment ratings, the trier of fact may lend greater credibility to the examiner adhering to the KSS methodology and using measurements from radiographs rather than from physical examination of lower limb alignment.

A Technical Tip: Surgical Exposure of Proximal Tibia in Total Knee Replacement Arthroplasty Using a Pin to Retract Patellar Tendon

A Technical Tip: Surgical Exposure of Proximal Tibia in Total Knee Replacement Arthroplasty Using a Pin to Retract Patellar Tendon

Aquatic Exercise and Land Exercise Treatments after Total Knee Replacement Arthroplasty in Elderly Women: A Comparative Study.

Background and Objectives: Early intensive exercise after total knee replacement arthroplasty (TKRA) has become increasingly popular due to its ability to enhance knee physical function and reduce pain. When implemented exclusively, aquatic exercise (AE) appears to be more advantageous than land exercise (LE), particularly in the early phase after TKRA. Our study aimed to compare the clinical efficacy of AE and LE with respect to their effects on pain and physical function after TKRA. Materials and Methods: Between February 2008 and January 2020, 100 female patients who underwent TKRA were enrolled in this retrospective study. We measured the range of motion (ROM) of the knee, the isokinetic strength of the knee joint (function), and pain both initially and one month after TKRA. Two weeks after TKRA, the participants were enrolled in either the AE or the LE program for a total of two weeks. Two 30 min sessions of intensive ROM and knee strengthening exercises and balance training were provided to the AE and LE groups for 10 days. The home exercise group (HE) only received information on ROM and strengthening exercises. There were 33, 21, and 46 patients allocated to the AE, LE, and HE groups, respectively. Results: The ROM of the side on which surgery was performed improved significantly in all groups, as did the pain scores. In the AE group, the knee flexor strength showed a tendency toward improvement. Contrastingly, there was no significant improvement in the knee extensor strength in the AE group. Conclusions: Overall, the AE and LE groups showed superior outcomes compared with HE. In addition, the AE group demonstrated some improvement in knee muscle strength even with a short hospital stay. Further study with long-term follow-up should be performed to better define the outcomes.

A new technique for cement plug removal in hip and knee arthoplasty exchange

Removal of cement and especially the distal cement plug during cemented arthroplasty replacements is key to the success of the surgery, but can be challenging for the surgeon. The methods employed for this step can be very varied, ranging from removal with the aid of rasps, drills, ultrasonic techniques, to bone windows for direct access to the plug. These techniques can sometimes lead to perforation of the bone cortex and even to the production of uncontrolled fractures that prevent safe implantation of the new implant.The aim of this study is to review the different cement removal techniques and to evaluate the efficacy of a new technique, which allows the cement plug to be removed in a safe and controlled manner, avoiding the need for osteotomies. A customised guide is used for this purpose. This allows an effective and leak-free re-cementing of the new implants.We present 3 cases of distal cement removal using a customised guide that allows the cement plug to be broached. In all 3 cases, after cement removal, the implantation of longer stems with correct cementation was achieved.It should be noted that the target population in all cases is an elderly Spanish population, a population of short stature with curved femurs and poor bone quality; these characteristics make perforation and intraoperative fractures much more likely. However, in our two patients there were no cortical perforations. The mean time for plug removal was 22min. ConclusionThe use of customised guides for cement plug removal during cemented hip and knee arthroplasty replacement is safe and effective.

Una nueva técnica para la retirada del tapón de cemento en recambios de artroplastia de rodilla y cadera

Removal of cement and especially the distal cement plug during cemented arthroplasty replacements is key to the success of the surgery, but can be challenging for the surgeon. The methods employed for this step can be very varied, ranging from removal with the aid of rasps, drills, ultrasonic techniques, to bone windows for direct access to the plug. These techniques can sometimes lead to perforation of the bone cortex and even to the production of uncontrolled fractures that prevent safe implantation of the new implant.The aim of this study is to review the different cement removal techniques and to evaluate the efficacy of a new technique, which allows the cement plug to be removed in a safe and controlled manner, avoiding the need for osteotomies. A customised guide is used for this purpose. This allows an effective and leak-free re-cementing of the new implants.We present 3 cases of distal cement removal using a customised guide that allows the cement plug to be broached. In all 3 cases, after cement removal, the implantation of longer stems with correct cementation was achieved.It should be noted that the target population in all cases is an elderly Spanish population, a population of short stature with curved femurs and poor bone quality; these characteristics make perforation and intraoperative fractures much more likely. However, in our two patients there were no cortical perforations. The mean time for plug removal was 22 minutes. ConclusiónThe use of customised guides for cement plug removal during cemented hip and knee arthroplasty replacement is safe and effective.A new technique for the removal of the cement plug in knee and hip arthroplasty replacements

Linear mixed modeling on the effects of varus knee surgery on the ankle joint weight-bearing axis

BackgroundVarus knee correction may affect the ankle and subtalar joints and impact the prognosis of ankle arthritis because the weight-bearing load on the lower extremity extends from the hip to the foot. We aimed to evaluate the changes in the mechanical axis and the weight-bearing axis of the ankle after varus knee surgery. MethodsPatients with a varus knee were followed up after undergoing high tibial osteotomy or total knee replacement arthroplasty. The inclusion criteria were age (>18 years) and a history of preoperative and postoperative scanograms. The postoperative change to the ankle joint axis point on the mechanical axis and weight-bearing axis according to the hip–knee–ankle angle correction was adjusted by multiple factors using a linear mixed model. ResultsOverall, 257 limbs from 198 patients were evaluated. The linear mixed model showed that the change in the ankle joint axis point on the mechanical axis was not statistically significant after high tibial osteotomy and total knee replacement arthroplasty (p = 0.223). The ankle joint axis point on the weight-bearing axis moved laterally by 0.9% per degree of postoperative hip–knee–ankle angle decrease (p < 0.001). ConclusionsVarus knee correction could affect the subtalar joint and the ankle joint. Our findings require consideration when utilized during pre- and postoperative evaluations using the weight-bearing axis of patients undergoing varus knee correction.

Diagnosis and treatment of bullous pemphigoid that developed twice after total knee replacement arthroplasty: a case report

BackgroundTotal knee replacement arthroplasty (TKA) is frequently performed in South Korea. Simple swelling-associated blistering around the periphery of the operative wound is a well-known adverse effect. However, in rare cases, the blisters are bullous pemphigoid (BP).Case presentationA 75-year-old male presented with knee pain that had not improved despite 5 years of medication. We performed TKA of the left knee, placing a Stryker posteriorly stabilized prosthesis. Three days later, blisters developed near the buttocks and thighs and, on day 10 after surgery, around the operative site. A skin biopsy revealed BP. Commencing on day 14 after surgery, prednisolone 10 mg was administered twice daily. The symptoms improved by 3 weeks after surgery and were healed at 4 months. After 1 year, we performed TKA of the right knee. On day 2 after surgery, as formerly, blisters developed on the buttocks and an immediate biopsy revealed BP. Commencing on day 3 after surgery, prednisolone 10 mg was administered twice daily. On day 10 after surgery, the blisters on the buttocks had improved and no blisters were observed at the surgical site. All symptoms had resolved by 2.5 months after surgery.ConclusionsAfter TKA surgery, generalized BP may develop, diagnosed via skin biopsy. A quick diagnosis is important because early treatment can prevent symptom progression and shorten treatment.

Functional outcome of bilateral total knee replacement arthroplasty in bilateral tricompartmental osteoarthritis of knee

Background & Objectives: Total knee arthroplasty is a well documented surgical procedure. It relieves pain and functional disability experienced by patients with moderate to severe arthritis of the knee, improving their quality of life. The success of Total knee Replacement arthroplasty is its ability to relieve the pain associated with knee joint pathology, while maintaining the mobility and stability of the knee joint. The most common condition for which total knee arthroplasty is done is severe osteoarthritis of the knee. The primary indication for this procedure is severe pain and the limitation in activities of daily living that it causes. To warrant doing total knee replacement, pain must be refractory to conservative measures such as oral nonsteroidal anti-inflammatory medication, weight reduction, activity restriction, and the use of supports such as a cane. The purpose of this study was to evaluate the clinical and functional outcomes of Total knee Replacement using Knee society score and radiological assessment. Methods: The study was carried out on 30 patients of Total knee Replacement operated in the Department of Orthopedics. Information on the patients was compiled from clinical details, case files and operation theater records. This was a prospective study. Patient follow up was for a minimum of 6 months to a maximum of 24 months (2 years). Results: Excellent or good pain relief and function were obtained in 29 patients after TKR, which was performed in a population of active patients. The mean total pre-operative score was poor (

The Optimal Combination of Monochromatic and Metal Artifact Reconstruction Dual-energy CT to Evaluate Total Knee Replacement Arthroplasty

PurposeTo evaluate the effects of gemstone spectral imaging-metal artifact reduction (GSI-MAR) on different dual-energy CT monochromatic images for patients with total knee replacement arthroplasty (TKRA) and to identify an appropriate protocol for clinical practice. MethodWe enrolled 34 patients with TKRA. CT images were iteratively reconstructed with or without GSI-MAR at different energy levels (70, 95, 115, and 140 keV). Two radiologists evaluated the objective and subjective image qualities and MAR-related new artifacts at the femoral and tibial levels. For objective analysis, the mean CT number and image noise of the selected regions of interest in the bone and muscle were recorded. To quantitatively evaluate the performance of GSI-MAR, a structural similarity index (SSIM) was used. For subjective analysis, streak artifacts and diagnostic confidence in detecting periprosthetic complications were assessed. Objective and subjective indicators were compared among the image combinations. ResultsIn the femoral component, 140 keV monochromatic energy images with GSI-MAR showed the lowest mean CT number, image noise, SSIM value, and streak artifacts, and the best diagnostic confidence. In the tibial component, the image noise differed significantly, but the SSIM and subjective indicators were similar among the image combinations. MAR-related new artifacts were noted in 14.7% of images, and all of them were observed in only the femoral component. ConclusionGSI-MAR with higher-energy monochromatic images showed fewer metal artifacts and better visualization. We recommend 140 keV with GSI-MAR for improving image quality and 140 keV without GSI-MAR for identifying MAR-related new artifacts when evaluating TKRA.

Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients

Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients

Low levels of salicylic acid and salicyluric acid are present in synovial fluid of patients taking aspirin at the time of knee arthroplasty surgery

Low doses of acetylsalicylic acid (aspirin) are recommended in some venous thromboembolism prophylaxis guidelines for total knee replacement arthroplasty surgery. As salicylic acid has antimicrobial activity it would be advantageous if aspirin's use reduced the risk of prosthetic joint infection. We measured salicylate levels in the synovial fluid of patients taking long term low dose aspirin who were having knee arthroplasty surgery. Low levels of salicylic and salicyluric acids were present in synovial fluid immediately pre surgery. Acetylsalicylic acid was not measurable in synovial fluid. The measured salicylic acid levels were lower than those previously shown to have antibacterial activity against any of the bacteria that typically cause prosthetic joint infection.

Multimodal Conservative Treatment of Complicated Open Wound After Total Knee Replacement Arthroplasty in Patients With Comorbidities.

Total knee replacement arthroplasty is a common procedure and postoperative wound complications are sometimes inevitable. Although invasive reconstructive surgery may be an option for nonhealed wounds, such procedures can limit early rehabilitation, adversely affecting the range of joint motion. Patients can achieve a wider range of motion if they undergo early rehabilitation with a conservative approach. From 2015 to 2017, 5 patients with comorbidities who underwent total knee replacement arthroplasty were referred to the reconstructive surgery department for nonhealed open wounds. Depending on their comorbidities and conditions, the patients underwent negative-pressure wound therapy based on multimodal conservative treatment. During the treatment, the patients continued rehabilitation. In the 5 patients, the mean duration of complete wound healing was 65.2 days (range = 57-81), during which all open wounds were well healed. For final wound closure, the patients underwent skin grafting, dermatotraction, or collagen dressing. Four patients achieved ranges of joint motion over 100 degrees after treatment. We believe that early coverage is important for open wounds. For complicated open wounds after total knee replacement arthroplasty in patients with comorbidities, less invasive multimodal treatment along with early rehabilitation may be more effective to achieve adequate final range of joint motion.