Left Total Knee Arthroplasty Research Articles

Impact of surgeon’s hand and ocular dominance on right and left total knee arthroplasty alignment

Postoperative alignment is an important modifiable confounder that contributes to the longevity of total knee arthroplasty (TKA). Studies have shown that surgeon’s handedness can affect surgical performance; however, no studies have assessed the effect of surgeon’s hand or ocular dominance on TKA alignment. The purpose of this study was to evaluate the effect of surgeon’s hand and ocular dominance on coronal plane alignment in TKA.
 We retrospectively evaluated 138 patients who underwent sequential bilateral TKA by the same surgeon, using the Genesis II PS knee (Smith & Nephew, Memphis, TN). We assessed postoperative alignment by measuring and comparing anatomical tibiofemoral angle (TFA) bilaterally on standard postoperative knee radiographs, as well as Knee Society function and pain scores to determine any functional differences. Lastly, we evaluated whether a crossed hand-ocular dominant surgeon had greater accuracy when performing a TKA on the side opposite their hand dominance compared to uncrossed hand-ocular dominant surgeons.
 All surgeons were right-hand dominant and there was a significantly larger anatomical TFA on left TKAs (mean [SD], 4.6° [2.8°]) compared to right TKAs (3.8° [2.5°]) (P = 0.003). There was no significant difference between right and left Knee Society function (P = 0.09) and pain scores (P = 0.86). When comparing left TKAs, surgeons with uncrossed hand-ocular dominance (4.5°) performed with equal accuracy compared to surgeons with crossed hand-ocular dominance (4.8°) (2-tailed test = 0.597), indicating no effect of ocular dominance.
 In summary, hand but not ocular dominance was shown to have significant postoperative alignment effects on TKA.

Brake response time is significantly impaired after total knee arthroplasty: investigation of performing an emergency stop while driving a car.

The objective of this study was to investigate whether total knee arthroplasty (TKA) impairs the ability to perform an emergency stop. An automatic transmission brake simulator was developed to evaluate total brake response time. A prospective repeated-measures design was used. Forty patients (20 left/20 right) were measured 8 days and 6, 12, and 52 wks after surgery. Eight days postoperative total brake response time increased significantly by 30% in right TKA and insignificantly by 2% in left TKA. Brake force significantly decreased by 35% in right TKA and by 25% in left TKA during this period. Baseline values were reached at week 12 in right TKA; the impairment of outcome measures, however, was no longer significant at week 6 compared with preoperative values. Total brake response time and brake force in left TKA fell below baseline values at weeks 6 and 12. Brake force in left TKA was the only outcome measure significantly impaired 8 days postoperatively. This study highlights that categorical statements cannot be provided. This study's findings on automatic transmission driving suggest that right TKA patients may resume driving 6 wks postoperatively. Fitness to drive in left TKA is not fully recovered 8 days postoperatively. If testing is not available, patients should refrain from driving until they return from rehabilitation.

A Rare Case of Pseudotumor Formation following Total Knee Arthroplasty.

A 59 year old man who had undergone left total knee arthroplasty in 2008 presented with a 5 month history of left knee pain and persistent swelling. Workup for infection was negative and the patient was suspected to be suffering from particle disease and chronic synovitis. Imaging revealed an internally rotated tibial component. Intraoperative findings revealed extensive polyethylene wear with resultant metalon- metal articulation, soft tissue metallosis and a pseudotumor like mass at the posterolateral aspect of the popliteal fossa. This was extensively debrided and revision knee arthroplasty was performed. Suboptimal component alignment can lead to localized high loading, wear and metallosis, which in this case resulted in the formation of a pseudotumor.

Church Pew Exercise Integrated With Conventional Physical Therapy Following Total Knee Arthroplasty (TKA): Case Report

Background and Purpose: Physical therapy treatment following Total knee Arthroplasty (TKA) consists of a combination of strengthening and range of motion exercises. The exercise technique, church pew exercise (CPE), has been proposed to enhance quadriceps facilitation and improve function. This is a technique that has the patient standing and rocking forward/back. The backward motion is arrested by engagement of the upper calf against a solid object, creating a sudden flexion torque at the knee and a sudden extension torque at the hip. The combination of CPE with standard physical therapy is claimed to provide better quadriceps control and faster walking post TKA. In this case study, a 51-year-old female with decreased knee active and passive range of motion (ROM), decreased lower extremity (LE) muscle strength, and limited ambulation post left knee TKA, received conventional physical therapy treatment plus CPE. Methods: The patient received 11 physical therapy home sessions. The first 8 sessions were used to strengthen her knee and increase active and passive ROM. The CPE intervention was performed 3 weeks post-surgery, during the last 3 physical therapy sessions. At these three sessions the patient performed the Timed Up and Go (TUG) before and after CPE. Outcomes: At initial evaluation, 4 days post left knee TKA, this patient’s left knee active ROM was only 15 to 76 degrees, and manual muscle testing at her hip and knee indicated strengths of 2- (hip flexors), 3- (hamstrings and quadriceps), and 3+ (hip abductors), all out of 5, and her times on two trials of the TUG were 30.31 and 30.65 sec, indicating impaired functional ability. At all CPE sessions (3 weeks post-surgery) the patient demonstrated increased gait speeds (i.e. shorter times) on the TUG after the CPE (pre CPE mean = 13.2 sec; post CPE mean = 11.2), increased stance time on her affected lower extremity, and increased step length on her contra-lateral lower extremity. The patient reported increased knee stability. Clinical Relevance: Rationale for CPE is based on neurological facilitation of quadriceps and other lower extremity muscles. However, to engage in this exercise the patient must have the ability to balance and to control the hip and knee joints. This patient required several weeks of strengthening and active and passive ROM exercises before she could perform the CPE. Once able to perform the CPE, she demonstrated improvements in her walking ability, and she expressed greater confidence. Conclusion: Provided a minimal level of strength and active and passive ROM has been attained, CPE may be a valuable short-term supplement to current strengthening regimens addressing quadriceps functional deficits following TKA. Other conditions that involve gait problems related to quadriceps insufficiency might also benefit. The long-term efficacy of CPE remains to be determined.

Pregabalin Induced Confusional State with Paranoid Delusions

A 70yearold woman presented to an acute inpatient rehabilitation facility on postoperative day three, after undergoing left total knee arthroplasty. Her past medical history included severe osteoarthritis, hypertension, and diabetes mellitus type 2 and was negative for any psychiatric illness. The patient took metformin, celecoxib, and oxycodone/acetaminophen prior to undergoing surgical intervention. After surgery, pregabalin, 50 milligrams twice a day, was added to her previous oral analgesic regimen of celecoxib and oxycodone/ acetaminophen. However, on the night of admission postoperative day two (POD #2), she developed mild paranoia. Her husband and nursing staff reassured her the entire night. In the morning, she apologized for acting strangely and participated in all therapy sessions. All medications that could cause psychiatric disturbance or delirium, including oxycodone/acetaminophen and pregabalin, were discontinued. That night, however, her paranoia returned and she remained emotionally labile and delusional despite reassurance and delirium intervention. During the night, she pulled the fire alarm in order to have the police and fire department come to protect her.

Poster 463 Novel Use of Genicular Nerve Block as an Alternative Treatment Option in a Patient with Chronic Bilateral Knee Pain after Left Total Knee Arthroplasty. A Case Report

Poster 463 Novel Use of Genicular Nerve Block as an Alternative Treatment Option in a Patient with Chronic Bilateral Knee Pain after Left Total Knee Arthroplasty. A Case Report

Fracture of the Cam Mechanism of a Posterior-Stabilized Total Knee Femoral Component: A Previously Unrecognized Mode of Failure

Fracture of the femoral component following total knee arthroplasty previously has been reported, although not as commonly as that of fracture failure of the tibial tray. Typically, implant failure has been related to reduced implant osseous support secondary to osteolysis, component design with resultant fatigue fracture, or manufacturing defects1-8. Previous studies have also implicated alignment and patient age, weight, and activity level in fracture failure of tibial components8-10. To the best of our knowledge, this case represents a previously unreported mechanism of fatigue fracture and femoral component failure in a total knee arthroplasty with an open-box posterior-stabilized design. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. After a diagnosis of bilateral osteoarthritis, a fifty-nine-year-old man (weight, 105.6 kg; height, 193 cm; body mass index, 28.3 kg/m2) underwent simultaneous bilateral total knee arthroplasty (Fig. 1). NexGen Legacy Posterior Stabilized (LPS) femoral components (Zimmer, Warsaw, Indiana) with 10-mm trabecular metal LPS monoblock tibial components were used. Both patellae were resurfaced, and all components were cemented in place. The undersurface of the tibial tray was cemented, but the trabecular metal pegs were left uncemented. Fig. 1 Anteroposterior (left) and lateral (right) radiographs of the left total knee arthroplasty six weeks postoperatively. The hospital course was uneventful, and the patient was discharged home. Following dismissal, however, the motion of both knees regressed. This was attributed to overly aggressive physical therapy, and the patient subsequently underwent bilateral knee manipulation under anesthesia. He went on to do quite well and was very pleased with the knee function. At the one, two, and five-year follow-ups, the patient reported no pain or activity limitations. The range of motion was from 0° to 115° bilaterally. Radiographically, all components were reasonably aligned and …

Synovial Metastasis Discovered During Total Knee Arthroplasty

A 70-year-old female presented with worsening left knee pain and underwent a left total knee arthroplasty. During the procedure, the synovial tissue was different from the usual with brown and hard tissue. Frozen section diagnosis revealed ”adenocarcinoma, metastatic” of bone and synovium. We report the case of a patient who presented a synovial metastasis has been discovered during total knee arthroplasty different from post total knee arthroplasty.

Patients with Black Hip and Black Knee Due to Ochronotic Arthropathy: Case Report and Review of Literature

Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis.

Late Abnormal Skin Changes Overlying Total Knee Arthroplasty: A Case Report.

More than 600,000 total knee arthroplasties are performed in the United States every year1. Superficial wound complications occur infrequently, and the overall appearance of the incision is important to judge appropriate healing. Ecchymosis about the knee is common postoperatively and typically resolves within the first few weeks. Persistent skin changes around the incision and knee are rare, and they prompt additional investigation regarding the etiology. We report on a seventy-four-year-old woman who had undergone an uncomplicated right total knee arthroplasty and, almost three and one-half years later, developed an atraumatic ecchymotic-appearing lesion involving the superior aspect of the incision. She was diagnosed with biopsy-proven pigmented purpuric dermatosis (PPD). To our knowledge, this is the first such case reported in the orthopaedic literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A seventy-four-year-old woman with a past medical history of hypertension, hypothyroidism, and a prior left total knee arthroplasty presented for a right total knee arthroplasty. She underwent femoral and sciatic nerve blocks followed by general anesthesia. A posterior cruciate ligament-retaining total knee prosthesis (Vanguard; Biomet, Warsaw, Indiana) was implanted uneventfully. The patella was resurfaced, and a lateral release was performed. She did well in the postoperative period with regard to …

Quality of life and radiographic severity of knee osteoarthritis predict total knee arthroplasty: data from the osteoarthritis initiative

Purpose: Total knee arthroplasty (TKA) is a clinically important outcome in persons with symptomatic osteoarthritis (OA) of the knee. Few studies, however, have examined predictors of TKA in community-based cohorts. We analyzed data from the Osteoarthritis Initiative (OAI) to determine the most parsimonious group of baseline variables that robustly predicted undergoing a TKA during 5 years of follow-up. Methods: Data for this analysis were obtained from the OAI public access database (http://www.oai.ucsf.edu). At each annual visit through 48 months, subjects completed an extensive battery of questionnaires, weight was measured with a balance beam scale, and fixed flexion, weight-bearing PA radiographs of both knees were obtained using a standard protocol and the Synaflexer™ platform; the 60-month follow-up visit only involved completion of questionnaires. Subjects reported TKAs at the time of their annual follow-up visits; these were confirmed by the Coordinating Center after review of medical records obtained by the Clinical Centers. We examined selected variables measured at the baseline visit for their role as predictors of TKA using knee-specific multiple variable logistic regression models. The best models were selected for each knee based on Chi-square values and area under the receiver operating characteristic curve (AUC). Results: Data from 4674 subjects enrolled in the OAI who either had symptomatic radiographic knee OA or were at risk for this condition were included in this analysis. At entry, subjects had a mean (SD) age of 61.32 (9.17) years and body mass index (BMI) of 28.74 (4.82) kg/m2; 2729 (58.4%) were women and 3677 (78.75%) were white. Baseline knee-specific WOMAC pain (0-20 scale) and function (0-68 scale) scores were 2.56 (3.26) and 8.26 (10.63) for the right knee and 2.39 (3.43) and 8.39 (11.44) for the left knee, respectively. Baseline KOOS pain and symptoms scores (0-100 scale) were 83.56 (17.37) and 85.95 (14.60) for the right knee and 84.80 (18.26) and 86.49 (15.87) for the left knee, respectively; KOOS quality of life (QoL, 0-100 scale) was 66.10 (22.43). Distribution of Kellgren-Lawrence (KL) grades of severity of radiographic knee OA at baseline was similar for both knees: 37, 18, 27, 14 and 4 percent had Grade 0, 1, 2, 3, 4 changes, respectively. During 60 months of follow-up, there were 91 right and 102 left TKAs. In models containing clinical variables and adjusted for age, gender, BMI and race, the best models included WOMAC pain and KOOS QoL (AUC = 0.80 and 0.82 for right and left knees, respectively). When KL grade was added to these models, the AUC improved to 0.89 and 0.90 for the right and left knees, respectively; race, BMI and WOMAC pain were no longer significantly associated with TKA outcome. The best parsimonious model included age, gender, KOOS QoL score and KL grade with an AUC = 0.89 and 0.90 for the right and left knee, respectively. Subjects with highest odds for a TKA were those in the lowest quartile of QoL scores and with KL grade 3 or 4 radiographic severity. Conclusions: These data suggest that knowledge of only a patient's age, gender, KOOS QoL score and KL grade of severity of radiographic knee OA can predict with high accuracy the odds of undergoing a TKA over the ensuing 5 years. These findings extend our prior report (Shurupoff K, et al: Osteoarthritis Cart 2011;19S1:S134 [abstract #284]) that KOOS QoL and radiographic severity can be used to model the outcome of "Virtual TKA".

Necrotizing Fasciitis in an Immunocompromised Elderly Woman

1Department of Medicine; 2Institute for Infectious Diseases Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario Correspondence: Dr Jennie Johnstone, Department of Medicine, McMaster University, 3200 MDCL, 1280 Main Street West, Hamilton, Ontario L8S 4L8. Telephone 905-525-9140 ext 22726, fax 905-389-5822, e-mail johnsj48@mcmaster.ca Case Presentation An 85-year-old woman presented to hospital with a rapidly progressing erythema of the lower left leg. The patient was well until several hours before admission when she noted a small area of painful erythema on her left shin that progressed over 2 h to involve the entire leg below the knee. There had been no erythema noted earlier that day when her daughter bathed her. Her medical history was significant for hypertension, congestive heart failure, remote left total knee arthroplasty and a recent diagnosis of temporal arteritis for which 40 mg of prednisone daily was perscribed. She had no recent travel history and no sick contacts. On presentation, the patient appeared well, was not in distress and was hemodynamically stable with a heart rate of 80 beats/min, blood pressure of 120/60 mmHg and a temperature of 36.7°C. Her physical examination was remarkable for erythema over the anterior lower left leg, extending around the calf. There were no bullae. Although the leg was tender to palpation, the pain was not out of proportion with the area of erythema. There was no crepitus, and no ulcers or ports of entry were apparent. No regional lymphadenopathy was present. Examination of the left knee found no warmth, effusion or erythema, and there was complete and pain-free range of motion. The remainder of her physical examination was unremarkable. Initial investigations revealed a hemoglobin level of 146 g/L, a leukocyte count of 6.5×109/L, a platelet count of 146×109/L and a creatinine level of 51 μmol/L. Venous Doppler ultrasound of the left leg showed no evidence of deep vein thrombosis. Blood cultures were obtained before the patient was started on empirical intravenous antibiotic therapy with cefazolin (1 g every 8 h) and clindamycin (600 mg every 8 h). After 24 h of therapy, the erythema of the leg improved; however, severe foot pain developed in the absence of any erythema. She remained hemodynamically stable with a blood pressure of 140/80 mmHg and a heart rate of 80 beats/min and remained afebrile with a temperature of 36.5°C but had a notable drop in her leukocyte count to 1.8 ×109/L. Her creatine kinase level (26 U/L) was normal (normal <150 U/L). Due to the confusing clinical picture and in light of her immunocompromised status, antibiotic coverage was broadened by discontinuing cefazolin and starting piperacillin/tazobactam (4.5 g every 8 h). Approximately 36 h after admission, she acutely deteriorated, developing fever (37.9°C), hypotension (80/60 mmHg), a decreased level of consciousness, and worsened edema and erythema of the left leg extending above the knee with multiple small foci of necrosis. She required transfer to the intensive care unit for inotropic support. Vancomycin was added to the piperacillin/tazobactam and clindamycin, intravenous immunoglobulin was given, and an urgent orthopedic surgery consultation was obtained. A fascial biopsy was performed, which was sent for frozen section and culture. The biopsy was consistent with necrotizing fasciitis (NF) and the patient was taken to the operating room for urgent debridement, where an above-knee amputation was performed. Postoperatively, the patient experienced ongoing hypotension and a new area of erythema over the upper left thigh extending to the abdomen. The piperacillin/tazobactam was discontinued and meropenem was added. The next day, there was growth in the tissue culture from the fascial biopsy. What was the causative organism?

A rare case of bilateral large osteolysis following cemented and cementless total knee arthroplasties

A 66-year old woman (BMI 36) presented for routine follow-up after undergoing total knee arthroplasty (TKA) in the right knee 12 years ago, and TKA in the left knee 4 years ago. The right TKA was a cementless cruciate-retaining prosthesis (Encore Medical Foundation Knee, femoral component porous coated CoCrMb alloy, tibial component Ti-alloy with 4 screws, PE insert 9 mm). The left TKA was a cemented cruciate-retaining prosthesis (Zimmer Natural Knee II, femoral component CoCrMb alloy, tibial baseplate component Ti-alloy, PE insert 9 mm). The patient reported only mild problems (knee score 88 points, function score 60 points). Radiographs and CT scans revealed extensive osteolysis at the proximal medial tibia of both knees (Figures 1 and ​and2).2). There was a mild varus malalignment (4°) of both legs. Rotational alignment measured on the CT scans showed a rotational mismatch between femoral and tibial components of 8° (femoral internal rotation) in the right knee and no mismatch (1° of femoral internal rotation) in the left knee. Figure 1. Anterioposterior and lateral radiograph and CT scans showing osteolysis of the distal right femur and the proximal tibia 12 years after implantation of a cemenless TKA. Figure 2. Anterioposterior and lateral radiograph and CT scans showing osteolysis of the distal left femur and the proximal tibia 4 years after implantation of a cemented TKA. Open biopsy was performed bilaterally to rule out a possible malignancy or infection. Microscopic histological examination revealed chronic inflammation and hisitocytic infiltrates in both knees. Polyethylene particles were observed within the cytoplasma of the histiocytes. There was no evidence of metal debris. All microbiological cultures were negative. During revision, both tibial baseplates were manually assessed as being well fixed to the lateral tibial bone stock, providing no evidence that baseplate loosening was the cause of the osteolysis. However, upon removal of the baseplates, the cortical bone at the proximal medial tibia was observed to be very thin and completely missing in some regions, as already revealed on the CT scans. Osteolytic defects were filled with autologous cancellous bone and augmented with bone cement, and both knees were implanted with a modular constrained TKA prosthesis.

How we treat: considerations for physiotherapy in the patient with haemophilia and inhibitors undergoing elective orthopaedic surgery

Ten weeks prior to a scheduled left total knee arthroplasty, a 25‐year‐old man with severe haemophilia A and a high‐titre inhibitor presented to the physical therapist for a preoperative assessment at the haemophilia treatment centre (HTC). Prior to the recommendation to proceed to surgery, the therapist and other members of the multidisciplinary care team had surmised that, despite two previous radiosynovectomies, an arthroscopic synovectomy, and most recently at the age of 18 years, an arthroscopic debridement, the patient continued to have a progression of joint disease manifested by pain, restricted range of motion and reduced strength. Based on these findings and the patient’s history of consistent adherence to and follow‐through with recommended treatments, the HTC staff and orthopaedic surgeon determined that he was a good candidate for total knee replacement. The patient’s pain and joint disease severely limited his mobility and participation in functional activities. The most recent radiographs were notable for severe tricompartmental arthropathy of the left knee with joint deformity, flexion contracture, and osteoporosis. When queried about current haemostatic therapy during the initial preoperative visit with the physical therapist, the patient explained that he was self‐infusing a bypassing agent to treat active bleeds and as prophylactic treatment before participating in vigorous physical activity, as advised by his haematologist. He had previously managed his joint pain with cyclooxygenase‐2 inhibitors and both short‐ and long‐acting opioids, in addition to physical therapy. His current personal inventory of mobility and rehabilitative aids consisted of crutches, compressive wraps, and a cold‐compression unit. Further assessment of relevant environmental and psychosocial factors revealed that the patient was living with his girlfriend and 3‐year‐old daughter, for whom he was the primary caregiver, in a two‐story home with five steps to enter. He was also working part‐time from home as a computer consultant. The visit concluded with a formal physical assessment and discussion of next steps, including plans for additional preoperative physical therapy sessions. The therapist also informed the patient about what to expect postoperatively in terms of rehabilitation and recovery.

Mycoplasma pneumoniae Periprosthetic Joint Infection Identified by 16S Ribosomal RNA Gene Amplification and Sequencing

Chronic, culture-negative septic arthritis represents a major clinical dilemma. It often results in prolonged courses of antimicrobial therapy, which may or may not have activity against the organism responsible for the infection. It is not possible to cultivate all types of pathogens in vitro with use of traditional laboratory testing methods, but emerging techniques can be helpful to define the etiology of these infections in some cases. We describe a case of a periprosthetic joint infection in a thirty-year-old woman with juvenile rheumatoid arthritis (JRA) and hypogammaglobulinemia, who developed septic arthritis after prolonged pneumonia. She received multiple courses of antimicrobial therapy without improvement of the joint symptoms. The microbiologic diagnosis was made with use of 16S ribosomal RNA (rRNA) gene amplification and sequencing from synovial fluid and tissue. The patient gave permission for this information to be submitted for publication. A thirty-year-old woman with JRA and hypogammaglobulinemia was referred for evaluation of an infection at the site of a total knee arthroplasty. Her JRA had been managed with multiple courses of corticosteroids, infliximab, and, more recently, rituximab. She had undergone bilateral shoulder and knee synovectomy, and right elbow synovectomy, and finally had required left total knee arthroplasty in 2006. In the fall of 2009, the patient was hospitalized because of pneumonia, which had a prolonged course, with several hospitalizations due to recurrences over two months. Chest radiographs confirmed right upper lobe pneumonia, which later progressed to bilateral pneumonia. She was treated with azithromycin and ceftriaxone and initially showed improvement, but she then had a relapse with recurrent symptoms. During the multiple relapses, she was treated with vancomycin and cefepime followed by ertapenem. She had five bronchoscopy procedures. The bronchoscopies all showed purulent secretions, but all cultures were negative, including fungal and mycobacterial cultures. Polymerase chain reaction (PCR) for Mycoplasma pneumoniae …

Left knee prosthesis-related Mycobacterium goodii infection

Non-tuberculous mycobacteria are increasingly being recognized as important human pathogens. We present the case of a 44-year-old non-diabetic male who underwent left total knee arthroplasty for degenerative arthritis after trauma. He developed left knee swelling and progressively worsening pain over the next 4 weeks. He was referred for treatment using whirlpool baths and developed a blister at the surgical incision site. Repeated aspirations of the left knee failed to show any growth of organism on routine cultures. He finally underwent explantation of the left knee prosthesis with antimicrobial spacer placement 4 months later. Cultures of three different intra-operative specimens turned positive for Mycobacterium goodii. This infection was successfully treated with combination oral antimicrobials for 6 months. The patient underwent revision left knee arthroplasty subsequently and was symptom-free until his last follow-up visit 1 year later. This patient highlights the importance of testing for mycobacteria in prosthesis-related infections with previously negative routine bacterial cultures.

Prehabilitation versus usual care before total knee arthroplasty: A case report comparing outcomes within the same individual

This case report compared pre- and postoperative functional ability, knee strength, and pain of a female who underwent two separate total knee arthroplasty (TKA) procedures. The female patient was part of a larger research study. The first surgery on the right knee was preceded with usual care and the second surgery on the left knee was preceded by prehabilitation. Functional ability was assessed by a 6-minute walk, chair raises, and the time required to ascend and descend stairs. Knee extension and flexion isokinetic strength was assessed using the KinCom Isokinetic Dynamometer. Pain was assessed using the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). Functional abilities, knee strength, and pain were assessed at baseline measurements 4 weeks before surgery, 1 week before surgery, and at 1 and 3 months post surgery during each TKA procedure. Results indicate that the prehabilitation intervention had a favorable impact on improving functional ability up to 30%, increasing knee strength by 50% and decreasing pain prior to the left knee TKA. For this patient, prehabilitation increased functional ability and strength prior to surgery. Gains in strength were maintained in the nonsurgical knee after surgery. These findings indicate that prehabilitation may be effective at facilitating the rehabilitation following a TKA.

Deep vein thrombosis: how long will it remain?

To the Editor: A 75-year-old woman underwent computer-navigated left total knee arthroplasty (TKA) under general anesthesia with sevoflurane, fentanyl, and remifentanyl combined with ultrasound-guided femoral nerve block with a total amount of 25 mL of 0.3% ropivacaine, followed by intravenous fentanyl PCA postoperatively. She had undergone right total knee arthroplasty 3 years prior to the present surgery, and her past history was otherwise unremarkable. All the surgical and anesthesiological procedures were uneventful, and the intermittent pneumatic compression (IPC) system was immediately started after the surgery. The initial dose of once-daily subcutaneous injection of 1.5 mg of fondaparinux was started

Total knee arthroplasty after an artificial femoral-popliteal arterial bypass graft

We experienced one case of left knee total knee arthroplasty (TKA) after artificial vascular bypass surgery for both femoral arteries from the right inguinal region. Patients requiring TKA after arterial bypass surgery to report a thrombosis are very rare, but the incidence of thrombosis in the cases of TKA after arterial bypass surgery was reported to be higher when compared to the incidence of acute arterial occlusion after common TKA. When TKA is performed in such a patient, a strict anticoagulation therapy is necessary to perform assessment of vascular status carefully pre- and postoperatively. Further, it is important to perform surgery with consideration of intraoperative procedures such as no use of tourniquets during surgery. In addition, if a postoperative ischemia is suspected, it is necessary to perform emergent vascular reconstructive surgery immediately.

Early Nontraumatic Fracture of the Polyethylene Tibial Post in a NexGen LPS-Flex Posterior Stabilized Knee Prosthesis

Fracture of a polyethylene tibial post in a knee prosthesis after a total knee arthroplasty (TKA) is an uncommon but severe complication of polyethylene tibial post wear. A fractured tibial post results in an unstable and malfunctioning knee. Revision knee surgery is necessary to restore function of the affected knee. We report a case of a nontraumatic fracture of a tibial polyethylene post that occurred in a 63-year-old man with left-sided hemiparesis 3 years after he had undergone left TKA with a NexGen LPS-Flex total knee prosthesis. To our knowledge, this is the first report of a nontraumatic fracture to the tibial post with anterolateral to posterior breakage after a NexGen LPS-Flex TKA.