Post Knee Arthroplasty Research Articles

Evaluation of reduced (‘Lite’) compression versus brief bandaging to manage post-operative pain after total knee arthroplasty surgery; a single-centre randomised controlled trial

PurposeInvestigate efficacy of reduced compression bandage for the control of pain after total knee arthroplasty. Patients & methodsProspective, single-centre, randomised controlled trial involving data for 56 out of 94 consented patients; 29 standard care versus 27 Andoflex TLC Calamine Lite. Comparison of standard care (non-compression bandage applied for up to one day) versus Andoflex TLC Calamine Lite (25–30 mmHg) two-layer compression bandage worn for five days. Outcomes measured with validated pain (McGill, 10-cm visual scale) and functionality (KOOS) tools. ResultsAt day 5 post-surgery, the median pain level was 3.0 cm vs 4.0 cm (p-value 0.47, Mann-Whitney U test) respectively. Generic pain levels, pain types, and knee functionality did not differ between the interventions at days 3/5/12 and week 6 post-surgery. An exception was the degree of ‘tender’ pain at day 12, which was significantly lower in the Andoflex TLC Calamine Lite arm (p-value 0.041, Mann-Whitney U test). Binary logistic regression analysis showed that application of Andoflex TLC Calamine Lite, administration of oxycodone, and male sex were all significantly associated with less ‘tender’ pain. ConclusionReduced compression bandaging does not affect overall pain levels post knee arthroplasty surgery, but may alleviate pain experienced as ‘tender’, highlighting the different types of pain that may be experienced. Patients' need for, and the use of, opioid medication (oxycodone) is a significant confounding variable when assessing adjuvant therapy to control pain. The applicability of reduced compression bandaging may therefore be limited and is less efficient than medical pain control.

POST-OPERATIVE REHABILITATION OF A RIGHT SIDED TOTAL KNEE ARTHROPLASTY PATIENT- A CASE REPORT

Background and purpose:Osteoarthritis(OA) is a progressive degenerative condition resulting from the cartilage wear and tear that leads to knee joint deformities and functional limitations. Total knee arthroplasty (TKA) has become the gold standard treatment for surgically managing knee osteoarthritis, but physical rehabilitation after surgery is critical for returning function to pre-surgery levels. The purpose of this case report is to describe the effectiveness of physical therapy intervention and report outcomes following a right TKA. Case Description:The present case report describes the 12-week outpatient physical therapy rehabilitation of an 86-year-old woman who underwent right-sided TKA. She suffered from knee pain and limited ambulating speed since three years. During outpatient rehabilitation patient received treatment for improving functional mobility, ROM, strength, and gait training. Outcomes:During course of 12 weeks of physical therapy rehabilitation improvement was seen in pain from 2/10 to 0/10 on NPRS, flexion ROM from 110degrees to 130 and strength from 3-/5 to 4/5 on MMT. Additional outcome measures that showed improvement includes Time Up and Go Test (TUG) for mobility from 16.5 to 14.97 seconds and gait speed 0.6 m/s to 0.78 m/s. She was able to accomplish both short-term and long-term goals. Discussion:This study supports that early mobilization and therapeutic exercises in post knee arthroplasty can improve functional outcomes and help patient to return to the prior level of function. Although, it is recommended that further research is needed to be done on a larger population to establish its effectiveness.

Previous cartilage surgery is associated with inferior patient-reported outcomes after knee arthroplasty.

The hypothesis of the present study assumed that a history of focal cartilage lesions would not affect Knee Injury and Osteoarthritis Outcome scores (KOOSs) following knee arthroplasty compared to a matched national cohort of knee arthroplasty patients. Fifty-eight knee arthroplasty patients with previous surgery for focal cartilage lesions (cartilage cohort) were compared to a matched cohort of 116 knee arthroplasty patients from the Norwegian Arthroplasty Register (control group). Age, sex, primary or revision arthroplasty, type of arthroplasty (total, unicondylar or patellofemoral), year of arthroplasty surgery and arthroplasty brand were used as matching criteria. Demographic data and KOOS were obtained through questionnaires. Regression models were employed to adjust for confounding factors. Mean follow-up post knee arthroplasty surgery was 7.6 years (range 1.2-20.3) in the cartilage cohort and 8.1 (range 1.0-20.9) in the control group. The responding patients were at the time of surgery 54.3 versus 59.0 years in the cartilage and control group, respectively. At follow-up the control group demonstrated higher adjusted Knee Injury and Osteoarthritis Outcome subscores than the previous focal cartilage patients with a mean adjusted difference (95% confidence interval in parentheses): Symptoms 8.4 (0.3, 16.4), Pain 11.8 (2.2, 21.4), Activities of daily living (ADL) 9.3 (-1.2, 18.6), Sport and recreation 8.9 (-1.6, 19.4) and Quality of Life (QoL) 10.6 (0.2, 21.1). The control group also demonstrated higher odds of reaching the patient-acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores with odds ratio: Symptoms 2.7 (1.2, 6.4), Pain 3.0 (1.3, 7.0), ADL 2.1 (0.9, 4.6) and QoL 2.4 (1.0, 5.5). Previous cartilage surgery was associated with inferior patient-reported outcomes after knee arthroplasty. These patients also exhibited significantly lower odds of reaching the patient-acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores. Level III.

Role of geniculate artery embolization in the treatment of knee pain secondary to osteoarthritis

BackgroundOsteoarthritis (OA) is a leading cause of chronic knee pain and disability with a reported prevalence of 25–30% of the population. Knee OA has traditionally been thought as a degenerative disease only related to chronic repetitive injury “wear and tear” mechanism, yet it is now considered as a much more complex disease of inflammatory nature induced by cytokines and inflammatory mediators through abnormal neo-vascularization (angiogenesis). The rational of geniculate artery embolization (GAE) is based on the hypothesis that suggesting a direct relationship between the abnormal angiogenesis and the chronic knee pain. As a novel treatment option based on occlusion of these abnormal neo-vessels via geniculate artery embolization, we postulated that such a mechanism will relieve pain and improve the quality of life. GAE has been previously approved as a safe and effective treatment in cases of post-knee arthroplasty hemarthrosis.PurposeTo evaluate the feasibility, safety, and efficacy of geniculate artery embolization for OA-related knee pain.Materials and methodsSixteen patients with knee pain secondary to chronic OA refractory to conservative therapies for at least 6 months and not yet fit for total knee replacement were enrolled in a prospective single arm interventional study. GAE was performed using 150–300 μm microspheres. Patients were assessed and followed up using the visual analogue scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for the overall knee function at baseline and at 1 week, 1, 3, and 6 months post-embolization.ResultsA total 16 patients presented by knee pain secondary to chronic OA were enrolled. All of them showed a remarkable improvement in the VAS and WOMAC scores, with better clinical outcome after GAE. Pre- versus post-embolization ± MDs in VAS score from 8.38 ± 0.81 (baseline) to 2.88 ± 1.54 after 6 months (post-embolization) equivalent to 66.66% improvement. There was also a satisfactory improvement in the WOMAC scores, with ± MDs drop from 77.94 ± 10.62 (baseline) to 49.69 ± 15.43 (post-embolization) equivalent to 37.41% improvement. No severe or life-threatening complications were reported.ConclusionsGAE holds promise as an effective minimally invasive procedure for the treatment of knee pain secondary to OA and could be introduced as a safe technique with no serious complications.

Tibiofemoral compressive force during downhill walking in patients with primary total knee arthroplasty: A statistical parametric mapping approach

BackgroundDownhill walking is a necessary part of daily life and an effective activity in post-operative rehabilitation following total knee arthroplasty. The purpose of this study was to determine differences in the behavior of total, medial, and lateral tibiofemoral compressive forces as well as knee extensor and flexor muscle forces between different limbs of patients with total knee arthroplasty (replaced, non-replaced) during downhill and level walking. MethodsMusculoskeletal modeling and simulation were implemented to determine muscle forces and tibiofemoral compressive forces in 25 patients with total knee arthroplasty. A 2 × 2 [Limb (replaced, non-replaced) × Slope (0°, 10°)] Statistical parametric mapping repeated measures analysis of variance was conducted on selected variables. FindingsStatistical parametric mapping did not identify any between-limb differences for compressive or muscle forces. Differences in joint compressive and muscle forces persisted throughout different intervals of stance-phase between level and downhill walking. Knee extensor muscle forces were distinctly greater during level walking for nearly all of stance phase. Knee flexor muscle force was greater during downhill walking for >60% of stance. Statistical parametric mapping did identify regions of significance between level and downhill walking that coincided temporally (near loading response and push off) with peak joint moment and joint compressive forces traditionally reported using discrete variable analyses. InterpretationDownhill walking may be a safe and useful rehabilitation tool for post-knee arthroplasty rehabilitation that will not disproportionally load either the replaced or the non-replaced joint and where the quadriceps muscles can be strengthened during a gait-specific task.

Treatment options for entrapment neuropathy of infrapatellar branch of saphenous nerve post knee arthroplasty: a case report

BackgroundThe infrapatellar branch of the saphenous nerve is highly prone to form a neuroma or undergo transaction after midline incision of knee arthroplasty. The presence of neuroma and entrapment of these fibers can cause pain and numbness/tingling in the knee. The presence of these symptoms can significantly impact rehabilitation outcomes and long-term outcomes.Case presentationThe patient is a 63-year-old Caucasian female reported to an outpatient orthopedic physical therapy clinic post left knee arthroplasty. The patient reported severe pain (VAS-9/10) with knee range of motion from 5 to 64° flexion. The lower extremity functional score was 42/80 with moderate deficits in function.ConclusionThe anterior inferior knee pain with saphenous nerve entrapment can cause severe symptoms. Soft tissue mobilizations followed by neurodynamic techniques can improve neural mobility and functional outcomes (LEFS-52/80).

Return to sport post-knee arthroplasty : an umbrella review for consensus guidelines.

AimsReturn to sport following undergoing total (TKA) and unicompartmental knee arthroplasty (UKA) has been researched with meta-analyses and systematic reviews of varying quality. The aim of this study is to create an umbrella review to consolidate the data into consensus guidelines for returning to sports following TKA and UKA.MethodsSystematic reviews and meta-analyses written between 2010 and 2020 were systematically searched. Studies were independently screened by two reviewers and methodology quality was assessed. Variables for analysis included objective classification of which sports are safe to participate in postoperatively, time to return to sport, prognostic indicators of returning, and reasons patients do not.ResultsA total of 410 articles were found, including 58 duplicates. Seven articles meeting inclusion criteria reported that 34% to 100% of patients who underwent TKA or UKA were able to return to sports at 13 weeks and 12 weeks respectively, with UKA patients more likely to do so. Prior experience with the sport was the most significant prognostic indicator for return. These patients were likely to participate in low-impact sports, particularly walking, cycling, golf, and swimming. Moderate-impact sport participation, such as doubles tennis and skiing, may be considered on a case-by-case basis considering the patient’s prior experience. There is insufficient long-term data on the risks to return to high-impact sport, such as decreased implant survivorship.ConclusionThere is a consensus that patients can return to low-impact sports following TKA or UKA. Return to moderate-impact sport was dependent on a case-by-case basis, with emphasis on the patient’s prior experience in the sport. Return to high-impact sports was not supported. Patients undergoing UKA return to sport one week sooner and with more success than TKA. Future studies are needed to assess long-term outcomes following return to high-impact sports to establish evidence-based recommendations. This review summarizes all available data for the most up-to-date and evidence-based guidelines for returning to sport following TKA and UKA to replace guidelines based on subjective physician survey data.Cite this article: Bone Jt Open 2022;3(3):245–251.

Inadequate perioperative control of modifiable risk factors in total knee arthroplasty and implications on functional results

Diabetes and increased body mass index are two of the most associated comorbidities in patients undergoing total knee arthroplasty. With the number of patients undergoing knee arthroplasty increasing and with the incidence of diabetes and increased BMI, we can expect that in the coming decades the association of the two comorbidities will be frequent. An ethical issue arises when the patients who are refused for total knee arthroplasty are instructed to change the risk factors, and they fail either because of a mental problem or because of a physical problem. This study analyzes the effects of controlled, uncontrolled, uncomplicated and complicated diabetes on the rates of postknee arthroplasty complications. The study proposes to evaluate obese patients in terms of functional outcomes and postoperative complications after total knee arthroplasty.

Developments in technology assisted gait analysis in post-knee arthroplasty

Developments in technology assisted gait analysis in post-knee arthroplasty

Real-World Experience Using Emicizumab Prophylaxis for Hemophilia a: Single-Center Experience

INTRODUCTION: Emicizumab is a recombinant humanized bispecific antibody that mimics Factor VIII by bridging Factor IXa and X. It is an important breakthrough in the therapeutic armamentarium for Hemophilia A. Recently concluded Phase III HAVEN trials demonstrated that prophylaxis with emicizumab is superior to recombinant Factor VIII (rFVIII). Patients with Hemophilia A with inhibitors had a 79% reduction in the Annualized Bleeding Rate (ABR) while on emicizumab prophylaxis vs other bypassing agents. Patients without inhibitors had a 68% reduction in ABR on emicizumab vs rFVIII prophylaxis. However, there is limited data on its use in the post-marketing era. METHODS: We report our experience with emicizumab in children and adults with Hemophilia A with and without inhibitors at a single Hemophilia Treatment Center. This Northwell IRB approved retrospective analysis (Jan 2017 - Jun 2020) included data from 12 months prior to starting emicizumab prophylaxis RESULTS: A total of 38 patients on emicizumab prophylaxis were included. 35 patients (92.1%) had severe and 3 (7.9%) had moderate Hemophilia A. 11 patients (28.9%) had a FVIII inhibitor. The mean age was 16.4 yrs with 18 patients (47%) below the age of 12 (age limit used in HAVEN trials). 54.1% of patients were Caucasian, 18.9% were Asian and 16.2% were African American. Thirty patients (78.9%) were on prophylaxis with either rFVIII (71.5%) or FEIBA (21.4%) before starting emicizumab. All 38 patients were started on emicizumab with a loading dose of 3 mg/kg once weekly for 4 weeks followed by a maintenance dose of 1.5 mg/kg weekly. The ABR decreased by 52% for inhibitor patients (3.6 events before and 1.7 events after starting emicizumab). Similarly, there was a dramatic 70.6% reduction for non-inhibitor patients (1.5 events before and 0.44 events after starting emicizumab). Patients on emicizumab prophylaxis experienced 35 bleeding events over 24 months. Nine out of these 35 events occurred in one patient alone with a high titer FVIII inhibitor. 56.5% of these events were joint bleeds, 26.1% (muscle bleeds), 13% (soft tissue bleeds) and 4.4% were mucocutaneous bleeds. Barring 2 events, all episodes (93.9%) were managed outpatient. A majority of these bleeds (72.1%) in inhibitor patients were treated with recombinant Factor VIIa (rVIIa, 16-24 doses for documented hemarthroses) and 3.4% were treated with FEIBA after nonresponse to rVIIa (9-15 doses) due to delayed treatment. Remaining non -inhibitor patients were treated with rFVIII (2-5 doses) with a good response. 52 % of these bleeds were trauma-related. Five surgeries were conducted in the inhibitor patients while on emicizumab prophylaxis and none experienced perioperative bleeding. RVIIa was used as a bypassing agent for 2 of these surgeries - a hemispherectomy and a port removal. No bypassing agent was used for the remaining 3 port removals. Five surgeries (1 total knee arthroplasty and 4 port removals) were performed in patients without a FVIII inhibitor. Recombinant Factor VIII was used as the replacement agent and the patient with knee arthroplasty experienced post-operative bleeding. There were no thrombotic episodes or deaths and all but one continued on emicizumab. The patient post knee arthroplasty discontinued emicizumab after recurrent bleeds into the replaced joint despite aggressive replacement with rFVIII and absence of an inhibitor. DISCUSSION: We report a real-world experience on the use of emicizumab prophylaxis for Hemophilia A with and without inhibitors in children and adults with 78.9% of our cohort below the age of 21 years. Our study demonstrated a similar decrease in ABR for non-inhibitor patients comparable to the HAVEN clinical trials. However, our inhibitor patients experienced a lower bleed reduction rate on emicizumab and all patients still experienced a considerable number of trauma-related bleeds (likely due to increased participation of inhibitor patients in sports). Two patients with traumatic muscle/joint bleeds were treated with aPCC due to non-response to rVIIa suggesting the need for early treatment of suspected bleeds on emicizumab. No thrombotic events or thrombotic microangiopathy was observed in our patient cohort. Our data suggest the need for ongoing patient education for early bleed recognition on emicizumab prophylaxis, prompt treatment of breakthrough bleeds and pre-sports prophylaxis with FVIII or bypassing agents. Disclosures Acharya: BPL: Membership on an entity's Board of Directors or advisory committees; Novonordisk: Membership on an entity's Board of Directors or advisory committees; Bayer Pharma Inc.: Research Funding.

Infrapatellar neuralgia due to bullous morphea in postknee arthroplasty patients treated with radiofrequency

Injury or entrapment of the infrapatellar branch of the saphenous nerve (IPS) can cause persistent anterior and medial knee pain. However, IPS neuralgia because of bullous morphea is rare and not reported earlier. We present a case of IPS neuralgia after total knee replacement where the pain was attributed to local skin lesion of bullous morphea (BM). After a successful diagnostic block, radiofrequency treatment was done to provide prolonged relief. We have discussed the possible pathogenesis of nerve entrapment and pain by BM in our case and the basis of treatment by radiofrequency ablation.

Geniculate Artery Embolization in Patients With Recurrent Hemarthrosis After Knee Arthroplasty: A Retrospective Study

BackgroundRecurrent hemarthrosis after knee arthroplasty is an uncommon and disabling complication of this frequently performed procedure. Selective endovascular embolization of the geniculate arteries is one of the therapeutic options to manage this complication. The purpose of this study is to analyze the effectiveness of this treatment in patients suffering from recurrent hemarthrosis after knee arthroplasty. MethodsWe performed a retrospective study of 31 patients (39 embolization procedures) with recurrent hemarthrosis after knee arthroplasty. There were 17 men and 14 women with a median age of 67 years (range 48-90). All patients were referred for geniculate artery embolization between January 2007 and November 2016. ResultsTwenty-seven procedures were executed on the right side and 12 on the left side. Total knee arthroplasty was performed on 29 patients, only 2 patients underwent unicompartmental knee arthroplasty. Embolization of the superior geniculate arteries was achieved in all patients. In 12 of 39 procedures (31%), at least 1 of the inferior geniculate arteries could not be catheterized, therefore embolization was achieved through collaterals. Symptomatic improvement was observed in 26 of 31 patients (84%). Discomfort or mild postprocedural pain was observed in most patients, needing only minor pain medication, mostly resolving within 24 hours. Two patients presented with a severe complication: a 48-year-old male patient developed septic arthritis and an 85-year-old hypertensive female patient treated with anticoagulants showed aseptic necrosis of the femoral condyles. ConclusionEmbolization of geniculate arteries is a safe and effective treatment in recurrent hemarthrosis post knee arthroplasty. Clinical improvement was seen in most patients.

Development of a functional rehabilitation intervention for post knee arthroplasty patients: COmmunity based Rehabilitation post Knee Arthroplasty (CORKA) trial

Knee osteoarthritis is a common cause of disability in older people and knee arthroplasty surgery in the UK is increasing. The CORKA trial is a randomised controlled trial of rehabilitation targeted at patients identified as being at risk of a poor outcome after knee arthroplasty. This paper describes the development and delivery of the CORKA intervention. It was informed by current evidence, relevant guidelines, expert and patient opinion, practical considerations and a pilot study. The intervention is a multicomponent rehabilitation programme with the main component being an exercise programme delivered to participants in their own home. It includes functional task practice, strategies to improve adherence and where appropriate the provision of appropriate aids and equipment.

Development of a functional rehabilitation intervention for post knee arthroplasty patients: COmmunity based Rehabilitation post Knee Arthroplasty (CORKA) trial

Development of a functional rehabilitation intervention for post knee arthroplasty patients: COmmunity based Rehabilitation post Knee Arthroplasty (CORKA) trial

The role of the patellar tendon angle and patellar flexion angle in the interpretation of sagittal plane kinematics of the knee after knee arthroplasty: A modelling analysis

BackgroundMany different measures have been used to describe knee kinematics. This study investigated the changes of two measures, the patellar tendon angle and the patellar flexion angle, in response to variations in the geometry of the knee due to surgical technique or implant design. MethodsA mathematical model was developed to calculate the equilibrium position of the extensor mechanism for a particular tibiofemoral position. Calculating the position of the extensor mechanism allowed for the determination of the patellar tendon angle and patellar flexion angle relationships to the knee flexion angle. The model was used to investigate the effect of anterior–posterior position of the femur, change in joint line, patellar thickness (overstuffing, understuffing), and patellar tendon length; these parameters were varied to determine the effect on the patellar tendon angle/knee flexion angle and patellar flexion angle/knee flexion angle relationships. ResultsThe patellar tendon angle was a good indicator of anterior–posterior femoral position and change in patellar thickness, and the patellar flexion angle a good indicator of change in joint line, and patellar tendon length. ConclusionsThe patellar tendon angle/knee flexion angle relationship was found to be an effective means of identifying abnormal kinematics post-knee arthroplasty. However, the use of both the patellar tendon angle and patellar flexion angle together provided a more informative overview of the sagittal plane kinematics of the knee.

Effectiveness of Different Pain Control Methods in Patients with Knee Osteoarthritis after Knee Arthroplasty.

The number of patients with knee osteoarthritis has increased in tandem with population aging. Consequently, the number of knee arthroplasties has also risen. The postoperative pain is the biggest challenge faced by patients soon after knee arthroplasty; therefore, this study is among different methods for post-knee arthroplasty pain control. A prospective longitudinal research design was employed; 177 adult patients who proposed for primary knee arthroplasty were enrolled and recruited. The patients were divided into conventional Group 1 (n = 120) and patient-controlled analgesia (PCA) Group 2 (n = 57) according to the treatment methods they received. All patients experience the highest pain level on the day of their surgery; women complained of higher pain levels than men did, while the PCA group had lower postoperative pain. Meanwhile, patients with general anesthesia experienced more pain than those with spinal anesthesia in postoperative period. Patients with a higher postoperative pain index have a smaller optimal knee flexion angle. The PCA group had lower postoperative pain; all patients experienced the highest pain level on the day of their surgery. The results of this study could serve as a reference for nurses where PCA ensures a better postoperative pain control and therefore facilitates recovery and improves the quality of nursing.

An efficient method to capture the impact of total knee replacement on a variety of simulated patient types: A finite element study

Osteoporosis resulting in a reduction in bone stiffness and thinning of the cortex is almost universal in older patients. In this study a novel method to generate computational models of the distal femur which incorporate the effects of ageing and endosteal trabecularisation are presented. Application of this method to pre- and post-knee arthroplasty scenarios is then considered. These computational methods are found to provide a simple yet effective tool for assessing the post-arthroplasty mechanical environment in the knee for different patient types and can help evaluate vulnerability to supracondylar periprosthetic fracture following implantation. Our results show that the stresses in the periprosthetic region increase dramatically with ageing; this is particularly true for higher flexion angles. Stresses in the anterior region of the femoral cortex were also found to increase significantly post-implantation. The most dramatic increases in stresses and strains at these locations were observed in old osteoporotic patients, explaining why this patient group in particular is at greater risk of periprosthetic fractures.

Closed Incision Negative Pressure Wound Therapy vs Conventional Dry Dressings After Primary Knee Arthroplasty: A Randomized Controlled Study

BackgroundThe purpose of this study was to assess the effect of negative pressure wound therapy (NPWT) on quality of life (QoL), wound complications, and cost after primary knee arthroplasty. MethodsA prospective analysis of 33 patients undergoing primary knee arthroplasty performed by 3 surgeons in one institution. The first 12 patients (3 bilateral and 9 unilateral) had conventional dry dressings (CDD) applied and cost of dressings was assessed. The other 21 patients all underwent bilateral knee arthroplasty and had either side randomized to receiving NPWT or CDD. Cost of dressings, wound complications, and QoL were compared. ResultsOne patient had a reaction to the NPWT requiring readmission. Another had persistent wound drainage that required NPWT application. There were no wound issues in the remaining 31 patients. The average cost in the first 12 patients was Australian dollar $48.70 with an average of 1.5 changes on ward. In the 21 patients receiving both dressings, the average cost for CDD was less (Australian dollar $43.51 vs $396.02, P ≤ .011, effect size [ES] = 1.06). When comparing QoL factors, wound leakage (0.14 vs 0.39 P = .019, ES = 1.02), and wound protection (0.16 vs 0.33, P = .001, ES = 0.021) were better in the NPWT group. There was no other significant difference in QoL factors. The average number of changes on the ward was less for the NPWT group (1.19 vs 1.38, P = .317, ES = 1.02). ConclusionWe found no benefit in wound healing or cost with NPWT post knee arthroplasty. There was some benefit in NPWT QoL factors less wound leakage and better protection.

Conditions of Use, Reliability, and Quality of Audio/Video-Mediated Communications During In-Home Rehabilitation Teletreatment for Postknee Arthroplasty.

Audio/video-mediated communication between patients and clinicians using videoconferencing over telecommunication networks is a key component of providing teletreatments in rehabilitation. The objectives of this study were to (1) document the conditions of use, performance, and reliability of videoconferencing-based communication in the context of in-home teletreatment (TELE) following total knee arthroplasty (TKA) and (2) assess from the perspective of the providers, the quality attributes of the technology used and its impact on clinical objectives. Descriptive embedded study in a randomized controlled trial using a sample of 97 post-TKA patients, who received a total of 1,431 TELE sessions. Technical support use, service delivery reliability, performance, and use of network connection were assessed using self-report data from a costing grid and automated logs captured from videoconferencing systems. Physical therapists assessed the quality and impact of video-mediated communications after each TELE session on seven attributes. Installation of a new Internet connection was required in 75% of the participants and average technician's time to install test and uninstall technology (including travel time) was 308.4 min. The reliability of service delivery was 96.5% of planned sessions with 21% of TELE session requiring a reconnection during the session. Remote technical support was solicited in 43% of the sessions (interventions were less than 3-min duration). Perceived technological impacts on video-mediated communications were minimal with quality of the overall technical environment evaluated as good or acceptable in 96% of the sessions and clinical objectives reached almost completely or completely in 99% of the sessions. In-home rehabilitation teletreatments can be delivered reliably but requires access to technical support for the initial setup and maintenance. Optimization of the processes of reliably connecting patients to the Internet, getting the telerehabilitation platform in the patient's home, installing, configuring, and testing will be needed to generalize this approach of service delivery.

3:00 PMAbstract No. 326 - Selective geniculate artery embolization for management of recurrent hemarthrosis after knee arthroplasty

PurposeSpontaneous recurrent hemarthrosis occurs in up to 1.6% of patients following total knee arthroplasty, most often related to hypervascular proliferative synovium and associated component impingement, making the synovium prone to trauma and bleeding. Hemarthrosis may result in poor arthroplasty function or failure. When conservative management fails, targeted geniculate artery embolization (GAE) can serve as a treatment alternative to synovectomy. We present a single institutional experience with GAE for recurrent hemarthrosis in the setting of prior knee arthroplasty.MaterialsAll GAE performed in patients with clinical and/or imaging findings of recurrent hemarthrosis post knee arthroplasty between July 2003 and September 2015 were included in this study. Iatrogenic pseudoaneurysms were excluded. Patient demographics, embolic agent, technical success, procedure time, and immediate complications were ascertained. Imaging and clinical follow-up data was reviewed.Results46 GAE performed in 35 patients (17 male, 18 female; mean age 67, range 41-83 years) met inclusion criteria. Intraprocedural angiography demonstrated focal synovial hyperemia in 100% of cases. Embosphere particles were used in all but one case where microcoils were used. Particle size ranged from 100-700 um, 93% of cases utilizing solely 100-300 um particles. Embolization was technically successful in all cases. Postembolization angiograms demonstrated diminished or absent synovial hypervascularity in all cases. Periprocedural transient cutaneous ischemia occurred in 11%. Postprocedural follow-up was available for 25 cases with a mean follow-up interval of 70 days (range 1-413 days), with 23 (92%) exhibiting clinical improvement of symptoms. 11 repeat GAEs were performed in 9 patients experiencing recurrence or persistence of symptoms. Of these, review of initial post GAE angiogram revealed residual synovial blush in 10 (91%).ConclusionsTargeted GAE with spherical particles is an effective treatment for recurrent hemarthrosis following knee replacement with low immediate complication rates. Residual focal hyperemia on immediate postembolization angiogram may be associated with clinical recurrence or persistence.