Post Total Knee Arthroplasty Research Articles

The Role of a Seven-Day Physiotherapy Service in Reducing Length of Stay and Improving Cost-Effectiveness in Arthroplasty Surgery.

Background Length of hospital stay post hip and knee arthroplasty is influenced by several factors, including gender, home circumstancesand underlying diagnosis. Due to increasing demand for hip and knee arthroplasty, elective units, operating within already stressed healthcare systems, must identify methods of increasing efficiency and capacity. We sought to establish whether the lack of a seven-day inpatient physiotherapy service resulted in an increased hospital length of stay post primary hip and knee arthroplasty. Methods One hundred consecutive joint replacements (50 total hip replacements and 50 total knee replacements (TKRs)), performed in our institution from January to February 2020, were assessed. The length of stay for the cohort was analysed, anddelays to discharge were identified. T-test was used to analyse the difference in length of stay based on the dayof the week the surgery was performed. Results The mean length of stay for all primary hip and knee arthroplasties was 3.42 (standard deviation (SD): 1.62) days. Hip and knee arthroplasties performed on a Thursday or Friday had a significantly higher average length of stay than those performed on Monday, Tuesday or Wednesday (3.89 versus 3.02, p=0.006). We calculated that operating a six-day versus seven-day physiotherapy service in our unit cost 318 bed days per year equating to €986,535. Conclusion Length of stay post total hip and knee arthroplasty in our unit is significantly affected by the day of the week that surgery is performed. Elective orthopaedic units should consider all means of maximising efficiency and lowering costs given the future challenges in service provision.

The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression.

Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery. A systematic literature search was conducted in PubMed (Medline), Cochrane Library (CINAHL, Embase) and Web of Science (until 29th of June 2022). Main inclusion criteria were ≥ 1 preoperative and ≥ 1 measurement ≥ 3-months post-operation and ≥ 1 objective assessment of quadriceps strength, muscle mass or neuromuscular activity, measured at both legs. Studies were excluded if they met the following criteria: further impairment of treated extremity or of the contralateral extremity; further muscle affecting disease, or muscle- or rehabilitation-specific intervention. The Robins-I tool for non-randomized studies, and the Cochrane Rob 2 tool for randomized controlled studies were used for risk of bias rating. Pre-surgery, 3 months, 6 months and 1 year after surgery data were pooled using random effects meta-analyses (standardized mean differences, SMD, Hedge's g) in contrast to the pre-injury values. 1417 studies were screened, 21 studies on 647 participants were included. Thereof, 13 were non-randomized controlled trails (moderate overall risk of bias in most studies) and 7 were randomized controlled trials (high risk of bias in at least one domain in most studies). Three (k = 12 studies; SMD = -0.21 [95% confidence interval = -0.36 to -0.05], I2 = 4.75%) and six (k = 9; SMD = -0.10 [-0.28 to -0.08]; I2 = 0%) months after total knee arthroplasty, a deterioration in the strength of the operated leg compared with the strength of the non-operated leg was observed. One year after surgery, the operated leg was stronger in all studies compared to the preoperative values. However, this increase in strength was not significant compared to the non-operated leg (k = 6, SMD = 0.18 [-0.18 to 0.54], I2 = 77.56%). We found moderate certainty evidence that deficits in muscle strength of the knee extensors persist and progress until 3 months post-total knee arthroplasty in patients with end-stage knee osteoarthritis. Very low certainty evidence exists that preoperatively existing imbalance of muscle strength and mass in favor of the leg not undergoing surgery is not recovered within 1 year after surgery.

The Effect of a Multidimensional Home Rehabilitation Program for Post-Total Knee Arthroplasty Elderly Patients.

Patients with total knee arthroplasty (TKA) experience pain, decreased muscle strength, and decreased knee function, resulting in increases in depression and decreased subjective well-being. A multidimensional home program may prevent these adverse events. The aim of this study was to test the effect of a home rehabilitation program that included education, exercise, aroma massage, and phone counseling for post-TKA patients. We used a randomized control group pretest/posttest design. Fifty-nine patients participated, with 29 in the experimental group and 30 in the control group. Pain, knee joint range of motion (ROM), quadriceps strength, depression, and subjective well-being were measured as outcome variables. Data were analyzed using repeated-measures analysis of variance and generalized estimating equations. The experimental group showed significant improvement in knee pain, active ROM, muscle strength, depression, and subjective well-being with no significant between-groups difference in passive ROM. The multidimensional home rehabilitation program can be an effective nursing intervention for physical and emotional recovery of patients with TKA.

Clinical Interpretability of Quadriceps Strength and Gait Speed Performance in Total Knee Arthroplasty: A Longitudinal Study.

After a total knee arthroplasty, physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function. A sample of 2624 patients with primary total knee arthroplasty participated in this retrospective longitudinal study. Monthly, for 4 mos after surgery, quadriceps strength and gait speed were quantified. At the month-6 time point, self-reported walking and stair climbing function was measured. All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher month-6 self-reported walking and stair climbing function ( P < 0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P < 0.001). Among female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 wks after total knee arthroplasty. By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Understand how self-reported walking and stair climbing abilities improved from baseline before total knee arthroplasty (total knee arthroplasty) to 6 mos postoperatively; (2) Describe the time course of the 2 performance-based measures of quadriceps strength and walking speed after a total knee arthroplasty; and (3) Relate the trajectories of post-total knee arthroplasty quadriceps strength and walking speed measurements across distinct levels of self-reported walking and stair climbing function. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Kneeling tolerance following intramedullary nailing or plate fixation of uncomplicated distal tibia fractures

IntroductionDistal tibia fractures often occur in younger, high demand patients, though the literature surrounding management remains contentious. This study sought to quantitatively determine differences in kneeling ability and self-reported knee function in patients managed with either intramedullary nailing (IMN) or open reduction internal fixation (ORIF) with compression plating following distal tibia fracture to assist in the preoperative consent process. HypothesisThere is no difference in kneeling tolerance following either tibial nailing or plate fixation of distal tibia fractures. Material and methodsRetrospective sampling of public hospital data with outpatient prospective functional testing were completed. The primary outcome measure was the Kneeling Test (KT). Secondary outcome measures were The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Forgotten Joint Score (FJS) for the knee joint. There were 28 patients recruited (18 IMN and 10 ORIF) with a mean age of 44years. Mean overall follow-up was 13.3months (range 8–25, SD 3.6). All fractures had completely healed without postoperative complication. ResultsThe IMN affected limb had a significantly worse overall kneeling function than their non-affected limb (mean KT: 70.4 vs. 94.9 respectively, p<0.005) Additionally, the IMN group performed significantly worse when compared to the ORIF group (mean KT 70.4 vs. 92.5 respectively, p<0.005). No significant differences (p>0.05) in kneeling function existed for the ORIF group when comparing affected to non-affected limbs. Secondary outcome analysis showed significantly worse overall WOMAC and FJS in the IMN group compared to the ORIF group (mean WOMAC 19.3 vs. 6.9 respectively, p=0.040; mean FJS 38.3 vs. 75.9 respectively, p=0.005). DiscussionThe use of intramedullary nailing for the treatment of distal tibia fracture results in a mean reduction of 20% in kneeling tolerance in comparison to ORIF. The resulting kneeling tolerance is comparable to that of patients post-total knee arthroplasty. The present findings should assist in the consent process for patients with high kneeling demands in sportive, professional or cultural pastimes. Level of evidenceIV; retrospective cohort study with quantitative outcome measurement.

Patient-reported outcomes measurement information system physical function and knee injury and osteoarthritis outcome score relationship on performance measures in people undergoing total knee arthroplasty

Purpose Primary purpose was to identify relationships between performance-based measures onto both computerized adaptive testing [Physical Function-Computer Adaptive Testing (PF-CAT)] and joint-specific legacy [Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living (KOOS-ADL)] instruments pre- and 12-month post-TKA. Methods The PF-CAT and KOOS-ADL were identified as outcomes and performance on the 40-m fast-paced walking test, stair climb test and chair stand test were identified as predictors. Linear regression was used for all comparisons after adjusting for confounders. Results Sixty-eight people with TKA (56.7% male) were tested. Better scores on the 40-m fast-paced walking (KOOS-ADL, p = 0.02), stair climb (KOOS-ADL, p = 0.05) and chair stand (KOOS-ADL, p < 0.01) associated with better self-reported scores pre-TKA. Better scores on the 40-m fast-paced walking (PF-CAT, p = 0.05; KOOS-ADL, p = 0.01), stair climb (KOOS-ADL, p < 0.01), chair stand (PF-CAT, p < 0.01) and range of motion (KOOS-ADL, p = 0.02) were associated with better self-reported scores 12-month post-TKA. Decrease knee range of motion related to poorer 40-m fast-paced walking (p = 0.01) and stair climb (p = 0.03) scores pre-TKA. Quadriceps weakness related to poorer 40-m fast-paced walking (p = 0.04) score pre-TKA. Conclusion Self-reported instruments are a moderate, but inconsistent surrogate to performance-based measures pre- and post-TKA. Our findings indicate that both self-reported and performance-based measures are necessary to fully characterize physical function and should be used jointly to aid in the recovery analysis of people undergoing TKA. Implications for Rehabilitation Monitoring the trajectory of pre- to post-total knee arthroplasty (TKA) physical function is important as it directly relates to mortality, morbidity and poorer quality of life in older adults. Both self-reported and performance-based measures of physical function are used to determine progress in recovery for patients pre- and post- TKA. This study provides evidence that perceived physical function measures are a moderate, but an inconsistent, surrogate to objective physical function measures pre- and post-TKA. Joint specific deficits in knee range of motion and quadriceps strength were weakly associated with deficits in function measures pre-TKA, but no association was observed 12-month post-TKA. Our findings indicate that both self-reported and performance-based measures are necessary to fully characterize physical function and should be used jointly to aid in the complete recovery analysis of people undergoing TKA.

Can Knees be Forgotten 2 Years After Total Knee Arthroplasty?

Background: There have been multiple ways to measure outcomes post total knee arthroplasty. Ultimate goal is to replicate a natural joint to allow patients to perform most activities of daily living and give high satisfaction rates. Patient reported outcome measures (PROM) like Forgotten Joint Score (FJS), Oxford Knee Score (OKS)and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) have been validated and used for evaluation of TKA patients. FJS helps to evaluate how natural a prosthesis feels post surgery. Our aim was to study how natural a joint felt or was forgotten 2 year after surgery and how FJS correlates with OKS and WOMAC scores. Materials and Methods : We evaluated 254 total knee replacements with minimum 2 year post TKA. All the patients who were at least 2 year post operative, completed FJS questionnaire where scores are ranged from 0-100; OKS questionnaire where scores are ranged between 0-48; Short – form WOMAC questionnaire where scores are ranged between 0-28. Correlation analysis was performed for FJS with OKS and short - form WOMAC scores. Results: 254 patients with mean age of 65.01 years of which 83 males and 171 females were evaluated with minimum of 24 months follow up and average follow-up of 30.85 months. Average FJS, OKS and SF WOMAC were 77.24, 38.75 &amp; 79.97 respectively. FJS showed good correlation with OKS and SF WOMAC scores. Conclusion : FJS is an easy and equally effective outcome measure, which is valid and reliable like the other common well know measures like OKS and WOMAC. Patients experience a marked improvement in the FJS over the first two years. Patients in our series had good outcomes who had more natural feel of knees or a feeling of “forgotten knees” in their day to day activity after 2 years of surgery.

Machine Learning Algorithm to Predict Worsening of Flexion Range of Motion After Total Knee Arthroplasty

BackgroundPredicting the worsening of flexion range of motion (ROM) during the course post-total knee arthroplasty (TKA) is clinically meaningful. This study aimed to create a model that could predict the worsening of knee flexion ROM during the TKA course using a machine learning algorithm and to examine its accuracy and predictive variables. MethodsAltogether, 344 patients (508 knees) who underwent TKA were enrolled. Knee flexion ROM worsening was defined as ROM decrease of ≥10° between 1 month and 6 months post-TKA. A predictive model for worsening was investigated using 31 variables obtained retrospectively. 5 data sets were created using stratified 5-fold cross-validation. Total data (n = 508) were randomly divided into training (n = 407) and test (n = 101) data. On each data set, 5 machine learning algorithms (logistic regression, support vector machine, multilayer perceptron, decision tree, and random forest) were applied; the optimal algorithm was decided. Then, variables extracted using recursive feature elimination were combined; by combination, random forest models were created and compared. The accuracy rate and area under the curve were calculated. Finally, the importance of variables was calculated for the most accurate model. ResultsThe knees were classified into the worsening (n = 124) and nonworsening (n = 384) groups. The random forest model with 3 variables had the highest accuracy rate, 0.86 (area under the curve, 0.72). These variables (importance) were joint-line change (1.000), postoperative femoral-tibial angle (0.887), and hemoglobin A1c (0.468). ConclusionsThe random forest model with the above variables is useful for predicting the worsening of knee flexion ROM during the course post-TKA.

What Do Patients Expect from Total Knee Arthroplasty: A Qualitative Study

Patient expectations are key predictors of post-total knee arthroplasty (TKA) health outcomes. The expectations dictate the pain levels, functional outcomes, and disability post-surgery. The study aims at exploring pre-operative expectations of patients from TKA. The study sample (n = 15) consisted of participants diagnosed with knee osteoarthritis who had opted for elective replacement surgery. The mean (SD) age of the participants was 72.07 (5.7). The principles of the qualitative research approach guided the study’s methodology. The primary author conducted face-to-face semi-structured interviews, which were audio-recorded and transcribed verbatim. Each interview lasted for 15–30 min. The transcribed verbatims were thematically analyzed. The participants expected surgery to relieve their pain, improve their functional status, and make them productive for society. They also expected to be socially active and get rid of their medications. Participants lived experiences modulated their expectations. The study findings emphasize that health-care providers must consider the expectations of individuals undergoing surgery. Patients should be educated about realistic goals and attainments from surgery to ensure better post-operative health outcomes.

Does Postoperative Intravenous Ferric Carboxymaltose Hasten the Recovery of Hemoglobin in Patients Post Total Knee Arthroplasty?

Timely and effective iron supplementation may help reduce the incidence of postoperative anemia and its associated problems. In this study, we aim to assess the efficacy of intravenous ferric carboxy maltose (FCM) on improving hemoglobin(Hb) level posttotal knee arthroplasty (TKA). We retrospectively reviewed 263 patients who had undergone unilateral TKA with 157 patients in the study group (year 2019) and 106 in the control group (year 2016). Patients in the study group received FCM (500 mg IV) on postoperative day 1, whereas patients in the control group did not receive FCM or any other iron supplementation postoperatively. Hb levels were recorded preoperatively (Pr-Hb), postoperatively on day 3 (Day3-Hb) and postoperatively at 5(+1) weeks (Week5-Hb). Statistical analysis was performed using student's paired and unpaired t-tests. Pr-Hb and Day3-Hb levels were comparable in the control and study group, while Week5-Hb levels were significantly higher (P < .001) in the study group. The drop in Hb at Day3 from preoperative values was comparable between the two groups (P= 1.0). The rise in Hb from Day3 to 5 weeks was significantly higher in the study group as compared to the control group (P < .001). The difference between Pr-Hb and Week5-Hb was significantly lower (P < .001) in the study group compared to the control group. However, Week5-Hb in both groups remained lower than Pr-Hb (P < .001) in all patients. Intravenous FCM (500 mg) was found to be a safe method of iron supplementation to improve hemoglobin levels rapidly and consistently, post-TKA. We need to further study the additive effect of higher dose FCM (1000 mg) on hemoglobin recovery.

Can the Output of a Learned Classification Model Monitor a Person's Functional Recovery Status Post-Total Knee Arthroplasty?

Osteoarthritis is a common musculoskeletal disorder. Classification models can discriminate an osteoarthritic gait pattern from that of control subjects. However, whether the output of learned models (probability of belonging to a class) is usable for monitoring a person’s functional recovery status post-total knee arthroplasty (TKA) is largely unexplored. The research question is two-fold: (I) Can a learned classification model’s output be used to monitor a person’s recovery status post-TKA? (II) Is the output related to patient-reported functioning? We constructed a logistic regression model based on (1) pre-operative IMU-data of level walking, ascending, and descending stairs and (2) 6-week post-operative data of walking, ascending-, and descending stairs. Trained models were deployed on subjects at three, six, and 12 months post-TKA. Patient-reported functioning was assessed by the KOOS-ADL section. We found that the model trained on 6-weeks post-TKA walking data showed a decrease in the probability of belonging to the TKA class over time, with moderate to strong correlations between the model’s output and patient-reported functioning. Thus, the LR-model’s output can be used as a screening tool to follow-up a person’s recovery status post-TKA. Person-specific relationships between the probabilities and patient-reported functioning show that the recovery process varies, favouring individual approaches in rehabilitation.

A Pseudoaneurysm of the Inferior Lateral Geniculate Artery Following Total Knee Arthroplasty

Vascular complications after total knee arthroplasty are rare. We present a case of an inferior lateral geniculate artery pseudoaneurysm which became symptomatic 10 days after total knee arthroplasty in a patient with a cardiac comorbidity and using dabigatran. The pseudoaneurysm was most likely caused by iatrogenic injury during surgery. Fourteen days after the index surgery, the patient was seen with a painful but normal post-total knee arthroplasty effused knee, with a maximum flexion angle of 80 degrees. No signs of infection, hemarthrosis, or neurovascular deficit were present. Radiographic imaging included ultrasonography and computed tomography angiography. The pseudoaneurysm was successfully treated with coil embolization. The etiology, presentation, diagnosis, and treatment of a geniculate artery pseudoaneurysm are discussed in this case report.

Role of coagulation profile in prevention of bleeding complications in primary total knee arthroplasty patients

Introduction: Incidence of deep vein thrombosis (DVT) (1.9%-3%) and pulmonary embolism (PE) (0.01%) post total knee arthroplasty (TKA) in Asian population is less compared to western population (85% and 1.5%-10% respectively). Hence, routine chemoprophylaxis following Western protocols is debatable in Asia. Wound complications like bleeding, hematoma, blisters, skin necrosis are high with low molecular weight heparin (LMWH) as compared with Aspirin. Aspirin is associated with low rate of DVT and PE (0.008% - 0.35%). The aim is to study the coagulation profile and adverse events like DVT, PE and wound complications in postoperative TKA patients on pharmacological DVT prophylaxis and watch for correlation between coagulation parameters and bleeding complications, and accordingly administer thromboprophylactic agents. Methods: Prospective observational study. 463 patients undergoing primary unilateral TKA were bifurcated into groups according to thromboprophylaxis given by two surgeons. 1. 271 patients received LMWH 2. 192 patients received Aspirin Patients were evaluated with coagulation profile preoperatively and postoperatively and observed for wound complications, DVT and PE. Results: The use of LMWH conferred a significantly higher incidence of wound soakage (p

Pulsed Radiofrequency Rhizotomy of the Genicular Nerves of the Knee Guided by Radioscopy and Ultrasonography: Step-By-Step Technique

Osteoarthritis (OA) of the knee is highly prevalent and causes pain, stiffness, and harms the quality of life of millions of patients. Scientific evidence about radiofrequency ablation or rhizotomy of genicular nerves has been presented with increasing frequency in the literature for the treatment of chronic pain related to knee OA as an alternative to total knee arthroplasty. The main indication for this procedure is symptomatic OA unresponsive to conservative treatment, regardless of the disease evolution, although more common indications are in Kellgren–Lawrence grade III or IV, in post-total knee arthroplasty residual pain without an identified cause, in patients with comorbidities and high surgical risk, and those who do not want to undergo surgery. The aim of this study is to describe the step-by-step rhizotomy technique with pulsed radiofrequency of the 3 genicular nerves, guided by radioscopy and ultrasonography.

Evaluation Of Average Length of Follow-Up Duration Post Total Knee Arthroplasty: A Survey

Background: Among the various diseases in the world, osteoarthritis (OA) is a major contributing factor of disability. Total Knee Arthroplasty (TKA) is a widely performed procedure for advanced arthritis of the knee joint. Both subjective and objective assessments are necessary to evaluate the outcomes post TKA. The physiotherapy treatment program following the surgery is designed in a manner which is best suitable to the patient’s need, the efficacy of which will only be determined with regular follow up sessions. Objectives: The primary objective is to find out length of duration of follow up sessions post TKA with the Physiotherapist. The secondary objectives are to determine whether the reason for termination of follow-up is physiotherapist-based or patient-based and to determine whether the discharge criteria are based on measurable assessment tools. Purpose: In spite of the surgery being routinely performed, records of time period of follow up with the surgeons and physiotherapists are not maintained. It is also not documented whether the discharge occurs on the basis of formal functional assessments. Methodology: Pilot study was performed on a group of 10 physiotherapists to calculate the sample size. It was found to be 73. For the final study, candidates fitting in the inclusion criteria were chosen. Oral consent was taken. Self-designed questionnaire in the form of “Google-Form” was administered. The candidates were requested to fill the same. Descriptive analysis of the data obtained was performed to find out the average duration of follow-up post Total Knee Arthroplasty using PRISM Graph-Pad software. Results: Average (median) length of follow-up duration post TKA was found to be 6.000 weeks. Furthermore, the termination criteria of follow-up were more physiotherapist based and objective in nature. Conclusion: The time period of follow-up post TKA is inconsistent with the minimum period required for optimal functional recovery of various clinical parameters. Clinical Implication: A standardized protocol of follow-up post TKA must be devised. The decision making process of termination of follow-up which is based on measurable tools of assessment should be in line with current research findings. KEYWORDS: Total Knee Arthroplasty, Follow-up, Functional Recovery.

Retention Stitches: A Concept of Wound Closure of Knee Arthroplasty in Obese Patients.

Knee joint arthroplasty is a commonly performed procedure. However, number of obese patients undergoing total knee arthroplasty is on a rise. In such cases, post closure using routine techniques, there have been an increasing number of cases of wound dehiscence and complications like persistent discharge and delayed healing. To overcome this problem, the author has come up with an innovative technique in closure. 27 patients, who were obese, were included in the study and operated at Orthopaedic Arthroscopic Knee and Shoulder clinic. The patients were evaluated pre operatively clinically and planned for retention stitches for closure. Same technique was followed for closure in all the patients. Suture removal was done at 2weeks and patients were followed up for a period of 6months for any complications. In 27 patients undergoing retention stitches post total knee arthroplasty, patients were followed up for a mean period of 14months, with minimum being 6months and maximum being 5years. Patients showed no complications such as wound dehiscence, discharge, localised skin necrosis or cut-through of stitches. Retention stitches in knee arthroplasty is an innovative, ideal, yet easily replicable method of wound closure in obese patients, especially with BMI > 30 (Obesity grade 1 or more). Patients undergo better and uneventful wound healing, which is of paramount importance in a surgery like this. In all these patients, the rehabilitation post surgery is also similar to the other patients, hence not affecting the outcome. The online version contains supplementary material available at 10.1007/s43465-021-00596-y.

Quality of life post total knee arthroplasty: Saudi Arabian experience

Background and Objective:Osteoarthritis of knee is quite common in Saudi Arabian population. Total knee arthroplasty (TKA) was reluctantly accepted in Saudi Arabia about 2 decades ago but there are few small number reports on quality of life (QOL) postsurgery. The objective of this study was to investigate the QOL and overall satisfaction postTKA.Methods:We retrospectively studied 200 patients’ consecutive patients who underwent primary TKA at King Fahd Hospital of the University, AlKhobar, Saudi Arabia. Patient's age, sex, weight, height, body mass index, and range of movements at the time of surgery were extracted from the QuadraMED patients Database. The minimum follow-up was 24 months. At the last visit of 24 months, patients were evaluated using modified Western Ontario and McMaster Universities Osteoarthritis Index (MWOMAC), QOL using Short Form-36 Health Survey (SF-36), and patient satisfaction was assessed.Results:Among the 212 TKAs performed, 52 were male and 148 were female. One hundred and twenty two were right side and 90 were left side and 22 were bilateral. The mean age was 62.7 ± 5.1 years. There were no intraoperative complications. Nearly 95% resulted in patient satisfaction. SF-36 and all the parameters assessed significantly improved (P < 0.001). MWOMAC scores of the patients, which show all functions, had statistically significantly improved to (P < 0.001) except prayers before and after surgery did not change which was expected. The overall level of satisfaction was observed 95% of patients.Conclusions:Our study shows that TKA has a positive effect on pain, mobility, QOL, and ultimate satisfaction.

Alignment of the hindfoot following total knee arthroplasty: A systematic review.

BACKGROUNDThere appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis (OA). Despite this intrinsic link, there is a dearth of studies investigating alterations in hindfoot alignment following total knee arthroplasty (TKA) in patients with knee OA.AIMTo evaluate changes in alignment of the hindfoot following TKA, foot and ankle clinical outcomes in terms of subjective clinical scoring tools following surgical intervention, and to analyse the level of evidence (LOE) and quality of evidence (QOE) of the included studies.METHODSMEDLINE, EMBASE and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting changes in the postoperative alignment of the hindfoot following TKA were included. The level and QOE were recorded and assessed.RESULTSEleven studies with a total of 1142 patients (1358 knees) met the inclusion/ exclusion criteria. Six studies were of LOE II and 5 studies were of LOE III. Patients with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post TKA. Patients with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following TKA. Twelve different radiographic parameters were used to measure the alignment of the hindfoot across the included studies, with the tibio-calcaneal angle most frequently utilised (27.3%).CONCLUSIONThis systematic review demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee OA. However, the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between studies. Further, well designed studies are necessary to determine the changes and outcomes of hindfoot alignment following TKA.

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy.

Chronic pain is a common source of morbidity in many patient populations worldwide. There are growing concerns about the potential side effects of currently prescribed medications and a continued need for effective treatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potential treatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, which direct an applied current to afferent neurons providing sensory innervation to the painful area. In theory, the applied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, which interfere with the central processing of pain signals through small-diameter afferent fibers at the level of the spinal cord. Multiple studies have shown success in the use of peripheral nerve stimulation for acute post-surgical pain for orthopedic surgery, including post total knee arthroplasty and anterior cruciate ligament surgery, and chronic knee pain. Many studies have investigated the utility of peripheral nerve stimulation for the management of chronic shoulder pain. Peripheral nerve stimulation also serves as one of the potential non-pharmacologic therapies to treat back pain along with physical therapy, application of transcutaneous electrical neurostimulation unit, radiofrequency ablation, epidural steroid injections, permanently implanted neurostimulators, and surgery. Studies regarding back pain treatment have shown that peripheral nerve stimulation led to significant improvement in all pain and quality-of-life measures and a reduction in the use of opioids. Further studies are needed as the long-term risks and benefits of peripheral nerve stimulation have not been well studied as most information available on the effectiveness of peripheral nerve stimulation is based on shorter-term improvements in chronic pain.

Patient expectations and satisfaction in robotic-assisted total knee arthroplasty: a prospective two-year outcome study.

The impact of fulfillment of patient expectations throughout recovery on satisfaction in total knee arthroplasty (TKA) is not well understood. Utilizing a standardized TKA method with a robotically assisted (RA) platform, we investigated the impact of expectation fulfillment at 3-month (M) and 6-M on 1-year (Y) and 2-Y satisfaction. We hypothesize that early fulfillment of patient expectations is associated with improved midterm patient satisfaction. We also compare improvements in outcomes with RA-TKA to those of a recent large national TKA cohort study to determine whether RA-TKA meets or exceeds the current standard of care. One hundred six patients were prospectively enrolled and underwent robotic-assisted TKA by a single surgeon using the OMNIBotics system. Patients completed KOOS and New Knee Society Score (KSS) preoperatively and at 3M, 6M, 1Y, and 2Y postoperatively. Expectation fulfillment was subdivided into patients who were below or above the average expectation score pre-operatively, or fulfillment of expectation score at 3M and 6M post TKA. The satisfaction of each group was then compared at 1Y and 2Y post TKA. Study cohort outcomes were compared to contemporary literature from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) database. Patients with greater than average KSS expectation fulfillment at 3M reported significantly higher KSS satisfaction scores at 1Y (34.9 ± 5.3 vs 30.6 ± 6.7, p = 0.0012), and patients with greater than average 6M expectation fulfillment reported improved satisfaction at 1Y (33.9 ± 5.9 vs 31.1 ± 6.7, p = 0.0330) and 2Y (35.2 ± 4.8 vs 32.4 ± 6.8, p = 0.0323). When compared to the FORCE-TJR database, no significant differences in post-operative KOOS outcomes were observed except for Sports and Recreation, for which the RAS group demonstrated higher scores (65.5 ± 30.0 vs 53.0 ± 27.1 p < 0.0001); however, the study cohort reported significantly greater improvements in KOOS Pain, Symptoms, Sports and Recreation, and Quality of Life at multiple time points up to 2years post TKA. High early-expectation fulfillment was associated with improved satisfaction at 1Y and 2Y, indicating the importance of managing patient-specific post-operative care to ensure patients reach their pre-operative goals. Greater improvements in all KOOS sub-scores and in absolute Sports and Recreation at 1Y and 2Y were observed in this robotic-assisted cohort compared to a large contemporary database, indicating that RAS meets or exceeds current standard of care benchmarks for patient-reported outcomes.