Simultaneous Bilateral Knee Replacement Research Articles

Influencing factors of the outcome of patients with haemophilia after knee replacement–a retrospective study

ObjectiveTo explore the factors that affect the efficacy of knee replacement surgery in hemophiliacs.MethodsA retrospective analysis was conducted on 87 patients with hemophilia (PWH) (117knees) who underwent knee arthroplasty in our hospital from January 2012 to December 2020 (mean follow-up 70.8 ± 22 months). General information, hemophilia information, surgical information, follow-up information and psychological assessment information were collected. The knee joint efficacy was evaluated using the Hospital for Special Surgery (HSS) knee score, the American Knee Society’s Clinical (KSC) and Functional (KSF) scores, flexion contracture degree (FC), range of motion (ROM), and wound healing. The excellent and poor groups were divided based on these factors. Logistic regression analysis was used to analyze factors that may affect the knee joint efficacy of patients.ResultsSeventy-four cases of excellent knee joints and 43 cases of poor knee joints were included. Single factor analysis: The pre-ROM, SF-12MCS, HSS, KSF, and KSC of the excellent group were significantly higher than those of the poor group (P < 0.05); the Hamilton Depression Scale (HAMD), Preoperative Visual Analogue Scale(Pre-VAS), pre-FC degree of the excellent group were significantly lower than those of the poor group (P < 0.05). The proportion of patients undergoing Simultaneous bilateral knee replacement, severe hemophilia, and quadricepsplasty during surgery in the excellent group was significantly lower than that in the poor group (P < 0.05). Logistic regression: Pre-ROM and Simultaneous bilateral knee replacement are independent risk factors affecting knee joint efficacy. Pre-ROM is positively correlated with knee joint efficacy, while Simultaneous bilateral knee replacement is negatively correlated.ConclusionIn PWH, the efficacy of knee replacement surgery is related to preoperative ROM and Simultaneous bilateral knee replacement. Better preoperative knee joint mobility is associated with improved outcomes, whereas Simultaneous bilateral knee replacement negatively impacts surgical efficacy.

Demography of Total Joint Replacement Surgeries Performed in a Tertiary Care Hospital: A Cross-sectional Survey.

Total joint replacement of hip and knee is considered as one of the most successful orthopedic surgeries in the twenty-first century because of the only solution to end-stage arthritis of these joints. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to describe the demographic findings of the joint replacement surgeries among total lower limb surgeries in a tertiary care hospital. This cross-sectional survey was conducted using the hospital records of 73 total joint replacement surgeries of the lower limb in the Department of Orthopedics of a tertiary care hospital from November 2016 to November 2020. Ethical approval was taken from the Institutional Review Committee (reference number: 077/78-011). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. There were 73 total joint replacement of hips and knees. Of which, 32 (43.84%) total hip replacements were done in which one (3.13%) patient had a simultaneous bilateral hip replacement in single-stage and the other one (3.13%) had two-stage bilateral hip replacement. Forty one (56.16%) total knee replacements were done in which 18 (24.65%) had a simultaneous bilateral knee replacement and five (6.85%) had a unilateral knee replacement. Total joint replacements of the hip were more common among the lower limb surgeries.

Predictors of the use of analgesic drugs 1\u2009year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

BackgroundPain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics 1 year after surgery and focused on comorbidities and surgery-related factors.MethodsAll patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use 1 year after joint replacement were calculated.ResultsOf the 6238 hip replacement and 7501 knee replacement recipients, 3591 (26.1%) were still using analgesics 1 year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65–74.9 years (reference < 65), 1.1 (1.03–1.2); age > 75 years, 1.2 (1.1–1.3); female gender, 1.2 (1.1–1.3); BMI 30–34.9 kg/m2 (reference < 25 kg/m2), 1.1 (1.04–1.2); BMI > 35 kg/m2, 1.4 (1.3–1.6); and a higher number of comorbidities (according to the modified Charlson Comorbidity Index score), 1.2 (1.1–1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5–2.8), and knee surgery, 1.2 (1.1–1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77–0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids.ConclusionsObesity (especially BMI > 35 kg/m2) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases.

Ray C. Fish (1902–1962) was a leading figure in Houston's natural gas industry and a philanthropist. He believed in the American dream of “opportunity for success.” The Ray C. Fish Foundation was established so that others might be encouraged to broaden man's self-knowledge and to keep the American dream alive. After its founder's death from heart disease, the Fish Foundation granted $5 million to make the Texas Heart Institute a reality. For this reason, the Institute's highest professional award is given in honor of this extraordinary man. The award recognizes those whose innovations have made significant contributions to cardiovascular medicine and surgery. The 1st Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases were presented in 1972 to Dr. Norman Shumway. Since 1972, 25 other highly deserving recipients have been so honored by the Institute. The complete Roll of Recipients appears at the end of this article. In 2004, the faculty and staff of the Institute were extremely pleased to honor James L. Cox, MD. Dr. Cox received his award at a dinner held in conjunction with the Fifth Symposium on Cardiac Arrhythmias (New Pharmacologic and Interventional Strategies), on 14 February 2004, at the Houstonian Hotel, Club and Spa. James L. Cox, MD Dr. James L. Cox was honored for his seminal work in atrial fibrillation, a condition that affects up to 2 million people in the United States and is responsible for about 300,000 strokes every year. This disorder is characterized by spiraling electric signals that cause the heart to beat out of control. Dr. Cox has spent his career unraveling the mechanism behind this disorder and devising surgical techniques to cure it. In 1987, Dr. Cox performed his first Maze procedure. The Maze procedure definitively curbs the electrical, atrial chaos with a maze of incisions on the surface of the atria. The incisions block the signals, stopping the atrium from fibrillating. The Cox-Maze procedure has proved highly successful in long-term follow-up of patients. In 1967, Dr. Cox received his medical degree from the University of Tennessee, where he earned the Alpha Omega Alpha Distinguished Graduate Award as the outstanding student in his graduating class. He spent the next 11 years in surgical training under Dr. David Sabiston, Jr., at Duke University, except for a 2-year stint on active duty in the U.S. Army, which earned him a personal commendation from Brigadier General George S. Patton III. Dr. Cox was appointed an NIH Scholar in Academic Surgery for the remainder of his surgical training. After completing his residency, he remained at Duke for 5 years before leaving to become chief of the Division of Cardiothoracic Surgery at Washington University School of Medicine in St. Louis. In 1997, he left St. Louis for Washington, D.C., and the chairmanship of the Department of Cardiothoracic Surgery at Georgetown University. Not long thereafter, simultaneous bilateral knee replacements forced him to give up the clinical practice of surgery, but he has remained very active in the field. Currently, he is chairman and chief executive officer of The World Heart Foundation and a member of the board of directors of The Cardiothoracic Surgery Network (CTSNet). In addition, Dr. Cox was editor-in-chief of 2 of the 3 official journals of the American Association for Thoracic Surgery. Dr. Cox has trained more than 100 residents and fellows, delivered over 150 peer-reviewed scientific presentations, given over 180 invited lectures, and served as visiting professor at 79 institutions nationally and internationally and as invited operating surgeon at 40 international institutions. Dr. Cox has been a director of the American Board of Thoracic Surgery, a board member of the Thoracic Foundation for Research and Education, a member of the NIH Study Section on Surgery and Bioengineering, and chairman of the Residency Review Committee for Thoracic Surgery; in 2001, he was president of the American Association for Thoracic Surgery.

Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment.Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture.OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees.DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

Compare Between the Complication of Simultaneous and Staged Bilateral Knee Replacement at King Abdulaziz Medical City (KAMC) - Riyadh

Introduction: Total Knee replacement is a procedure commonly performed for degenerative joint disorder, e.g. osteoarthritis and rheumatoid arthritis. It is considered to be the most common and successful joint replacement. There will be an increase demand for the bilateral total knee replacement in the future due to increase of aging population and the indication to perform the surgery. There are controversies in the post surgical complication following simultaneous and staged bilateral total knee replacement; many studies have shown an increase in the mortality rate with simultaneous bilateral knee replacement. Other studies are showing evidence that suggest that there is no difference in the complication between simultaneous and staged bilateral total knee replacement. Methods: The study included 84 simultaneous BTKR, 110 staged BTKR (with time interval between the two 3 to 6 months) and 51 UTKR whom performed the surgery between January 2000 and August 2014. The collected data included demographic data, surgical data, complications and length of stay. We also have collected some variables of interest; Demographic (Gender, Age and Weight), Type of surgery (study groups), Hospital stay, Duration of procedure, Amount of bleeding, hemoglobin level before and after the operation and type of anesthesia. Results: We have a total of 245 patients. 110 (44.9%) underwent staged bilateral total knee replacement (BTKR), 84 underwent simultaneous bilateral total knee replacement (BTKR), and 51 of did the surgery on only one. The results showed that out of the 245, 194(79.18%) have not developed any complications, 62(73.81%) were simultaneous BTKR, 89(80.91%) of the staged BTKR and only 43(84.31%) were bilateral TKR. 43(17.55%) have developed minor complications which includes, Infection, UTI, Infected knee post operation or pulmonary complication other than pulmonary embolism. 18(21.43%) underwent simultaneous BTKR, 17(15.45%) for the staged BTKR and 8(15.69%) for the unilateral TKR. Only 8 patients have developed major complication (3.27%) of the general population. 4(4.76%) of the simultaneous BTKE and 4(3.64%) of the staged BTKR. None of the unilateral has developed major complication. We found a mean ± SE of the total days of hospital stay for all the groups was 12.58±. 52, for the simultaneous BTKR patients, the mean ± SE of hospital stay was 11.05±0.39 days, and for the staged was 16.19±1.31 days and 9.96±0.58 days, with a p value <.0001. Conclusion: We can say that simultaneous TKR is a save procedure to be performed especially in hospital where there is long waiting list as well difficulty of having elective bed as in our hospital. And we found out that patients whom underwent staged BTKR stayed at the hospital more than patients whom underwent simultaneous BTKR.

Limb Alignment Improves with Computer-Assisted Navigation in Total Knee Replacement, But Questions Remain

The value of intraoperative computer navigation during total knee arthroplasty has been debated for more than a decade. Despite substantial research, contradictory results and reservations about the cost and efficacy of the technology have contributed to the failure of computer navigation to become the accepted standard for establishing limb alignment during knee replacement surgery. In their paper, Zhang and colleagues report the results of a well-designed, prospective, randomized study that was conducted to compare the short-term clinical and radiographic results of total knee arthroplasty performed with computer navigation with the results of total knee arthroplasty performed with conventional mechanical instruments. The authors attempted to control for as many variables as possible by studying patients with bilateral knee arthritis who were undergoing simultaneous bilateral knee replacement. For each patient, both the order of the surgery and the knee that was assigned to the computer-navigation group were selected by randomization. During the follow-up period, the clinician, radiologist, and patient were blinded with regard to the type of procedure that had been performed on each knee. The outcomes recorded included overall limb alignment on full-length radiographs; various parameters of prosthetic positioning on both standard radiographs and …

Closed-chain exercise after simultaneous bilateral knee replacement surgery: A case report

ABSTRACTThe purpose of this case report was to present a method for assessing entire lower extremity performance and describe a Medical Exercise Therapy (MET) training program early after simultaneous bilateral total knee replacement (TKR). We also documented perceived function, mobility, and weight-bearing ability during functional tasks. The patient was a 50-year-old male who underwent a simultaneous bilateral procedure and began physical therapy (PT) 16 days postsurgery. Lower extremity performance (weight, repetitions, and load*volume) was assessed weekly using a one-legged horizontal press. Perceived physical abilities, mobility, and body weight placed over each limb during a sit to stand and a squat at two different flexion angles were assessed. At discharge load*volume for the weakest limb was 87% of the strongest side. At discharge, sit-to-stand, and 30 and 60 degree squat asymmetry ranged from 4% to 6%. Perceived abilities and mobility improved from initial visit to discharge. The patient was able to tolerate the closed-chain assessment of lower extremity performance and MET training program early after surgery. The patient made improvements in all functional tests and more importantly maintained a fairly equal distribution of body weight over both limbs during functional activities.

The relative safety of one-stage bilateral total knee arthroplasty

Patients with osteoarthritis of the knee often require bilateral knee replacement before fulfilling their full ambulatory potential. Despite extensive research there is considerable debate about the risks of performing simultaneous bilateral knee replacements under the same anaesthetic. Our aim was to compare the relative short-term morbidity of one-stage bilateral with unilateral total knee arthroplasty in a retrospective, consecutive cohort of patients. Seventy-two bilateral knee replacements were case-matched for age and gender with 144 unilateral knees. One-stage bilateral arthroplasty was associated with increased morbidity with respect to wound (6.0 vs 0.7%; p = 0.003) and deep prosthetic (3.5% vs 0.7 %; p = 0.02) infections, cardiac complications (3.5% vs 0.7%; p = 0.04) and chest infections (7.0% vs 1.4%; p = 0.04). No differences were observed in the mortality rates (p = 0.30) and risk of thrombo-embolism (p = 0.70). We conclude that one-stage bilateral total knee arthroplasty is associated with increased morbidity compared with unilateral knee replacement.

Complications and outcomes of single‐stage bilateral total knee arthroplasty

A recent literature review by the senior authors of this study revealed that simultaneous bilateral knee arthroplasty is uncommon and controversial. Reported complications include myocardial infarction, deep venous thrombosis, pulmonary embolus, thromboembolic complications, pseudo-obstruction, postoperative ileus and death. This present study was designed to identify complications of single-stage bilateral total knee arthroplasty to compare with reports in the international literature. A retrospective study of 40 cases of simultaneous total knee arthroplasty carried out by the senior authors at Wellington over the last 10 years, examined details of surgery, anaesthesia, preoperative and postoperative management to identify the occurrence of complications. Thirty-one patients completed an Oxford Knee Score, a EuroQuol-5 Dimension (EQ-5D) questionnaire and reported their experience of the bilateral procedure. Complications reported in the international literature did not occur in the patients studied. Complications that did occur included urinary retention, wound infections and oedema of the limbs or knees. The mean Oxford Knee Score was 20.79. In 2003 the New Zealand national mean for primary total knee arthroplasty was 23.35. The EQ-5D revealed high patient satisfaction and good functional status. While the outcomes and cost benefits of single stage bilateral replacement are established, the risk of complications remains. This study establishes the low complication rate associated with this procedure in the senior authors' hands, and documents the high patient satisfaction. The study demonstrates that, in selected patients, simultaneous bilateral knee replacement surgery can be performed with good outcomes without a definite increase in perioperative risk.

Bilateral Total Knee Replacement Using the Same Anesthetic Is Not Justified by Assessment of the Risks

The question of whether simultaneous bilateral knee replacement is associated with an increased risk of perioperative morbidity and mortality remains controversial. There are no true prospective randomized studies that address this question. There is general agreement that the risk is higher for older patients and for those with considerable medical comorbidities, particularly those with a history of cardiac disease. There is no general agreement on the appropriate threshold for age or comorbidities in order to minimize risk. Based on available retrospective data, there is evidence to suggest that there may be some patient selection bias favoring patients with simultaneous bilateral knee replacements; despite this bias, the perioperative risks are higher for these healthier patients. The highest risk for the patient having simultaneous bilateral knee replacement seems to be that of early postoperative mortality followed by the risk of a cardiac event. The risks of thromboembolic, gastrointestinal, and neurologic dysfunction also are increased. These patients also have a higher likelihood of requiring homologous blood transfusions and of requiring posthospitalization transfer to a rehabilitation center. Because of the absence of established patient selection criteria, thresholds for assessment of the increased risks, the patient having simultaneous bilateral replacement faces an increased risk of perioperative mortality and morbidity on a random basis. Patients should be aware of this information when deciding whether to proceed with simultaneous bilateral knee replacement.