Total Knee Arthroplasty In Terms Research Articles

Enhanced recovery after day surgery total knee arthroplasty, the new standard of care: An Asian perspective

BackgroundThis study describes the implementation of Enhanced Recovery After Surgery (ERAS) total knee arthroplasty (TKA) with day-surgery protocol to assess the outcome of ERAS day surgery TKA compared with traditional ERAS inpatient TKA in terms of length of stay (LOS), 30-day readmission, complications, and patient-reported outcome measures (PROMs). MethodsPatients who underwent unilateral primary TKA from August 2020 to July 2021 were followed up. All TKAs were performed with the ERAS protocol. Patients who fulfilled the following inclusion criteria were offered day-surgery protocol: (1) ASA ≤ 3; (2) agreeable for discharge home. In addition, this day-surgery protocol comprised the following: (i) on-call physiotherapy review; (ii) home visit by physiotherapist at 1 week postoperative; (iii) home visit by nurse at 2 weeks postoperative. Day surgery was defined as discharge within 24 h. Patients were followed up for 6 months and PROMs, postoperative complications, and re-admissions recorded. ResultsA total of 738 patients were included (342 ERAS day surgery, 396 ERAS inpatient). 92.4% of patients in the day-surgery group were successfully discharged within 24 h, leading to a shorter mean LOS of 1.13 days compared with 4.12 days in the inpatient group (P < 0.005). Both groups achieved significant and comparable improvement in Knee Society Score, Oxford Knee Score, and Physical and Mental component of Short Form-36. Both groups had similar rate of 30-day readmission and complications. ConclusionPatients who underwent ERAS day surgery TKA achieved similar functional and quality of life improvement compared with ERAS inpatient TKA with no increased complication rate. ERAS day surgery TKA is safe and cost effective, and its use should be promoted.

Robotic-assisted total knee arthroplasty in clinical practice: protocol for a randomised controlled trial

Between 2 and 20% of patients who undergo total knee arthroplasty (TKA) report restricted motion and anterior knee pain. Non-optimal alignment of the implant components is a common cause of such complaints. Robotic-assisted TKA has been advocated to improve the accuracy of component positioning to match patients’ anatomy and biomechanics. However, the advantages of robotic surgery over conventional freehand TKA are still unclear. The present study is a protocol for a single-blind clinical trial in which patients will be randomly allocated to undergo either robotic-assisted TKA or conventional freehand TKA. A restricted kinematic alignment with medial para-stellar approach shall be made in all patients. The present study follows the SPIRIT guidelines. The primary outcome of interest is to compare robotic TKA versus traditional freehand TKA in terms of patient-reported outcome measures (PROMs), length of hospitalisation, blood values, blood transfusion units, and range of motion. The second outcome of interest is to evaluate the accuracy of component positioning of robotic-assisted TKA compared to the conventional freehand TKA.Level of evidence Level I, randomised controlled trial.Registration German Registry of Clinical Trials (ID: DRKS00030614).

COMPARISON BETWEEN INTRA-ARTICULAR AND INTRAVENOUS TRANEXAMIC ACID APPLICATION IN PRIMARY UNILATERAL KNEE JOINT ARTHROPLASTY

To compare the efficacy of intra-articular and intravenous modes of administration of tranexamic acid in primary total knee arthroplasty in terms of blood loss and fall in haemoglobin level.Study Design: Randomized controlled trial.Duration of Study: Six months, from May 2019 to Nov 2019.Seventy-eight patients were included in the study. All patients undergoing unilateral primary total knee replacement were included in the study. Exclusion criteria were patients with hepatitis B and C, history of previous knee replacement, bilateral total knee replacement, allergy to TXA, Hb less than 11g/dl in males and less than 10g/dl in females, renal dysfunction, use of anticoagulants for 7 days prior to surgery and history of thromboembolic diseases. Patients were randomly divided into group A and B. Group A patients undergoing unilateral primary total knee replacement (TKR) were given intravenous tranexamic acid (TXA) while group B were infiltrated with intra-articular TXA. Volume of drain output, fall in haemoglobin (Hb) level and need for blood transfusion were measured immediately after surgery and at 12 and 24 hours post operatively in both groups.The study included 35 (44.87%) male and 43 (55.13%) female patients. Mean age of patients was 61 ± 6.59 years. The mean drain output calculated immediately after surgery in group A was 45.38 ± 20.75 ml compared with 47.95 ± 23.86 ml in group B (p=0.73). At 24 hours post operatively, mean drain output was 263.21 ± 38.50 ml in intravenous group versus 243.59 ± 70.73 ml in intra-articular group (p=0.46). Regarding fall in Hb level, both groups showed no significant difference (p&gt;0.05). About 12.82% (n=5) patients in group A compared to 10.26% (n=4) patients required blood transfusion post operatively (p=0.72).Intra-articular and intravenous TXA are equally effective in patients undergoing primary total knee arthroplasty in reducing post-operative blood loss.

Comparison of Postoperative Pain and Function in Robotic Total Knee Arthroplasty and Conventional Total Knee Arthroplasty Amongst Patients at King Fahad Medical City in Riyadh, Saudi Arabia.

Background Total knee arthroplasty (TKA) is the definitive surgical treatment for end-stage osteoarthritis and has been proven to relieve pain and improve function. With the rise in demand and the number of TKA procedures every year, more studies have been conducted on robotic TKA. Objective The objective of this study is to compare the postoperative pain between robotic and conventional TKA and the postoperative functional level between robotic and conventional TKA. Method This is a quantitative, observational, prospective study conducted from February 2022 to August 2022 amongst patients in the orthopaedic department of King Fahad Medical City, Riyadh, Saudi Arabia, who have undergone primary TKA for end-stage osteoarthritis using robotic TKA and conventional TKA. After applying the exclusion and inclusion criteria, a total of 26 patients (12 robotic and 14 conventional) were included in the study. The patients were assessed at three time points: two weeks, six weeks, and three months post-op. They were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the visual analogue scores (VAS) used to assess pain. Result A total of 26 patients were included in this research. The patients were divided into two groups: 12 robotic TKA patients and 14 conventional TKA patients. In this study, while comparing patients who underwent robotic TKA with those who underwent conventional TKA, no statistical significance was found regarding pain and function at all stages postoperatively. Conclusion There was no short-term difference between robotic and conventional TKA regarding pain and function. There is a need for further extensive research on robotic TKA in terms of cost-effectiveness, complications, implant survivorship, and long-term outcomes.

Intraarticular use of tranexamic acid during primary total knee arthroplasty

Background: Tranexamic acid (TXA) is effective in reduction of blood loss after major surgical procedures. In TKA surgeries, it is commonly administered intravenously. Since there are contraindications of systemic use of TXA, local/intraarticular TXA can also be used. The efficacy of both systemic and local TXA administration is demonstrated in the literature. The aim was to assess the effect of intraarticular TXA during total knee arthroplasty in terms of total blood loss and transfusion rate. Methods: A total of 50 TKA in 34 patients were included in this prospective study. Patients received one dose of intraarticular TXA of 3 g after skin closure and before deflation of the tourniquet. Results: The mean total blood loss in intra-articular TXA was 456.9 ml. None of the patients required transfusion postoperatively including those who underwent bilateral staged TKR. Mean postoperative hemoglobin loss was 1.07. Conclusions: TXA reduced blood loss and transfusion requirement. Intra-articular administration of TXA seems to be more effective in terms of reducing total blood loss and transfusion rates. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss.

Mobile-Bearing has no Benefit Over Fixed-Bearing Total Knee Arthroplasty in Joint Awareness and Crepitus: A Randomized Controlled Trial

BackgroundGiven higher component conformity, rotational availability of polyethylene insert, and more physiologic patellofemoral tracking, mobile-bearing (MB) total knee arthroplasty (TKA) is supposed to offer advantages in joint perception and crepitus. The purpose of this study was to investigate whether MB TKA offers superior outcomes over fixed-bearing (FB) TKA in terms of joint awareness and crepitus. MethodsThis prospective, randomized, controlled trial included 49 FB and 49 MB TKAs that shared the same posterior-stabilized femoral component. Primary outcomes included joint awareness assessed with the Forgotten Joint Score and crepitus graded according to severity and sound at 3 years postoperatively. Secondary outcomes were the range of motion, the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, component position, and joint line level on radiographs. ResultsThe Forgotten Joint Score showed no significant difference between the FB (67 points; range, 0-100) and MB groups (63 points; range, 13-100) (P = .440). For crepitus, no significant differences were found in the overall incidence rate (FB group, 18%; MB group, 12%; P = .386) and grade (grade 1, 6 versus 5; grade 2, 2 versus 1; grade 3, 1 versus 0, respectively). There were no significant differences in range of motion, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index, as well as radiographic outcomes between the two groups (all, P > .05). ConclusionMB TKA offers no benefits in terms of joint awareness and crepitus compared with FB TKA at mean 3 years postoperatively. The theoretical advantages of MB TKA have yet to be demonstrated in practice, leaving the selection of bearing type to the surgeon’s judgment. Level of EvidenceLevel II.

Effect of Oral Tranexamic Acid on the Blood Transfusion Rate and the Incidence of Deep Vein Thromboembolism in Patients after TKA.

Purpose To explore the effect of oral tranexamic acid treatment on the blood transfusion rate and the incidence of deep vein thromboembolism after total knee arthroplasty (TKA). Methods 90 patients undergoing TKA admitted to First People's Hospital of Changshu City from January 2019 to January 2020 were selected and randomized into the control group and the experimental group accordingly (45 cases in each group). The control group intravenously received 20 mL/kg tranexamic acid before the incision was closed. The experimental group was given 1 g of tranexamic acid orally before anesthesia, 6 h and 12 h after the operation. Results The experimental group witnessed better perioperative indexes in relation to the control group. The experimental group displayed better postoperative coagulation function indexes as compared to the control group (P < 0.05). Remarkably lower postoperative vascular endothelial function indexes in the experimental group than in the control group were observed. The experimental group experienced a markedly lower incidence of deep vein thromboembolism in comparison with the control group (P < 0.05). The postoperative knee society score (KSS) score of the experimental group was significantly higher than that of the control group. A significantly higher postoperative modified rivermead mobility index (MRMI) score was yielded in the experimental group in contrast to the control group (P < 0.05). The experimental group obtained lower numerical rating scale (NRS) scores at T2 and T3 as compared to the control group. Conclusion Oral tranexamic acid is a suitable alternative for patients undergoing TKA in terms of reducing the blood transfusion rate, relieving pain, and accelerating the recovery of the patient's limbs.

The current role of the virtual elements of artificial intelligence in total knee arthroplasty.

The current applications of the virtual elements of artificial intelligence (AI), machine learning (ML), and deep learning (DL) in total knee arthroplasty (TKA) are diverse.ML can predict the length of stay (LOS) and costs before primary TKA, the risk of transfusion after primary TKA, postoperative dissatisfaction after TKA, the size of TKA components, and poorest outcomes. The prediction of distinct results with ML models applying specific data is already possible; nevertheless, the prediction of more complex results is still imprecise. Remote patient monitoring systems offer the ability to more completely assess the individuals experiencing TKA in terms of mobility and rehabilitation compliance.DL can accurately identify the presence of TKA, distinguish between specific arthroplasty designs, and identify and classify knee osteoarthritis as accurately as an orthopedic surgeon. DL allows for the detection of prosthetic loosening from radiographs.Regarding the architectures associated with DL, artificial neural networks (ANNs) and convolutional neural networks (CNNs), ANNs can predict LOS, inpatient charges, and discharge disposition prior to primary TKA and CNNs allow for differentiation between different implant types with near-perfect accuracy.

Effectiveness of mental simulation practices after total knee arthroplasty in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.

Mental simulation practices, such as motor imagery, action observation, and guided imagery, have been an intervention of interest in neurological and musculoskeletal rehabilitation. Application of such practices to postoperative patients in orthopedics, particularly after total knee arthroplasty, has resulted in favorable physical function outcomes. In this systematic review and meta-analysis, we wish to determine the effectiveness of mental simulation practices with standard physical therapy compared to standard physical therapy alone in patients who underwent total knee arthroplasty in terms of postoperative pain, physical functions, and patient-reported outcome measures. We identified randomized controlled trials from inception to August 28, 2021, by using the PubMed, Cochrane Library, EMBASE, and Scopus databases. Data collection was completed on August 28, 2021. Finally, eight articles (249 patients) published between 2014 and 2020 were included. The meta-analysis revealed that mental simulation practices caused more favorable results in pain [standardized mean difference = −0.42, 95% confidence interval (CI) (−0.80 to −0.04), P = 0.03], range of motion [0.55, 95% CI (0.06–1.04), P = 0.03], maximal strength of quadriceps [1.21, 95% CI (0.31–2.12), P = 0.009], and 36-Item Short-Form Survey [0.53, 95% CI (0.14–0.92), P = 0.007]. Our data suggest that mental simulation practices may be considered adjunctive to standard physiotherapy after total knee arthroplasty in patients with knee osteoarthritis.

Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty

BackgroundThis study aimed to assess whether use of continuous passive motion (CPM) could improve range of motion in patients after total knee arthroplasty (TKA), if it could affect the surgical wound aspect (SWA) and if it could influence on pain management after TKA.MethodsWe randomized 210 patients in two groups, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain were measured before surgery, on the 1st, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the “surgical wound aspect score” (SWAS) in the next 48 h after surgery. This scale analyzes swelling, erythema, hematoma, blood drainage and blisters.ResultsThere was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for hematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain.ConclusionsThe application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in hematoma appearance.

Functional Outcome of Rotating Platform Versus Fixed Platform of Total Knee Arthroplasty- A Comparative Study

Background: Total knee arthroplasty (TKA) has shown to be a successful and reliable procedure for older, debilitatedpatients with knee osteoarthritis. TKA’s indications were widened to include younger and more active patients after itsinitial success.Objectives: To compare the functional outcome of rotating vs fixed platform of total knee arthroplastyMethods: All patients who are fit to undergo total knee arthroplasty like advanced stages of osteoarthritis and rheumatoidarthritis in age group of 50-70 years . We compared the functional outcome between rotating platform versus fixedplatform of Total Knee Arthroplasty. Clinical and radiological follow-up was performed at 1, 3, 6 months and 1year afterthe operation. Pre-operative and follow-up ratings according to Knee Society Scoring system were obtained for all thepatients. In addition, a visual analogue scale was used to specially assess the severity of the painResults: In group A and group B there were 6 males (30%) and 14 females (70 %). In both the groups the mean postoperative range of movements were significantly improved for the follow-up at every 3months with the mean ROM of120° achieved at 1year follow-up. The ROM has significantly improved from 90° at 3rd month follow- up to 120° at 1yearfollow-up. The mean KSS knee and functional score were gradually improved in post operatively in 3rd, 6th and 1yearfollow-up compared to the pre operative KSS score.Conclusion: The post-operative range of motion and the Knee Society functional score were similar in both groups. Therewas no significant statistical difference between the two groups of Total Knee Arthroplasty in terms of post-operativerange of motion and functional outcomes.

Abstracts

Abstracts

No significant difference in early clinical outcomes of custom versus off-the-shelf total knee arthroplasty: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to collect, synthesise and critically appraise findings of clinical studies that report outcomes of custom total knee arthroplasty (TKA). The hypothesis was that, compared to off-the-shelf (OTS) TKA, custom TKA would yield better surgical, clinical and radiographic outcomes. This systematic review and meta-analysis was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). On 8 February 2021, two authors independently searched and screened articles using MEDLINE®, Embase® and the Cochrane Library without restriction on date of publication. Findings from eligible articles were narratively synthesised and tabulated, and when ≥ 3 comparative studies reported the same outcome, results were pooled and summarised in forest plots. Quality assessments of the studies were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists. A total of 15 articles were eligible for data extraction, of which 9 were case-control studies reporting on 929 custom versus 998 OTS TKA, 5 were case series reporting on results of 587 custom TKA, and 1 was a cross-sectional study reporting on results of 44 custom versus 132 OTS TKA. Five studies that compared early revision rates found the overall effect in favour of OTS TKA(odds ratio (OR), 0.4; p = n.s.) but the result did not reach statistical significance. Four studies found no statistically significant difference inKSS knee (standardised mean difference (SMD), -0.10; p = n.s.) and function (SMD, 0.03; p = n.s.), and five studies found no statistically significant difference in range of motion (SMD, 0.02; p = n.s.). One study that compared bone-implant fit between custom and three OTS tibial components found no overhang but revealed under-coverage of up to 18% in knees with custom tibial baseplates. Custom TKA demonstrated no significant benefits compared to OTS TKA in terms of pooled clinical outcomes, but had considerably higher early revision rates. The findings of the present systematic review and meta-analysis suggest the need for studies with better comparable groups and standardisation of reporting outcomes amongst studies, that could increase the quality of evidence and enable pooling of results in future meta-analyses. Level IV.

Is Robotic TKA Having Added Advantage over Conventional TKA? A Comparative Study of Functional and Radiological Outcome of Robotic versus Conventional Total Knee Arthroplasty

Abstract Objective Total knee arthroplasty (TKA) is most commonly performed procedure in patients who are not showing improvement in pain, activities of daily living, and quality of life by conservative modalities. Precise component implantation and soft tissue management is required to achieve desired outcome following TKA. 1.3% patients remain disappointed due to persistent pain, 24% due to instability, and 2.5% due to malalignment following TKA. Robotic TKA is associated with the use of customized implants and bone cuts leading to precise component implantation and reduced deviation from mechanical axis in coronal, transverse, and sagittal plane and proper soft tissue management. This study compares conventional against robotic TKA in terms of clinical, functional, and radiological outcome. Materials and Methods This is a prospective randomized control trial carried over period of 3 years where patients were selected on the basis of inclusion and exclusion criteria and were randomly divided into both groups and compared using their pre- and postoperative radiological and functional outcomes as well as intraoperative and postoperative complications and statistical significance of difference was calculated. Results There was no significant difference in terms of ROM, KOOS (Knee Injury and Osteoarthritis Outcome Score), (Knee Society Score) KSS, Eq. 5D, (Western Ontario and McMaster Universities Osteoarthritis Index) WOMAC, and (visual analog scale) VAS scores while we found significant difference in mechanical axis deviation, femoral and tibial implant alignment in both planes. Discussion Advantages of using robotic TKA are customized preoperative planning, implants, cuts, accuracy of the intraoperative procedure, and radiological superiority with no significant differences in clinical and functional outcomes. In fact, robotic TKA is associated with steep learning curve, increased cost, and operative time. Still there are no added complications caused by it.

Patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral osteoarthritis: a systematic review and meta-analysis

BackgroundIsolated patellofemoral osteoarthritis (PF-OA) is a common subtype of knee osteoarthritis, leading to a huge economic burden on health care systems. Although previous studies have shown that patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) have good clinical effects, it remains largely unclear which treatment is more effective for patients with isolated PF-OA. We aimed to compare postoperative function, complications, revision rates, level of physical activity, and satisfaction rate between the two surgical techniques.MethodsOur study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search of literature was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until November 2020. The included studies were those that provided direct comparison of postoperative outcomes between PFA and TKA. Data were extracted from eligible studies and combined to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). Sensitivity analysis and subgroup analysis were conducted to evaluate heterogeneity between the two groups.ResultsA total of 7 eligible studies (3 recent randomized controlled trials and 4 nonrandomized controlled trials) were included in this meta-analysis. The pooled results showed that both the PFA group and the TKA group had improved postoperative indicators, suggesting that the two operation modes could improve the knee function and quality of life of patients. Throughout the first 2 years postoperatively, higher activity level, and better functional recovery were observed for PFA compared with TKA in this study; moreover, the differences between the two operation modes were statistically significant (p < 0.05). We found no significant difference in complications, revision rates, and satisfaction rate between the two procedures.ConclusionAlthough there was no observed difference in the complications, revision rates, and satisfaction rate between PFA and TKA, PFA was superior to TKA in terms of knee function and physical activity in the first 2 years postoperatively. Therefore, PFA is a safe, effective, and less invasive treatment for patients with isolated PF-OA. Our findings are consistent with the systematic review of current evidence that PFA may be more suitable for younger patients with high activity needs. Patient selection is, therefore, thought to be of paramount importance. Individualized surgical plan should be designed according to the patient’s age, BMI, KOA site, and activity level and combined with the doctor’s personal experience.

Pain outcomes following total knee replacement

Purpose: Total knee arthroplasty (TKA) is the final treatment option for end-stage knee osteoarthritis. While it is expected to resolve pain, 15-40% of patients have persistent pain 6 months after surgery that is not otherwise explained (e.g., infection, joint loosening). While the majority of patients undergo only one knee replacement, a substantial fraction of patients has both knees replaced, and these are typically staged (performed sequentially). The implications of having two TKAs in terms of pain outcomes, and whether there is a proportion of patients who do not achieve pain resolution after two TKAs is unclear.

Intravenous versus oral acetaminophen as an adjunct on pain and recovery after total knee arthroplasty: A systematic review and meta-analysis.

Background:Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, intravenous (IV) versus oral acetaminophen (APAP) treatment is still a controversial subject in TKA. Therefore, we write this systematic review and meta-analysis to evaluate the efficacy of IV versus oral APAP on pain and recovery after TKA.Methods:Embase, Pubmed, and Cochrane Library were comprehensively searched. Randomized controlled trials, cohort studies were included in our meta-analysis. Five studies that compared IV APAP groups with oral APAP groups were included in our meta-analysis. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines to ensure the reliability and verity of results.Results:Pooled results indicated that no significant difference between the IV APAP groups and oral APAP groups in term of VAS score at 24 hours (P = .67), 48 hours (P = 0.08), and total morphine consumption at 24 hours (P = .07), but there was a significant difference in terms of length of hospital stay (LOS) (P = .0004).Conclusion:IV APAP was not found to be superior to oral APAP in patients undergoing TKA in terms of VAS scores at 24 hours, 48 hours, and total morphine consumption at 24 hours. However, it can significantly reduce the LOS. We still need a large of high-quality research to verify the relationship between the oral and the IV APAP to give the conclusion.

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Unicompartmental knee arthroplasty and total knee arthroplasty are well established treatment options for end-stage osteoarthritis, UKA still remains infrequently used if you take all knee arthroplasties into account. An important factor following knee arthroplasty is pain control in the perioperative experience, as high postoperative pain level is associated with persistent postsurgical pain. There is little literature which describes pain values and the need for pain medication following UKA and/or TKA. So far, no significant difference in pain has been found between UKA and TKA. The aim of the study was to evaluate differences in the postoperative course in unicompartmental knee arthroplasty vs. total knee arthroplasty regarding the need for pain medication and patient-reported outcomes including pain scores and side effects. We hypothesized that unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of postoperative pain values and the need of pain medication. In this project, we evaluated 2117 patients who had unicompartmental knee arthroplasty and 3798 who had total knee arthroplasty performed, from 2015 to 2018. A total of 4144 patients could be compared after performing the matched pair analysis. A professional team was used for data collection and short patient interviews to achieve high data quality on the first postoperative day. Parameters were compared after performing a 1:1 matched pair analysis, multicenter-wide in 14 orthopedic departments. Pain scores were significantly lower for the UKA group than those of the TKA group (p < 0.001 respectively for activity pain, minimum and maximum pain). In the recovery unit, there was less need for pain medication in patients with UKA (p = 0.004 for non-opioids). The opiate consumption was similarly lower for the UKA group, but not statistically significant (p = 0.15). In the ward, the UKA group needed less opioids (p < 0.001). Patient subjective parameters were significantly better for UKA. After implantation of unicompartmental knee arthroplasty, patients showed lower pain scores, a reduced need for pain medication and better patient subjective parameters in the early postoperative course in this study.

Flexible versus standard intramedullary rod in posterior stabilized primary total knee arthroplasty: protocol for a randomized controlled trial

BackgroundIn total knee arthroplasty (TKA) a flexible intramedullary rod can be used to account for sagittal bowing of the distal femur. Although patients report better post-operative functional outcome when the flexible rod was used, it is unknown how the use of the flexible rod affects the placement of the femoral TKA component, and how this relates to activities of daily living. It is expected that the use of the flexible rod will result in a more flexed femoral component, a larger patellar tendon moment arm, and consequently in better functional outcome. The goal of this study is to compare the flexible rod to the standard intramedullary rod in primary TKA in terms of fit of the TKA, functional outcome, and sizing of the femoral component.MethodsA single-blind randomized controlled trial with two groups (flexible vs standard rod), with patients blinded for group allocation, and 2 years post-operative follow-up. The fit of the TKA is quantified by two parameters: (1) the flexion angle of the TKA in the sagittal plane and (2) the sagittal profile of the distal femur compared between the pre-operative bone and the TKA. Both parameters are calculated in 3D volume images obtained using fluoroscopy. Functional outcome will be measured using (1) the timed Get-up and Go test (2), the stair climbing test (3), knee power output, and (4) patient and clinician reported outcomes. Different parameters will be measured during the TKA procedure to account for the invisibility of cartilage in the 3D volumes and to study if the amount of bone removed during the procedure is affected by group allocation.DiscussionThe sagittal fit of TKA is not a standardized outcome measure. We discuss our choice of parameters to define the sagittal fit (i.e., flexion angle and sagittal profile), our choice for the parameters we measure during the TKA procedure to account for the lack of cartilage thickness in fluoroscopy, and our choice for the parameters to study if the amount of bone removed during the procedure is affected by group allocation. Lastly, we discuss the merits of this planned trial.Trial registrationNetherlands Trial Register, 4888, registered 30 March 2015. https://www.trialregister.nl/trial/4888

Current evidence base for kinematic alignment.

Kinematic alignment recently became an alternative alignment option for total knee arthroplasty (TKA). Beside previous studies assessing mechanical alignment in comparison to unintentional malalignment of TKA in terms of implant survival and clinical outcome, more and more studies have focused on the direct comparison of intentional kinematic alignment with mechanical alignment of the prosthesis. In the past 5 years the number of studies with respect to kinematic alignment has risen from 11to 91studies. The aim of this review article is to give anarrative overview of the current literature in the debate concerning kinematic and mechanical alignment in TKA.