Total Knee Arthroplasty Surgery Research Articles

The "Wind Surf" Deformity-Correcting Fixed Flexion Deformity and Hyperextension in Bilateral CAS TKA.

Severe knee arthritis can result in complex coronal and sagittal angular deformities. Windswept deformity is used to describe a varus deformity and contralateral valgus deformity. We recognized a new sagittal pattern at the time of computer-assisted surgery (CAS) in total knee arthroplasty (TKA) in which one knee has a fixed flexion deformity (FFD), while the contralateral knee has a hyperextension deformity. We propose to define it as "wind surf" deformity mimicking the opposite pull of the wind and a surfer. The incidence of "wind surf" deformity in this series was 0.96% among a cohort of 2,291 bilateral TKAs performed between 2013 and 2018. Twenty-two patients were identified with an FFD of 5° to 20° on one knee and recurvatum of -5° to -20° on the contralateral knee. Additional bone resection and soft-tissue releases were performed for the FFD with a goal to maintain residual 1° to 3° of flexion. Minimal bone resection and soft-tissue disruption were performed on the knee with hyperextension with a goal to maintain 5° to 7° of flexion. These opposite strategies applied with the help of CAS prevented recurrence resulting in satisfactory clinical results at 2-year follow-up. The "wind surf" deformity variant should be identified in patients presenting with severe knee arthritis to guide surgical treatment, prevent recurrence, and obtain favorable clinical patient outcomes.

The relationship between body mass index and clinical efficacy of knee arthroplasty in patients with knee osteoarthritis.

BackgroundIncrease body mass index (BMI) is often accompanied by metabolic diseases such as diabetes, which will increase the uncertainty of total knee arthroplasty (TKA) efficacy and the risk of postoperative complications. The present study was to study the relationship between increase BMI and clinical efficacy of knee arthroplasty in patients with knee osteoarthritis.MethodsA total of 97 patients (36 males and 61 females) with knee osteoarthritis (KOA) who underwent TKA surgery were selected. According to the preoperative body mass index (BMI), the patients were divided into a normal group (n=42), overweight group (n=35), and obese group (n=20). All patients received TKA after admission. Seven days after surgery, the American Knee Society (AKS) and the Hospital for Special Surgery (HSS) scales were used to evaluate the recovery of knee function. The recovery was poor if the scores of AKS and HSS were less than 70.ResultsSeven days after TKA, the scores of AKS and HSS in different BMI groups were significantly different, and decreased with the increase of BMI (P<0.05). Age, increased BMI, diabetes, preoperative range of motion (ROM), intraoperative blood loss, postoperative C-reactive protein (CRP), postoperative posterior slope angle (PSA), postoperative infection, and postoperative deep vein thrombosis (DVT) of lower extremities were related to AKS score <70 (P<0.05). Diabetes, preoperative ROM, intraoperative blood loss, postoperative CRP, postoperative PSA, and postoperative infection were related to HSS score <70 (P<0.05). Increased BMI, diabetes, postoperative CRP, postoperative infection, and postoperative DVT were independent risk factors for AKS score <70 (HR =3.458, 1.152, 2.960, 1.023, 3.589, P<0.05). Increased BMI, diabetes, postoperative CRP, and postoperative infection were independent risk factors for HSS score <70 (HR =6.891, 1.263, 1.967, 1.235, P<1.235). The area under the curve (AUC) (95% CI) of BMI in diagnosing AKS <70 was 0.740 (0.641–0.839). The AUC (95% CI) of BMI in diagnosing HSS <70 was 0.809 (0.723–0.894).ConclusionsThe increase of BMI is an independent risk factor for the poor recovery of knee function after TKA in patients with KOA.

Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty.

BackgroundPain control after total knee arthroplasty (TKA) remains challenging. Tramadol is a weak opioid with potentially lower side effects and risk for dependency than stronger opioids. The purpose of this study was to evaluate efficacy and safety of tramadol after TKA in opioid-naïve patients compared with stronger opioids.MethodsA retrospective review of patients who underwent primary TKA was performed. In September 2018, opioid-naïve patients were prescribed tramadol instead of oxycodone. Patients receiving tramadol (low-opioid group) were matched to patients discharged with oxycodone before this transition (high-opioid group). We compared morphine milligram equivalent (MME) consumption and outcomes up to 3 months postoperatively.ResultsTwo-hundred and five patients underwent TKA, with 126 receiving tramadol. Fourteen patients were converted to stronger opioid (11.2% conversion rate). Seventy patients from the low-opioid group were matched to 70 patients in the high-opioid group. Average daily inpatient MME consumption was higher in the high-opioid group (40.0 ± 27.4 vs 16.3 ± 10.9, P = .000). Outpatient prescribed MME was significantly higher in the high-opioid group (135.5 ± 71.5 vs 75.3 ± 51.3, P = .000) along with a higher number of refills (0.53 ± 1.1 vs 0.886 ± 0.94, P = .041). Knee range of motion was not statistically different at any timepoint postoperatively. There was higher adverse event rate in the low-opioid group (8.6% vs 5.7%) but not statically significant.ConclusionsLow opioid regimen following TKA showed lower MME consumption than high opioid regimen with no effect on outcomes up to 3 months. Use of low opioid regimen should be considered for TKA surgery.

Intraoperative use of tranexamic acid in the control of bleeding in long bong fracture surgeries: a meta-analysis

&lt;p class="abstract"&gt;Tranexamic acid (TXA) has been used successfully in the practice of orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. The use of TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change and hospital-related costs at various degrees. This review aimed to evaluate the clinical results of the intraoperative use of TXA in long bone fracture surgeries. Relevant electronic articles were reviewed through a systematic search and selection process, resulting in the selection of five randomized control trials with a total of 295 participants. These studies compared the primary outcome of this meta-analysis, which was blood loss. Four of the studies included post-operative hemoglobin levels as their outcomes. Furthermore, two studies compared drop in hemoglobin levels, while three studies included blood transfusion events. Results showed a significant difference in terms of total blood loss when intraoperative administration of TXA was compared to placebo in long bone surgeries with a mean difference of -76.94 [-106.62, -47.26] (95% CI) (p≤0.00001). There was no significant difference in terms of post-operative hemoglobin levels (p=0.27) with a mean difference of 0.31 [-0.24, 0.86] (95% CI). No significant difference was also shown between the two groups as to drop in hemoglobin levels (p=0.29) with a mean difference of -0.34 [-0.97, 0.29] (95% CI). This meta-analysis showed that intraoperative use of TXA given during long bone fracture surgeries can effectively reduce total blood loss and reduce risk of transfusion events or avoid transfusion events.&lt;/p&gt;

Evaluating willingness for surgery using the SMART Choice\xa0(Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial

BackgroundApproximately 1 in 5 patients feel unsatisfied after total knee arthroplasty (TKA). Prognostic tools may aid in the patient selection process and reduce the proportion of patients who experience unsatisfactory surgery. This study uses the prognostic tool SMART Choice (Patient Prognostic Tool for Total Knee Arthroplasty) to predict patient improvement after TKA. The tool aims to be used by the patient without clinician input and does not require clinical data such as X-ray findings or blood results. The objective of this study is to evaluate the SMART Choice tool on patient decision making, particularly willingness for surgery. We hypothesise that the use of the SMART Choice tool will influence willingness to undergo surgery, especially when used earlier in the patient TKA journey.MethodsThis is a multicentred, pragmatic, randomised controlled trial conducted in Melbourne, Australia. Participants will be recruited from the St. Vincent’s Hospital, Melbourne (SVHM) Orthopaedic Clinic, and the client base of HCF, Australia (private health insurance company). Patients over 45 years of age who have been diagnosed with knee osteoarthritis and considering TKA are eligible for participation. Participants will be randomised to either use the SMART Choice tool or treatment as usual. The SMART Choice tool provides users with a prediction for improvement or deterioration / no change after surgery based on utility score change calculated from the Veterans-RAND 12 (VR-12) survey. The primary outcome of the study is patient willingness for TKA surgery. The secondary outcomes include evaluating the optimal timing for tool use and using decision quality questionnaires to understand the patient experience when using the tool. Participants will be followed up for 6 months from the time of recruitment.DiscussionThe SMART Choice tool has the potential to improve patient decision making for TKA. Although many prognostic tools have been developed for other areas of surgery, most are confined within academic bodies of work. This study will be one of the first to evaluate the impact of a prognostic tool on patient decision making using a prospective clinical trial, an important step in transitioning the tool for use in clinical practice.Trial registrationAustralia and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12622000072718. Prospectively registered – 21 January 2022.

Effects of physical activity interventions using wearables to improve objectively-measured and patient-reported outcomes in adults following orthopaedic surgical procedures: A systematic review.

ObjectiveTo synthesize evidence on physical activity interventions that used wearables, either alone or in combination with education or rehabilitation, in adults following orthopaedic surgical procedures.MethodsPubMed, CINAHL, PsycINFO and EMBASE were searched for randomized controlled trials of wearable-based interventions from each database’s inception to August 2021 in patients undergoing orthopaedic surgery. Relevant outcomes included physical activity, physical function, pain, psychological distress, or general health. PEDro scale scoring ranges from 0 to 10 and was used to appraise studies as high (≥7), moderate (5–6), or poor (<5) quality.ResultsOf 335 articles identified, 6 articles met eligibility criteria. PEDro scores ranged from 2 to 6, with 3 studies of moderate quality and 3 of poor quality. Studies included patients undergoing total knee (number; n = 4) or total knee or hip (n = 1) arthroplasty and lumbar disc herniation surgery (n = 1). In addition to wearables, intervention components included step diary (n = 2), motivational interviewing (n = 1), goal setting (n = 2), tailored exercise program (n = 2), or financial incentives (n = 1). Interventions were delivered in-person (n = 2), remotely (n = 3) or in a hybrid format (n = 1). Intervention duration ranged from 6 weeks to 6 months. Compared to controls, 3 moderate quality studies reported greater improvement in steps/day; however, 1 moderate and 2 poor quality studies showed no between-group difference in physical function, pain, or quality of life. No serious adverse events related to the use of wearable were reported.ConclusionsThe effects of physical activity interventions using wearables, either delivered in-person or remotely, appear promising for increasing steps per day after joint arthroplasty; however, this finding should be viewed with caution since it is based on 3 moderate quality studies. Further research is needed to determine the therapeutic effects of using wearables as an intervention component in patients undergoing other orthopaedic surgical procedures.Trial registrationPROSPERO Registration Number: CRD42020186103

Red Cell Distribution Width: A Clinical Indicator to Assess Severity and Guide Anti-Inflammatory Therapy in Patients with Knee Osteoarthritis

To explore the influence factors of the red cell distribution width (RDW) level in knee osteoarthritis (KOA) patients, the difference in RDW before and after total knee arthroplasty (TKA), and further explain the clinical value of the RDW level in KOA patients. Information of 195 patients with KOA and 43 patients with meniscus injuries undergoing surgical treatment in the Surgery Department of Joint and Microsurgery Repair and the Surgery Department of Sports Trauma and Joint Arthroscopy of the First Affiliated Hospital of Anhui Medical University from June 1, 2020, to December 1, 2020, were collected. All included patients’ gender, age, height, medical history, blood lipid, erythrocyte sedimentation rate (ESR), CRP, RDW, anteroposterior and lateral X-ray images of the knee joint, and magnetic resonance imaging (MRI) of the knee joint were recorded. The difference in RDW of KOA patients with different severities before and after unilateral TKA surgery was compared, and the difference between KOA patients and patients with only meniscus injury was also compared for further analysis of the influence factors of the RDW level in moderate-severe KOA patients. Among moderate-severe KOA patients with different imaging severities, the RDW level was significantly different (P = 0.022). There was no statistical difference between the groups with and without the TKA history. The RDW level was higher in KOA patients than in patients with only meniscus injuries, and the difference was statistically significant P &lt; 0.05 . To some extent, the RDW level could be taken as a predictor for the severity of moderate-severe KOA patients, and its elevation was primarily related to chondritis and synovitis caused by KOA, so it was suggested that the patients receive adjuvant anti-inflammation therapy after TKA surgery.

Pain, Function, and Satisfaction After Total Knee Arthroplasty, with or Without Bariatric Surgery

BackgroundThe impact of obesity on patient-reported outcome (PRO) after total knee arthroplasty (TKA) surgery has demonstrated varying results. We evaluated knee pain, Activity in Daily Life function (ADL), and satisfaction after TKA surgery in patients with and without prior bariatric surgery (BS).MethodsScandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) were used to identify patients operated on with primary TKA for osteoarthritis (OA) between 2009 and 2019 that had a BS within 2 years before the TKA (BS group). These patients were compared to patients with TKA without prior BS (no BS group). The patients filled in the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and one year postoperatively as well as satisfaction with the surgery one year postoperatively. Multiple linear regression analysis was used to evaluate 1-year postoperative KOOS pain and ADL function between the 2 groups. Adjustments were made for sex, age, and preoperative KOOS pain and ADL function respectively.ResultsForty-four patients were included in the BS group and 3,525 patients in the no BS group. We found no statistically or clinically significant difference in one-year postoperative KOOS pain and ADL function between the BS group and the no BS group. The majority of the patients in both groups were classified as satisfied or very satisfied one year postoperatively to the TKA.ConclusionsOur results indicate that patients without BS prior to the TKA gain similar 1-year outcome in pain, ADL function and satisfaction as patients with prior BS.Graphical abstract

Hip and Knee Arthroplasty Alternative Payment Model Successes and Challenges.

Hip and Knee Arthroplasty Alternative Payment Model Successes and Challenges.

The effect of whole-body vibration in osteopenic patients after total knee arthroplasty: a randomized controlled trial.

Total knee arthroplasty (TKA) is an important treatment for knee osteoarthritis, but the result of whole-body vibration (WBV) in knee function rehabilitation and bone loss with osteopenia was unknown. Therefore, the purpose of this study is to study whether low-frequency, low-amplitude WBV can improve the clinical outcome of knee osteoarthritis. This study was randomized and included 67 osteopenic patients (55-90years, 85% women) for TKA surgery (control group N = 32, WBV group N = 35). All selected patients after TKA surgery tested clinical results, such as knee function and bone mass in baseline, 3months after surgery, and 6months after surgery. Compared to the control group, the WBV group improved pain scores, thigh circumference, lower limb muscle strength, joint activity, and joint function in 6months after surgery. WBV intervention also improves bone density in the spine, the microstructure of the radius and tibia, and the bone turnover marker. At 3months after TKA surgery, the WBV group had no significant effect on knee function and bone loss. Whole-body vibration for osteopenic patients with knee arthroplasty showed good therapeutic results in 6months after TKA surgery, but the long-term therapeutic effect still needs to be further observed.

Failure Analysis in Multiple TKA Revisions-Periprosthetic Infections Remain Surgeons' Nemesis.

Background: The aim of this study was to categorize reasons for failure and to analyze the survivorship of multiple total knee arthroplasty (TKA) revisions. Methods: The study retrospectively evaluated all multiple TKA revisions performed between 2005 and 2015 at the authors’ institutions. Sixty-three patients (35 female, 28 male, age 64 ± 10 years, follow-up 55 ± 36 months) underwent a total of 157 re-revision TKA surgeries (range 2–5). The revision indications were divided up into main diagnoses. Survivorship was evaluated by mixed model analysis. Results: The main overall reason for re-revision was periprosthetic joint infection (PJI) (48%), followed by instability (12%), polyethylene wear (11%), malpositioning (8%), and aseptic loosening (8%). Survivorship shortened with an increasing number of revision surgeries (p = 0.003). While PJI was in 38% of all cases, the reason for the first revision, incidence increased constantly with the number of revisions (48% at second revision, 55% at third revision, 86% at fourth revision, and 100% at fifth revision, p = 0.022). If periprosthetic infection caused the first revision, patients showed an average of two more septic revisions at follow-up than patients with an aseptic first revision indication (p < 0.001). In 36% of cases, the reason for follow-up surgery in case of periprosthetic infection was again PJI. Conclusion: The probability of survival of the implanted knee arthroplasty is significantly reduced with each subsequent revision. Periprosthetic infection is the main cause of multiple revisions.

Robot-assisted surgery in total knee arthroplasty: trauma maker or trauma savior? A prospective, randomized cohort study.

BackgroundRobotic assistance has been increasingly employed to improve the operative precision in modern knee surgery. The purpose of the study was to evaluate the trauma effect of one of the first domestically developed orthopedic surgical robots in China in a clinical trial of robot-assisted total knee arthroplasty (RA-TKA).MethodsA total of 33 patients who underwent unilateral TKA for end-stage osteoarthritis were randomized to receive RA-TKA (17 cases) or conventional manual TKA (CM-TKA) in our institution in 2020. The trauma effects of the 4 main indicators with 48 sub-indicators in terms of subsectional operative time, inflammation and coagulation markers, physical and radiographical analyses of osteotomy deviation, and postoperative comfort were analyzed.ResultsSubsectional operative time analysis showed that the times for bone cutting and gap balancing with RA-TKA were 5.3 and 2.2 min shorter than those with CM-TKA (p = 0.010, p = 0.02), respectively. Arterial blood gas indicators (partial pressure of carbon dioxide, partial pressure of oxygen and SO2) 24 h after RA-TKA, as well as the white blood cell count and neutrophil ratio, were significantly lower than those after CM-TKA (p < 0.05). Inflammatory markers at 72 h after surgery showed the increments of C-reactive protein, erythrocyte sedimentation rate and D-dimer of RA-TKA declined by 180.7, 22.0 and 1050.0% (p < 0.05), respectively, referenced to the preoperative baseline values, as compared to CM-TKA. Mechanical deviation distribution exhibited percentages of region I errors for RA-TKA and CM-TKA of 76.5% and 27.1% (p = 0.000), respectively, and the success rates of one-time osteotomy were 94.1% and 62.5% (p = 0.039), respectively. Radiographical verification showed RA-TKA was more conducive to achieving mechanical alignment and ideal tibial component azimuths. Postoperative efficacy showed that patients were more comfortable after RA-TKA in terms of reduced administration of tranexamic acid, hydrocortisone and the utilization rate of temporary intensive opioid analgesics. No statistical difference in patient-reported outcome measures and complications were recorded between the two groups during continuous observation.ConclusionsCompared with CM-TKA, RA-TKA decreases rather than increases trauma. It might shorten the time required for bone cutting and gap balancing, reduce mechanical errors related to the osteotomy and prosthesis position, and improve the accuracy of the mechanical alignment reconstruction. RA-TKA is also favorable in promoting postoperative comfort and minimizing inflammatory response and drug consumption.Trial registrationThe Chinese Clinical Trial Registry (ChiCTR2000031282) approved registration on 26 March 2020.

Patella related problems as common reason for revision of NexGen PS® total knee arthroplasty without patella resurfacing: An analysis of 5911 primary total knee arthroplasties registered in the Dutch Arthroplasty Register

BackgroundPatella resurfacing remains controversial in primary total knee arthroplasty (TKA).The aim of this study was to investigate if there was a difference in revision rate and reason for revision within 8 years after single brand primary cemented TKA with or without patella resurfacing, using data from the Dutch Arthroplasty Register. MethodsAll primary TKA surgeries with a posterior stabilized cemented primary NexGen®, between 2010 and 2013 with diagnosis osteoarthritis were analyzed (n = 5911). Multivariate cox regression analyses were performed to analyze differences in revision rate between TKA with or without patella component, and was adjusted for age and previous surgery. ResultsOf 5911 TKA surgeries, 4795 were performed without patella resurfacing (81.1%) and 1116 with patella resurfacing (18.9%). There was a significant difference in patellar problems as reason for revision between patients after primary TKA with patella resurfacing (9.3%) and without patella resurfacing (29.9%) (p = 0.01). This was mostly caused by patellar pain (28.0%). There was no significant difference in cumulative revision rate within between TKA with patella resurfacing and without patella resurfacing. ConclusionIn conclusion, 30% of patients who need revision surgery after TKA using NexGen® PS without patella resurfacing the reason for revision is patella related problems, compared to 9% after TKA NexGen® PS with patella resurfacing. There was no difference in cumulative incidence of revision after primary surgery of all TKA’s using NexGen® PS with or without patella. To reduce the probability of reoperation for patella related problems, our data suggest the patella should be resurface during primary TKA.

Crohn’s disease in total knee arthroplasty patients correlates with increased rates of 90-day and overall postoperative complications and readmissions

BackgroundJoint involvement is a common extraintestinal manifestation of Crohn’s Disease (CD) that may require total knee arthroplasty (TKA). There is a paucity of evidence regarding the relationship between CD and postoperative outcomes after TKA surgery. This study seeks to evaluate the impact of CD on 90-day and ≥2-year follow-up postoperative outcomes of TKA patients. MethodsWe retrospectively analyzed the Statewide Planning and Research Cooperative System database (2009–2013) and isolated ICD-9 codes for TKA patients (8154), while excluding those with any revision of knee replacements (0080–0084) and split into 2 groups with or without CD (5550–5559). Patient demographics and postoperative outcomes were compared. Logistic regression analyses with covariates (sex, race, Deyo score, age, and insurance) were utilized to evaluate the association of CD with 90-day and overall postoperative outcomes. ResultsA total of 89,134 TKA patients were identified, 244 of whom had CD. Significant differences in age, race distribution, insurance, and Deyo score (all, p < 0.05) were found. Multivariable analysis demonstrated CD was an independent risk factor for 90-day and overall medical complications, surgical complications, and readmission. Univariate and multivariable analyses report CD had significant increased rates and was a predictor, respectively, of overall blood transfusions (OR 1.5 [95% CI 1.1–2.0] p < 0.01), acute renal failure (OR 1.7 [95% CI 1.1–2.6] p = 0.03), and pulmonary embolism (OR 2.5 [95% CI 1.3–4.6] p = 0.01). ConclusionPatients with CD undergoing TKA have increased risk both 90-day and overall surgical and medication complications, as well as readmissions compared to patients without CD.

Comparing outcomes between enhanced recovery after surgery and traditional protocols in total knee arthroplasty: a retrospective cohort study

BACKGROUND: Knee replacement surgery was traditionally associated with prolonged recovery and rehabilitation programmes in hospital. Enhanced recovery after surgery (ERAS) protocols have been shown to be cost effective while not compromising patient safety or functional outcome. Despite this proven efficacy, ERAS has not been widely adopted in South African orthopaedic practices. The aim of this study is to determine if it is possible to practise these guidelines in South Africa so as to decrease the length of stay (LOS) without an increase in complication rate or compromise in functional outcome. METHODS: Included in the study were 119 patients undergoing elective total knee arthroplasty between 2013 and 2017. They were divided into two cohorts. The first group was treated with a traditional protocol and included 59 patients. The second group was treated with ERAS and included 60 patients, following implementation of the ERAS protocol in 2015. The functional outcome was assessed using the Oxford Knee Score (OKS). The 30-day readmission rate was used to assess safety of early discharge. LOS and patient demographics were also collected to compare the cohorts. RESULTS: There was no clinically significant difference between the cohorts with regards to OKS or readmission rate. Two sample t-tests were used to compare these parameters. The mean OKS for the traditional group was 59.1 (SD 2.4), and for the ERAS group, 58.7 (SD 5.0) (p = 0.73). The readmission rate was 8.5% in the traditional group and 10% in the ERAS group (p = 1.00). The LOS was significantly decreased in the ERAS group, with a mean of 2.3 days (SD 1.8) compared to 5.0 (SD 2.2) in the traditional group (p &lt; 0.001). CONCLUSION: ERAS protocols used in the South African context in elective total knee arthroplasty significantly decrease the LOS without compromising patient safety or functional outcome. Level of evidence: Level 3.

Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005-2011 and 2012-2017 in a Referral Center.

Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery.

Analgesic efficacy of etoricoxib versus ibuprofen in unilateral hip or knee arthroplasty: an open-label randomized trial

Background and objective The preventive perioperative use of etoricoxib versus ibuprofen in patients undergoing either elective total hip arthroplasty or total knee arthroplasty (THA/TKA) surgeries has not been evaluated.Patients and methods This randomized open-label trial was conducted in 60 patients of the American Society of Anesthesiologists physical status I/II, of either sex, 18–70 years, undergoing elective unilateral THA/TKA. Group ibuprofen (n=30) received ibuprofen 400 mg per oral 1 h before surgery and then every 6 h for 48 h postoperatively. Group etoricoxib (n=30) received etoricoxib 120 mg of per oral 1 h before surgery and then at 24 and 48 h postoperatively. Both groups received combined spinal–epidural anesthesia intraoperatively and patient-controlled epidural analgesia postoperatively for 48 h. The primary outcome of the study was pain assessment using visual analog scale (VAS). The number of epidural bolus, rescue tramadol consumption, hemodynamics, postoperative nausea and vomiting, and side effects in 48 h postoperatively were also recorded.Results The VAS at rest at 4 h was greater in group ibuprofen versus in group etoricoxib, P value of 0.023. The VAS on movement at 2 and 4 h was greater in group ibuprofen versus group etoricoxib, P value of 0.013, P value of 0.014, respectively. The mean±SD (range) blood loss was reported to be greater in group ibuprofen as compared with group etoricoxib, P value of 0.013. There were no side effects.Conclusion Preventive use of oral etoricoxib versus ibuprofen for 48 h postoperatively reported similar pain relief in patients receiving following elective THA/TKA surgeries.Trial registration The clinical trial was registered with Clinical Trial Registry India (CTRI/2011/07/001901).

Evaluation of local tissue peri-implant reaction in total knee arthroplasty failure cases.

Introduction:Implant-related hypersensitivity is emerging as a causative factor as a potential source of total knee arthroplasty (TKA) failure. Mechanistically, this type IV hypersensitivity reaction (T4HR) is mediated by effector T-cells, macrophages, and leukocytes that infiltrate to the site of implant and react to metal exposure and induce inflammatory tissue damage.Methods:A case–control study was performed where cortical bone was taken at the time of revision surgery for all patients operated on for primary TKA in which metal allergy was suspected and for revision TKA cases done for presumed metal allergy. Cytof was used to determine the cell density of inflammatory cells, specifically Th1, Th2, M1, and M2 cells.Results:Comparing the mean cell density of primary versus revision TKA, revision TKA patients had significantly higher number of Th2 cells compared with Th1 cells (p = 0.0043). Among revision cases, there were significantly more M1 versus M2 macrophages (p = 0.034) within a patient. When comparing mean cell density of M1 versus M2 macrophages, there was a significant difference in both primary and revision TKA surgeries (p = 0.0041 primary, p < 0.001 revision). Among revision patients who had a predominance of Th2 cells, four (44%) of nine patients had a negative LTT/patch test.Conclusion:These data support metal hypersensitivity, mediated by a T4HR, for some cases of TKA failure. Current methods to screen patients for metal hypersensitivity prior to primary TKA have been inclusive. This study demonstrates the need for a more sensitive screening test from specimens in the knee joint, to more accurately identify patients who will exhibit a T4HR to metal.

TOTAL KNEE ARTHROPLASTY: UNILATERAL, SIMULTANEOUS BILATERAL OR STAGED BILATERAL IN ADVANCED AGE?

Introduction: Most people with arthritic knees often present with symmetrical joint involvement, a condition often requiring surgery for both knees. There are, however, some disagreements concerning whether or not total knee arthroplasty should be performed simultaneously or in stages. This study aimed to evaluate the length of hospital stay, the need for erythrocyte suspension transfusion, the need for intensive care, and the mortality rates of the patients who underwent unilateral, simultaneous bilateral, and staged bilateral total knee arthroplasty. Materials and Methods: This retrospective study included 1,129 patients, who were divided into three groups based on whether they underwent unilateral, simultaneous bilateral, or staged bilateral total knee arthroplasty, and they were evaluated in terms of hospital stay, erythrocyte suspension transfusion needs, intensive care needs, and mortality rates. Results: Of all the patients, 85.5% were women, with the mean age of 67.58±7.23 years; and 75.6% of them underwent unilateral, 19.9% underwent simultaneous bilateral, 4.5% had staged bilateral total knee arthroplasty, 8.8% required ICU care, and 5 patients died. The need for erythrocyte suspension transfusion and length of hospital stay were highest in those who underwent staged bilateral knee arthroplasty surgery, while it was lowest in those who underwent simultaneous bilateral total knee arthroplasty surgery (all p&lt;0.001). There was no statistically significant difference in terms of the need for intensive care need, length of stay in intensive care unit and mortality rates between patients who underwent unilateral, simultaneous bilateral, and staged bilateral total knee arthroplasty. Conclusion: Simultaneous bilateral total knee arthroplasty may be preferred in younger patients with bilateral knee osteoarthritis but without risky comorbidities, just as we practiced in our clinic. Keywords: Osteoarthritis, Knee; Arthroplasty, Replacement, Knee; Mortality

Mathematical modeling of recovery curves

As the population of people in the globe continues to age, there will be a growing demand for health issues including treatment of Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). This will result in a growth in post-operation rehabilitation services. In order to meet this growth, it will be beneficial for occupational therapists and physical therapists to have an understanding of a patient’s expected post-surgery recovery rate. Once developed these rates can be used to benchmark individual patient improvement, help estimate expected costs and lengths of therapy, and possibly help design optimal treatment session scheduling. In this paper, we consider Hierarchical Linear Model to analyze how male and female patients respond to TKA and similar surgeries.