Total Knee Replacement Patients Research Articles

Comparative study of adductor canal block versus femoral nerve block for effect on quadriceps muscle strength and postoperative pain in the patients undergoing Total knee replacement surgery

Background: Total knee replacement (TKR) patients experience severe pain during the early postoperative period1 as it involves extensive bone resection and soft tissue manipulation. The objective of this prospective, randomized, comparative study is therefore to compare the adductor canal block (ACB) with femoral nerve block (FNB) on quadriceps muscle strength preservation and analgesic efficacy in the patients undergoing TKR. Material and Methods: Present study conducted in ppatients of age group 35-70 years, ASA physical status class I, II and III patients posted for unilateral TKR. 50 ppatients were randomized equally by block randomization technique. Group 1 received Adductor Canal Block (15 ml bolus of 0.18% ropivacaine followed by infusion at the rate of 8-10ml/hr), Group 2 received Femoral Nerve Block (15 ml bolus of 0.18% ropivacaine followed by infusion at the rate of 8-10ml/hr) with electromechanical infusion pump for 24 Hours. Results: Gender, BMI distribution between two groups doesn’t have significant difference. Out of 50 patients in our study 19.6% (9) patients were ASA I, 75% (39) were ASA II and 5.4% (2) patients were ASA III. Heart rate, systolic blood pressure and diastolic blood pressure were measured preoperatively, post-operative at 6-8 hrs, at 12 hrs. and at 24 hrs. The difference in those parameters at any given time was not statistically significant. ACB is similar to FNB with respect to quadriceps muscle strength measured by MRC grading at 6 hours. However ACB is very effective in preserving the quadriceps muscle strength measured by MRC grading at 12 and 24 hours with a statistically significant ‘P’ value of 0.0001. Conclusion Adductor canal block makes early rehabilitation after total knee replacement without the risk of inpatient falls.

Cohort profile: the St Vincent’s Melbourne Arthroplasty Outcomes (SMART) Registry, a pragmatic prospective database defining outcomes in total hip and knee replacement patients

PurposeThe St Vincent’s Melbourne Arthroplasty Outcomes (SMART) Registry is an institutional clinical registry housed at a tertiary referral hospital in Australia. The SMART Registry is a pragmatic prospective database, which...

Better immediate and early postoperative outcomes of unicompartmental knee replacement comparing with total knee replacement: A matched cohort of patients with medial knee osteoarthritis

Introduction: This study compared the immediate and early postoperative outcomes of medial compartment knee osteoarthritis patients receiving unicompartmental knee replacement (UKR) with a matched cohort of total knee replacement (TKR). Methods: 26 UKR patients were matched with 26 TKR patients based on age, body mass index, pre-operative radiographic severity, range of motion (ROM), Knee Society score (KSS) and Feller patella score. Immediate postoperative outcomes were reflected by postoperative pain, blood loss, length of stay and the number of physiotherapy sessions attended. Early postoperative outcomes (ROM and KSS) were measured at 3 months and 1 year post-operatively. Results: UKR patients had less hemoglobin drop (UKR: 1.2 g/dL, TKR: 1.6 g/dL, p = 0.04), shorter length of stay (UKR: 4.3 days, TKR: 6.0 days, p < 0.001) and required less physiotherapy sessions for recovery (UKR: 6.9 sessions, TKR: 9.3 sessions, p < 0.05). There were no statistically significant differences in early post-operative pain score and postoperative analgesia use ( p > 0.05) between the two groups. Patients receiving UKR had significantly higher post-operative KSS (UKR: 155.9, TKR: 142.4, p = 0.005) and ROM (UKR: 115.8o, TKR: 98.8o, p < 0.001) at 3 months. The KSS and ROM of UKR group at 3 months was better than TKR group at 1-year follow-up. Conclusion: In patients with medial knee osteoarthritis, UKR showed less postoperative analgesic use and blood loss, shorter length of stay, shorter course of rehabilitation and faster recovery with better early KSS and ROM than TKR. Follow up is necessary for comparison in long term outcome and survivorship between the two groups.

A comparative retrospective analysis of indoor patients between 50 to 85 years of age suffering from osteoarthritis to determine the effectiveness of epidural and intravenous tramadol in pain relief and functional recovery after total knee replacement surgery

BACKGROUND: Total knee replacement surgery is among the most common major orthopedic surgery performed in cases of osteoarthritis on the knee joint. Total knee arthroplasty is considered to cause moderate-to-severe postoperative pain. No clear consensus in the available literature suggests a clear advantage between epidural tramadol and intravenous tramadol postoperatively due to the complications associated with an epidural catheter. AIM: This study aimed to determine the effectiveness of epidural tramadol and intravenous tramadol in pain relief and functional recovery in postoperative total knee replacement patients. MATERIALS AND METHODS: All cases operated for total knee replacement and postoperatively managed by epidural tramadol and intravenous tramadol were studied. This group included 20 patients of total knee replacement managed by epidural tramadol compared to 20 patients of total knee replacement managed by intravenous tramadol. RESULTS: Patients in the group managed postoperatively with intravenous tramadol for postoperative pain management showed a better functional outcome and pain relief as compared to patients managed with epidural tramadol. It was noted that in patients managed with intravenous tramadol, the knee range of motion and static and dynamic quadriceps exercises were started earlier and the patients were more compliant, which intern helped to achieve a better functional outcome posttotal knee replacement surgery. CONCLUSION: We would like to suggest in our limited 40 patient study group, the pain managed in patients by intravenous tramadol showed a better functional outcome as compared to the pain managed in the patients by epidural tramadol. Within our study group of 40 patients, it was noted that patient compliance and comfort was better in cases where tramadol was administered through an intravenous line as compared to an epidural catheter with no statistically significant difference in postoperative pain as well as functional outcome and recovery.

Study of Patients with Bilateral Knee Osteoarthritis Undergoing Total Knee Replacement Procedure with Coexisting Lumbar Spondylosis Symptoms.

Study DesignThis is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms.PurposeThe objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms.Overview of LiteratureNo studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery.MethodsThe study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively.ResultsAll 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention.ConclusionsA significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

Knowledge and attitude among physiotherapy interns towards physiotherapy and total knee replacement in case of osteoarthritis of knee

Aims: To find the knowledge and attitude among physiotherapy interns towards physiotherapy and total knee replacement in case of osteoarthritis of knee. Material and Methods: A cross-sectional observational study was carried out using a structured questionnaire. The structured questionnaire was designed to assess the knowledge and attitude among physiotherapy interns towards physiotherapy and total knee replacement in case of osteoarthritis of knee across the colleges in Gujarat. The data was analyzed by using the Statistical Package for Social Sciences (SPSS) statistical software, version 16. Results: Total 250 Interns students were participated in the study. Majority of Physiotherapy students believed 75-100% successful in improving functional mobility. Physiotherapy is effective in mild and moderate stage of osteoarthritis knee. Physiotherapy was considered as an alternative to total knee replacement by 85% of Interns, and they think that it can delay or avoid total knee replacement in patient with minimal symptoms, and if patient with minimal symptoms are advised for total knee replacement then they take an effort as to discuss with the orthopedic surgeons to take physiotherapy as first treatment option. Conclusion: Interns knowledge and attitude on Physiotherapy for osteoarthritis knee concludes that physiotherapy is effective in mild to moderate stage of osteoarthritis knee for improving functional mobility. Their opinion for advising criteria of total knee replacement to the individual having NPRS 8-10, Flexion range of motion restriction of 45-90 degrees, Extension range of motion restriction 0-45 degrees, Fixed flexion deformity, Medial Instability and ADL’s affection i.e. Getting out from chair, sit to stand, crossed leg sitting, squatting etc. Keywords: Osteoarthritis of knee, total knee replacement, Interns physiotherapy students. Physiotherapy.

Profile and Trends in Comorbidity for Patients Undergoing Hip and Knee Arthroplasty Using the Rx-Risk Measure with Pharmaceutical Dispensing Records

IntroductionPatient comobidity at time of primary joint replacement (JR) impacts on outcomes including revision and mortality. Understanding changes in comorbidity profiles is important when assessing change in outcomes over time. Most arthroplasty registries have limited comorbidity information due to their minimum dataset. One approach to obtaining additional comorbidity data is linking registry data with national administrative data. Objectives and ApproachObjectives were to quantify pre-operative comorbidity profile of patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) for osteoarthritis. Also, to examine temporal trends in individual comorbidities for THR and TKR patients. National pharmaceutical dispensing data were linked with THR and TKR arthroplasty patients. Medication dispensing histories in 12-months preceding JR (2003-2017) for 237,333 THR and 394,965 TKR patients, were mapped to 47 comorbidity classes using the Rx-Risk-V measure - a pharmacy-based measure of comorbidity. Comorbidity scores were calculated by summing comorbidity categories for individual patients. Trends in comorbidity scores/categories were described, with comorbidity information presented by PBS beneficiary category (concessional/general), stratified by age (&lt;65/≥65 years). ResultsMedian (interquartile range) comorbidity scores were higher in concessional patients ≥65y, THR:5(3-6), TKR:5(3-7); &lt;65y,TKR:5(3-6) but not THR:4(2-6). Comparative scores for general patients (both ages) were THR:4(2-6) and TKR:3(2-5). Trends in median comorbidity scores were consistent across study period, THR:4- 5(concessional)/2-3(general) and TKR:4-5(concessional)/4(general). Commonly identified comorbidities in younger concessional THR patients were pain, measured by opioid use (62.4%), inflammation/pain, measured by use of non-steroidal anti-inflammatories (62.2%), GORD (36.2%) and hypertension (36.1%). Individual comorbidities remained generally stable over time. However, increased patient proportions were seen in THR concessionals &lt;65y for opioid pain (59.1%-71.1%), depression (24.5-42.5%), whilst inflammation/pain (82.1-56.1%) and antiplatelet use (≥65y:23.5-9.2%) declined. Conclusion / Implicationsn THR or TKR patients no appreciable change in comorbidity score or comorbidity profile occurred over time. This suggests that improving JR outcomes over time are unlikely due solely to variation in patient comorbidity profiles.

Quality of life in total knee replacement (TKR) patients – A review

Worldwide, severe pain and disability are caused to patients by Osteoarthritis, which is a common condition of the joints. A need for knee replacement had become a great option for patients when conventional treatment fails in granting appropriate relief in them, especially in elderly patients. Like all joint replacement surgeries, a total knee replacement procedure is also a quite painful and risky procedure that requires sufficient postoperative rehabilitation and therapies to prevent further complications. Post-surgical pain had a great influence on the patients' quality of life and a need to measure pain intensity had become a basic requirement. Measuring pain intensity can be done using traditional pain scales like a visual analogue scale (VAS), and a numerical rating scale (NRS). A risk assessment and predictor tool (RAPT) determines the discharge accuracy in patients. The WOMAC scale which is the abbreviated form of the questionnaire for checking the health status of the patients known as the Western Ontario and McMaster University Osteoarthritis Index. This questionnaire is used to assess the quality of life of the osteoarthritis patients after a surgery for the total knee replacement. The results of the assessment show that pain had become a significant factor in the reduction in quality of life. In conclusion, a well-designed multimodal analgesic regimen should be incorporated into the patient's rehabilitation care, which in turn will intensify the patient's quality of life, lessen the hospital stay, and minimize the socio-economic burden

Do Total Ankle Replacements have Worse Outcomes when Compared to Total Knee and Hip Replacements at 10 Years Post-Operatively? A Prospective Clinical Study

Category:Ankle Arthritis; AnkleIntroduction/Purpose:There is paucity of literature comparing patient reported outcomes (PROMs) between total joint arthroplasties. There is a need to study the PROMS data to understand outcomes of treatment and factors affecting outcomes. We aimed to to study the PROMs data for total ankle replacement (TAR) to 10 years. To study how PROMS outcomes of TAR compare to total hip replacement (THR) and total knee replacement (TKR) at 10 yearsMethods:This is a prospective data collection from local hospital joint registry. 10 year follow up data was collected from patients who underwent a total joint replacement (Hip, Knee or ankle), provided informed consent for their data. Patients who refused consent, or had cognitive language problems were not approached for participation in the registry. Self-administered questionnaire data included WOMAC scores, Foot and ankle outcomes scores (FAOS), SF-36 scores and patient satisfaction data. Data was collected at pre-op, 3 years, 5 years and 10 years post operatively. Statistical tests including ANOVA, GLM univariate tests and chi-square tests were used for analysis.Results:There were 119 patients who underwent TAR for the duration of 2006-2009. 74 patients were male (62.18%). Average age of patients was 59.1 yrs. Data was available on 2672 THR and 3520 TKR patients. At 5 years, TAR patients reported lower scores for stiffness, similar outcomes to THR and TKR for mental health score, similar to TKR for ¾ physical domains (p<0.05), but lower satisfaction rates for ADL and recreation when compared to THR (p<0.05). We are currently processing the questionnaires for 10 year mailing returns (completion expected March 2020).Conclusion:The outcomes for TAR were similar to outcomes reported by TKR patients at 10 years but lower than THR. The lower score of TAR was due to stiffness and recreational activity comparing to THR. We aim to present the complete set of results if the abstract is accepted (data completion March 2020).

Preoperative iron treatment in anaemic patients undergoing elective total hip or knee arthroplasty: a systematic review and meta-analysis

ObjectivesPreoperative anaemia is associated with increased risks of postoperative complications, blood transfusion and mortality. This meta-analysis aims to review the best available evidence on the clinical effectiveness of preoperative iron...

Patient-Reported Outcomes Following Total Knee Replacement in Patients

An increasing number of total knee replacements (TKRs) are being performed in response to the growing burden of osteoarthritis. Patients <65 years of age represent the fastest growing group of TKR recipients and are expected to account for an increasing number of primary and revision procedures. Concerns have been raised about the outcomes that can be expected by this age demographic who are more active, physically demanding, and have longer life expectancies compared to older TKR recipients. This systematic review and meta-analysis evaluated the effectiveness of TKR for osteoarthritis in patients <65 years of age, compared to older individuals. A systematic search of Embase and Medline was conducted to identify studies which examined patient-reported outcomes measured using disease-specific and generic health-related quality of life instruments. Ten studies met our inclusion criteria and were included in this review. These studies comprised 1747 TKRs performed between 1977 and 2014. In the meta-analysis of two prospective studies (288 TKRs), patients <65 years of age were able to attain large and clinically meaningful improvements in pain, function, and quality of life. One of these studies (61 TKRs) suggested that patients <55 years of age attained a larger degree of improvement compared to older individuals. Results into the second postoperative decade were less certain, with some data suggesting a high prevalence of pain and patterns of functional decline. Further research is required to investigate longer-term outcomes following TKR for osteoarthritis in younger patients.

Predictive value of the morphology of proximal tibiofibular joint for total knee replacement in patients with knee osteoarthritis.

The association between proximal tibiofibular joint (PTFJ) and knee osteoarthritis (OA) has been understudied. The objective of this study was to determine whether the morphology of PTFJ has predictive value for the risk of total knee replacement (TKR). Case knees from Osteoarthritis Initiative participants with TKR at 24-60 months follow up (cases) were 1:1 matched with control knees (no TKR throughout 60 months) by baseline age, sex, and Kellgren-Lawrence grade. PTFJ morphological parameters, including coronal inclination angle (angle α), sagittal inclination angle (angle β), fibular contacting area (S), load-bearing area (Sτ), lateral stress-bolstering area (Sφ), and posterior stress-bolstering area (Sυ) were assessed using coronal and sagittal magnetic resonance imaging (MRI), respectively. Associations of the morphological measures at baseline and the time point before TKR (T0 ) and their changes with TKR risks were examined using conditional logistic regression analyses. Two hundred and twenty-three knees of 193 participants received TKR between 12 and 60 months and therefore were matched with 223 control knees. Of these, 173 paired knees had MRI readings available both at baseline and T0 time point. While baseline angle α was positively associated with TKR risk, other measures at baseline and all measures at T0 were not significantly associated with TKR risk. Changes in S, Sτ, and Sυ were significantly and negatively associated with the risk of TKR (ΔS, odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.19-0.76; ΔSτ, OR = 0.37, 95% CI: 0.16-0.87; ΔSυ, OR = 0.22, 95% CI: 0.08-0.62, respectively). This data shows that morphological changes of PTFJ predict the risk of TKR, suggesting PTFJ may play a role in knee OA.

Incidence of Total Knee Replacement in Patients With Previous Anterior Cruciate Ligament Reconstruction.

To determine the rate of total knee replacement (TKR) after anterior cruciate ligament reconstruction (ACL-R) compared to the general population. Retrospective review. All hospitals that performed TKR and ACL-R in Manitoba between 1980 and 2015. All patients that underwent TKR and ACL-R in Manitoba between 1980 and 2015. Patient factors gathered at time of surgery included: age, sex, urban or rural residence, neighborhood income quintile, and resource utilization band (RUB). Each person was matched with up to 5 people from the general population who had never had ACL-R and had not had a TKR at the time of the case ACL-R. The rate of TKR after ACL-R. Overall from 1980 to 2015, 8500 ACL-R were identified within the 16 to 60 years age group with a resultant 42 497 population matches. Sex was predominantly male. The mean age of the ACL-R group at the time of TKR was 53.7 years, whereas the mean age for the matched cohort was 58.2 years, P < 0.001. Those with ACL-R were 4.85 times more likely to go on to have TKR. Apart from age, no other risk factors examined (location, year of surgery, place of residence, income quintile, and RUB) seemed to increase risk of TKR after ACL-R. Patients who underwent ACL-R were 5 times more likely to undergo TKR.

NO DIFFERENCE BETWEEN A BICRUCIATE STABILISING KNEE AND CRUCIATE RETAINING KNEE REGARDS TO FUNCTIONAL OUTCOMES OVER THE BMI RANGE

Background: Clinical Commissioning Groups are increasingly withholding funding for total knee replacement in patients with higher BMIs and request that patients lose weight prior to surgery. In addition there is increasing evidence of variation in results across the BMI range coupled with some implants being specifically marketed as producing improvement in outcome scores.

EFFECTS OF FULL IMMERSION VIRTUAL REALITY TRAINING ON BALANCE AND KNEE FUNCTION IN TOTAL KNEE REPLACEMENT PATIENTS: A RANDOMIZED CONTROLLED STUDY

Background: Recently, new methods have emerged that encourage voluntary participation by allowing patients to perform tasks, including exercises or treatments, in a virtual reality (VR) environment. Aim: This study aimed to examine the effects of full immersion virtual reality training on balance and knee function in patients who had undergone total knee replacement. Design: Single blind randomized controlled trial. Setting: Department of Physical Therapy in a rehabilitation center. Population: A total of 30 elderly patients ([Formula: see text]65 years old) who had undergone total knee replacement. Methods: Participants were randomly allocated to an experimental group ([Formula: see text]) and a control group ([Formula: see text]). The experimental group received with a continuous passive motion machine, exercise therapy, and a full immersion VR training program; the control group received only with a continuous passive motion machine and exercise therapy. Biorescue was used to test static and dynamic balance ability, and the Timed Up and Go and Western Ontario and McMaster Universities tests were used to assess knee function. Paired [Formula: see text]-tests were used to examine differences by time in each group, and independent [Formula: see text]-tests were used to examine differences between the groups. Results: In terms of within-group differences by time, both the experimental group and the control group showed significant changes in the anterior, and posterior limits of stability in both sides; static balance; and knee function. In the between-groups comparison, among static balance tests, there was a significant difference in center of mass path length in the standing position with eyes open ([Formula: see text]); among dynamic balance tests, there were significant differences in left, right, anterior, and posterior limits of stability ([Formula: see text]). Conclusions: VR training produced better early balance ability and knee function than what was seen in the control group. We believe that VR training in initial post-operative rehabilitation of total knee replacement patients may increase the rate of recovery. Clinical Rehabilitation Impact: VR exercise programs are effective in early rehabilitation after total knee replacement, and have clinical value as inexpensive methods that can promote active participation.

Population-Based and Personalized Design of Total Knee Replacement Prosthesis for Additive Manufacturing Based on Chinese Anthropometric Data

At present, most total knee replacement (TKR) prostheses on the market are designed according to the sizes of Caucasians. However, extensive studies have indicated that human anatomies differ among different ethnicities. A number of reports have indicated that Chinese TKR patients do not match with available prostheses. In this study, computed tomography (CT) images of 52 knees of Chinese men and women were used for anthropometric measurements. Index and geometric measurements were defined and used for correlation analysis. Key parameters from the measurement results were identified. Detailed geometries of knees were measured as coordinates. A deformable three-dimensional (3D) knee model based on anatomical coordinates correlating with the identified key parameters was generated. A prosthesis was then designed according to the analyzed results. Surface matching analysis, bone resection analysis, and cadaveric trials were conducted and compared with commercial products to validate the proposed design. The femoral component designed by this study resulted in the highest accuracy (root mean square point-to-surface (RMS PS), (1.08 ± 0.20) mm) and lowest amount of resected bone volume (27 412 mm3) in comparison with two commercial knee prostheses. This study suggests a new approach for population-based patient-specific femoral prosthesis design. With a single, easily acquired dimension—namely, epicondyle width (ECW)—as input, a patient-specific femoral prosthesis can be designed according to the analyzed measured data and manufactured by additive manufacturing (AM) methods. Meanwhile, the reconstructed femoral condylar surface was compared with the femoral condylar surface in the original CT scanning data. The average RMS PS distance of the reconstructed femoral condylar surface among all data was (1.10 ± 0.18) mm, which is comparable to other statistical shape modeling methods using multiple radiographs as input data. There is a need to develop an anthropometric-based knee prosthesis for the Chinese population. Based on the anthropometry of the Chinese population, our new design fits Chinese patients better and reserves more bone volume compared with current commercial prostheses, which is an essential step toward AM for personalized knee prostheses.

Retraction Notice: Immediate Postoperative Portable Radiograph After Total Knee Replacements: A Necessity or a Burden?

Background Total Knee Replacement (TKR) is one of the most commonly performed orthopaedic surgery(1). Immediate postoperative portable radiographs are performed after primary TKR in order to identify any potential complications and technical flaws. It also serves as a reference for comparison with subsequent radiographs. The aim of this study was to evaluate the clinical and economical value of these radiographs in TKR. It compares the quality of the portable radiograph, taken immediately post-operation, with in-suite radiographs taken 5-7 weeks post-operation. Methods In this retrospective study, a consecutive series of 389 TKR patients from January-2011 to March-2015 were reviewed. Radiological evaluation consisted of assessing the beam angle and the exposure on the images. Implant positioning was also compared by measuring the anatomical axis to look for component alignment discrepancies. Results The quality of the portable recovery room radiograph was overall inferior to the radiology suite radiograph regarding both beam angle and exposure. Component alignment discrepancies were also identified in the angle measurements between both types of radiographs. Conclusion Therefore, our study demonstrated that there is no clinical or financial value obtained from postoperative portable radiograph. Furthermore, Immediate recovery room radiographs should be avoided from being performed routinely and may only be used in cases where the surgeon is utilizing a new implant or technique. No external funding was provided for this study from any source.

Developing thresholds for intervention recommendation and treatment success after orthopedic surgery

Abstract Background Patient reported outcome measures (PROMs) are increasingly used to monitor recovery paths and the outcome of orthopedic procedures. One of the focus areas is endoprosthetic joint care. Unfavorable post-surgery PROM scores might indicate adverse recovery paths. As of now, an adequate definition of thresholds for recommending an adaptation of therapy does not exist. The same is true for thresholds defining treatment success. Methods To address this research gap, minimal clinical improvement differences and patient acceptable symptom states are estimated using anchor-based methods. Moreover, to better capture the variance in patients' recovery paths, we calculate thresholds for subgroups of patients exhibiting similar pre-operative PROM scores. For this purpose, we use patient data from two German hospitals, covering roughly 6,000 total hip and knee replacement patients treated between 2016 and 2018. Patients answered standard PROM (WOMAC, EQ-5D) and tailored patient satisfaction questionnaires prior to surgery as well as three and twelve months after surgery. Results Whereas we found similar threshold values for total hip and knee replacement patients at the 12 months mark, threshold values after 3 months are systematically better for hip patients than for knee patients. Moreover, we find that thresholds depend on pre-surgery PROM scores. Patients with low pre-surgery scores recover slower, patients in mid-quartiles show large score improvements, and patients in the highest quartile show only mild improvements. Conclusions The study shows that when defining thresholds, it should not only be discriminated by indication but also by patient's pre-surgery condition. This pre-surgery condition can best be described by pre-surgery PROM scores. Further, to implement thresholds into standard care, policy makers need to collaborate with public sickness funds and hospitals to refine thresholds based on nation-wide data. Key messages An adequate definition of PROM score thresholds is necessary to be able to evaluate intervention recommendations and treatment success after surgery. So far, existing research is limited. Recovery paths and therefore PROM score thresholds differ between indications and are dependent on patients’ pre-surgery condition, best described by pre-surgery PROM scores.

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population.A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review.One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella.It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes.There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes.Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031

CRP (C Reactive Protein) level after total knee replacement in Indian population--- does it follow Anglo-Saxon trend?

BackgroundThis study was to determine how C-reactive protein (CRP) responds after total knee replacement (TKR), including both unilateral and simultaneous bilateral TKR in Indian population and if it follows Anglo-Saxon trend. Published literature from North America and Europe shows CRP value peaks on the 2nd post-operative day and drops to normal by 6–8 weeks. We started the study with null hypothesis.Material and methodsThis is a prospective study, with 50 patients (all females, 25 received unilateral operations and 25 bilateral ones) included. CRP levels were measured, on the 2nd day, 8, 12 and 16 weeks after operation.ResultsIn both groups, CRP level rose the 2nd post-operative day. The rise in CRP level was significantly higher in the simultaneous bilateral TKR group than in the unilateral TKR group. In unilateral cases, CRP on the 2nd postoperative day ranged from 65 to 110 mg/l with average level of 80 mg/ml. In bilateral TKR cases, CRP level on the 2nd postoperative day was between 110 and 180 mg/l with a mean of 140 mg/ml. The CRP level returned to normal in about 40% of unilateral TKR patients 8 weeks after operation, while in 92% (23 out of 25) of bilateral simultaneous TKR patients it stayed at a high level 8 weeks post-op and did not come back to normal. At 12 weeks CRP decreased to normal in all 100% of unilateral TKR patients and 32% of bilateral TKR patients. At 16 weeks, CRP was normal in all bilateral TKR patients.Conclusion60% of our unilateral TKR patients and 92% of our simultaneous bilateral TKR patients did not achieve a normal CRP 8 weeks after operation. These findings are significant as CRP is commonly used as a very sensitive indicator of postoperative joint infection. Hence we conclude that in the Indian TKR patients the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Published results regarding the normal levels of CRP in unilateral TKR should not be extrapolated to simultaneous bilateral TKR patients.