Total knee arthroplasty for primary knee osteoarthritis: Changing pattern over the past 10 years

Objective: To review the epidemiology of total knee arthroplasty for primary osteoarthritis and the change of patient characteristics over the last decade. Design: Retrospective review. Setting: A tertiary referral centre for joint replacement surgery in a teaching hospital in Hong Kong. Patients: All patients who underwent primary total knee arthroplasty for primary knee osteoarthritis from January 2000 to December 2009. Results: In all, 1157 total knee arthroplasties (589 left and 568 right) were performed on 588 females and 162 males. The annual number of total knee arthroplasties increased from 91 in 2000 to 181 in 2009. The annual number of patients increased from 58 (46 female, 12 male) in 2000 to 159 (117 female, 42 male) in 2009. When compared yearly results, there were no significant changes in the preoperative Knee Society Knee Score, Knee Society Functional Assessment, and passive range of motion of these patients. However, there was a significant decreasing trend with regard to lower limb mechanical axis mal-alignment, from 15.1° deviation from the neutral axis in 2000, to 14.8° deviation in 2004, and then 12.9° deviation in 2009 (mostly varus deformity). There was no difference between left knees and right knees, and between females and males. The mean age of the patients did not show significant change over the past decade, but the number and proportion of patients over 80 years old showed an increase from 4.8% (2000 to 2004) to 13.8% (2005 to 2009). On the other hand, the number and proportion of patients under the age of 60 years did not change. Conclusions: There was an increasing trend towards total knee arthroplasties, both in terms of number of operations and patients. The number of younger patients having total knee arthroplasty did not increase over the last 10 years, whereas the number of those older than 80 years increased significantly over that period.published_or_final_versio

Review article: Venous thromboembolism after total joint replacement

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Antibiotic prophylaxis after total joint replacements

Objectives: To review the latest evidence on antibiotic prophylaxis for patients with total joint replacements to prevent prosthesis infections. Data sources: Literature search of Medline and PubMed until June 2009. Study selection: Studies of patients with total joint replacements from around the world, studies concerning antibiotic prophylaxis, as well as chemoprophylaxis guidelines from orthopaedic associations were searched. Data extraction: Literature review, original articles, case reports, best practice guidelines. Data synthesis: With the rising incidence of patients with total joint replacements, subsequent deep infection of the implants is a rare but dreaded complication which has immense physiological, psychological, financial, and social implications. Guidelines from urologists, gastroenterologists, and dental surgeons attempt to identify high-risk patients who may be more susceptible to prosthetic joint infections. These patients are provided with prophylactic antibiotics before any invasive procedure that may cause bacterial seeding to prosthetic joints. Most orthopaedic associations around the world adopt a similar policy to provide prophylaxis to cover any anticipated chance of bacteraemia. The American Association of Orthopaedic Surgeons adopts the most cautious approach in which all patients with total joint replacements who undergo any procedure that breaches a mucosal surface receive prophylactic antibiotics. Conclusion: The guidelines from the American Association of Orthopaedic Surgeons seem to have an all-encompassing policy when it comes to providing prophylactic antibiotics. Nonetheless, physicians must still exercise their judgement and customise the treatment to each patient. The benefits of prophylactic antibiotics must be balanced against the risks of drug side-effects and the emergence of antibiotic resistance.published_or_final_versio

Why do Hong Kong patients need total hip arthroplasty? An analysis of 512 hips from 1998 to 2010

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Surgical debridement with prostheses retention for the treatment of acute periprosthetic infections following total knee arthroplasty

Free Paper Presentation Session 6 – Adult Joint Reconstruction: no. 6.3INTRODUCTION: Periprosthetic infection after total knee arthroplasty (TKA) is difficult to treat. Surgical debridement with retention of prostheses is one of the valid methods ...postprin

Case series of Jehovah's witnesses having Total Knee Arthroplasty in Hong Kong

Electronic Poster Presentations: P48INTRODUCTION: Total knee arthroplasty (TKA) is challenging in Jehovah’s Witnesses (JW), as they do not accept transfusions. We report our experiences with a series of TKAs in JW in our ...postprin

Perioperative antithrombotic management in joint replacement surgeries

Objectives To determine optimal perioperative antithrombotic management for patients with cardiac diseases undergoing joint replacement surgeries. Data sources MEDLINE and PubMed database search up to January 2013. Study selection Those dealing with perioperative antithrombotic management of patients undergoing orthopaedic operations, especially joint replacement, and also those undergoing general surgery. Various combinations of the following key words were used in our search: 'antiplatelet', 'antithrombotic', 'anticoagulant', 'coronary stent', 'perioperative', 'venous thromboembolism', 'cardiovascular', 'surgery', 'orthopaedic', 'knee replacement', 'hip replacement', 'joint replacement', and 'arthroplasty'. Data extraction Literature review, original articles, and best practice guidelines. Data synthesis Patients should be stratified according to their risk of developing arterial thromboembolism in order to decide the most appropriate perioperative antiplatelet or anticoagulant regimen for them. After recent coronary stenting, including bare-metal stents implanted within 6 weeks and drug-eluting stents implanted within 6 months, surgery should be deferred. For venous thromboembolism prophylaxis in patients already on aspirin, the dosage should be adjusted as necessary or additional low-molecular-weight heparin administered. Conclusion The perioperative management of patients with cardiac diseases in receipt of antithrombotic agents is based upon a delicate balance between the perceived risk of arterial thromboembolism and the perceived risk of perioperative bleeding. One must exercise good judgement in deciding the most appropriate perioperative antithrombotic regimen. Venous thromboembolism is also a common problem after joint replacement surgeries. For patients already on aspirin, optimal venous thromboembolism prophylaxis is still being debated.published_or_final_versio

Efficacy of Functional Magnetic Stimulation in Neurogenic Bowel Dysfunction after Spinal Cord Injury

[[abstract]]Objective: The aims of this study were to assess the usefulness of functional magnetic stimulation in controlling neurogenic bowel dysfunction in spinal cord injured patients with supraconal and conal/caudal lesions, and to investigate the efficacy of this regimen with a 3-month follow-up. Design: A longitudinal, prospective before-after trial. Subjects: A total of 22 patients with chronic spinal cord injured and intractable neurogenic bowel dysfunction. They were divided into group 1 (supraconal lesion) and group 2 (conal/caudal lesion). Methods: The colonic transit time assessment and Knowles-Eccersley-Scott Symptom Questionnaire were carried out for each patient before they received a 3-week functional magnetic stimulation protocol and on the day following the treatment. Results and conclusion: Following functional magnetic stimulation, the mean colonic transit time for all patients decreased from 62.6 to 50.4 h (p < 0.001). The patients’ Knowles-Eccersley-Scott Symptom scores decreased from 24.5 to 19.2 points (p < 0.001). The colonic transit time decrement in both group 1 (p = 0.003) and group 2 (p = 0.043) showed significant differences, as did the Knowles-Eccersley-Scott Symptom score in both groups following stimulation and in the 3-month follow-up results (p < 0.01). The improvements in bowel function indicate that functional magnetic stimulation, featuring broad-spectrum application, can be incorporated successfully into other therapies as an optimal adjuvant treatment for neurogenic bowel dysfunction resulting from spinal cord injury.[[journaltype]]國外[[incitationindex]]SCI[[booktype]]紙本[[countrycodes]]SW

Liner Exchange Into A Well Fixed Acetabular Shell In Revision Total Hip Arthroplasty

OBJECTIVE To investigate clinical outcomes and complications of isolated polyethylene liner exchange for revision total hip arthroplasty. METHODS From April 1 995 to December 2007, 80 patients (93 hips) underwent revision total hip arthroplasty during which only polyethylene liner was exchanged with reservation of acetabular cup. There were 41 males and 39 females, aged from 27 to 82 years (average, 53.3 years). The duration from the primary THA to the revision surgery ranged from 0.3 to 18.4 years (average, 10.9 years). The reasons for liner exchange included: polyethylene wear with osteolysis (78 hips), polyethylene wear without osteolysis (5 hips), polyethylene wear with stem loosening (4 hips), recurrent dislocation (3 hips), infection (1 hip), periprosthetic fracture (1 hip) and liner dislodgement (1 hip). Forty-seven liners were fixed into the old cup using cement, and 46 were fixed with the original locking mechanism. Sixty cross-linked polyethylene liners and 33 conventional polyethylene liners were used. RESULTS All patients were followed up for 5 to 15 years (average, 7 years). The average Harris hip score improved from preoperative 86.0±16.9 to 89.4±11.6 at final follow-up. Complications included dislocation (10 hips), infection (2 hips), periprosthetic fracture (1 hip) and liner dislodgement (1 hip). Ten hips underwent rerevision due to different reasons: cup exchange (5 hips), conventional polyethylene wear (2 hips), infection (2 hips) and liner dislodgement (1 hip). Using component loosening as the end point, the 10-year survival rate was 100% in the cement fixation group and 84.8% in the original locking group. Using rerevision as the end point, the 10-year survival rate was 90.4% in the cement fixation group and 65.0% in the original locking group. CONCLUSION Liner exchange either with cement or original locking mechanism is a safe and successful method. Highly cross-linked polyethylene has a higher wear resistance, which can reduce incidence of osteolysis and improve survival rate of prosthesis.目的探討保留髖臼杯更換聚乙烯襯墊在全髖關節翻修術中的作用.方法1995年4月至2007年12月,80例(93髖)接受保留髖臼杯更換聚乙烯襯墊手術.男41例,女39例;年齡2782歲,平均53.3歲.初次置換與更換襯墊手術間隔0.318.4年,平均10.9年.翻修原因:聚乙烯磨損及骨溶解78髖,聚乙烯接近完全磨損但無骨溶解5髖,聚乙烯磨損及股骨柄假體鬆動4髖,復發性關節脫位3髖,感染1髖,假體周圍骨折1髖,襯墊脫位1髖.翻修襯墊採用高交聯聚乙烯60髖、普通聚乙烯33髖,以骨水泥固定47髖、原鎖定機制固定46髖.結果隨訪515年,平均7年.術前Harris髖關節評分(86.0±16.9)分,終末隨訪時(89.4±11.6)分.並發症包括脫位10髖,感染2髖,假體周圍骨折1髖,襯墊脫落1髖.10髖再次翻修:髖臼杯翻修5髖,普通聚乙烯磨損2髖,感染2髖,襯墊脫落1髖.普通聚乙烯組新發骨溶解12髖.以假體鬆動為終點,十年生存率骨水泥固定組100%、原鎖定機制固定組84.8 %;以再次翻修為終點,十年生存率分別為90.4%和65.0%.結論以骨水泥或原鎖定機制固定翻修襯墊均安全有效.高交聯聚乙烯耐磨性較好,能降低骨溶解風險,假體存活率更高

Mild component malalignment may not affect the postoperative range of motion in posterior-stabilised total knee arthroplasty

Free Paper Presentation Session 6 – Adult Joint Reconstruction: no. 6.11INTRODUCTION: The optimal lower limb alignment and component positions in achieving a high flexion angle in posterior-stabilised total knee arthroplasty (TKA) were not well understood. We analysed pre- and post-operative clinical and radiological parameters in patients received TKA for knee ...postprin