Timeframe for return to driving for patients with minimally invasive knee arthroplasty is associated with knee performance on functional tests

BACKGROUND: This study hopes to establish the timeframe for a safe return to driving under different speed conditions for patients after minimally invasive total knee arthroplasty and further explores how well various kinds of functional tests on knee performance can predict the patients’ braking ability. METHODS: 14 patients with right knee osteoarthritis were included in the present study and instructed to perform three simulated driving tasks at preoperative, 2 weeks postoperative and 4 weeks postoperative. RESULTS: The results showed that the total braking time at 4 week postoperative has attained the preoperative level at the driving speed 50 and 70 km/hr but not at the driving speed 90 km/hr. It had significantly improving in knee reaction time and maximum isometric force at 4 weeks postoperative. Besides, there was a moderate to high correlation between the scores of the step counts and the total braking time. CONCLUSIONS: Summary, it is recommended that driving may be resumed 4 weeks after a right knee replacement but had to drive at low or moderate speed and the best predictor of safety driving is step counts

Impact of the COVID-19 Pandemic on the Field of Orthopedics

During the COVID-19 pandemic, countries all over the world suffered from different kinds of service disruption or reduction in the field of orthopedics with or without lockdowns. The consequences include no restriction, partial disruption, overburden of medical services and complete shutdown of clinical practices. This chapter systematically reviews the current published literature on the global impact of COVID-19 on the field of orthopedics through multiple aspects, including educational impact, service volume impact, workload impact, personal practice change, psychological impact, and impact on orthopedic research. The rates of all surgeries and elective surgeries decreased by 15.6%–49.4% and 43.5–100%, respectively. The overall impact was attributable to the staff redeployment in response to the pandemic. Therefore, it is important to maintain a flexible allocation of manpower and more sufficient and reservable staffing measures in case of emergency staff shortages. Orthopedic surgeons are suggested to prepare proper preventive strategies and set up special equipment and places for regular telemedicine for virtual consultations or virtual teaching. It can be expected that the integration of the different experiences of global countries from the impact of COVID-19 may help us to face possible similar impacts in the future

The Effects of a Patient-Specific Integrated Education Program on Pain, Perioperative Anxiety, and Functional Recovery following Total Knee Replacement

The perioperative care of patients undergoing total knee arthroplasty (TKA) affects functional recovery and clinical outcomes. This study aims to introduce a patient-specific integrated education program (IEP) into the TKA clinical pathway and to evaluate patient outcomes between the intervention and control groups. We performed a two-site, two-arm, parallel-prospective controlled trial. The experiment group received an IEP incorporating verbal preoperative education, prehabilitation, multidisciplinary personalized rehabilitation during hospitalization, and supervised self-executed home-based exercise after discharge. The control group received regular TKA clinical care. We monitored the pain intensity, anxiety scores, and functional scores at six time points from the pre-operation interview to 3 months post-operation. The pain score was significantly decreased in the IEP group during hospitalization (p < 0.01) and before discharge (p < 0.05). The anxiety status was also improved after intervention in terms of state and trait anxiety inventory scores (p < 0.001) during hospitalization. The patient-reported (WOMAC) or physician-reported (American Knee Society Score) functional scores (p < 0.01 at most of the time points) all improved significantly under hospitalization. We found that the patient-specific IEP combining preoperative education, prehabilitation, the in-hospital group education class, and postoperative care navigation is effective in reducing postoperative pain, decreasing perioperative anxiety, and facilitating functional recovery following TKA

The Effects of a Patient-Specific Integrated Education Program on Pain, Perioperative Anxiety, and Functional Recovery following Total Knee Replacement

The perioperative care of patients undergoing total knee arthroplasty (TKA) affects functional recovery and clinical outcomes. This study aims to introduce a patient-specific integrated education program (IEP) into the TKA clinical pathway and to evaluate patient outcomes between the intervention and control groups. We performed a two-site, two-arm, parallel-prospective controlled trial. The experiment group received an IEP incorporating verbal preoperative education, prehabilitation, multidisciplinary personalized rehabilitation during hospitalization, and supervised self-executed home-based exercise after discharge. The control group received regular TKA clinical care. We monitored the pain intensity, anxiety scores, and functional scores at six time points from the pre-operation interview to 3 months post-operation. The pain score was significantly decreased in the IEP group during hospitalization (p &lt; 0.01) and before discharge (p &lt; 0.05). The anxiety status was also improved after intervention in terms of state and trait anxiety inventory scores (p &lt; 0.001) during hospitalization. The patient-reported (WOMAC) or physician-reported (American Knee Society Score) functional scores (p &lt; 0.01 at most of the time points) all improved significantly under hospitalization. We found that the patient-specific IEP combining preoperative education, prehabilitation, the in-hospital group education class, and postoperative care navigation is effective in reducing postoperative pain, decreasing perioperative anxiety, and facilitating functional recovery following TKA.</jats:p

Efficacy and Safety of Extracorporeal Shockwave Therapy for Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis

Abstract Objective The objective of this study was to assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) for treatment of knee osteoarthritis (OA) using a systemic review and meta-analysis. Methods An extensive search of relevant articles from electronic databases Pubmed, Embase, and Cochrane Library from inception to March 2019 was conducted. The treatment outcomes (visual analog scale [VAS] and the Western Ontario and McMaster Universities Arthritis Index [WOMAC]) of the included articles were pooled to calculate effect sizes. The assessment of heterogeneity among articles was evaluated using I2. Statistical analyses were conducted using RevMan software. Results The results showed that the ESWT group had significant improvement in pain relief compared with the control group through 12 months based on WOMAC and VAS scores. Compared with the baseline level, the patients had significant improvement in pain relief at most follow-up points (one week to 12 months) based on WOMAC and VAS scores. The patients showed significant improvement in physical function at six- and 12-month follow-up when compared with the control group and for all follow-up (one to 12 months) when compared with the baseline level. Additionally, only minor complications were observed after ESWT treatment. Conclusions The use of ESWT for treatment of knee OA had a beneficial effect on pain relief and physical function improvement for up to 12 months, and only minor complications occurred after ESWT treatment. However, there remains a lack of clarity regarding the frequency and dosage levels of ESWT required to achieve the maximum improvement. </jats:sec

Computer-navigated minimally invasive total knee arthroplasty for patients with retained implants in the femur

AbstractTotal knee arthroplasty (TKA) in patients with knee arthritis and retained implants in the ipsilateral femur is a challenge for knee surgeons. Use of a conventional intramedullary femoral cutting guide is not practical because of the obstruction of the medullary canal by implants. Previous studies have shown that computer-assisted surgery (CAS) can help restore alignment in conventional TKA for patients with knee arthritis with retained femoral implants or extra-articular deformity, without the need for implant removal or osteotomy. However, little has been published regarding outcomes with the use of navigation in minimally invasive surgery (MIS)-TKA for patients with this complex knee arthritis. MIS has been proven to provide less postoperative pain and faster recovery than conventional TKA, but MIS-TKA in patients with retained femoral implants poses a greater risk in limb malalignment. The purpose of this study is to report the outcome of CAS-MIS-TKA in patients with knee arthritis and retained femoral implants. Between April 2006 and March 2008, eight patients with knee arthritis and retained femoral implants who underwent the CAS-MIS-TKA were retrospectively reviewed. Three of the eight patients had extra-articular deformity, including two femur bones and one tibia bone, in the preoperative examination. The anteroposterior, lateral, and long-leg weight-bearing radiographs carried out at 3-month follow-up was used to determine the mechanical axis of lower limb and the position of components. The mean preoperative femorotibial angle in patients without extra-articular deformity was 3.8° of varus and was corrected to 4.6° of valgus. With the use of navigation in MIS-TKA, the two patients in this study with extra-articular femoral deformity also obtained an ideal postoperative mechanical axis within 2° of normal alignment. Overall, there was a good restoration of postoperative mechanical alignment in all cases, with a mean angle of 0.4° of varus. No limb malalignment or component malposition was found. In clinical assessments, there were also significant improvements in knee specific scores, functional scores, and motion arc. The results of this study suggest that navigation can help achieve accurate alignment and proper prosthesis positioning in MIS-TKA for patients with retained femoral implants and for whom intramedullary rod guidance is impractical