Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not been reported previously after unicompartmental knee arthroplasty in the literature. Low level of suspicion may delay the diagnosis, as popliteal vascular injury and compartment syndrome are not well recognized as possible complications of unicompartmental knee arthroplasty

Neuropathic-like symptoms and the association with joint-specific function and quality of life in patients with hip and knee osteoarthritis

Objective There is an association between osteoarthritis-related pain severity and function, yet clear evidence about the sole influence of neuropathic-like symptoms on joint function and health-related quality of life (HRQoL) is lacking. Previous studies among knee OA patients show an association between neuropathic-like symptoms, lower functional status and lower quality of life, however analyses were unadjusted or had limited adjustment for influential covariates like pain intensity. The aim of this study was therefore to determine the influence of neuropathic-like symptoms-adjusted for multiple influential covariates-on joint-specific function and HRQoL in hip and knee OA patients. Methods In this observational study 255 patients (117 with hip OA and 138 with knee OA) completed the modified painDETECT questionnaire (mPDQ) to identify subjects with neuropathic-like symptoms (mPDQ score>12, possible neuropathic pain [NP] phenotype). The WOMAC and the RAND-36 were used to asses respectively function and HRQoL. Results were adjusted stepwise for age, sex and BMI (Model 1); back disorder, painful body regions, comorbidities and previous surgery (Model 2); and pain intensity and analgesic usage (Model 3). Results A possible NP phenotype was experienced by 37% of hip and 46% of knee OA patients. Final model 3 analysis revealed that hip OA patients with neuropathic-like symptoms scored significantly lower on pain-related aspects of HRQoL (GRAND-36 bodily pain: 6.8 points, p = 0.047) compared to patients with the unlikely NP phenotype. In knee OA patients, a possible NP phenotype was associated with diminished joint function (AWOMAC domains ranging 7.1 to 10.5 points, p Conclusion Neuropathic-like symptoms deteriorate the subjective rating of pain-related quality of life in hip OA patients and significantly influence function in knee OA patients

Habitual Physical Activity After Total Knee Replacement:analysis in 830 patients and comparison with a sex-and age-matched normative population (vol 92, pg 1109, 2012)

Background. Previous studies on physical activity after total knee arthroplasty (TKA) concentrated mainly on a return to sports activities. Objective. The objectives of this study were to determine the habitual physical activity behavior of people who had undergone TKA (TKA group) 1 to 5 years after surgery and to examine to what extent they adhered to international guidelines for health-enhancing physical activity. Additional aims were to compare younger (= 65 years old) people as well as men and women in the TKA group and to compare the results for the TKA group with those for a sex- and age-matched normative population (normative group). Design. This investigation was a cohort study. Methods. All people who had a primary TKA at 1 of 2 participating hospitals between 2002 and 2006 were sent the Short Questionnaire to Assess Health-Enhancing Physical Activity at least 1 year after surgery. Results. The TKA group spent, on average, 1,347 minutes per week on physical activity, most of which was light-intensity activity (780 minutes per week). Participants younger than 65 years of age spent significantly more time on physical activity than participants 65 years of age or older. There was no significant difference between male and female participants. Compared with the sex- and age-matched normative group, the TKA group spent significantly less time on the total amount of physical activity per week and met the guidelines for health-enhancing physical activity less often (55% versus 64%). Limitations. A self-administered questionnaire was used to assess habitual physical activity, and presurgery data on physical activity were not available. Conclusions. Almost half of the TKA group did not meet the health-enhancing physical activity guidelines, and the TKA group was not as physically active as the normative group. People who have undergone TKA should be encouraged to be more physically active

No Difference in Recovery of Patient-Reported Outcome and Range of Motion between Cruciate Retaining and Posterior Stabilized Total Knee Arthroplasty:A Double-Blind Randomized Controlled Trial

Both from the perspective of the individual and from a socioeconomic point of view (e.g., return to work), it is important to have an insight into the potential differences in recovery between posterior cruciate ligament retaining (PCR) and posterior stabilized (PS) total knee arthroplasty (TKA) implants. The primary aim of this study was to compare the speed of recovery of patient-reported outcome between patients with a PCR and PS TKA during the first postoperative year. The secondary aim was to compare the effect on range of motion (ROM). In a randomized, double-blind, controlled, single-center trial, 120 adults diagnosed with osteoarthritis of the knee were randomized into either the PCR or PS group. Primary outcome was speed of recovery of patient-reported pain and function, measured with the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), with a follow-up of 1year. Main secondary outcome measure was ROM. A generalized estimating equations (GEE) analysis was used to assess whether there was a difference over time between groups (" p -value for interaction"). Between 2008 and 2011, 59 participants received a PCR TKA (mean age, 70.3 years [SD=7.7]; mean body mass index [BMI], 30.5kg/m (2) [SD=5.4]) and 55 participants a PS TKA (mean age, 73.5 years [SD=7.0]; mean BMI, 29.2kg/m (2) [SD=4.4]). Six patients (two PCR and four PS) were excluded because of early drop-out, so 114 patients (95%) were available for analysis. In between group difference for total WOMAC score was -1.3 (95% confidence interval [CI]: -5.6 to 3.1); p -value for interaction was 0.698. For ROM, in between group difference was 1.1 (95% CI: -2.6 to 4.7); p -value for interaction was 0.379. These results demonstrated that there are no differences in speed of recovery of WOMAC or ROM during the first postoperative year after PCR or PS TKA

Flow cytometric assessment of leukocyte kinetics for the monitoring of tissue damage

Leukocyte populations quickly respond to tissue damage, but most leukocyte kinetic studies are not based on multiparameter flow cytometry. We systematically investigated several blood leukocyte populations after controlled tissue damage. 48 patients were assigned to either an anterior or posterolateral total hip arthroplasty. Peripheral blood was collected pre-operatively and at 2 h, 24 h, 48 h, 2 and 6 weeks postoperatively and assessed by flow cytometry for absolute counts of multiple leukocyte populations using standardized EuroFlow protocols. Absolute counts of leukocyte subsets differed significantly between consecutive time points. Neutrophils increased instantly after surgery, while most leukocyte subsets initially decreased, followed by increasing cell counts until 48 h. At two weeks all leukocyte counts were restored to pre-operative counts. Immune cell kinetics upon acute tissue damage exhibit reproducible patterns, which differ between the leukocyte subsets and with “opposite kinetics” among monocyte subsets. Flow cytometric leukocyte monitoring can be used to minimally invasively monitor tissue damage.This was supported by Stichting Anna Fonds/NOREF (Dutch Orthopedic Research and Education Fund) and the Erasmus MC Medical research grant (grant no. DRP337224)

Adaptation, validity and reliability of the modified painDETECT questionnaire for patients with subacromial pain syndrome

Background The identification of a neuropathic component to subacromial pain may lead to different pain management strategies. The purpose of this study was to adapt the Dutch modified painDETECT (mPDQ-NL) Knee, which discriminates between nociceptive and neuropathic pain, to fit patients with subacromial pain syndrome and subsequently assess its validity and reliability. Methods The mPDQ-NL Knee was adapted into the mPDQ-NL Shoulder to fit and use for patients with subacromial pain syndrome. The study population consisted of patients suffering from subacromial pain syndrome who were asked to fill in the Dutch mPDQ-NL Shoulder, the self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and the Disabilities of the Arm, Shoulder and Hand (DASH) to determine construct validity (structural validity, hypotheses testing) of the mPDQ-NL Shoulder. Regarding reliability, internal consistency was determined and the mPDQ-NL Shoulder was assessed a second time with a two-week interval to determine measurement error and reliability. Results A total of 107 patients were included in the validity analysis and 58 in the reliability analysis. Validity (86% of predefined hypotheses met), internal consistency (Cronbach's alpha 0.8) and reliability (ICC 0.7) of the mPDQ-NL Shoulder were good, however, a systematic bias might be present. Conclusion The mPDQ-NL Shoulder was successfully modified from the mPDQ-NL Knee. This study shows that the mPDQ-NL Shoulder seems to reflect neuropathic-like pain symptoms experienced by patients with SAPS. Whether it may also be used as a tool to record change over time or after treatment has to be further assessed

An anterior cruciate ligament injury does not affect the neuromuscular function of the non-injured leg except for dynamic balance and voluntary quadriceps activation

The function of the anterior cruciate ligament (ACL) patients' non-injured leg is relevant in light of the high incidence of secondary ACL injuries on the contralateral side. However, the non-injured leg's function has only been examined for a selected number of neuromuscular outcomes and often without appropriate control groups. We measured a broad array of neuromuscular functions between legs of ACL patients and compared outcomes to age, sex, and physical activity matched controls. Thirty-two ACL-deficient patients (208 +/- 145 days post-injury) and active and less-active controls (N = 20 each) participated in the study. We measured single- and multi-joint neuromuscular function in both legs in each group and expressed the overall neuromuscular function in each leg by calculating a mean z-score across all neuromuscular measures. A group by leg MANOVA and ANOVA were performed to examine group and leg differences for the selected outcomes. After an ACL injury, duration (-4.3 h/week) and level (Tegner activity score of -3.9) of sports activity decreased and was comparable to less-active controls. ACL patients showed bilateral impairments in the star excursion balance test compared to both control groups (P Except for poorer dynamic balance and reduced quadriceps activation, ACL patients had no bilateral neuromuscular deficits despite reductions in physical activity after injury. Therapists can use the non-injured leg as a reference to assess the injured leg's function for tasks measured in the present study, excluding dynamic balance and quadriceps activation. Rehabilitation after an ACL injury should be mainly focused on the injured leg. III

Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature

Joint arthroplasty registries show an increased rate of aseptic loosening in uncemented acetabular components as compared to cemented acetabular components. Since loosening is associated with particulate wear debris, we postulated that uncemented acetabular components demonstrate a higher polyethylene wear rate than cemented acetabular components in total hip arthroplasty. We performed a systematic review of the peer-reviewed literature, comparing the wear rate in uncemented and cemented acetabular components in total hip arthroplasty. Studies were identified using MEDLINE (PubMed), EMBASE and the Cochrane Central Register of Controlled Trials. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search resulted in 425 papers. After excluding duplicates and selection based on title and abstracts, nine studies were found eligible for further analysis: two randomised controlled trials, and seven observational studies. One randomised controlled trial found a higher polyethylene wear rate in uncemented acetabular components, while the other found no differences. Three out of seven observational studies showed a higher polyethylene wear in uncemented acetabular component fixation; the other four studies did not show any differences in wear rates. The available evidence suggests that a higher annual wear rate may be encountered in uncemented acetabular components as compared to cemented components