Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series(.) For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%). Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs. The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors

Better Outcomes in Severe and Morbid Obese Patients (BMI > 35 kg/m2) in Primary Endo-Model Rotating-Hinge Total Knee Arthroplasty

The Endo-Model rotating-hinge prosthesis is preferably indicated as a primary implant in patients with advanced axial deviation of the lower limbs or unstable knees with severe bone defects. Outcomes were studied in 111 knees, operated in a three-year period; the mean followup was 28 months. Joint balance enhancement and limbs mechanical axis correction were achieved after surgery. There were 6 deep infections and 16 patients referred postoperative anterior knee pain. WOMAC index scores disaggregated by gender and BMI showed better outcomes in obese patients (specifically, those with a BMI of 35–40 kg/m2) and in men. Although the lack of a control group did not allow definite conclusions and despite a nonnegligible complication rate, our results reveal that the Endo-Model total knee arthroplasty can be a useful tool to deal with severe and morbid obese patients affected of severe gonarthrosis associated with marked axial deviations, ligament instability, or bone defects

Artroplastia total de rodilla: experiencia de una unidad monográfica

Introducción: Se presenta la experiencia de la Unidad de Prótesis de Rodilla (UPR) del Hospital Clínico de Barcelona. Pacientes y método: Estudio de casos. La población del estudio fueron los pacientes intervenidos durante los meses de mayo y junio, de los años 2004 y 2010. Las variables consideradas fueron: edad, sexo, permanencia promedio, dolor al alta, flexión al alta, deambulación al alta, comorbilidades y complicaciones durante el ingreso. Se compararon los resultados de ambos períodos. Resultado: En la comparación de los años 2004 y 2010 se observó, en el último período citado, un aumento de los recambios de prótesis. La permanencia promedia se mantuvo en alrededor de 7 días. La media de edad de los pacientes se mantuvo por encima de los 70 años. Hubo un mejor control del dolor, de la flexión y de la deambulación al alta. El de número de complicaciones se redujo y hubo un aumento de las personas con obesidad. Conclusiones: En los próximos años habrá una evolución hacia intervenciones más complejas por recambio de prótesis. Los indicadores de calidad para evaluar el éxito del tratamiento continuarán siendo muy parecidos. Habrá una tendencia a la disminución del tiempo de ingreso debido a cambios en la técnica quirúrgica. Se deberá continuar trabajando para disminuir complicaciones relacionadas con la herida quirúrgica y las infecciones. La obesidad será la comorbilidad más present

Therapeutic education and functional readaptation in obese patients on a waiting list for total knee replacement. A case-control study

Background Studies show patients with knee osteoarthritis (OA) on waiting list for total knee replacement (TKR) underused conservative treatment, did not adhere to clinical guidelines on knee OA management, and potentially had earlier surgery and a higher risk of revisions. Therapeutic education and functional readaptation (TEFR) plus conventional therapy in waiting list patients improved function and adherence. TKR patients are often obese, negatively influencing TKR results, many patients are dissatisfied after TKR, and around 14% of TKR are inappropriate..

Transcultural adaptation and validation of the ' Hip and Knee ' questionnaire into Spanish

BACKGROUND: The purpose of the present study is to translate and validate the 'Hip and Knee Outcomes Questionnaire', developed in English, into Spanish. The 'Hip and Knee Outcomes Questionnaire is a questionnaire planned to evaluate the impact in quality of life of any problem related to the human musculoskeletal system. 10 scientific associations developed it. METHODS: The questionnaire underwent a validated translation/retro-translation process. Patients undergoing primary knee arthroplasty, before and six months postoperative, tested the final version in Spanish. Psychometric properties of feasibility, reliability, validity and sensitivity to change were assessed. Convergent validity with SF-36 and WOMAC questionnaires was evaluated. RESULTS: 316 patients were included. Feasibility: a high number of missing items in questions 3, 4 and 5 were observed. The number of patients with a missing item was 171 (51.35%) in the preoperative visit and 139 (44.0%) at the postoperative. Internal validity: revision of coefficients in the item-rest correlation recommended removing question 6 during the preoperative visit (coefficient <0.20). Convergent validity: coefficients of correlation with WOMAC and SF-36 scales confirm the questionnaire's validity. Sensitivity to change: statistically significant differences were found between the mean scores of the first visit compared to the postoperative. CONCLUSION: The proposed translation to Spanish of the 'Hip and Knee Questionnaire' is found to be reliable, valid and sensible to changes produced at the clinical practice of patients undergoing primary knee arthroplasty. However, some changes at the completion instructions are recommended. LEVEL OF EVIDENCE: Level I. Prognostic study

Knee osteoarthritis and periarticular structure quantified by ultrasound. A case-control study

Background Assessment of pain and physical function is complex in patients with knee osteoarthritis (OA), as standard criteria are lacking.A previous study examining correlations between functional capacity and pain (WOMAC) and anthropometric characteristics and periarticular knee structure (quantified by ultrasound imaging) in females with knee OA found increased quadriceps muscle density was associated with higher functional disability and pain scores, suggesting that not only joint wear and symptom severity are involved and more objective measures are necessary..

Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series(.) For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%). Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs. The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors

Therapeutic education and functional readaptation in obese patients on a waiting list for total knee replacement. A case-control study

Background Studies show patients with knee osteoarthritis (OA) on waiting list for total knee replacement (TKR) underused conservative treatment, did not adhere to clinical guidelines on knee OA management, and potentially had earlier surgery and a higher risk of revisions. Therapeutic education and functional readaptation (TEFR) plus conventional therapy in waiting list patients improved function and adherence. TKR patients are often obese, negatively influencing TKR results, many patients are dissatisfied after TKR, and around 14% of TKR are inappropriate..

Meniscal harvesting, processing and preservation for allogeneic transplantation

El empleo del metal trabecular en la superficie tibial podría aumentar la supervivencia de las prótesis dentro de la población que presenta obesidad grave o mórbida (IMC > 35 kg/ m2 ). Se realizó un estudio prospectivo, descriptivo, con prótesis total de rodilla de componente de metal trabecular a pacientes con IMC > 35 kg/m2 , con un seguimiento mínimo de dos años, análisis estadístico mediante la prueba T Student a las escalas Knee Society Score y Western Ontario and McMaster Universities prequirúrgico y postquirúrgico. Prueba χ2 a valores de índice de masa corporal relacionándolos con mayor o menor imágenes de radiolucencias. En 39 pacientes, de los cuales se eliminaron tres pacientes por no contar con el seguimiento radiográfi co, seguimiento promedio de 34 meses (25-43), 35 fueron del sexo femenino, edad promedio de 69.4 años (57-81), índice de masa corporal promedio de 39.43 kg/m2 (35-55), todos con artrosis tricompartimental grado 3 y 4. KSS(R y F) y WOMAC, con un 95% de intervalo de confianza, mostraron mejoría con signifi cación estadística a la evaluación de los resultados prequirúrgicos y al fi nal del seguimiento. Existen escasos estudios que midan la supervivencia de los implantes a largo plazo. La mayoría de autores definen la supervivencia como ausencia de necesidad de revisión de los implantes protésicos, siendo el punto fi nal de la supervivencia la extracción o el recambio de los componentes protésicos. Actualmente el metal trabecular se utiliza en cirugía ortopédica y cada vez se están aumentando sus aplicaciones clínicas con buenos resultados

Meniscal harvesting, processing and preservation for allogeneic transplantation

El empleo del metal trabecular en la superficie tibial podría aumentar la supervivencia de las prótesis dentro de la población que presenta obesidad grave o mórbida (IMC > 35 kg/ m2 ). Se realizó un estudio prospectivo, descriptivo, con prótesis total de rodilla de componente de metal trabecular a pacientes con IMC > 35 kg/m2 , con un seguimiento mínimo de dos años, análisis estadístico mediante la prueba T Student a las escalas Knee Society Score y Western Ontario and McMaster Universities prequirúrgico y postquirúrgico. Prueba χ2 a valores de índice de masa corporal relacionándolos con mayor o menor imágenes de radiolucencias. En 39 pacientes, de los cuales se eliminaron tres pacientes por no contar con el seguimiento radiográfi co, seguimiento promedio de 34 meses (25-43), 35 fueron del sexo femenino, edad promedio de 69.4 años (57-81), índice de masa corporal promedio de 39.43 kg/m2 (35-55), todos con artrosis tricompartimental grado 3 y 4. KSS(R y F) y WOMAC, con un 95% de intervalo de confianza, mostraron mejoría con signifi cación estadística a la evaluación de los resultados prequirúrgicos y al fi nal del seguimiento. Existen escasos estudios que midan la supervivencia de los implantes a largo plazo. La mayoría de autores definen la supervivencia como ausencia de necesidad de revisión de los implantes protésicos, siendo el punto fi nal de la supervivencia la extracción o el recambio de los componentes protésicos. Actualmente el metal trabecular se utiliza en cirugía ortopédica y cada vez se están aumentando sus aplicaciones clínicas con buenos resultados