Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

Background To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant's sagittal stability is mainly dependent on its medial ball-in-socket design

Meeting report : new research and solutions to postoperative wound care challenges

A one-hour symposium entitled ‘New research and solutions to postoperative wound care challenges’ was held by Mölnlycke Health Care on Thursday 29th September at the fifth congress of the World Union of Wound Healing Societies (WUWHS) in Florence, Italy. The overriding aim of the session was to focus on the challenges of postoperative wound care, i.e. blistering, surgical site infection (SSI), and their associated costs. The importance of clinicians being able to select appropriate dressings was addressed with a discussion surrounding potential benefits associated with the use of a new, advanced postoperative wound dressin

A prospective randomized controlled clinical investigation comparing two post-operative wound dressings used after elective hip and knee replacement; Mepilex® Border Post-Op versus Aquacel® surgical

Background: Post-operative wound complications, including blistering and surgical site infections, can increase recovery times, costs associated with hospital stay and morbidity. Aim: To compare two post-operative wound dressings (Mepilex Border Post-Op and Aquacel Surgical), in patients undergoing elective hip or knee arthroplasty. Methods: International, open-label, prospective, superiority, multicentre, randomised, parallel-group, controlled trial. Primary outcome was dressing failure, a composite endpoint assessing four factors weighted from highest to lowest in relation to the risk of surgical site infection. Results: Mepilex Border Post-Op was comparable or superior to Aquacel (R) Surgical in all parameters investigated. Dressing failure rates, skin redness, itching under the dressing, pain during dressing removal and number of patients requiring a dressing change were low in both groups. Mepilex (R) Border Post-Op outperformed Aquacel Surgical for ease of application (p<0.0001) and removal (p<0.0001), ability to handle blood (p<0.0001), prevention of dressing residuals (p=0.0167), patient satisfaction of wearing the dressing during rehabilitation training (p=0.0037) and patients' overall experience with the dressing (P=0.0025). Conclusion: Both dressings performed well in terms of minimizing post-operative wound complications. However, in relation to clinician satisfaction, minimization of pain and facilitation of patient comfort, Mepilex (R) Border Post-Op outperformed Aquacel Surgical

Quick Transition to One Day Length of Stay after Hip and Knee Arthroplasty Using a Digital Follow-Up Tool during COVID-19: A Retrospective Comparative Study

The COVID-19 pandemic highlighted the need for efficient use of hospital infrastructure. The hypothesis was that a rapid shift to outpatient surgery after hip or knee arthroplasty could be implemented without compromising quality of care. The aim of this study was to assess the safety, pain management and patient-reported outcomes before and after the implementation of an accelerated discharge program using a digital follow-up tool. A retrospective cohort design was used to compare 97 patients who received primary total hip or knee arthroplasty during the pandemic (early discharge) to comparable 194 pre-pandemic patients (normal discharge). Both cohorts had the same inclusion criteria and were closely monitored using the digital follow-up tool. The accelerated discharge program reduced length of stay from a median of 3 days (before the pandemic) to a median of 1 day (during the pandemic) (p p > 0.05). Patient-reported outcomes for matched samples of hip (n = 100) and knee (n = 82) arthroplasty patients were similar before, at 6 weeks and 3 months after surgery for both groups (p > 0.05). There were no differences in pain and medication consumption for the first 6 weeks (p > 0.05). This study demonstrates that reducing length of stay from three to one night after total knee or hip arthroplasty, with the help of a digital follow-up tool, results in a stable rate of complications, readmission, and comparable clinical outcomes, while reducing the socio-economic burden on the health system

A neuro-anatomically grounded scheme for LIA gives superior analgesia and comfort levels compared to epidural analgesia until seven days after total knee arthroplasty

LIA is an emerging alternative for patient-controlled epidural analgesia(PCEA) after total knee arthroplasty(TKA). LIA allows faster mobilisation, eliminates the risks of epidural catheters, and can hasten patient turnover. Conversely, PCEA provides reliable pain relief in the first days after this type of surgery. The purpose of this study was to evaluate the quality of antinociception, postoperative nausea & vomiting (PONY), and general comfort until 7 days postoperatively. 40 patients received PCEA and 41 received LIA. Patients were retrospectively asked for pain scores at the day of surgery(=D0), D2, and D7, PONV, and general comfort scores. Patients in the LIA group reported equal pain scores at DO, significantly better PONV scores and pain scores at D2 and D7. In addition to faster mobilisation and elimination of the risks and burden of an epidural catheter and PCEA, LIA delivers equal to better analgesia, and better PONY and general comfort scores

Local infiltration of anesthetics gives better results for pain and comfort scores then patient controlled anesthesia in total knee arthroplasty

Background : Local infiltration of anesthetics (LIA) is an upcoming alternative method for analgesia following total knee arthroplasty (TKA). It could replace patient controlled epidural anesthesia (PCEA). The advantages of LIA are faster mobilization, less risks compared to placement of an epidural catheter, and it increases patient care in a quantitative and qualitative way. On the other hand, PCEA provides prolonged analgesia postoperatively. The aim of this study was to compare the effects of LIA and PCEA on pain and comfort scores during the seven days following TKA. Methods : Two weeks after hospital dismissal, a questionnaire was sent to 116 patients who underwent TKA. Patients were asked for their pain scores on the day of surgery (=D0), two days after (=D2) and 7 days after (=D7). They were also asked about their general comfort, postoperative nausea and vomiting (PONV), vertigo and comfort urinating. The primary endpoint was pain at D7, secondary endpoints were pain on D0 and D2. and comfort scores. Results : Data of 81 patients were analyzed. 40 were provided with PCEA and 41 patients received LIA. Pain scores on D7 were significantly better in the LIA-group (18 [0-75] vs 38 [0-100] for LIA and PCEA, respectively (p=0.01)). Pain scores on D2 were also significantly better in the LIA group, whereas no difference in pain scores was seen on D0. There was less PONV on D0 and less discomfort urinating on D7 in the LIA group. Other scores showed no significant differences between the two groups. Conclusion : LIA showed in lower pain scores and improved comfort scores, compared to PCEA