43,612 research outputs found

    Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis : do we sacrifice ankle to the knee?

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    Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10A degrees underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. Pre-operatively, the mean HKA was 16.6A degrees and the mean AA was 10.41A degrees, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6A degrees and the mean AA to -2.1. The mean LDTA was 87.3A degrees. Before the operation, the mean AJOA was -7.6A degrees, opening to the medial aspect of the ankle, and it was 0.04A degrees after the operation and opening to the lateral aspect (p < 0.05). Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle

    Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

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    Abstract: Purpose: The association of diabetes mellitus with knee stiffness after total knee arthroplasty is still being debated. The aim of this study was to assess through meta-analysis the impact of diabetes mellitus on the prevalence of postoperative knee stiffness after total knee arthroplasty. Methods: We conducted a literature search for terms regarding postoperative knee stiffness and diabetes mellitus on Embase, CINAHL, and PubMed NCBI. Results: Of 1142 articles, seven were suitable for analysis. Meta-analysis showed that diabetes mellitus does not confer an increased risk of primary or revision total knee arthroplasty-induced postoperative knee stiffness when compared to nondiabetic patients (primary total knee arthroplasty, estimated odds ratio [OR] 1.474 and 95% confidence interval [CI] 0.97–2.23; primary and revision total knee arthroplasty, OR 1.340 and 95% CI 0.97–1.83). Conclusion: There is no strong evidence that diabetes mellitus increases the risk of knee stiffness after total knee arthroplasty. The decision to proceed with total knee arthroplasty, discussion as part of the consent process, and subsequent rehabilitation should not differ between patients with and without diabetes mellitus with regards to risk of stiffness. Level of evidence: Level III (meta-analysis

    Conversion of patellofemoral arthroplasty to total knee arthroplasty: A matched case-control study of 13 patients

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    Background and purpose The long-term outcome of patellofemoral arthroplasty is related to progression of femorotibial osteoarthritis with need for conversion to total knee arthroplasty. We investigated whether prior patellofemoral arthroplasty compromises the results of total knee arthroplasty

    Do Adults Undergoing Minimally Invasive Quadriceps-Sparing Total Knee Arthroplasty Have Less of a Risk of Developing a Postoperative Deep Venous Thrombosis as Compared to Patients Undergoing a Standard Medial Parapatellar Total Knee Arthroplasty?

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    OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Do adults undergoing minimally invasive quadriceps-sparing total knee arthroplasty have less of a risk of developing a postoperative deep venous thrombosis as compared to patients undergoing a standard medial parapatellar total knee arthroplasty?” STUDY DESIGN: A review of one case series published in 2007 and two randomized controlled trials published in 2014. DATA SOURCES: Primary literature found in PubMed that compared the surgical outcomes of minimally invasive quadriceps-sparing total knee arthroplasty to standard medial parapatellar total knee arthroplasty. OUTCOME MEASURED: Postoperative deep venous thrombosis development. RESULTS: All three studies reported that zero patients that received the minimally invasive surgery developed a DVT. In each study, at least one patient that received the standard surgery developed a DVT. In King et al., 4 patients who received the standard medial parapatellar total knee arthroplasty developed a DVT. In both Tasker et al. and Tomek et al. 1 patient who received the standard medial parapatellar total knee arthroplasty developed a DVT. CONCLUSIONS: Although further research needs to be done to make a general statement, there is some evidence, based on the information in the studies reviewed, that adults undergoing minimally invasive quadriceps-sparing total knee arthroplasty have less of a risk of developing a postoperative deep venous thrombosis as compared to patients undergoing a standard medial parapatellar total knee arthroplasty

    TOTAL KNEE ARTHROPLASTY IN A PATIENT WITH HOFFA FRACTURE PSEUDARTHROSIS: CASE REPORT

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    ABSTRACTA rare occurrence of a case of Hoffa fracture pseudarthrosis in an alcoholic patient with genu valgum associated with venous insufficiency who underwent total knee arthroplasty is reported. The literature is reviewed and the main factors for surgical indication of total knee arthroplasty after a fracture of the knee are discussed. Total knee arthroplasty was a viable option in a 60-year-old patient with Hoffa fracture pseudarthrosis and comorbidities

    Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient

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    <p>Abstract</p> <p>Background</p> <p>Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty.</p> <p>Methods</p> <p>The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI) >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates.</p> <p>Results</p> <p>Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p < 0.01), estimated blood loss (176.7 versus 111.6 mL, p = 0.01), percentage of patients requiring blood transfusion (64.9% versus 13.9%, p < 0.01), length of hospital stay (3.72 versus 3.30 days, p < 0.01), and percentage of patients requiring extended care facility usage at discharge (63.6% versus 27.8%, p < 0.01). No significant difference between unilateral and bilateral groups was seen in regards to total complication rate, major or minor complication subgroup rate, or any particular complication noted. Doubling the variables in the unilateral group for a staged total knee arthroplasty scenario did create significant increases over the simultaneous data in almost every data category.</p> <p>Conclusions</p> <p>Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.</p

    Unicompartmental and total knee arthroplasty in the treatment of knee osteoarthritis

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    Even though total knee arthroplasty has been a highly successful operation, as many as 20% of patients are somewhat dissatisfied with their prosthesis. In at least 25% of patients, the pattern of osteoarthritis is isolated medial, which could be treated with medial unicompartmental rather than total knee arthroplasty. Medial unicompartmental arthroplasty has been associated with a shorter hospital stay, faster recovery time, lower cost, subjective preference for a more normal-feeling knee, and reduced perioperative morbidity and mortality compared with total knee arthroplasty. However, its survival has been inferior to that of total knee arthroplasty in national registries. The primary objective of this study was to evaluate the influence of the preoperative degree of knee osteoarthritis on the risk of reoperation; to determine the short-term survivorship of cementless mobile-bearing unicompartmental arthroplasty and to compare that of cemented mobile-bearing unicompartmental arthroplasty and total knee arthroplasty; to evaluate the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in a randomized, controlled, assessor-blind comparison. We found that in the preoperative weight-bearing radiographs, the degree of knee osteoarthritis should be severe, to diminish the revision rate. In the short term, use of a cementless unicompartmental device is associated with increased survivorship over the use of a cemented device and the functional outcome scores favored medial unicompartmental arthroplasty at 2 months and 1-year follow-up but the primary outcome were comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The present study supports the use of medial unicompartmental arthroplasty in patients with anteromedial arthritis. The revision rate can be reduced by following the original indications and using cementless mobile-bearing components. Medial unicompartmental arthroplasty provides a comparable outcome for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years and faster postoperative recovery than total knee arthroplasty. However, the overall survivorship of mobile-bearing unicompartmental knee arthroplasty is inferior to that of cemented total knee arthroplasty and must be taken into consideration.Osatekonivel ja kokotekonivel polven nivelrikon hoidossa Vaikka kokotekonivelleikkaus on erittäin hyvä hoitomuoto, niin jopa 20 % potilaista on leikkauksen jälkeen osittain tyytymättömiä lopputulokseen. Vähintään 25 %:lla potilaista polven nivelrikko on rajoittunut polven sisäreunalle ja osatekonivel soveltuu näiden potilaiden hoitoon. Osatekonivelen etuina kokotekonivelleikkaukseen verrattuna ovat muun muassa lyhyempi sairaalahoitoaika, nopeampi toipuminen toimenpiteestä, edullisempi hoidon hinta, sekä pienempi leikkauksen jälkeinen sairastuvuus ja kuolleisuus. Lisäksi leikattu polvi voi myös tuntua enemmän omalta polvelta. Siitä huolimatta sen uusintaleikkausriski on ollut merkittävästi korkeampi kaikissa kansallisissa tekonivelrekistereissä. Tämän tutkimuksen tavoitteena oli: 1) selvittää leikkausta edeltävän nivelrikon vaikeuden vaikutusta leikkauksen jälkeiseen uusintaleikkausriskiin. 2) Selvittää sementillisen ja sementittömän osatekonivelen uusintaleikkausriskiä lyhyellä aikavälillä verrattuna polven kokotekoniveleen. 3) Selvittää polven osatekonivelleikkauksen vaikuttavuutta verrattuna polven kokotekonivelleikkaukseen kontrolloidussa, kaksoissokkoutetussa vertailututkimuksessa. Tutkimuksen johtopäätöksenä voidaan todeta, että polven nivelrikon aste seisten otetussa kuormitusröntgenkuvauksessa tulee olla pitkälle edennyt, jotta uusintaleikkausmäärä vähenee. Polven sementittömän osatekonivelen pysyvyys oli viiden vuoden seurannassa parempi kuin sementillisen ja polven osatekonivelleikkauksesta toipuminen tapahtui nopeammin verrattuna kokotekonivelleikkaukseen. Tämän tutkimuksen perusteella polven osatekonivelen uusintaleikkausmääriä voidaan vähentää pitäytymällä alkuperäisissä indikaatioissa, välttämällä lievän nivelrikon hoitoa tekonivelleikkauksella ja käyttämällä sementitöntä osatekoniveltä. Polven osatekonivelleikkaus tuottaa potilaalle nopeamman toipumisen ja tulos kahden vuoden kohdalla on verrannollinen kokotekonivelleikkauksen tulokseen. Tämä tutkimus tukee polven osatekonivelen käyttöä polvinivelen sisäpuolen nivelrikon hoitona. On kuitenkin huomioitava, että polven osatekonivelen pysyvyys on sementöityä kokotekoniveltä huonompi

    Complications after Total Knee Arthroplasty

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    Nowadays, the incidence of knee arthritis increases with the prolongation of human life and the increase in world population. As a result, total knee arthroplasty application rates increased and surgeons gained more experience. There have also been technical advances and total knee arthroplasty operations have been performed using better implants. However, despite these developments, the number and variety of complications are increasing. In addition to performing total knee arthroplasty correctly, it is now becoming more important to recognize complications that may or may develop. Variety of complications after total knee replacement; from minor skin problems to life-threatening complications. In this review article, we aimed to investigate early and late complications during and after total knee replacement surgery

    A numerical investigation into the effects of overweight and obesity on total knee arthroplasty

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    Overweight and obesity increase risks of knee osteoarthritis, which is a major cause of disability. Severe knee osteoarthritis can be treated by knee arthroplasty. Total knee arthroplasty has been used in overweight and obese patients; however, clinical reports showed that the outcome of this group of patients was not good as normal-weight patients. Two computer models were created in this paper to simulate the effect of excess loads on the distal femoral bone and contact pressures in total knee arthroplasty during a gait cycle. The numerical results showed increased stress in periprosthetic distal femoral bones and higher contact pressure on tibial polyethylene insert during the stance phase. Based on the computer simulation results and published research work, cementless total knee arthroplasty with thicker tibial polyethylene insert may be a better option for overweight patients

    Predictors of perioperative blood loss in total joint arthroplasty.

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    UNLABELLED: UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%. in the print version now reads as During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 g/dL or a hematocrit level of at least 33%. in the online version. In Table III, the footnote that reads as The values are given as the estimate and the standard error in milligrams per deciliter. in the print version now reads as The values are given as the estimate and the standard error in grams per deciliter. in the online version. BACKGROUND: Despite advances in surgical and anesthetic techniques, lower-extremity total joint arthroplasty is associated with considerable perioperative blood loss. As predictors of perioperative blood loss and allogenic blood transfusion have not yet been well defined, the purpose of this study was to identify clinical predictors for perioperative blood loss and allogenic blood transfusion in patients undergoing total joint arthroplasty. METHODS: From 2000 to 2008, all patients undergoing unilateral primary total hip or knee arthroplasty who met the inclusion criteria were enrolled in the study. Perioperative blood loss was calculated with use of a previously validated formula. The predictors of perioperative blood loss and allogenic blood transfusion were identified in a multivariate analysis. RESULTS: Eleven thousand three hundred and seventy-three patients who underwent total joint arthroplasty, including 4769 patients who underwent total knee arthroplasty and 6604 patients who underwent total hip arthroplasty, were evaluated. Multivariate analysis indicated that an increase in blood loss was associated with being male (263.59 mL in male patients who had undergone total hip arthroplasty and 233.60 mL in male patients who had undergone total knee arthroplasty), a Charlson Comorbidity Index of \u3e3 (293.99 mL in patients who had undergone total hip arthroplasty and 167.96 mL in patients who had undergone total knee arthroplasty), and preoperative autologous blood donation (593.51 mL in patients who had undergone total hip arthroplasty and 592.30 mL in patients who had undergone total knee arthroplasty). In patients who underwent total hip arthroplasty, regional anesthesia compared with general anesthesia reduced the amount of blood loss. The risk of allogenic blood transfusion increased with the amount of blood loss in the patients who underwent total hip arthroplasty (odds ratio, 1.43 [95% confidence interval, 1.40 to 1.46]) and the patients who underwent total knee arthroplasty (odds ratio, 1.47 [95% confidence interval, 1.42 to 1.51]), but the risk of blood transfusion increased with the Charlson Comorbidity Index only in patients who underwent total knee arthroplasty (odds ratio, 3.2 [95% confidence interval, 1.99 to 5.15]). The risk of allogenic blood transfusion decreased with preoperative autologous blood donation in patients who underwent total hip arthroplasty (odds ratio, 0.01 [95% confidence interval, 0.01 to 0.02]) and patients who underwent total knee arthroplasty (odds ratio, 0.02 [95% confidence interval, 0.01 to 0.03]). CONCLUSIONS: This study identified some clinical predictors for blood loss in patients undergoing total joint arthroplasty that we believe can be used for implementing more effective blood conservation strategies. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence
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