Dynamic radiostereometry can objectively quantify the kinematic laxity patterns and rotation instability of the knee during a pivot-shift test.

PURPOSE: The pivot-shift test is used to clinically assess knee instability in patients with anterior cruciate ligament (ACL) lesions; however, it has low interobserver reliability. Dynamic radiostereometry (dRSA) is a highly precise and noninvasive method for the objective evaluation of joint kinematics. The purpose of this study was to quantify precise knee kinematics during a pivot-shift test using dRSA imaging. METHOD: Eight human donor legs, including hemipelvises, were evaluated. Arthroscopic intervention was performed inducing ligament lesions in the ACL, and anterolateral ligament (ALL) section was performed as a capsular incision. The pivot-shift test was recorded with dRSA on knees with intact ligaments, ACL-deficient and ACL + ALL-deficient knees. RESULTS: A pivot-shift pattern was identifiable after ligament lesion, as a change in tibial posterior drawer velocity from 7.8 mm/s (95% CI: 3.7; 11.9) in ligament intact knees to 30.4 mm/s (95% CI 23.0; 38.8) after ACL lesion to 35.1 mm/s (95% CI 23.4; 46.7) after combined ACL-ALL lesion. The anterior-posterior drawer excursion increased from 2.8 mm (95% CI 2.1; 3.4) in ligament intact knees to 7.2 mm (95% CI 5.5; 8.9) after ACL lesion to 7.6 mm (95% CI 5.5; 9.8) after combined lesion. A statistically significant increase in tibial external rotation towards the end of the pivot-shift motion was observed when progressing from intact to ACL + ALL-deficient knees (p < 0.023). CONCLUSION: This experimental study demonstrates the feasibility of dRSA to objectively quantify the kinematic laxity patterns of the knee during the pivot-shift test. The dynamic parameters obtained through dRSA revealed the kinematic changes from ACL to combined ACL-ALL ligament lesion. LEVEL OF EVIDENCE: Not applicable.

Single- or two-stage revision after failed ACL reconstruction: No differences in re-revision rates and clinical outcomes.

PURPOSE: The surgeons' choice of a single-stage or a two-stage procedure in revision anterior cruciate ligament reconstruction (ACLr) is based on the possibility of reuse of the tibia and femoral bone tunnels after primary ACLr. The purpose of this study was to compare failure rates and clinical outcomes following single-stage and two-stage ACL revisions in a cohort of patients from The Danish Knee Ligament Reconstruction Registry. METHODS: Patients identified from 2005 to 2022 with ACL revision and met the following criteria: minimum 2-year follow-up, isolated ACL revision and registered single- or two-stage ACL revision. The primary outcome was ACL re-revision rate. Secondary outcomes were arthrometer sagittal knee laxity (side-to-side difference) and pivot shift (rotational stability difference) evaluated at 1-year follow up. RESULTS: One thousand five hundred seventy-four ACL revisions were included in the study (1331 = single-stage and 243 = two stage). Baseline characteristics showed no difference in relation to age, gender, knee laxity, pivot shift, meniscus injury, cartilage damage or injury mechanism between the two groups. Significant differences were found in relation to the type of graft. No statistical difference in 2-years revision rates between single-stage group 2.79 (95% CI 2.03-3.84) and two-stage group 2.93 (95% CI 1.41-6.05) was found. No significant difference was seen in knee laxity and pivot shift between stage-groups at 1-year follow up. Both groups demonstrated significant improvements in knee stability from baseline to 1-year follow-up. CONCLUSION: The present study found that ACL revision outcomes were similar in terms of rerevision rates and knee laxity for patients managed with a single- or a two-stage surgical strategy. LEVEL OF EVIDENCE: Level III.

Combined anterior cruciate ligament revision with reconstruction of the antero-lateral ligament does not improve outcome at 2-year follow-up compared to isolated acl revision; a randomized controlled trial.

PURPOSE: It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. METHODS: The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (- ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. RESULTS: A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the - ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. CONCLUSION: Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. LEVEL OF EVIDENCE: Level I.

A comparison of multi-ligament reconstruction and isolated anterior cruciate ligament reconstruction at one year follow-up: results from the Danish Knee Ligament Reconstruction Registry.

INTRODUCTION: The Danish Knee Ligament Reconstruction Registry (DKRR) has monitored the outcomes of surgeries for multi-ligament knee injuries (MLKI) since 2005. This study aimed to compare the subjective clinical outcomes of patients who had undergone surgery after MLKI with those of patients who had received isolated anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: This study used patient-reported outcome scores at 1-year follow-up as the primary outcome and contains the outcome data of knee ligament surgeries retrieved from the DKRR. Clinical subjective outcomes and knee function were evaluated with Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Tegner Activity Scale (Tegner) scores. Demographic differences were examined using the Student's t-test and the chi-square test. Multiple linear regression was used to analyse the data and adjust for potentially confounding factors. P-values < 0.05 were considered to be statistically significant. RESULTS: A total of 31,686 knee ligament surgeries were registered in the DKRR between 2005 and 2017, resulting in 1,160 multi-ligament patients and 28,843 isolated ACL patients. The mean age of the MLKI group was significantly higher than that of the isolated ACL group (33.2 years [95% CI 32.5-33.9] vs. 28.3 years [95% CI 28.1-28.4]). The adjusted KOOS Sport and Quality of Life (QoL) sub-scores and Tegner scores of the MLKI group significantly improved from the baseline to the 1-year follow-up (16.7 points [95%CI 12.8;20.6], 12.6 points [95%CI 9.6;15.6] and 1.76 points [95%CI 1.43;2.08], respectively). The KOOS Sport and QoL sub-scores of the isolated ACL group were significant and increased more than those of the MLKI group. No differences in the Tegner scores were observed. CONCLUSIONS: Surgical reconstruction after multi-ligament knee injury resulted in significant subjective outcome improvements at 1- year follow-up. The KOOS Sport and QoL sub-scores of the isolated ACL group significantly increased compared to those of the MLKI group.

Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction.

PURPOSE: Open or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts. It was hypothesized that open architecture interference screws would stimulate bone ingrowth into the screw cavities. METHODS: Twelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus-/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, six and twelve months postoperatively. On CT reconstruction slices bone ingrowth into the screw was measured. Subjective and objective clinical outcome international knee documentation committee score and instrumented knee laxity determination were collected. RESULTS: At six months no implants demonstrated more than 10% bone ingrowth. At twelve months 42% (5/12) implants had more than 10% bone ingrowth (p = 0.009). The average bone filling into the screws was 7.7%. There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm at twelve months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction. CONCLUSION: The present study demonstrated that open architecture thread PEEK interference screw can stimulate bone ingrowth into the screws after soft tissue ACL reconstruction with at 12 months with an average bone filling into screws was 7.7%. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies. TRIAL REGISTRATION: The study was registered at ClinicalTrials # NCT02382341 . 12-09-2014. LEVEL OF EVIDENCE: IV.

Magnetic resonance imaging can increase the diagnostic accuracy in symptomatic meniscal repair patients.

PURPOSE: The purpose of this study was to evaluate meniscal repair healing in symptomatic patients through combined clinical assessment, magnetic resonance imaging (MRI) and re-arthroscopy. This study investigated the diagnostic accuracy of MRI and clinical assessment in determining failed meniscal repair in symptomatic meniscal repair patients, as verified by re-arthroscopy. METHODS: Eighty patients were included. All had undergone a primary meniscal repair followed by an MRI and re-arthroscopy due to clinical symptoms of a meniscal lesion. A validated semi-quantitative scoring system was employed for identifying MRI-diagnosed healing failure. The clinical assessment was divided into joint swelling, joint-line tenderness, locking and a positive McMurray's test. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI and positive clinical findings were calculated using second-look arthroscopy as a standard. RESULTS: The MRI results showed healing of 22 (27.5%) of the menisci and 58 (72.5%) unhealed menisci, whereas second-look arthroscopy identified 15 (19%) healed menisci and 65 (81%) unhealed menisci. The isolated MRI findings were 0.85, 0.8, 0.95 and 0.55 for sensitivity, specificity, PPV and NPV, respectively. The PPVs of the clinical assessments were 0.78, 0.85 and 0.94, with one, two and three clinical findings, respectively. A grade 3 MRI combined with joint-line tenderness presented a PPV of 0.98. CONCLUSION: A supplementary MRI will increase diagnostic accuracy when fewer than three clinical findings are present in a symptomatic meniscal repair patient. The clinical relevance of this finding is that MRI contributes to enhancing the diagnostic accuracy of an unhealed meniscal repair when there are limited clinical signs of meniscal pathology. LEVEL OF EVIDENCE: III.

No Difference in Outcome Between Femoral Soft-Tissue and Screw Graft Fixation for Reconstruction of the Medial Patellofemoral Ligament: A Randomized Controlled Trial.

PURPOSE: The aim of the present randomized controlled trial was to compare 2 different medial patellofemoral ligament reconstruction (MPFL-R) techniques that utilize different femoral fixation principles, which could affect subjective clinical outcomes and surgical morbidity. METHODS: Sixty patients were randomly assigned to 2 MPFL-R techniques: bone or soft-tissue fixation of the graft at the femoral condyle. Patients had operations performed between 2010 and 2015 at a single center. Indication for surgery was 2 or more patellar dislocations. When the bone fixation technique was used, the gracilis tendon was fixed with the use of an interference screw. When the soft-tissue fixation technique was used, the gracilis tendon was looped around the adductor magnus tendon. Both techniques used patella-graft fixation with drill holes in the medial patellar edge. Clinical outcomes were evaluated by means of Kujala, knee injury and osteoarthritis outcome, and pain scores before the operation and at 1- and 2-year follow-up examinations. Surgical morbidity was evaluated by pain on palpation along the reconstruction site. RESULTS: Kujala scores were 88 and 89 for bone and soft-tissue fixation groups, respectively, with no difference between groups (P = .73). No significant differences in knee injury osteoarthritis outcome or pain scores were found. Analysis of surgical morbidity, defined as femoral-based tenderness overlying the fixation site, demonstrated that 13% and 12% of patients had significant tenderness at the reconstruction site after bone and soft-tissue MPFL-R, respectively. No patellar re-dislocations were observed in either group. CONCLUSIONS: MPFL-R with soft-tissue graft fixation at the femoral condyles resulted in findings for subjective clinical outcome, patellar stability, and pain level similar to those associated with MPFL-R with bone fixation. Surgical morbidity was also similar between patients who had soft-tissue and those who had bone fixation MPFL-R. Soft-tissue femoral graft fixation does not result in inferior clinical outcomes compared with screw fixation, and it can be used safely for MPFL-R.

The lateral joint space width can be measured reliably with Telos valgus stress radiography in medial knee osteoarthritis.

OBJECTIVE: To examine the reproducibility of valgus stress radiographs with the Telos stress device for assessment of lateral compartment degenerative changes in patients with medial osteoarthritis of the knee. MATERIALS AND METHODS: A prospective reliability study was performed. Seventy-nine patients (80 knees) were included, and standardized valgus stress radiographs were obtained using the Telos stress device. Osteophytes and joint space narrowing (JSN) were graded using the OARSI (Osteoarthritis Research Society International) classification, and the joint space width (JSW) was measured in millimeters. Reproducibility was determined as intra-and inter-rater reliability and test-retest reliability. Weighted kappa was used to determine the reliability of osteophyte and JSN grading, and the intra-class correlation coefficient for JSW. RESULTS: Grading of osteophytes had an intra- and inter-rater reliability ranging from 0.40 to 0.83 on the medial side and ranging from 0.39 to 0.87 on the lateral side. Grading of medial JSN had an intra- and inter-rater reliability ranging from 0.62 to 0.84, and grading of lateral JSN had an intra- and inter-rater reliability ranging from 0.32 to 0.65. Intra- and inter-rater reliability of JSW ranged from 0.84 to 0.98 on the medial side, and from 0.59 to 0.89 on the lateral side. Test-retest reliability of JSW of the medial and lateral side ranged from 0.69 to 0.92. CONCLUSIONS: Standardized valgus stress radiographs taken with the Telos stress device are a reliable supplement in the assessment of medial OA of the knee. Evaluation of the lateral compartment on valgus stress radiographs is most reliable with measurement of the lateral JSW.

Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis.

BACKGROUND: An anterior cruciate ligament (ACL) rupture often occurs during rotational trauma to the knee and may be associated with damage to extracapsular knee rotation-stabilizing structures such as the anterolateral ligament (ALL). PURPOSE: To investigate ex vivo knee laxity in 6 degrees of freedom with and without ALL reconstruction as a supplement to ACL reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: Cadaveric knees (N = 8) were analyzed using dynamic radiostereometry during a controlled pivotlike dynamic movement simulated by motorized knee flexion (0° to 60°) with 4-N·m internal rotation torque. We tested the cadaveric specimens in 5 successive ligament situations: intact, ACL lesion, ACL + ALL lesion, ACL reconstruction, and ACL + ALL reconstruction. Anatomic single-bundle reconstruction methods were used for both the ACL and the ALL, with a bone-tendon quadriceps autograft and gracilis tendon autograft, respectively. Three-dimensional kinematics and articular surface interactions were used to determine knee laxity. RESULTS: For the entire knee flexion motion, an ACL + ALL lesion increased the mean knee laxity (P < .005) for internal rotation (2.54°), anterior translation (1.68 mm), and varus rotation (0.53°). Augmented ALL reconstruction reduced knee laxity for anterior translation (P = .003) and varus rotation (P = .047) compared with ACL + ALL-deficient knees. Knees with ACL + ALL lesions had more internal rotation (P < .001) and anterior translation (P < .045) at knee flexion angles below 40° and 30°, respectively, compared with healthy knees. Combined ACL + ALL reconstruction did not completely restore native kinematics/laxity at flexion angles below 10° for anterior translation and below 20° for internal rotation (P < .035). ACL + ALL reconstruction was not found to overconstrain the knee joint. CONCLUSION: Augmented ALL reconstruction with ACL reconstruction in a cadaveric setting reduces internal rotation, varus rotation, and anterior translation knee laxity similar to knee kinematics with intact ligaments, except at knee flexion angles between 0° and 20°. CLINICAL RELEVANCE: Patients with ACL injuries can potentially achieve better results with augmented ALL reconstruction along with ACL reconstruction than with stand-alone ACL reconstruction. Furthermore, dynamic radiostereometry provides the opportunity to examine clinical patients and compare the recontructed knee with the contralateral knee in 6 degrees of freedom.

Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty.

PURPOSE: The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant migration can be used as a predictor of implant loosening. METHODS: A prospective radiostereometric cohort study was performed. Forty-five patients with medial OA of the knee were included and received a cemented Sigma® UKA. The patients were followed for 24 months with radiostereometric analysis (RSA) and clinical outcome scores (Oxford knee score). Clinical precision was based on double determinations taken at 4 and 12 months. Tibial implants were classified as stable (difference in MTPM < 0.2 mm between 1 2 and 24 months) or as continuously migrating (difference in MTPM > 0.2 mm between 12 and 24 months). RESULTS: No significant differences in migration were found for the femoral component. For the tibial component, a difference of 0.05 mm was shown for translation on the x-axis between 4 months and 12 (p < 0.01) and between 4 months and 24 months (p < 0.01). A difference of - 0.23 to - 0.50° was shown for rotation around the x-axis (p < 0.01) and a difference of - 0.11° was shown for rotation around the z-axis between 4 and 12 months (p = 0.02). These differences in migration over time were small and fall within the clinical precision of the measurements. Tibial components were divided into a stable group (N = 26) and a continuously migrating group (N = 11), which showed a significant difference in maximal total point motion (MTPM) (p < 0.01). The Oxford knee score improved significantly from poor before surgery (23.2) to good at follow-up (37.5-40.9). CONCLUSIONS: The Sigma® UKA showed low implant migration and good clinical outcomes, suggesting that the Sigma UKA can be used in clinical practice. However, continuous migration was found in 30% of our patients which could indicate a risk of later revision surgery in this group. LEVEL OF EVIDENCE: II.

Clinical outcomes after revision surgery for medial patellofemoral ligament reconstruction.

PURPOSE: Medial patellofemoral ligament reconstruction (MPFL-R) is the standard surgical intervention for patella instability. However, limited knowledge exists concerning the causes for failure, and outcome after revision MPFL-R. The purpose of this study is to evaluate the causes of primary MPFL-R failure and clinical outcomes after revision MPFL-R. METHODS: Twenty-three patients (6 males and 17 females) with failed primary MPFL-R underwent isolated revision MPFL-R or combined revision MPFL-R with tibial tuberosity osteotomy (TTO). The mean age was 23 (SD 8.6). Prior to surgery, dysplasia of the patellofemoral joint, sulcus angle, Insall-Salvati index, cartilage lesions, tibial tuberosity trochlear groove (TTTG) distance, and tunnel placement were evaluated by magnetic resonance imaging (MRI). Their scores on the Kujala Anterior Knee Pain Scale and pain scores were assessed prior to surgery, 1 year post-operatively and at final follow-up. The mean follow-up time was 44 months (median range 39). The radiographic characteristics and clinical outcomes were compared with a 224 primary MPFL-R patient cohort (240 knees). RESULTS: Non-anatomical fixation of the graft at the medial femoral condyle after primary MPFL-R was seen in 67% of revision patients with anterior/proximal misplacement in most cases. Severe trochlear dysplasia Dejour types C and D were seen in 36% of the patients compared to 30% of primary MPFL-R patients (NS). The mean Kujala Anterior Knee Pain Scale score at final follow-up was 61.7 (SD 18.8) compared to 80.3 (SD 18) in primary MPFL-R patients (P < 0.01). The mean pain score at rest was 2.3 (SD 2.5) for revision MPFL-R patients compared to 1.7 (SD 2.5) in primary MPFL-R patients (NS) and their mean pain score during activity was 5.0 (SD 3.2) compared to 1.3 (SD 2.2) in primary MPFL patients (P < 0.001). CONCLUSION: Although revision MPFL-R establishes acceptable patellar stability, the subjective outcomes after revision MPFL-R do not improve significantly, and are poorer than after primary MPFL-R. Non-anatomical graft position can be an important cause of MPFL-R failure. The clinical relevance of this study is that it shows that it may be difficult to improve self-reported outcomes in revision MPFL-R patients. LEVEL OF EVIDENCE: III.

[Treatment of patellar instability].

First-time patellar luxation appears typically in teenagers and young adults below the age of 16 years, with a prevalence of 45/100,000/year. This luxation is treated with brief limited mobility in a bandage, and with a complementary physiotherapy if the mobility is influenced afterwards. Risk factors for patellar instability are patellofemoral dysplasia, hyperlaxity, patella alta and valgus malalignment in the knee joint. In case of repeated luxation the treatment is surgical, i.e. reconstruction of the medial patellofemoral ligament recreating the medial patella-stabilizing structures. If the dysplasia is severe, tuberositas tibiae-osteotomy and trochlea plastic can correct a lateral tracking of the knee joint. Generally, patella-stabilizing surgery is successful with a reluxation rate of only a few per cent.

Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees.

PURPOSE: Little is known about the anterolateral ligament's (ALL) influence on knee laxity. The purpose of this study was to investigate rotational knee laxity against a pure axial rotational stress using radiostereometric analysis (RSA) after cutting and reconstructing both the anterior cruciate ligament (ACL) and the ALL. METHODS: Eight human donor legs were positioned and stereoradiographically recorded at 0°, 30° and 60° of knee flexion using a motorised fixture, while an internally rotating force of 4 Nm was applied to the foot. Anterior-posterior and rotational laxity were investigated for knees with intact ligaments and compared with those observed after successive ACL and ALL resection and reconstruction. RESULTS: After cutting the ALL in ACL-deficient knees, the internal rotation was increased in all three knee flexion angles, 0° (p = 0.04), 30° (p = 0.03) and 60° (p < 0.01) by 1.0°, 1.6° and 2.5°, respectively. However, no decrease in laxity was found after reconstructing the ALL in ACL-reconstructed knees. CONCLUSIONS: The ALL was confirmed as a stabiliser of internal rotation in ACL-deficient knees. However, reconstructing the ALL using a gracilis autograft tendon did not decrease the internal rotation laxity in the ACL-reconstructed knee. Based on the results of this study, we do not recommend reconstructing the ALL in ACL-reconstructed knees to decrease internal knee laxity.

Posterior cruciate ligament reconstruction in skeletal immature children.

PURPOSE: Rupture of the posterior cruciate ligament (PCL) is a rare knee injury in children with open growth plates. The follow-up results of six patients with open physes treated with PCL reconstruction are presented. The objective is to evaluate the clinical outcomes of PCL reconstruction for six skeletally immature patients. METHODS: Between 2006 and 2010, six skeletally immature patients were treated with PCL reconstruction. At the time of surgery, the median age was 9 years (range 6-14). The median follow-up time after surgery was 50 months (range 41-90). Outcomes were evaluated by KOOS and Tegner scores, instrumented knee laxity, and radiologic long-axis leg length measurements. RESULTS: The median KOOS score at follow-up was 88 (range 26-98). The median Tegner score was 6 (range 4-7). The median side-to-side difference in laxity according to KT-1000 was 2 mm (range 1-5) at 25° of flexion and 3 mm (range 3-6) at 70° of flexion. A median side-to-side difference in flexion of 8° was found. All but one patient had returned to playing sports at follow-up. One patient's index leg had a length discrepancy of 16 mm. CONCLUSIONS: PCL reconstruction resulted in fair to good clinical outcomes for skeletally immature children. Clinically relevant leg length discrepancy was found in one of the six patients examined in this study. LEVEL OF EVIDENCE: Level IV.

Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up.

BACKGROUND: Approximately 12,000 hip and knee replacements were performed in Denmark in 2005. Accelerated perioperative interventions are currently implemented, but there is conflicting evidence regarding the effect. We therefore performed an efficacy study of an accelerated perioperative care and rehabilitation intervention in patients receiving primary total hip replacement, and both total and unicompartmental knee replacement. METHODS: A randomized clinical trial was undertaken in which 87 patients were randomized to either a control group receiving the current perioperative procedure, or an intervention group receiving a new accelerated perioperative care and rehabilitation procedure. Outcome measures were length of stay (LOS) in hospital, and gain in quality of life (QOL) using EQ-5D from baseline to 3-month follow-up. RESULTS: Mean LOS was reduced (p < 0.001) from 8 days (95% CI: 7.1-8.4) in the control group to 5 days (95% CI: 4.2-5.6) in the intervention group. This was accompanied by a greater gain in QOL of 0.08 (95% CI: 0.004-0.16) in the intervention group (p = 0.03). INTERPRETATION: An accelerated perioperative care and rehabilitation intervention in patients undergoing primary total hip replacement, and total or unicompartmental knee replacement is indeed effective-and of advantage to both the hospital and the patient.