The Effects of Cryotherapy on Early Rehabilitation Following Total Knee Arthroplasty: A Prospective Cohort Study.

Purpose The objective of this study was to investigate whether cryotherapy is effective in reducing pain, opioid consumption, and length of stay (LOS) in hospital following total knee arthroplasty (TKA). Methods This prospective cohort study included 191 consecutive patients who underwent TKA without having access to cryotherapy, followed by 193 consecutive patients who underwent TKA and received automated cryotherapy as part of the recovery phase. All patients had their surgical procedures performed by the same surgeons and received post-operative care by the same nursing, medical, and physiotherapy team. The pain score using the visual analog scale (VAS)and the amount of opioid used on the first three post-operative days were recorded along with the length of hospital stay. Results There was no difference in baseline characteristics between the two groups. The use of cryotherapy was associated with a reduced pain score on all three days compared to when cryotherapy was not used: Day 1 pain score was 5.2 versus 6.1 (p < 0.01), Day 2 was 3.6 versus 4.8 (p = 0.03), and Day 3 was 2.8 versus 3.8 (p < 0.01). Cryotherapy was also associated with a significant reduction in analgesia consumption on all three days. The median amount of Oramorph used on all three days in the cryotherapy group was 15.0 mg compared to 40.0 mg in the control arm (p < 0.01). Additionally, the LOS was shorter in the cryotherapy group, with a mean of 3.86 days versus 4.20 days in the control group (p = 0.02). Conclusion The use of cryotherapy following TKA was associated with decreased pain and opioid consumption along with a reduced time to hospital discharge compared to when no cryotherapy was used.

Medial patellofemoral ligament reconstruction and tibial tuberosity transfer can be used to successfully manage patellofemoral instability in the setting of trochlea dysplasia.

BACKGROUND: Management of patella instability remains a challenge particularly in the presence of trochlea dysplasia. The aim of this study is to assess the recurrence rates of those with patellar instability who have undergone a combined tibial tuberosity transfer (TTT) and medial patellofemoral ligament reconstruction (MPFLR) in the setting of trochlea dysplasia. METHODS: All skeletally mature patients who underwent combined TTT and MPFLR for recurrent patella instability were identified between January 2009 and December 2019. A retrospective review was conducted, with information regarding re-dislocation/subluxation and complications collected. RESULTS: Seventy patients with a mean age 25.3 years were identified and evaluated. Thirteen patients were found to have low-grade dysplasia (Dejour A), with 57 patients having high-grade dysplasia (Dejour B/C/D). No patients in the low,grade dysplasia group suffered a recurrence of their symptoms, with four in the high-grade group suffering episodes of re-dislocation/subluxation. Three patients subsequently underwent a trochleoplasty, with the other patient managed successfully non-operatively. There were a total of 13 complications in 11 patients. CONCLUSIONS: A combined procedure of MPFLR and TTT can be used to manage patellofemoral instability even in the setting of trochlea dysplasia with a low rate of recurrence. Trochlea dysplasia, however, remains an anatomical risk factor for recurrence and patients should be counselled accordingly. The anatomical risk factors should be assessed in all patients to allow for the development of the most appropriate management plan, of which this combined procedure represents a potentially successful option. LEVEL OF EVIDENCE: IV (Case Series).

Modified Technique of Tibial Tuberosity Transfer.

Tibial tuberosity transfer is a well-established procedure in the treatment of patellar instability and in selected cases of anterior knee pain. Several techniques have been advocated in the literature. Some of the common complications associated with this procedure have been pain and discomfort due to prominent screw heads, necessitating their removal; nonunion and delayed union of the osteotomy; and failure of fixation. Tibial fractures have also been reported in some case reports. We present our technique of tibial tuberosity transfer using two 4-mm cannulated screws for stabilization of the tuberosity fragment. We have used this technique either for isolated tibial tuberosity transfer or as part of a combined procedure along with medial patellofemoral ligament reconstruction in treating patellar instability. Using this technique, we have encountered no patients with wound problems, nonunion, delayed union, or loss of fixation and only 1 patient with a metal work problem needing a second procedure for its removal. We attribute our good outcomes to the preservation of the soft-tissue attachments to the tuberosity fragment; minimal soft-tissue dissection, which allows rapid bony consolidation of the osteotomy, which in turn allows accelerated rehabilitation; and the use of 4-mm cannulated screws for fixation of the osteotomy, minimizing the potential for metal work problems.