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1.
Medicine (Baltimore) ; 100(35): e26873, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477120

RESUMO

ABSTRACT: Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.


Assuntos
Meloxicam/normas , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Anti-Inflamatórios não Esteroides/normas , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Masculino , Meloxicam/uso terapêutico , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Recuperação de Função Fisiológica
2.
Medicine (Baltimore) ; 100(35): e27097, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477145

RESUMO

ABSTRACT: We retrospectively investigated the natural course of hemoglobin (Hb) level after total knee arthroplasty (TKA) and identified the benefit of tranexamic acid injection at the operation field for unilateral TKA patients who have not received blood transfusions.There were 115 cases conducted by a surgeon who performed TKA without injecting tranexamic acid and 62 cases by another surgeon with injection. During 2-weeks of hospitalization, Hb level was checked on the day of surgery and 1, 2, 3, 5, 7, 11 days after surgery.Regardless of whether whom the operator was and tranexamic acid was injected or not, the same natural course of Hb level after TKA was observed. The lowest value of Hb was shown at postoperative day 3, after which it tended to recover. In repeated measures analysis of variance test, mean difference from preoperative Hb level showed a statistically significant difference between tranexamic acid injected and noninjected groups (P = .01). In post hoc test, the differences from preoperative Hb levels were significantly lower at all measurements in surgeon with injection of tranexamic acid.When deciding whether to transfuse after TKA, it should be noted that the patient tends to show the lowest Hb level on postoperative day 3. Also, the authors emphasize that tranexamic acid injection in the joint at the operation field is an effective method to reduce the loss of Hb after TKA.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Hemoglobinas/análise , Ácido Tranexâmico/uso terapêutico , Idoso , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Injeções Intra-Articulares/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/fisiopatologia , Ácido Tranexâmico/administração & dosagem
3.
Acta Ortop Mex ; 35(1): 23-27, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480435

RESUMO

INTRODUCTION: Total navigated knee replacement uses a computer-guided system, which provides immediate information on pre-cut trans-operative conditions of the knee, in relation to pelvic limb alignment. MATERIAL AND METHODS: Observational, descriptive study conducted from March 2003 to February 2019. Total bilateral knee replacement was performed at the same time surgically by a surgeon, evaluating function and pain on the WOMAC, EVA, and range of motion scores of both knees. Two groups of patients were studied: the first represents presurgical and the second post-surgical. Student's t-test and 2 were applied for statistical analysis. RESULTS: 31 patients (62 prostheses), 83.9% of the female sex and 16.1% male, average age 67.32 years, average follow-up 6.55 years (± 3.8) were studied. It was identified that 100% of the patients in both knees have a deviation between 0o and 2o measured in the mechanical axis. The WOMAC scale showed an average of 22.71 ± 3.34 presurgical and 4.16 ± 1.84) post-surgical, with statistically significant differences. The average analog visual scale was 9.06 ± 0.814 presurgical and 2.35 ± 1.427 post-surgical. CONCLUSIONS: This technique is reliable, safe and satisfactory. Excellent clinical and radiographic results were evident regarding the positioning of prosthetic components.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Cirurgia Assistida por Computador , Idoso , Computadores , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Duração da Cirurgia , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
4.
Acta Ortop Mex ; 35(1): 61-68, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480442

RESUMO

INTRODUCTION: At the national and international levels, there are few studies on early knee tumor periprosthetic infection. We present a review of patients operated by knee tumor arthroplasty, obtaining information on the clinical and bacteriological profile of early tumor periprosthetic infections. MATERIAL AND METHODS: Observational, retrospective and descriptive study, review of patient records with knee tumor replacement, from 1 January 2013, to 31 December 2017 and minimum follow-up of 2 years. RESULTS: 35 patients with average age 32. Left knee 71.4%, 77.1% distal femur, 54.2% was osteosarcoma. Complications in 82.8% of patients, prosthetic retention 62.8%; periprosthetic infection accounts for 34.2% of early complications in 90% of cases. Osteosarcomas and GCT had early infection in equal proportion (44%). The most common comorbidity was overweight/obesity at 66%, smoking by 55%. 55% of infected patients received chemotherapy. 58% of the isolated bacteria were Staphylococcus sp. 83.3% of bacteria showed antibiotic resistance. 66% of infected patients required radical management. CONCLUSIONS: Early periprosthetic infection represents a devastating pathology in our institution. Prosthetic retention is achieved at 66%. In our unit the bacteriological profile is resistant.


Assuntos
Artroplastia do Joelho , Osteossarcoma , Infecções Relacionadas à Prótese , Adulto , Artroplastia do Joelho/efeitos adversos , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Infecções Relacionadas à Prótese/epidemiologia , Reoperação , Estudos Retrospectivos
5.
Acta Ortop Mex ; 35(1): 69-74, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480443

RESUMO

INTRODUCTION: The two most commonly used types of prostheses are the total knee prosthesis with posterior cruciate ligament preservation and posterior cruciate ligament replacement. OBJECTIVE: To assess whether there is a difference in functionality between the two procedures. MATERIAL AND METHODS: Observational, retrospective and cross-sectional study with 134 patients divided into group A (N = 67) with ligament preservation and group B (N = 67) with posterior substituting. Using the American Association Scale for Knee Prosthetics with Insall modification to assess functionality. Statistical analysis: use of 2 with Yates correction. RESULTS: In group A the results: excellent (31%); good (24%); regular (22%) bad (22%). In group B the results: excellent (34%); good (31%); regular (16%) and bad (19%); without statistical difference between the two groups. CONCLUSIONS: No statistically significant difference was observed between age, gender, laterality of injury, or between number of patients with excellent results, good regular and bad according to the scale used. The high percentage of poor results in both groups of this series for the knee prosthesis is striking.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Ligamento Cruzado Posterior , Estudos Transversais , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos
6.
Acta Biomed ; 92(4): e2021324, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487091

RESUMO

BACKGROUND AND AIM: There are no gold standard markers to estimate the risk of developing periprosthetic infections. Our aim is to compare the risks of periprosthetic infection in patients with THA and THA and to investigate the predictive significance of the CRP / albumin ratio. METHODS: This is a retrospective study containing data from 241 osteoarthritis patients and 19 patients with periprosthetic infections who underwent TKA and THA in our hospital from January 2014 to January 2019.12 risk factors(CRP/ albumin, albumin, CRP, age, gender, BMI, DM, ASA, nasal culture, urine culture, hospital stay, operation time) were analyzed. RESULTS: In the binary logistic regression model and multivariate regression analysis, the rate of CRP / albumin was 17.161 times higher than the patients with ≤0.16 cut-off value. (CRP / albumin ratio (odds ratio (OR) = 17.16, 95% CI: 1.55-189.03, P: 0.02). High BMI increased the risk of periprosthetic infection 1.3 times. Nasal bacterial colonization (OR = 0.99, 95% CI: 0.868-1.38, P: 0.7) and bacterium in urine (OR = 0.502, 95% CI: 0.07-3.598, P: 0.703) did not pose a significant risk for periprosthetic infection. CONCLUSION: According to our findings, the CRP / albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. CRP / albumin ratio is a cheap and easy to apply marker. Routine urine and nasal bacteria screening is not required before total joint arthroplasty.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Proteína C-Reativa/análise , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos
7.
JNMA J Nepal Med Assoc ; 59(237): 477-481, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508435

RESUMO

INTRODUCTION: Total knee arthroplasty is one of the most successful orthopedic surgeries performed in recent decades. However, there are controversies regarding the simultaneous or staged bilateral total knee arthroplasty. The aim of this study is to find the prevalence of bilateral total knee arthroplasty in elderly patients among severe osteoarthritis of knee joints in a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted from hospital records of 2015 to 2019 in elderly patients with severe osteoarthritis in a Tertiary Care Hospital. Ethical clearance (20/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 1200 patients with severe osteoarthritis, the prevalence of bilateral total knee arthroplasty was found to be 80 (6.67%) (95% Confidence Interval = 6.60-6.74). The mean Knee Society Score was 36±3.70 preoperatively. There were 21 (26.2%) patients having hypertension, 17 (21.2%) diabetes mellitus, 14 (17.5%) chronic obstructive pulmonary disease and 7 (8.7%) coronary artery disease. CONCLUSIONS: Bilateral simultaneous total knee arthroplasty was required in less patients with severe osteoarthritis of knee joints. Bilateral simultaneous total knee arthroplasty is safe, convenient, effective with early functional recovery, higher patient satisfaction and cost effective with acceptable cardiac, pulmonary and neurological complications in properly selected patients.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Estudos Transversais , Humanos , Articulação do Joelho , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Centros de Atenção Terciária
8.
Bone Joint J ; 103-B(9): 1514-1525, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465156

RESUMO

AIMS: The aims of this study were to investigate the ability to kneel after total knee arthroplasty (TKA) without patellar resurfacing, and its effect on patient-reported outcome measures (PROMs). Secondary aims included identifying which kneeling positions were most important to patients, and the influence of radiological parameters on the ability to kneel before and after TKA. METHODS: This prospective longitudinal study involved 209 patients who underwent single radius cruciate-retaining TKA without patellar resurfacing. Preoperative EuroQol five-dimension questionnaire (EQ-5D), Oxford Knee Score (OKS), and the ability to achieve four kneeling positions were assessed including a single leg kneel, a double leg kneel, a high-flexion kneel, and a praying position. The severity of radiological osteoarthritis (OA) was graded and the pattern of OA was recorded intraoperatively. The flexion of the femoral component, posterior condylar offset, and anterior femoral offset were measured radiologically. At two to four years postoperatively, 151 patients with a mean age of 70.0 years (SD 9.44) were included. Their mean BMI was 30.4 kg/m2 (SD 5.36) and 60 were male (40%). They completed EQ-5D, OKS, and Kujala scores, assessments of the ability to kneel, and a visual analogue scale for anterior knee pain and satisfaction. RESULTS: The ability to kneel in the four positions improved in between 29 (19%) and 53 patients (35%) after TKA, but declined in between 35 (23%) and 46 patients (30%). Single-leg kneeling was most important to patients. After TKA, 62 patients (41%) were unable to achieve a single-leg kneel, 76 (50%) were unable to achieve a double-leg kneel, 102 (68%) were unable to achieve a high-flexion kneel and 61 (40%) were unable to achieve a praying position. Posterolateral cartilage loss significantly affected preoperative deep flexion kneeling (p = 0.019). A postoperative inability to kneel was significantly associated with worse OKS, Kujala scores, and satisfaction (p < 0.05). Multivariable regression analysis identified significant independent associations with the ability to kneel after TKA (p < 0.05): better preoperative EQ-5D and flexion of the femoral component for single-leg kneeling; the ability to achieve it preoperatively and flexion of the femoral component for double-leg kneeling; male sex for high-flexion kneeling; and the ability to achieve it preoperatively, anterior femoral offset, and patellar cartilage loss for the praying position. CONCLUSION: The ability to kneel was important to patients and significantly influenced knee-specific PROMs, but was poorly restored by TKA with equal chances of improvement or decline. Cite this article: Bone Joint J 2021;103-B(9):1514-1525.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Estudos Longitudinais , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/fisiopatologia , Articulação Patelofemoral/cirurgia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Inquéritos e Questionários
9.
Bone Joint J ; 103-B(9): 1449-1456, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465158

RESUMO

AIMS: The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA). METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included. Study quality was assessed, evidence was graded (one-star: no evidence, two-star: limited evidence, three-star: moderate evidence, four-star: strong evidence), and recommendations were made based on the available evidence. RESULTS: A total of 49 studies were identified for inclusion. With respect to PROMs, there was two-star evidence in support of mechanical axis alignment (MAA), femorotibial angle (FTA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), femoral rotation, tibial and combined rotation/mismatch, and implant size/overhang or offset on PROMs, and one-star evidence in support of tibial sagittal angle (TSA), impacting PROMs. With respect to survival, there was three- to four-star evidence in support FTA, FCA, TCA, and TSA, moderate evidence in support of femoral rotation, tibial and combined rotation/mismatch, and limited evidence in support of MAA, FSA, and implant size/overhang or offset impacting survival. CONCLUSION: Overall, there is limited evidence to suggest that PROMs are impacted by the accuracy of implant placement, and malalignment does not appear to be a significant driver of the observed high rates of patient dissatisfaction following TKA. However, FTA, FCA, TCA, TSA, and implant rotation demonstrate a moderate-strong relationship with implant survival. Efforts should be made to improve the accuracy of these parameters in order to improve TKA survival. Cite this article: Bone Joint J 2021;103-B(9):1449-1456.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Medidas de Resultados Relatados pelo Paciente , Humanos , Desenho de Prótese , Falha de Prótese
10.
BMC Musculoskelet Disord ; 22(1): 787, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34517870

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. METHODS: A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients' Experience with Anticoagulation in the Post-discharge Period) for quality improvement. RESULTS: The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2-4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. CONCLUSIONS: These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Tromboembolia Venosa , Assistência ao Convalescente , Idoso , Anticoagulantes/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , China/epidemiologia , Hospitais , Humanos , Pessoa de Meia-Idade , Alta do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Inquéritos e Questionários , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia
11.
J Opioid Manag ; 17(7): 179-182, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520040

RESUMO

This case report demonstrates using buprenorphine 32 mg to achieve adequate pain control after a total knee replacement. The patient stopped buprenorphine 48 hours before surgery. He was prescribed 150 tablets of oxycodone 5 mg. After finishing oxycodone, he experienced significant pain that was relieved by 32 mg of buprenorphine daily. Urine drug screens were negative perioperatively. Patients with opioid use disorder require careful discharge planning to avoid opioid relapses or misuses of pain medications. Buprenorphine offers many unique advantages in acute pain control, including lower risk of respiratory depression, abuse potential, and lower risk of nephrotoxicity.


Assuntos
Artroplastia do Joelho , Buprenorfina , Analgésicos Opioides/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Masculino , Oxicodona/efeitos adversos , Dor
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1125-1132, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523277

RESUMO

Objective: To compare the effectiveness of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the treatment of severe medial compartment osteoarthritis (OA). Methods: A clinical data of 69 patients (69 knees), who underwent joint replacement due to severe medial compartment OA between February 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. Among them, 38 cases were treated with UKA (UKA group) and 31 cases with TKA (TKA group). There was no significant difference in gender, age, body mass index, course of disease, lesion side, and preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Feller score, range of motion of knee, physiological and psychological scores of short-form 12 health survey scale (SF-12) between the two groups ( P>0.05). The femorotibial angle (FTA) of TKA group was bigger than that of UKA group, and hip-knee-ankle angle (HKA) was smaller, showing significant differences ( P<0.05). The operative time, incision length, blood loss, time for flexion 90°, ambulation time, hospital stay, and incidence of deep venous thrombosis of lower extremity were recorded and compared between the two groups. The VAS score, HSS score, WOMAC score, Feller score, range of motion, and physiological and psychological scores of SF-12 were used to evaluate patients' quality of life. FTA, HKA, and prosthesis looseness were observed by X-ray films. Kaplan-Merier survival analysis was used to evaluate the survival rate of prosthesis. Results: All operations were successfully completed in both groups. Compared with TKA group, UKA group had shorter incision length, longer operative time, and less blood loss ( P<0.05). There was no significant difference in time for flexion 90°, ambulation time, hospital stay, and the incidence of deep venous thrombosis of lower extremity between the two groups ( P>0.05). The incisions in both groups healed by first intention. During follow-up, 3 patients in the UKA group and 1 patient in the TKA group developed mild anterior knee pain. Patients were followed up (30.7±9.6) months in the UKA group and (34.9±8.7) months in the TKA group, and the difference was not significant ( t=-1.832, P=0.071). At last follow-up, there were significant differences in the HSS score, Feller score, WOMAC score, range of motion, VAS score, and physiological and psychological scores of SF-12 between pre- and post-operation ( P<0.05). The range of motion in the UKA group was bigger than that in the TKA group ( Z=-2.666, P=0.008), and there was no significant difference in the other indexes between the two groups ( P>0.05). X-ray films showed that the alignment of the two groups recovered well, and the FTA and HKA of the two groups were improved at 1 week after operation ( P<0.05). No radiolucency was found around the prosthesis during follow-up, no prosthesis loosening and meniscal bearing dislocation occurred. The survival rates of the prostheses in the two groups were 100%. Conclusion: For severe medial compartment OA, the early survival rates of the two prostheses are similar, but UKA has less traumatic, can preserve the normal structure of the knee, and the range of motion of the knee after operation is significantly better than TKA.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
13.
Sensors (Basel) ; 21(17)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34502645

RESUMO

The purposes of this pilot study are to utilize digital remote monitoring to (a) evaluate the usability and satisfaction of a wireless blood pressure (BP) and heart rate (HR) monitor and (b) determine whether these data can enable safe mobilization at home after same-day discharge (SDD) joint replacement. A population of 23 SDD patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) were given a cellular BP/HR monitor, with real-time data capture. Patients took three readings after surgery, observing for specific blood pressure decreases, HR increases, or hypotensive symptoms. If any criteria applied, patients followed a hydration protocol and delayed ambulation. Home coaching was also provided to each patient. Patient experience was surveyed, and responses were assessed using descriptive statistics. Of 18 patients discharged (78%), 17 returned surveys, of which 100% reported successful device operation. The mean "ease of use" rating was 8.9/10; satisfaction with home coaching was 9.7/10; and belief that the protocol improved patient safety was 8.4/10. A total of 27.8% (n = 5) had hypotensive readings and appropriately delayed ambulation. Our pilot findings support the feasibility of and confirm the satisfaction with remote monitoring after SDD arthroplasty. All patients with symptoms of hypotension were successfully remotely managed using a standardized hydration protocol prior to safe mobilization.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Humanos , Monitorização Fisiológica , Alta do Paciente , Projetos Piloto
14.
BMC Musculoskelet Disord ; 22(1): 783, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511058

RESUMO

BACKGROUND: Total knee replacement (TKR) is one of the most commonly performed routine procedures in the world. Prognostic studies indicate that the number of TKR will further increase constituting growing burden on healthcare systems. There is also substantial regional heterogeneity in TKR rates within and between countries. Despite the known therapeutic effects, a subset of patients undergoing TKR does not benefit from the procedure as intended. To improve the appropriateness of TKR indication, the EKIT initiative ("evidence and consensus based indication critera for total arthroplasty") developed a clinical guideline for Germany on the indication of TKR. This guideline is the basis for a digital medical decision aid (EKIT tool) to facilitate shared decision making (SDM) in order to improve decision quality for elective surgery. The aim of this cluster randomized trial is to investigate the effectiveness of the EKIT tool on decision quality. METHODS: The Value-based TKR study is a prospective pragmatic multi-center, stepped wedge, cluster randomized controlled trial (SW-RCT). The EKIT tool provides (1) a systematic presentation of individual patient and disease-specific information (symptoms, expectations), (2) the fulfillment of the indication criteria and (3) health information about safety and effectiveness of TKR. All study sites will follow routine care as control clusters until the start of the intervention. In total, there will be 10 clusters (study sites) and 6 sequential steps over 16 month, with clusters receiving the intervention with a minimum 2 months of standard routine care. The primary outcome is patients' decision quality measured with the Decision Quality Instrument (DQI)-Knee Osteoarthritis questionnaire. Furthermore, we will collect information on global patient satisfaction, patient reported outcome measures and the fulfilment of the individual expectations 12 months after SDM. The power calculation yielded an estimated power of 89% using robust Poisson regression under the following assumptions: 10 study sites with a total of N=1,080 patients (including a dropout rate of 11%), a 10% increase in decision quality due to the use of the EKIT tool, and a significance level of 5%. DISCUSSION: There is a high potential for transferring the intervention into routine practice if the evaluation is positive. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04837053 . Registered on 08/04/2021.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Médicos , Artroplastia do Joelho/efeitos adversos , Técnicas de Apoio para a Decisão , Humanos , Estudos Multicêntricos como Assunto , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
BMC Musculoskelet Disord ; 22(1): 784, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511101

RESUMO

BACKGROUND: Patellofemoral overstuffing after total knee arthroplasty (TKA) can cause limited range of motion and anterior knee pain. This study compared anterior prominence of femoral components among different prothesis designs in surgical simulation models utilizing the anterior reference (AR) and posterior reference (PR) techniques. METHODS: Surgical simulations were performed using on a three-dimensional planning system preoperative computed tomography data of consecutive 30 patients with knee osteoarthritis scheduled to undergo TKA. Four implant models were used: Attune, Persona, Journey II, and Legion. Rotational alignment was set parallel to the transepicondylar axis and size was selected based on the absence of notch formation in the femoral anterior cortex and the best fit with the shape of the medial posterior femoral condyle. For each combination of surgical technique (AR or PR method) and implant model, measurements were taken of the maximum medial, central, and lateral prominence of the implant from the anterior femoral cortex. RESULTS: Using either the AR or PR method, the medial and central prominences were significantly lower with Journey II than with the other models. The lateral prominence was the lowest with Attune in the AR method. The AR method was associated with significantly less prominence compared with the PR method, regardless of implant model. CONCLUSIONS: The degree of anterior prominence of the femoral implant is affected by the implant design when the AR method is used. The PR method is associated with greater anterior prominence compared with the AR method, and the pitch size is an additional factor in the PR method. Surgeons should be familiar with implant designs, including the thickness of the anterior flange and the available size selections.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular
16.
BMC Musculoskelet Disord ; 22(1): 772, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511113

RESUMO

BACKGROUND: No studies have directly evaluated kinematic changes during squatting before and after bicruciate-stabilized total knee arthroplasty (BCS-TKA) with the dual cam-post mechanism and asymmetric surfaces. This study investigated the effect of BCS-TKA on changes to pre- and postoperative skeletal knee kinematics, to identify factors associated with postoperative skeletal kinematic parameters. METHODS: Seventeen knees in 17 patients were prospectively recruited before primary TKA for advanced medial knee osteoarthritis. Subjects underwent BCS-TKA and were evaluated more than 1 year postoperatively. In vivo dynamic skeletal knee kinematics were evaluated using periodic radiographic images collected during squatting to quantify the tibiofemoral functional extension/flexion angle, anteroposterior (AP) translation, and axial rotation angle using image-matching techniques. Rotational alignments of femoral and tibial components were measured postoperatively using computed tomography images. RESULTS: The pre- and postoperative tibiofemoral functional extension/flexion angles during squatting were 12.2° ± 6.7°/100.1° ± 16.8° and 9.6° ± 8.6°/109.4° ± 16.8°, respectively, with a significant difference in flexion angle (p < .05). Total AP translation was significantly larger postoperatively than preoperatively (10.8 mm ± 3.7 mm vs. 14.4 mm ± 4.2 mm, respectively; p < .05). The pre- and postoperative total rotation angles were 6.6° ± 3.0° and 6.4° ± 3.7°, respectively, indicating no significant difference. The pre- and postoperative tibiofemoral functional flexion angles were significantly associated with each other (p = .0434, r = .49). The postoperative total rotation angle was significantly smaller when the total component rotational mismatch angle between the femoral and tibial components was above 5° vs. below 5° (4.6° ± 2.7° vs. 8.3° ± 3.9°, respectively; p < .05). CONCLUSIONS: BCS-TKA significantly increased the tibiofemoral functional flexion angles, with larger AP translation postoperatively. Both preoperative skeletal kinematics and surgical techniques affected the skeletal kinematics of the replaced knee. A total component rotational mismatch angle greater than 5° significantly decreased postoperative total knee rotation during squatting.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Rotação , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
17.
BMC Musculoskelet Disord ; 22(1): 791, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34525989

RESUMO

BACKGROUND: There are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI), however, national or international guidelines for a standardised treatment regime are still lacking. The present paper evaluates the use of the predominant treatment protocols for PJI in certified total joint replacement centres (EPZ) in Germany based on an EndoCert questionnaire. MATERIALS AND METHODS: The questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the treatment protocols for septic revision arthroplasties in EPZ. Questions targeted the various treatment options including prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and diagnostic sampling prior to re-implantation. All certified EPZ participated (n = 504) and the results from the current survey in 2020 were compared to data from a previous analysis in 2015. RESULTS: The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option increased (hip: + 6.3%; knee: + 6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the preferred interval between prosthesis removal and re-implantation in two-stage revision in hip as well as knee revisions. Centres with a higher number of revision surgeries (> 200 revisions/year), opted even more often for the 4-8 week period (92.3%). In two-stage revision the use of metal-based spacers with/without reinforcement with antibiotic-containing cement as an interim placeholder was significantly reduced in 2020 compared to 2015. There was also a clear preference for cemented anchoring in two-stage revision arthroplasty in the knee in 2020, whereas the majority of hip replacements was cementless. Additionally, in 2020 the number of samples for microbiological testing during the removal of the infected endoprosthesis increased and 72% of the centres took five or more samples. Overall, the number of EPZ with a standardised protocol for the procedure expanded from 2015 to 2020. CONCLUSION: While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Censos , Desbridamento , Alemanha/epidemiologia , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
18.
Acta Chir Orthop Traumatol Cech ; 88(4): 291-301, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34534059

RESUMO

PURPOSE OF THE STUDY The purpose of the study is to verify the correct alignment of components of the Oxford medial unicompartmental knee arthroplasty using the Zimmer Microplasty® instrumentation at the beginning of the learning curve. The implantation of prosthetic components of partial knee arthroplasty in proper alignment has an effect on long-term survival of the prosthesis and should eliminate the occurrence of frequent complications. MATERIAL AND METHODS The study group includes 20 patients, 9 men with the mean age of 68 years (range 62-78 years) and 11 women with the mean age of 69 years (range 52-81 years). 13 patients underwent surgery on the right knee and 7 patients on the left knee. The mean length of symptoms was 13 months (range 7-20 months), the mean varus knee deformity was 7° (range 4-12°). The selected patients met both the clinical and radiological criteria for enrolment in the study. In all of them medial unicompartmental knee arthroplasty was performed in 2019 by the same surgeon. After surgery, the parameters of accuracy of alignment of individual prosthetic components were measured on the full-length radiograph of the limb under load. The WOMAC score was recorded preoperatively and one year after surgery and subsequently compared. The knee joint flexion preoperatively and one year after surgery was evaluated. RESULTS The analysis of radiographs revealed that in 12 cases the femoral component was implanted in the mean valgus angle of 1.6° (range 1-3°) and in 8 cases in the mean varus angle of 3° (range 1-5°). All femoral components were implanted in the mean flexion of 7.3° (range 3-11°), no component was implanted in extension. As concerns the tibial component, 19 components were implanted in a neutral or minimum varus angle with the mean value of 1.1° (range 0.3-4°). One component only was implanted in the valgus angle of 1°. All tibial components were implanted with the mean dorsal slope of 6.5° (range 4-8°). The incision was 5 mm deep on average (range 3-6 mm). There was a slight divergence between the components, namely 2.8° on average (range 2-7°) and the distance between the components was 4mm on average (range 3-5 mm). The mean knee joint flexion achieved preoperatively by patients was 115° (range 110-123°), whereas postoperatively the mean flexion achieved was 126° (range 111-138°). The preoperative Womac score was 84.5 points on average (range 64-96 points), whereas postoperatively it was 26.4 points on average (range 7-52 points). None of the components was implanted outside the permitted range, no early complications of the partial replacement (luxation of polyethylene mobile bearing insert, early loosening of the prosthesis, tibial fracture) were observed. DISCUSSION Our radiographic measurements show that when Zimmer Microplasty® instrumentation is used correct alignment of the femoral and tibial component can be achieved and the individual components were correctly aligned within the recommended range. Every single component met the required criteria for alignment. When comparing the values obtained by us in measurements with those obtained by other authors from abroad, similar results regarding the alignment of components were achieved. CONCLUSIONS When using Zimmer Microplasty® instrumentation, excellent results can be achieved also at the beginning of the learning curve of partial knee replacement. Key words: medial gonarthrosis, unicompartmental arthroplasty, hemiarthroplasty, alignment of components.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia
19.
Acta Chir Orthop Traumatol Cech ; 88(4): 302-306, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34534060

RESUMO

PURPOSE OF THE STUDY The aim of this study was to evaluate and compare the functional outcomes and complication rates of patients in the midterm follow-up period when patients applied with medial unicondylar knee arthroplasty (UKA) were grouped according to Body Mass Index (BMI) values MATERIAL AND METHODS The study included 125 patients applied with medial UKA between December 2013 and December 2017 because of isolated medial compartment gonarthrosis and completed at least 2 years of follow-up. The patients were separated into three groups: non-obese with a BMI < 30 kg/m2, obese with BMI of 30-39 kg/m2, and morbidly obese (BMI ≥ 40 kg/m2). The implants used in all surgeries were cemented fixed-bearing implants. All patients were evaluated preoperatively with bilateral orthoroentgenograms, and weight-bearing anteroposterior and flexed lateral knee X-rays. Postoperatively, bilateral orthoroentgenograms and weight-bearing anteroposterior and flexed lateral knee X-rays were taken. Pre- and post-operative clinical outcomes were evaluated using the Knee Society Score (KSS), functional Knee Society Score (fKSS) Oxford Knee Score (OKS) and Visual Analogue Scale (VAS). RESULTS The 125 study patients comprised 83 females and 42 males with a mean age of 54 years (range, 42-71 years). No significant difference was determined between the three groups in respect of age, gender and side distribution (p > 0.05). In all three groups, the fKSS, KSS, OKS and VAS values at the final follow-up examination were statistically significantly improved compared to the preoperative values. No periprosthetic infection was determined in any patient throughout the follow-up period. Revision surgery was applied for various reasons to 5 patients; 2 in the non-obese group, 2 in the obese group, and 1 in the morbidly obese group. DISCUSSION In the last 20 years, a general increase has been seen in the number of obese patients with knee osteoarthritis requiring surgery. The increase in obesity represents an important worldwide public health problem. CONCLUSIONS The results of this study suggest that obesity does not influence the middle term outcomes of UKA. The functional outcome scores after surgery and improvement in these scores were comparable to patients with normal BMI. Key words: medial gonarthrosis, obesity, unicondylar knee arthroplasty.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Obesidade Mórbida , Osteoartrite do Joelho , Adulto , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
20.
BMC Musculoskelet Disord ; 22(1): 800, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535109

RESUMO

BACKGROUND: The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement. METHODS: Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision. RESULTS: The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41). CONCLUSIONS: The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Humanos , Lituânia/epidemiologia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Reoperação , Estudos Retrospectivos , Staphylococcus aureus , Suécia/epidemiologia
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