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1.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194200

RESUMO

BACKGROUND: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). OBJECTIVE: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. METHOD: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. RESULTS: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p˂0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p˂0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p˂0.05). CONCLUSION: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery


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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Profilaxia Pós-Exposição/métodos , Artroplastia do Joelho/métodos , Educação de Pacientes como Assunto , Readmissão do Paciente
2.
Medicine (Baltimore) ; 99(35): e21868, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871911

RESUMO

BACKGROUND: The choice between unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA) is likely to have long-term implications for patient-reported health outcomes. However, high-quality studies that compare the outcomes of TKA and UKA and their effects are still lacking in the literature. Thus, the aim of the present study was to compare the UKA and TKA techniques with regard to functional outcomes and perioperative complications in patients who had isolated medial osteoarthritis. METHODS: This was a retrospective, single-center, matched-controlled study performed with approval of our hospital (Kunshan hospital of Traditional Chinese Medicine affiliated to Nanjing University of Traditional Chinese Medicine), with the ethics number KZY2020-37. To reduce the effect of selection bias and potential confounding in this observational study, a 1:1 matching algorithm was applied. The groups were split by sex, age to within 6 years, and body mass index within 5 kg/m. Thus, we retrospectively reviewed the records of 240 consecutively enrolled patients who underwent UKA and 240 patients who underwent TKA from January 2013 to June 2015 from the database of our institution. Written informed consent was obtained from all subjects participating in the trial. Clinical outcomes included range of motion, Short Form 12 score, new Knee Society Score, Western Ontario and McMaster Universities Arthritis Index, and the complications. The outcome measures were evaluated by a physiotherapist and were assessed preoperatively and postoperatively at 6 months and 2 years. The mean follow-up time was 3 years. CONCLUSION: We hypothesized that there was no significant difference between the 2 groups in terms of postoperative outcomes. TRIAL REGISTRATION: Our study was registered in Research Registry (researchregistry5828).


Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Projetos de Pesquisa , Estudos Retrospectivos , Adulto Jovem
3.
Medicine (Baltimore) ; 99(35): e21881, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871917

RESUMO

BACKGROUND: Pain control after total knee arthroplasty has shown many advances; however, the optimal method remains controversial. The purpose of this present study is to assess the efficacy and safety of the addition of local infiltration analgesia to adductor canal block for pain control after primary total knee arthroplasty. METHODS: This prospective randomized controlled research was conducted from January 2018 to June 2019. All the patients and their family members signed the informed consent forms, and this work was authorized via the ethics committee of Jinxiang Hospital Affiliated to Jining Medical College (JXHP0024578). Inclusion criteria were 55 years old or older, who possess the physical status I-III of American Society of Anesthesiologists, and the body mass index in the range of 18 to 30 kg/m. Exclusion criteria were regional and/or neuroaxial anesthesia contraindications, the history of drug allergy involved in the research, neuropathic pain, as well as the chronic pain requiring opioid therapy. Seventy-two patients were divided into 2 groups randomly. Study group (n = 36) received both adductor canal block and local infiltration analgesia. Control group (n = 36) received adductor canal block alone. Primary outcome included postoperative pain score (visual analog scale 0 to 10 cm, in which 0 represents no pain and 10 represents the most severe imaginable pain). The measures of secondary outcome included the knee range of motion, opioid consumption, the hospital stay length as well as the postoperative complications (for instance, pulmonary embolism, deep vein thrombosis, and the wound infection). All the analyses were conducted through utilizing the SPSS for Windows Version 20.0. RESULTS: The results will be shown in .(Table is included in full-text article.) CONCLUSION:: The study will provide more evidence on the combination use of adductor canal block and local infiltration analgesia in the treatment of pain after the total knee arthroplasty. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5832).


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Bupivacaína/administração & dosagem , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Ropivacaina/administração & dosagem , Escala Visual Analógica
4.
Orthopade ; 49(9): 808-814, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32885289

RESUMO

BACKGROUND: The German Arthroplasty Registry, EPRD, has the ability to examine early factors influencing the probability of failure of total hip arthroplasty (THA) and knee arthroplasty (TKA). The study analyses the influence of the overall experience of a hospital, as well as the change in supplier on the revision rate. MATERIALS AND METHODS: A total of 164,903 cementless THA and 155,577 cemented TKA were in follow-up from 656 hospitals from 2012 to 2019. The number of arthroplasties performed per hospital per year was used as a surrogate parameter for institutional experience. This number was subdivided into 250, 251-500 and more than 500 for hip and knee per year and the overall revision rate was analysed. Additionally, the effects of the change of a major supplier of implant systems to a hospital were analysed. At least 70% of the documented implant components for each calendar quarter were used in that hospital to define the company as a major supplier. RESULTS: The overall revision rate for THA was 3.9% for hospitals with up to 250 arthroplasties per year, 3.3% for hospitals with 251-500 arthroplasties per year and 2.9% for hospitals performing over 500 surgeries per year (p < 0.0001). The revision rate for TKA was also significantly different between the three groups with 3.4, 3.3 and 2.7% (p < 0.0001). Changing the supplier of implant systems also showed a significant increase of the revision rate (p < 0.0001 for THA, p = 0.02 for TKA). CONCLUSION: The institutional experience significantly influences short-term results in terms of the revision rate of hip and knee arthroplasty. Changing the implant system even in an experienced hospital has a major impact on the early revision rate and, therefore, needs careful transition.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Alemanha , Humanos , Articulação do Joelho , Sistema de Registros , Reoperação , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 99(35): e21672, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871881

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is known to be a painful orthopedic procedure and moderate to severe pain is common, especially immediately postoperatively and during active motion. The aim of the present study was to compare epidural analgesia (EA) and adductor canal block (ACB) techniques with regard to early period pain levels, need for additional opioids, and ambulation and functional scores in patients who had undergone primary TKA. METHODS: Approval for the study was granted by the Changji Branch of the First Affiliated Hospital of Xinjiang Medical University. Written informed consent will be obtained from all of the participants. Inclusion criteria included the following: planned unilateral TKA; spinal anesthesia; American Society of Anesthesiologists physical status classification score of I to III. Prospective assessment will be done for 100 patients who are scheduled for unilateral primary TKA surgery in our academic hospital by a single senior surgeon between August 2020 and December 2021. Patients were randomized to ACB treatment or EA treatment by a computer random number generator. The primary outcome was visual analog scale pain scores in the immediate postoperative period. Secondary outcomes included postoperative opioid use, length of hospital stay, activity level during physical therapy, and knee range of motion. Results were evaluated in a confidence interval of 95% and at a significance level of P < .05. CONCLUSIONS: We hypothesized that standard ACB would be as effective as EA for postoperative pain management following TKA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5775).


Assuntos
Analgesia Epidural , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Humanos , Articulação do Joelho/fisiopatologia , Medição da Dor , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular
6.
Bone Joint J ; 102-B(10): 1324-1330, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993324

RESUMO

AIMS: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level. METHODS: A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). RESULTS: The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. CONCLUSION: This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.


Assuntos
Artroplastia do Joelho/instrumentação , Doença Iatrogênica , Lesões dos Tecidos Moles/etiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Desenho de Equipamento , Humanos , Fatores de Risco , Tomografia Computadorizada por Raios X
7.
Bone Joint J ; 102-B(10): 1341-1348, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993339

RESUMO

AIMS: Preoperative nasal Staphylococcus aureus screening and eradication reduces surgical site infections (SSIs) but its impact on reducing early prosthetic joint infection (PJI) remains controversial. This study aims to assess the effect of preoperative nasal S. aureus screening and eradication on the incidence of early PJI in general and S. aureus-induced early PJI. METHODS: All primary total hip arthroplasties (THA) and total knee arthroplasties (TKA) performed from January 2006 to April 2018 were retrospectively reviewed for the incidence of early PJI. Demographic parameters, risk factors for PJI (American Society of Anaesthesiologists classification, body mass index, smoking status, and diabetes mellitus) and implant types were collected. A preoperative screening and eradication protocol for nasal colonization of S. aureus was introduced in October 2010. The incidence of early PJI was compared before and after the implementation of the protocol. Missing data were imputed via multiple imputation by chained equations. Inverse probability weighting was used to account for differences between patients in both groups. Weighted univariate logistic regression was used to evaluate the incidence of early PJI for both groups. RESULTS: In total, 10,486 THAs and TKAs were performed in the research period. After exclusion, a cohort of 5,499 screened cases and 3,563 non-screened cases were available for analysis. Overall, no significant reduction in early PJI was found in the screened group (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.55 to 1.11; p = 0.173). However, the incidence of S. aureus-induced PJI was significantly reduced (OR 0.58, 95% CI 0.36 to 0.92; p = 0.027) in the screened group. CONCLUSION: A preoperative nasal S. aureus screening and eradication protocol did not significantly reduce the overall incidence of early PJI after THA or TKA. However, a decreased incidence of S. aureus-induced early PJI was established. These findings can help to establish better consensus around the value of these screening protocols. Cite this article: Bone Joint J 2020;102-B(10):1341-1348.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Programas de Rastreamento , Período Pré-Operatório , Infecções Estafilocócicas/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Nariz/microbiologia , Estudos Retrospectivos , Fatores de Risco , Staphylococcus aureus , Infecção da Ferida Cirúrgica/microbiologia
8.
Bone Joint J ; 102-B(10): 1331-1340, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993344

RESUMO

AIMS: Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties. METHODS: Well-functioning primary TKAs (n = 11), failed non-fibrotic TKAs (n = 5), and patients with a clinical diagnosis of fibrosis1 (n = 8) underwent an MRI scan with advanced metal suppression (Slice Encoding for Metal Artefact Correction, SEMAC) with gadolinium contrast. Fibrotic tissue (low intensity on T1 and T2, low-moderate post-contrast enhancement) was quantified (presence and tissue thickness) in six compartments: supra/infrapatella, medial/lateral gutters, and posterior medial/lateral. RESULTS: Fibrotic tissue was identified in all patients studied. However, tissue was significantly thicker in fibrotic patients (4.4 mm ± 0.2 mm) versus non-fibrotic (2.5 mm ± 0.4 mm) and normal TKAs (1.9 mm ± 0.2 mm, p = < 0.05). Significant (> 4 mm thick) tissue was seen in 26/48 (54%) of compartments examined in the fibrotic group, compared with 17/30 (57%) non-fibrotic, and 10/66 (15%) normal TKAs. Although revision surgery did improve range of movement (ROM) in all fibrotic patients, clinically significant restriction remained post-surgery. CONCLUSION: Stiff TKAs contain intra-articular fibrotic tissue that is identifiable by MRI. Studies should evaluate whether MRI is useful for surgical planning of debridement, and as a non-invasive measurement tool following interventions for stiffness caused by fibrosis. Revision for stiffness can improve ROM, but outcomes are sub-optimal and new treatments are required. Cite this article: Bone Joint J 2020;102-B(10):1331-1340.


Assuntos
Artroplastia do Joelho , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Imagem por Ressonância Magnética/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Fibrose , Humanos , Aumento da Imagem , Masculino , Metais , Pessoa de Meia-Idade
9.
Zhonghua Yi Xue Za Zhi ; 100(33): 2601-2606, 2020 Sep 08.
Artigo em Chinês | MEDLINE | ID: mdl-32892606

RESUMO

Objective: To compare the perioperative blood loss in patients undergoing a total knee arthroplasty (TKA) across three different techniques: computer-assisted navigation surgery (CAS), patient specific instrumentation (PSI) and conventional instrumentation (CI). Methods: Ninety consecutive patients with severe knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital Orthopedics Department from January 2018 to December 2018 were enrolled in this prospective study. The patients were randomly divided into three groups (30 case in each group): CAS-TKA group, PSI-TKA group and CI-TKA group. The study measured intraoperative blood loss, total blood loss, hidden blood loss, decreases of hemoglobin and hematocrit, and the post-TKA blood transfusions in the three groups. One-way ANOVA was used to detect the differences among the cohorts, and LSD was used for the post-hoc test. Results: The overall intraoperative blood loss of all patients was 6 ml (5~8 ml). The mean total blood loss and hidden blood loss in CAS-TKA group, PSI-TKA group and CI-TKA group was (1 147.0±301.8) and (1 140.1±301.9)ml, (1 044.3±454.1) and (1 038.5±454.0)ml, (1 154.0±483.6) and (1 145.3±482.7)ml, respectively; there was no significant differences among the three groups (F=0.639, 0.616, both P>0.05). There were no patients who received allogeneic blood transfusion. There were no significant differences in decrease of hemoglobin and hematocrit among the three groups neither (both P>0.05). Conclusions: Compared with conventional TKA, CAS and PSI does not increase the total blood loss of TKA. However, they both demonstrate a potential benefit in reducing blood loss of TKA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Cirurgia Assistida por Computador , Humanos , Articulação do Joelho , Impressão Tridimensional , Estudos Prospectivos , Estudos Retrospectivos
10.
Orthop Clin North Am ; 51(4): 441-452, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950213

RESUMO

It is essential for total knee arthroplasty patients to return to their previous level of activity to maintain a healthy lifestyle. This article reviews the current recommendations regarding return to physical activity after total knee arthroplasty and trying to find the balance between levels of activity and prosthetic joint preservation. In general, most total joint replacement patients are able to return to their previous level of activity and to a lesser extent to sports. This article discuss patients' actual levels of activity including their return to work and sport and the factors that influence meeting their expectations for surgery.


Assuntos
Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Humanos , Volta ao Esporte , Esportes/fisiologia
11.
Orthop Clin North Am ; 51(4): 453-459, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950214

RESUMO

Psychosocial health may influence the outcomes after total knee arthroplasty (TKA). We investigated the hypothesis that multimodal therapy influences the quality of life and function in patients diagnosed with osteoarthritis of the knee joint. Secondly, in patients who then proceed to have TKA post-multimodal therapy, does the response to the multimodal therapy influence the overall functional outcome of surgery? Patients diagnosed with osteoarthritis of the knee were enrolled in the study and prospectively followed-up. A total of 526 patients were enrolled and available for the study. All participants were enrolled for 12 classes of 60-minute duration over 6-weeks. Apart from an exercise program, the class also included physiotherapist-led education and a 'weight management' lecture by a dietitian. In summary, the multimodal therapy program improved the SF-12, OKS, pain scores (visual analogue scale) and WOMAC scores significantly. The multimodal therapy protocol can optimize patients' psychological scores prior to TKA and may enhance ultimate functional outcome.


Assuntos
Artroplastia do Joelho/reabilitação , Osteoartrite do Joelho/reabilitação , Artroplastia do Joelho/psicologia , Terapia Combinada , Humanos , Osteoartrite do Joelho/cirurgia , Recuperação de Função Fisiológica
12.
Medicine (Baltimore) ; 99(37): e21956, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925729

RESUMO

BACKGROUND: Several studies reported short-term analgesic efficacy of obturator nerve block (ONB), as in comparison with the femoral nerve block (FNB) in the treatment of postoperative pain after the total knee replacement (TKR). The optimal method remains under debate. The purpose of our current work is to compare the safety and efficacy of FNB and ONB for postoperative analgesia after TKR. METHODS: This prospective, randomized, and controlled study was performed from January 2018 to December 2019. It was authorized via the Institutional Review Committee in NO.971 Hospital of the People's Liberation Army Navy (2019-PLAN-132).Two hundred patients were divided randomly into 2 groups, the control group (n = 100) and study group (n = 100). The experimental group received FNB and control groups received ONB. Primary outcome included pain at different time point (Visual Analogue Scale score of anterior knee pain at rest and in motion). The Visual Analogue Scale scores were marked by patients themselves on a paper with a graduated line starting at 0 (no pain) and ending at 10 (the most painful). Opioid consumption was converted to equivalents of oral morphine uniformly for statistical analysis. Secondary outcomes included the knee range of motion, the hospital stay length as well as the postoperative complications such as pulmonary embolism and deep vein thrombosis. RESULTS: Table 1 will show the clinical outcomes between the 2 groups. CONCLUSION: This trial would provide an evidence for the use of different types of peripheral nerve blocks in TKR.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Administração Oral , Analgésicos Opioides/administração & dosagem , Nervo Femoral , Humanos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Nervo Obturador , Manejo da Dor/métodos , Medição da Dor , Complicações Pós-Operatórias , Estudos Prospectivos , Músculo Quadríceps
13.
Medicine (Baltimore) ; 99(38): e22213, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957356

RESUMO

BACKGROUND: Some patients undergoing the total knee arthroplasty (TKA) have suboptimal postoperative results, and preoperative anxiety may be one of the reasons for these unsatisfactory results. We perform this randomized control study protocol to determine the effectiveness of nursing intervention, on the basis of motivational interview, to decrease the preoperative anxiety in patients receiving TKA. METHODS: This is a double-blinded, single-center, placebo-controlled and randomized trial, which will be conducted from December 2020 to June 2021. The protocol of this study was approved by the West China Hospital of Sichuan University (W20200803-28). Sixty patients who will undergo TKA are included in our study. Patients are randomly divided into experiential group (with 30 patients) and the control group (with 30 patients). The control group and experimental group receive an informative and separate session via nursing about the operation preparation and operation process. Both the control group and the experimental group are given habitual treatment, but the experimental group need to receive additional motivational interviews. The primary outcomes are the Hospital Anxiety and Depression Scale and the Amsterdam Preoperative Anxiety and Information Scale. Secondary outcome is postoperative pain, which is assessed by visual analogue scale . RESULTS: Figure 1 will display the comparison of preoperative and postoperative total average anxiety scores in control group and the experimental group. CONCLUSION: Preoperative psychological distress is familiar in our patients. We hypothesized that nursing intervention may be associated with reduced preoperative anxiety in the patients receiving TKA.


Assuntos
Ansiedade/enfermagem , Artroplastia do Joelho/psicologia , Cuidados Pré-Operatórios/enfermagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Zhonghua Yi Xue Za Zhi ; 100(37): 2892-2896, 2020 Oct 13.
Artigo em Chinês | MEDLINE | ID: mdl-32993246

RESUMO

Objective: To Explore the current status and risk factors of perioperative allogenic red blood cell transfusion following enhanced recovery hip and knee joint arthroplasty. Methods: Patients who have taken their primary unilateral total hip and knee arthroplasty (THA, TKA) or simultaneous primary THA were retrospectively included from January, 2019 to December, 2019 in West China Hospital. The baseline characteristics were compared between patients with allogeneic transfusion and those without. And logistic regression were used to analyze the risk factors of perioperative allogeneic red blood cell transfusion. Results: A total of 2 034 patients (2072 arthroplasties) were included, 705 males and 1 329 females, aged (60±24) years. Of all, 1 137 patients received primary THA (38 simultaneous THA), 897 patients received primary unilateral TKA. Eleven (0.54%) patients received allogeneic red blood cell transfusion, and the mean volume was (2.6±1.2) U. Deep venous thrombosis occurred in 2 patients (0.09%) undergoing primary TKA. The transfusion rate in primary THA patients was 0.79% (9/1 137), and 0.22% (2/897) in TKA. Lower preoperative hemoglobin level (P=0.041) and more hematological comorbidities (P=0.005) were detected in transfused patients. And logistic analysis further revealed that preoperative substandard hemoglobin level was the most important risk factor for transfusion (OR=5.663, P=0.018). Conclusions: Under the intervention of enhanced recovery after surgery concept and modern blood management strategies, the transfusion requirement has been significantly reduced following primary joint arthroplasty. Pre-operative hemoglobin level should be an important threshold for perioperative blood management.


Assuntos
Artroplastia do Joelho , Transplante de Células-Tronco Hematopoéticas , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
15.
Medicine (Baltimore) ; 99(36): e21971, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899035

RESUMO

BACKGROUND: The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. METHODS: Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. RESULTS: We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours (P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). CONCLUSIONS: LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.


Assuntos
Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Morfina/administração & dosagem , Anestesia Local , Humanos , Injeções Espinhais , Tempo de Internação , Dor Pós-Operatória/prevenção & controle
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1096-1100, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929900

RESUMO

Objective: To explore the safety and effectiveness of quadriceps snip in complex total knee arthroplasty (TKA). Methods: A clinical data of 19 cases (29 knees) with complex TKA assisted with quadriceps snip between January 2016 and May 2017 were retrospectively analyzed. There were 9 males (13 knees) and 10 females (16 knees). The age of patients ranged from 34 to 66 years (mean, 50.2 years). Four patients (8 knees) were ankylosing spondylitis, 5 patients (7 knees) were rheumatoid arthritis, and 10 patients (14 knees) were knee osteoarthritis. The average disease duration was 10.9 years (range, 8-15 years). There were 12 knees of Kellgren-Lawrence grade Ⅲ and 17 knees of Kellgren-Lawrence grade Ⅳ. The range of motion (ROM) of knee was (19.86±7.23)°. The clinical and function scores of knee society score (KSS) were 47.86±11.26 and 15.52±11.21, respectively. Postoperative complications, ROM, KSS scores, extensor lag, and prosthesis loosening were observed to evaluate the effectiveness. Results: All incisions healed by first intention, and no infection or cardiovascular and cerebrovascular accidents occurred. All patients were followed up 25-39 months (mean, 30.3 months). At last follow-up, the ROM of knee was (91.03±7.30) °, the KSS clinical score was 83.62±9.99 and functional score was 66.38±7.89, showing significant differences when compared with preoperative ones ( P<0.05). Postoperative extensor lag (10°, 10°, 15°) occurred in 3 cases. There was no evidence of prosthesis loosening or osteolysis on X-ray films during follow-up. Conclusion: The application of quadriceps snip in complex TKA can effectively improve the operative field exposure and reduce incidence of complications such as patella tendon tearing, patella fracture, and quadriceps tendon injury. The surgical technique of Krackow tendon suture can effectively guarantee early rehabilitation without occurrence of other complications.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1200-1204, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929917

RESUMO

Objective: To summarize the methods of tibial prosthesis rotation alignment in total knee arthroplasty, and provide reference for clinicians to select and further study the methods of tibial prosthesis rotation alignment. Methods: The advantages and disadvantages of various tibial prosthesis rotation alignment methods were analyzed and summarized by referring to the relevant literature at home and abroad in recent years. Results: There are many methods for tibial prosthesis rotation alignment, including reference to relevant anatomical landmarks, range of motion (ROM) technique, computer-assisted navigation, and personalized osteotomy. The inner one-third of the tibial tuberosity is a more accurate reference anatomical landmark, but the obesity, severe knee deformity and dysplasia have impacts on the precise placement of the tibial prosthesis. ROM technique do not need to refer to the anatomical landmark of the tibia, and aren't affected by landmark variation. It can be used for severe knee valgus deformity and the landmarks that are difficult to identify. However, it may cause internal rotation of tibial prosthesis. Computer- assisted navigation and personalized osteotomy can achieve more accurate alignment in sagittal, coronal, and rotational alignment of femoral prosthesis. However, due to the lack of reliable anatomical landmarkers related to tibia fixation, it is still controversial whether it can help the alignment of tibial prosthesis rotation. Conclusion: The surgeon should master the methods of rotation and alignment of tibial prosthesis, make preoperative plans, select appropriate alignment methods for different patients, and achieve individualization. Meanwhile, several anatomical landmarkers should be referred to properly during the operation, which can be used to detect the correct placement of tibial prosthesis and avoid large rotation error.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Humanos , Articulação do Joelho/cirurgia , Rotação , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
18.
Zhonghua Wai Ke Za Zhi ; 58(9): 687-690, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878415

RESUMO

There is a low prevalence of osteoarthritis in the lateral compartment of the knee, but the overall number of domestic patients is large, and lateral unicompartmental arthroplasty (UKA) has good prospects.The unique anatomical structure and kinematic characteristics of the lateral compartment make the surgical operation more challenging.Traditional UKA patients have a high incidence of lower limb mal-alignment and poor prosthetic position, which leads to limit of their promotion and application.In recent years, with the development of treatment concepts, surgical techniques and materials, the survival time of UKA prosthesis has been continuously extended, and the clinical effect has been continuously optimized.Strictly grasp the surgical indications in radiology, anatomy and clinical manifestations, familiarize with the lateral compartment anatomy and biomechanical features, and master the technical details are the prerequisites and guarantees for the success of the lateral UKA.With the advancement of technology, minimal invasion, precision and individuation should be the goal pursued for lateral UKA surgery.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Humanos , Prótese do Joelho , Resultado do Tratamento
19.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 406-410, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879065

RESUMO

OBJECTIVES: To evaluate the efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty (TKA). METHODS: A total of 50 patients with knee osteoarthritis treated by TKA from July to September 2018 were randomly divided into two groups (n=25). The Group 1 underwent anterior intra-articular injection before prosthesis implanted while the Group 2 underwent posterior intra-articular injection before prosthesis implanted. Visual Analogue Scale (VAS) of all patients for pain during activity and at rest, maximal flexion degree of the knee at the 48th h and the 72th h after surgery, the time of raise leg, usage rate of patient-controlled analgesia (PCA), and complications were evaluated and analyzed. RESULTS: VAS for pain at rest of patients in the Group 1 was significantly less than that in the Group 2 at the 6th, 12th, and 24th h after surgery (all P<0.05). Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the Group 1 was better than that in the Group 2 (both P<0.05). The Group 1 costed less time than the Group 2 on the ability to perform an active straight leg raise (P=0.027). CONCLUSIONS: The anterior intra-articular cocktail analgesic mixture injection can strongly relieve the pain early after TKA, which can improve knee function and achieve painless rehabilitation in most patients, with safety.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho/cirurgia , Analgésicos , Humanos , Injeções Intra-Articulares , Medição da Dor , Dor Pós-Operatória/prevenção & controle
20.
Medicine (Baltimore) ; 99(39): e22394, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991462

RESUMO

OBJECTIVE: We perform this protocol for randomized controlled trial to compare the efficacy of intrathecal morphine and local infiltration anesthesia (LIA) in the treatment of the postoperative pain after total knee replacement (TKR). METHODS: This is a randomized controlled, single center trial which was performed from March 2019 to March 2020. This trial is conducted according to the SPIRIT Checklist of randomized researches. It is authorized via the Ethics Committee of Beijing Friendship Hospital (2019-P2-050-01). Eighty participants who undergo TKR were randomized into 2 groups. Intrathecal morphine group: 0.1 mg of the morphine was intrathecally injected, and the spinal anesthetic was injected at the same time in the group LIA; In the LIA group: the knee joint was infiltrated with epinephrine, ketorologic acid and ropivacaine in the process of operation, and the identical mixture was injected 2 bolus through the intraarticular catheter after operation. The main outcome variables were the visual analog scale and the consumption amount of opioid every 6-hour interval within 2 days postoperatively. The secondary outcome variables were the side effects associated with opioid, the length of hospital stay, motion range, and the loss of blood collected by the closed suction drainage. All the required analyses were carried out via applying the SPSS for Windows Version 19.0. RESULTS: The clinical outcome variables between groups were shown in . CONCLUSION: This protocol will provide the evidence on which technique can achieve better analgesia after TKR.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia Local , Artroplastia do Joelho/efeitos adversos , Morfina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Humanos , Injeções Espinhais , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
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