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1.
Pain Manag ; 12(1): 105-116, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34551582

RESUMO

Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
2.
Acta Ortop Mex ; 35(2): 158-162, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34731916

RESUMO

PURPOSE: Identify the incidence and risk factors for acute kidney injury (AKI) following total knee arthroplasty (TKA) with and without tourniquet. MATERIAL AND METHODS: 100 patients were randomized into two groups. Postoperative AKI was defined as the postoperative creatinine level 0.3 mg/dl compared with baseline. Potential variables associated with AKI were analyzed by multivariate logistic regression model to identify the AKI risk factors in TKA patients with and without tourniquet. RESULTS: AKI rate was 22%, tourniquet use (OR = 2.66, p = 0.014), blood loss > 500 cm3 (OR = 3.99, p = 0.001), postoperative Hb < 10 g/dl (OR = 2.68, p = 0.008), blood transfusions (OR = 2.86, p = 0.012) and diabetes (OR = 2.80, p = 0.006) were associated with increased risk of postoperative AKI. CONCLUSIONS: The use of tourniquet should be indicated with caution and should not be used routinely in patients with other risk factors for the development of acute kidney dysfunction, other measures to achieve trans-surgical hemostasis should be implemented in our environment to reduce the incidence of acute kidney dysfunction related to the use of the tourniquet.


Assuntos
Injúria Renal Aguda , Artroplastia do Joelho , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica , Humanos , Incidência , Estudos Prospectivos , Fatores de Risco , Método Simples-Cego , Torniquetes
3.
BMC Musculoskelet Disord ; 22(1): 927, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732184

RESUMO

BACKGROUND: Numerous patients who receive hemodialysis (HD) undergo total knee arthroplasty (TKA) due to advanced knee joint arthritis. However, there are few studies that describe the clinical outcomes and complications of TKA in HD patients. This study investigated the mid-term results of TKA in patients undergoing HD. METHODS: This single-center retrospective study compared clinical and surgical outcomes following TKA in patients who were receiving HD with those who were not. We used propensity scores to match 21 knees of 18 patients who received HD to 706 knees of 569 patients who had not received HD, from a total of 727 knees (587 patients) that underwent primary unilateral TKA. The clinical outcomes were evaluated using the American Knee Society Score-knee (AKSS-knee) and AKSS-function scores. The primary surgical outcome measure was the number of knees with postoperative complications. RESULTS: In both the HD and non-HD groups, postoperative AKSS-knee and function scores significantly improved when compared to preoperative values. Postoperative AKSS-knee and function scores were not significantly different between the groups. The number of knees with postoperative complications was larger in the HD group than the non-HD group within the first postoperative month, 0-12 months, 12-24 months, 0-24 months, and two years after surgery. Additionally, in the HD group, more complications occurred in the first month than any subsequent month in the two years after surgery. CONCLUSIONS: TKA improves AKSS-knee and function scores equivalently for HD patients and non-HD patients. However, HD patients develop more complications after TKA, especially within the first month. Therefore, surgeons who perform TKA for HD patients should obtain informed consent after explaining the possible complications, and HD patients should be carefully observed following TKA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Estudos de Coortes , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
4.
BMC Musculoskelet Disord ; 22(1): 945, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772392

RESUMO

BACKGROUND: Postoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects. We sought to investigate predictors of delirium after TJA. METHODS: PubMed, EMBASE, Cochrane Library and Web of Science were searched up to 2020 for studies examining POD following TJA in elderly patients. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation. RESULTS: Fifteen studies with 31 potential factors were included. In the primary analysis, 9 factors were associated with POD, comprising advanced age (MD 3.81; 95% confidence interval (CI) 1.80-5.83), dementia (OR 24.85; 95% CI 7.26-85.02), hypertension (OR 2.26; 95% CI 1.31-3.89), diabetes (OR 2.02; 95% CI 1.15-3.55), stroke (OR 14.61; 95% CI 5.26-40.55), psychiatric illness (OR 2.72; 95% CI 1.45-5.08), use of sedative-hypnotics (OR 6.42; 95% CI 2.53-16.27), lower preoperative levels of hemoglobin (MD - 0.56; 95% CI - 0.89-- 0.22), and lower preoperative mini-mental state examination score (MD - 0.40; 95% CI - 0.69-- 0.12). Twelve studies were included in the systematic review, of which 24 factors were additionally correlated with POD using single studies. CONCLUSIONS: Strategies and interventions should be implemented for the elderly patients receiving TJA surgeries with potential predictors identified in this meta-analysis.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Delírio , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Humanos , Razão de Chances , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
6.
Medicina (Kaunas) ; 57(11)2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34833468

RESUMO

Background and Objectives: Some of the postoperative complications following orthopaedic surgeries are associated with a systemic inflammatory response (SIR), which varies depending on the anaesthetic technique. We aimed to compare the effects of general and spinal anaesthesia on the SIR after total knee arthroplasty (TKA), based on C-reactive protein (CRP) levels, the platelet-lymphocyte ratio (PLR), and the neutrophil-lymphocyte ratio (NLR). Materials and Methods: Patients who underwent TKA between January 2014 and December 2018 were included. Electronic medical records of the patients were retrospectively reviewed and analysed. To reduce the impact of potential confounding factors, we performed propensity score matching according to the anaesthetic technique. Results: A total of 1311 TKA cases were analysed. After propensity score matching, the maximal CRP value and changes in CRP levels in the general anaesthesia group were higher than those in the spinal anaesthesia group. However, the maximal NLR and PLR and the changes in NLR and PLR were not different between the two groups. There were no differences in postoperative clinical outcomes. Conclusion: Spinal anaesthesia tended to induce a lower inflammatory response than general anaesthesia when considering CRP levels in patients undergoing TKA. However, the effects of anaesthetic techniques on the overall outcomes were not significant.


Assuntos
Raquianestesia , Artroplastia do Joelho , Raquianestesia/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Humanos , Pontuação de Propensão , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica
7.
BMC Musculoskelet Disord ; 22(1): 978, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34814889

RESUMO

BACKGROUND: Optimizing patients' total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. METHODS: We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients' characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. RESULTS: The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients' THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36-0.66], p-value < 0.01). CONCLUSION: Whatever the perioperative program, the key to improving patients' THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients' experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients' THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Recuperação Pós-Cirúrgica Melhorada , Artroplastia do Joelho/efeitos adversos , Humanos , Pacientes Internados , Tempo de Internação , Pacientes Ambulatoriais
8.
Acta Orthop Traumatol Turc ; 55(5): 417-421, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34730528

RESUMO

OBJECTIVE: The aim of this study was to determine which type of knee arthroplasty is easier to forget by comparing levels of joint awareness evaluated with the Forgotten Joint Score (FJS-12) after unicondylar versus total knee arthroplasty. METHODS: Patients who underwent either unicondylar or total knee arthroplasty due to primary gonarthrosis were retrospectively identified and then divided into 2 groups: the TKA group (218 patients; mean age = 68.93 ± 7.14 years) and the UKA group (131 patients; mean age = 60.39 ± 7.03 years). The status of joint awareness after knee replacement surgery was assessed using the Turkish version of the FJS-12 at the final follow-up by telephone interview. Also, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and The EuroQol five-dimensional (EQ-5D) scores were obtained to assess the clinical status of the patients. RESULTS: The mean follow-up was 2.8 years (range = 24-49 months) in the TKA group and 3.2 years (range = 24-50 months) in the UKA group. The FJS-12 was significantly higher in the UKA group (73.60 ± 9.95) than in the TKA group (64.88 ± 9.47) (P = .001). The WOMAC score was significantly better in the UKA group (81.39 ± 9.84) than in the TKA group (74.92 ± 9.99) (P = .001). No significant difference in EQ-5D existed between the groups (0.76 ± 0.14 for the TKA group, 0.79 ± 0.17 for the UKA group; P = .441). In terms of gender, the FJS-12 showed no differences between the groups; however, more favorable scores were recorded in younger patients with UKA. CONCLUSION: The results of this study have demonstrated that UKA may be better than TKA in terms of the patient perception of pain, stiffness, and physical functioning. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
Acta Orthop Belg ; 87(3): 449-451, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34808718

RESUMO

Rotating-hinge knee implants are fully constrained knee prostheses commonly used for revision total knee arthroplasty. Nevertheless, rotating-hinge devices have been increasingly utilized in primary setting. Complications are inevitable in orthopedic surgery, however, implant breakage after RHK arthroplasty has been rarely described in medical literature. We present a rare case of 70-year-old Caucasian, male patient who suffered an atraumatic femoral stem breakage in a primary NexGen ® Rotating Hinge Knee (Zimmer-Biomet ® , Warsaw, IN, USA).


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Masculino , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
10.
Acta Orthop Belg ; 87(3): 461-468, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34808720

RESUMO

Tourniquet-use has been described in litera- ture as a surgical factor leading to increased post-operative hidden blood loss in total knee arthroplasty (TKA). The hypothesis for this retro- spective study was that low-pressure tourniquet TKA would offer the benefits of tourniquet surgery without the potential negative effects on late blood loss after the procedure. Therefore, this study evaluated total (TBL) and hidden blood loss (HBL) in TKA with or without a tourniquet. We retrospectively compared two groups : one group (n= 54) undergoing TKA without a tourniquet and one group with a low-pressure tourniquet (n= 110). The outcomes compared were hemoglobin levels 2 weeks before surgery and at days 2 and 4 after surgery to calculate total and hidden blood loss, transfusion rate, and functional outcome. A higher total blood loss was observed in the no tourniquet group with a mean loss of 1073 mL against 890 mL in the tourniquet group (p-value = 0,003). Hidden blood loss values between both groups were statistically not significant : in the no-tourniquet group, Hb drop between D2 and D4 was 0.5 g/dL against 0.4 g/ dL in the low-pressure tourniquet group. The tourniquet-less group did not present with better functional scores. This study showed that low- pressure tourniquet use reduces TBL without increasing HBL in TKA.


Assuntos
Artroplastia do Joelho , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica , Humanos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Torniquetes
11.
Ann Palliat Med ; 10(9): 9927-9939, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628917

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) has brought hope to patients with malignant knee joint diseases. Infection is one of the serious complications after TKA, and the purpose of this study was to use bibliometrics to analyze the current research status of infection after this surgery, to unmask any deficiencies with current research, and to provide references for future researchers. METHODS: We used the Science Citation Index Expanded (SCI-E) database in the Web of Science Core Collection (WOSCC) as the data source, using the search terms "total knee arthroplasty" and "infection" respectively. The "And" operation was performed on the search results of the two subject terms, and the intersection of the two search results was taken as the final search result. CiteSpace software was used to analyze the results. RESULTS: The search results consisted of 5,600 documents, with a total citation frequency of 148,871. The average number of citations for each literature was 26.58, and the h-index was 142. The top five countries in the number of publications were the United States, China, Germany, the United Kingdom, and Spain, while the top five centrally ranked countries were the United States, the Netherlands, Germany, the United Kingdom, and France. The top five institutions with the number of publications were Thomas Jefferson Univ, Mayo Clin, Hosp Special Surg, Rush Univ, and Cleveland Clin, while the top institutions for centrality were Thomas Jefferson Univ, Tel Aviv Univ, Univ Melbourne, and Rush Univ. The top five authors of the number of published articles were Parvizi J, Mont MA, Valle CJD, Chen AF, and Hanssen AD, and the top three authors for centrality were Parvizi J, Mont MA, and Valle CJD. The main journals were J Bone Joint Surg Am, Clin Orthop Relat R, J Arthroplasty, J Bone Joint Surg Br, and Int Orthop, and the top five keywords used were total knee arthroplasty, total hip arthroplasty, replacement, infection, and arthroplasty. CONCLUSIONS: There is a lack of studies with high-level evidence. The focus of related research in recent years has not changed significantly. More randomized controlled studies are required to provide evidence-based medicine.


Assuntos
Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artroplastia do Joelho/efeitos adversos , Bibliometria , China , Bases de Dados Factuais , Humanos , Estados Unidos
12.
Trials ; 22(1): 703, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654469

RESUMO

BACKGROUND: Enhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA. METHODS: This is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, before wound closure, 80 ml of the cocktail analgesic will be injected into the muscle and joint capsule for local infiltration analgesia; the participants will be randomly assigned to three groups to receive a high dose of betamethasone MCPI (group H), normal dose of betamethasone MCPI (group N), and non-betamethasone MCPI (group C). The following indices will be recorded and analyzed: the strongest knee pain experienced during 90° flexion at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1 min walking ability; and circumference around the patella at 2, 5, 14, and 30 days after surgery; Knee Society knee score at 14 days and 30 days after surgery; C-reactive protein and blood sedimentation; blood sugar 2, 5, 14, and 30 days following surgery; rescue analgesic consumption; and adverse events. If any participant withdraws from the trial, an intention-to-treat analysis will be performed. DISCUSSION: The results of this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000038671 . Registered on September 27, 2020.


Assuntos
Artroplastia do Joelho , Corticosteroides/efeitos adversos , Anestésicos Locais , Artroplastia do Joelho/efeitos adversos , Humanos , Injeções Intra-Articulares , Manejo da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Medicine (Baltimore) ; 100(37): e27156, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664841

RESUMO

BACKGROUND: The purpose of this meta-analysis was to assess the effects of Modified Robert Jones Bandage (MRJB) in primary total knee arthroplasty (TKA). METHODS: PubMed, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were systematically searched for randomized controlled trials (RCTs). All RCTs were compared to receive either MRJB (study group) or conventional wound dressing (control group) in TKA. Statistical analysis was assessed using RevMan 5.3 software. RESULTS: A total of 5 RCTs involving 362 patients were included in the meta-analysis. No significant difference between the 2 groups was found in terms of total blood loss (Mean difference [MD], -25.41; 95% confidence interval [CI], -90.52 to 39.70; P = .44), intra-operative blood loss (MD, -13.77; 95% CI, -31.84 to 4.29; P = .14), drain blood loss (MD, 0.83; 95% CI, -30.07 to 31.72; P = .96), and transfusion rate (risk ratio, 0.95; 95% CI, 0.55-1.64; P = .86); There was also no significant difference in terms of range of motion (MD, -0.93; 95% CI, -3.64 to 1.79; P = .50), visual analog scale pain sores (MD, -0.02; 95% CI, -0.34 to 0.30; P = .90), and operative time (MD, -3.12; 95% CI, -13.42 to 7.18; P = .55), without increasing the risk of wound-related complications (risk ratio, 0.75; 95% CI, 0.27-2.08; P = .58) in both groups. No deep venous thrombosis occurred in all studies. CONCLUSIONS: The current meta-analysis of the available evidence indicates patients with MRJB had not required the additional advantage compared to the conventional wound dressing for TKA. However, more high-quality studies are needed to confirm the above conclusions. LEVEL OF EVIDENCE: Level I, therapeutic study.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bandagens/normas , Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia/classificação , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/enfermagem , Hemorragia/prevenção & controle , Humanos , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
14.
BMC Musculoskelet Disord ; 22(1): 856, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625057

RESUMO

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols were rapidly adopted in many surgeries such as fast-track arthroplasty. The study aimed to investigate the impact of ERAS protocols on the clinical effect of total knee arthroplasty (TKA) via the midvastus approach. METHODS: A total of 69 patients who underwent primary unilateral TKA via the midvastus approach from October 2018 to June 2019 were enrolled and randomly divided into two groups: ERAS group and Control group. The ERAS protocols were adopted for the ERAS group and consisted of pure juice drinking 2 h before the surgery, optimization of the preoperative anesthesia plan, phased use of tourniquets, and the use of tranexamic acid as well as a drug cocktail. The operative time, first postoperative walking time, first straight leg elevation time, postoperative hospitalization time, visual analogue scale score (VAS score), Hospital for Special Surgery score (HSS score), conventional Knee Society score (KSS), and knee range of motion (ROM) were used to assess the clinical effects in the two groups. All the included patients were followed up for 12 months. RESULTS: There were no significant differences in the basic demographic information and operation time between the ERAS and Control groups (P > 0.05). The first postoperative walking time (2.11 ± 0.11 h) and first postoperative straight leg elevation time (6.14 ± 1.73 h) in the ERAS group were significantly earlier than those in the Control group (P < 0.001) and the postoperative hospitalization time was significantly shorter (3.11 ± 0.32 days). The postoperative mean VAS scores in both groups were significantly reduced compared with those before surgery (P < 0.001). The VAS scores for the ERAS group were significantly lower than those for the Control group at 1, 2, and 7 days after surgery (P < 0.001). The mean HSS scores, KSS, and knee ROM were significantly increased in both the ERAS and Control groups at 1, 3, 6, and 12 months after surgery (P < 0.001). In addition, the HSS scores, KSS, and knee ROM in the ERAS group were significantly higher than those in the Control group at 1 month after surgery (P < 0.001). CONCLUSIONS: ERAS protocols improved the clinical effects of TKA via the midvastus approach, facilitating early out-of-bed activity and comfortable postoperative rehabilitation exercise, and further increasing patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04873544 .


Assuntos
Artroplastia do Joelho , Recuperação Pós-Cirúrgica Melhorada , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Torniquetes
15.
BMC Musculoskelet Disord ; 22(1): 859, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625077

RESUMO

BACKGROUND: The use of Oxford uni-compartmental knee arthroplasty (UKA) has rapidly increased worldwide,however,the relevance of younger patients for postoperative function after Oxford UKA remains unclear. The main purpose of our study is to clarify the effectivemess of Oxford UKA in the younger Chinese patients with anteromedial osteoarthritis (AMOA). METHODS: We retrospectively enrolled 252 consecutive patients who underwent Oxford UKA for AMOA with a minimum follow-up of 5 years between March 2013 and December 2016. The patients were divided into the younger (≤60 years) and elderly (> 60 years) age groups. The demographic data and surgery variables were recorded and compared. Patient satisfaction grade, range of motion (ROM), Oxford knee score (OKS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index score and postoperative complications were recorded. The 5-year survival of the implants were also compared with TKA revision as the endpoint. RESULTS: A total of 252 consecutive patients were recruited, including 96 aged 60 years or less and 156 aged over 60 years. The mean follow-up duration in the younger and elderly groups were 73.6 months (SD,standard deviation, 4.1) and 74.7 months (SD 6.2) respectively. Patient satisfaction rate was high in both groups (P = 0.805). Furthermore, no significant differences were observed in postoperative ROM(P = 0.299), OKS(P = 0.117), HSS(P = 0.357) and WOMAC scores(P = 0.151) between the younger and elderly groups (P>0.05). However, the incidence of joint stiffness (P = 0.033) and delayed wound dehiscence (P = 0.026) were significantly different between both groups. Five-year implant survival without revision were also similar in both groups (96.9% vs 97.4%, P = 0.871), and that for the entire cohort was 97.2% (95% CI 95.4-99.6). CONCLUSION: Oxford UKA for AMOA demonstrated favorable results in younger patients aged ≤60 years at a minimum 5-year follow-up in terms of patient satisfaction, functional outcomes, implant survival and postoperative complications. Therefore, younger patients might not be considered as an absolute contraindication to Oxford UKA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Seguimentos , Humanos , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
16.
Am J Case Rep ; 22: e931857, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34648481

RESUMO

BACKGROUND Chronic posterior knee dislocation after total knee arthroplasty (TKA) is a rare but serious complication, especially when it coexists with septic implant loosening, flexion contracture, and extensive comorbidities. Although the severity is comparable to that in the native knee dislocation, there are few reports in the literature. When TKA dislocation is complicated with infection, bone defect, and patient's comorbidity, treatment becomes even more difficult. For these complex complications, in order to provide stable and mobile knees, constrained total knee prostheses are used. CASE REPORT We present the case of a 63-year-old, non-ambulatory man, with mental retardation and multiple comorbidities, who had a 9-year history of neglected posterior TKA dislocation, which later became complicated with septic loosening and productive fistula for 4 years. The patient required use of a wheel-chair for several years, was obese with a body mass index (BMI) of 34.3, and the affected knee was in a prolonged flexion contracture at 90°. The posterior TKA dislocation was later infected by Staphylococcus hominis and Staphylococcus epidermidis. He was successfully treated with two-stage revision surgery and managed to become ambulatory after 6 years of requiring use of a wheel-chair. CONCLUSIONS Neglected posterior dislocation of TKA is a rare and potentially limp-causing complication, especially when accompanied with chronic infection, implant loosening, severe bone loss, flexion contracture, and extensive comorbidities. A multidisciplinary approach with careful preoperative planning, exceptional surgical technique, and prolonged supervised physiotherapy are the keystones for a successful outcome.


Assuntos
Artroplastia do Joelho , Contratura , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Contratura/etiologia , Contratura/cirurgia , Humanos , Articulação do Joelho , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Resultado do Tratamento
17.
BMC Health Serv Res ; 21(1): 1151, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34696785

RESUMO

BACKGROUND: Approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Due to the growing number of TKA procedures, this will affect an increasing number of people worldwide. Catastrophic thinking, dysfunctional illness perception, poor mental health, anxiety and depression characterize these non-improvers, and indicate that these patients may need individualized treatment using a treatment approach based on the bio-psycho-social health model. The present study developed an internet-delivered cognitive behavioral therapy (iCBT) program to be combined with exercise therapy and education for patients with knee osteoarthritis (OA) at increased risk of chronic pain after TKA. METHODS: The development process followed the first two phases of the UK Medical Research Council framework for complex interventions. In the development phase, the first prototype of the iCBT program was developed based on literature review, established iCBT programs and multidisciplinary workshops. The feasibility phase consisted of testing the program, interviewing users, condensing the program, and tailoring it to the patient group. A physiotherapist manual was developed and adapted to physiotherapists who will serve as mentors. RESULTS: The development process resulted in an iCBT program consisting of 10 modules with educational texts, videos and exercises related to relevant topics such as goalsetting, stress and pain, lifestyle, automatic thoughts, mindfulness, selective attention, worry and rumination. A physiotherapist manual was developed to guide the physiotherapists in supporting the patients through the program and to optimize adherence to the program. CONCLUSIONS: The iCBT program is tailored to patients at risk of chronic pain following TKA, and may be useful as a supplement to surgery and/or exercise therapy. A multicentre RCT will evaluate the iCBT program in combination with an exercise therapy and education program. This novel intervention may be a valuable contribution to the treatment of OA patients at risk of chronic pain after TKA. TRIAL REGISTRATION: The RCT is pre-registered at ClinicalTrials.gov: NCT03771430 11/12/2018.


Assuntos
Artroplastia do Joelho , Dor Crônica , Terapia Cognitivo-Comportamental , Artroplastia do Joelho/efeitos adversos , Dor Crônica/etiologia , Dor Crônica/terapia , Terapia por Exercício , Humanos , Internet
18.
J Knee Surg ; 34(13): 1388-1395, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600438

RESUMO

Total knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artrite Infecciosa/cirurgia , Artroplastia do Joelho/efeitos adversos , Humanos , Período Pós-Operatório , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/terapia , Estudos Retrospectivos
19.
Ann Saudi Med ; 41(5): 299-306, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618608

RESUMO

BACKGROUND: Isolated involvement of the medial compartment of the knee in degenerative disease is encountered in about 25% of patients with gonarthrosis. We aim to show that in a well-selected group of such patients, medial unicompartmental knee arthroplasty (UKA) is a good option. OBJECTIVES: Review the functional outcomes of patients undergoing UKA and determine the long-term survivorship of the implants and complications of the procedure. DESIGN: Analytical retrospective chart review. SETTING: Academic tertiary care medical center and tertiary care private hospital in the western region of Saudi Arabia. PATIENTS AND METHODS: We selected patients who underwent medial UKAs by the same surgeon between December 1988 and December 2009. The life table approach and the Kaplan-Meier statistical method were used to estimate the survival rate (5-30 years) with revision as the endpoint. Functional outcome scores were determined according to the Knee Society Clinical Rating System. MAIN OUTCOME MEASURES: Change in performance scores for pain, walking, and range of movement. Survivorship of the implants with removal of the implant as the endpoint; post-operative complications. SAMPLE SIZE: 218 implants on 142 patients. RESULTS: The survival rate of UKA was 94.7% at 10 years (95% CI 0.906-0.970), 80.9% at 20 years (95%CI 0.724-0.871), and 77.8% at 30 years (95%CI 0.669-0.855). The average grand total functional score increased from 61 (maximum 200) at 0 months to above 150 at ≥6 months. CONCLUSION: UKA is a good option for isolated medial compartment gonarthrosis with excellent functional outcome and good survivorship in selected patients. LIMITATION: Single center experience, retrospective. We lost 6.0% of patients during follow-up. Comparison with other treatment modalities is based on literature review and not on our own data. CONFLICT OF INTEREST: None.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Sobrevivência , Resultado do Tratamento
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