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1.
Bone Joint J ; 102-B(11): 1527-1534, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135435

RESUMO

AIMS: Vitamin E-infused highly cross-linked polyethylene (E1) has recently been introduced in total knee arthroplasty (TKA). An in vitro wear simulator study showed that E1 reduced polyethylene wear. However there is no published information regarding in vivo wear. Previous reports suggest that newly introduced materials which reduce in vitro polyethylene wear do not necessarily reduce in vivo polyethylene wear. To assist in the evaluation of the newly introduced material before widespread use, we established an in vivo polyethylene wear particle analysis for TKA. The aim of this study was to compare in vivo polyethylene wear particle generation between E1 and conventional polyethylene (ArCom) in TKA. METHODS: A total of 34 knees undergoing TKA (17 each with ArCom or E1) were investigated. Except for the polyethylene insert material, the prostheses used for both groups were identical. Synovial fluid was obtained at a mean of 3.4 years (SD 1.3) postoperatively. The in vivo polyethylene wear particles were isolated from the synovial fluid using a previously validated method and examined by scanning electron microscopy. RESULTS: The total number of polyethylene wear particles obtained from the knees with E1 (mean 6.9, SD 4.0 × 107 counts/knee) was greater than that obtained from those with ArCom (mean 2.2, SD 2.6 × 107 counts/knee) (p = 0.001). The particle size (equivalent circle of diameter) from the knees with E1 was smaller (mean 0.5 µm, SD 0.1) than that of knees with ArCom (mean 1.5, SD 0.3 µm) (p = 0.001). The aspect ratio of particles from the knees with E1 (mean 1.3, SD 0.1) was smaller than that with ArCom (mean 1.4, SD 0.1) (p < 0.001 ). CONCLUSION: This is the first report of in vivo wear particle analysis of E1. E1 polyethylene did not reduce the number of in vivo polyethylene wear particles compared with ArCom in early clinical stage. Further careful follow-up of newly introduced E1 for TKA should be carried out. Cite this article: Bone Joint J 2020;102-B(11):1527-1534.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Falha de Prótese , Líquido Sinovial/química , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis/análise , Humanos , Polietileno/análise , Falha de Prótese/etiologia , Vitamina E
2.
Clin Appl Thromb Hemost ; 26: 1076029620961450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141613

RESUMO

Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. The Department of Orthopaedic Surgery at Syosset Hospital/Northwell Health, which performs over 1200 arthroplasties annually, has validated and is using the 2013 version of the Caprini Risk Assessment Model (RAM) to stratify each patient for risk of postoperative VTE. This tool results in a culling of information, past and present, personal and familial, that provides a truly thorough evaluation of the patient's risk for postoperative VTE. The Caprini score then guides the medication choices for thromboprophylaxis. The Caprini score is only valuable if the data is properly collected, and we have learned numerous lessons after applying it for 18 months. Risk stratification requires practice and experience to achieve expertise in perioperative patient evaluation. Having access to pertinent patient information, while gaining proficiency in completing the Caprini RAM, is vital to its efficacy. Ongoing, real time analyses of patient outcomes, with subsequent change in process, is key to improving patient care.


Assuntos
Artroplastia de Substituição/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco/métodos , Tromboembolia Venosa/prevenção & controle , Idoso , Artroplastia de Substituição/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Feminino , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pré-Medicação , Tromboembolia Venosa/etiologia
3.
Medicine (Baltimore) ; 99(44): e22674, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126306

RESUMO

BACKGROUND: Inconsistent results have been obtained regarding postoperative pain control using local infiltration and epidural analgesia for patients after total knee or hip arthroplasty (TKA and THA). We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of local infiltration vs epidural analgesia for TKA and THA. METHODS: Electronic searches were conducted on PubMed, EmBase, and the Cochrane library to identify eligible RCTs conducted up to February 2020. Weighted mean difference (WMD) and relative risk with 95% confidence interval (95%CI) were applied to calculate pooled effect estimates between local infiltration and epidural analgesia using the random-effects model. RESULTS: Seven RCTs including a total of 412 TKA patients, and three RCTs including a total of 200 THA patients were selected for this meta-analysis. We noted that local infiltration was associated with lower visual analog scale (VAS) scores at rest after 48 hours (WMD: -1.31; 95%CI: -2.44 to -0.18; P = .024) and 72 hours (WMD: -0.95; 95%CI: -1.39 to -0.52; P < .001) for patients with TKA, while local infiltration significantly reduced VAS scores at rest after 12 hours for patients with THA (WMD: -1.00; 95%CI: -1.49 to -0.51; P < .001). Moreover, local infiltration was associated with lower VAS scores during movement after 48 hours in TKA patients (WMD: -1.08; 95%CI: -1.86 to -0.29; P = .007), while there were higher VAS scores during movement after 24 hours for patients with THA (WMD: 1.06; 95%CI: 0.67 to 1.45; P < .001). Furthermore, we noted that local infiltration was associated with higher flexion angles compared with epidural analgesia after 24 hours (WMD: 7.11; 95%CI: 2.30-11.93; P = .004), 48 hours (WMD: 6.69; 95%CI: 3.78 to 9.59; P < .001), and 72 hours (WMD: 5.19; 95%CI: 0.95-9.44; P = .016). There were no significant differences between local infiltration and epidural analgesia for the length of hospital stay, nausea, or wound infection. CONCLUSIONS: Local infiltration is superior to epidural analgesia for postoperative pain control after TKA, whereas for THA patients inconsistent results were obtained at various times.


Assuntos
Analgesia Epidural/estatística & dados numéricos , Analgésicos/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Articulação do Quadril/efeitos dos fármacos , Humanos , Articulação do Joelho/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Can J Surg ; 63(5): E409-E411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009895

RESUMO

SUMMARY: There is currently no consensus on the appropriate sports and occupational restrictions for military service members with a joint replacement. Data from the United States show that 14% of military patients complete an operational deployment after the index surgery. No published data are available on arthroplasty in the militaries of other North Atlantic Treaty Organization countries. Research is needed to determine the appropriate medical employment limitations for Canadian Armed Forces members with a knee or hip replacement. Service members wanting to continue military service should be carefully screened to ensure that their duties do not compromise the longevity of the implant and that the risk of mission-threatening complications is minimal.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Medicina Militar/normas , Militares/estatística & dados numéricos , Falha de Prótese , Canadá , Consenso , Teste de Esforço/normas , Humanos , Medicina Militar/estatística & dados numéricos , Aptidão Física , Guias de Prática Clínica como Assunto , Estados Unidos , Avaliação da Capacidade de Trabalho
5.
Zhonghua Yi Xue Za Zhi ; 100(39): 3104-3108, 2020 Oct 27.
Artigo em Chinês | MEDLINE | ID: mdl-33105963

RESUMO

Objective: To explore the effect of a delayed pedicle gastrocnemius muscle flap transposition for the treatment of a knee joint deep infection secondary to wound necrosis after total knee arthroplasty (TKA). Methods: The clinical data of 7 patients treated in Shanxi Provincial People's Hospital with a delayed pedicle gastrocnemius muscle flap transposition from December 2015 to September 2019 for wound necrosis, exposed prosthesis and deep infection of knee joint after TKA were analyzed retrospectively. Before the muscle flap transplantation, 5 of the patients had received at least one debridement but failed for relapse, and resulted in an exposed prostheses and infected knee joint. Four patients were positive in their wounds or joint exudates bacterial culture, while the other 3 patients were negative but only with an obvious purulent secretion. The radiographs in all of the patients had no signs of lucent peripheral to or sink of the prosthesis. Results: The patients were followed-up for a mean time of 16.5 months (7-39 months). The flap and skin graft survived uneventfully with no pain, sinus, fistula, edema, and hematoma occurred. The appearances of the legs were normal. Only 1 patient had a mild limp, and the others gained almost a normal gait. One of the patients recurred 5 months after the gastrocnemius muscle flap transposition, and a two-stage revision procedure was applied, that involving a prosthesis remove and vancomycin impregnated cement (4 grams of vancomycin powder mixed with forty grams of polymethylmethacrylate) spacer implanted, and a new prosthesis was re-implanted 6 months later. The assessment of Knee Society Score (KSS) graded as: 4 patients classified as excellence, 2 as fine, 1 as general. Conclusions: Delayed pedicle gastrocnemius muscle flap transposition is an effective method for the complication of wound necrosis, deep infection, prosthesis exposure after TKA. This protocol was appropriate for those who have experienced a comparative long time of infection while had no signs of prosthesis loosening, and with which the implant may be salvaged, the defect be closed, and the infection be eradicated.


Assuntos
Artroplastia do Joelho , Infecções , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Músculo Esquelético , Estudos Retrospectivos
6.
Zhongguo Gu Shang ; 33(10): 922-7, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107254

RESUMO

OBJECTIVE: To compare influence of retention or resection subpatellar fat pad on patella height during rheumatoid knee replacement. METHODS: Totally 48 patients with rheumatoid arthritis who underwent total knee replacement from October 2013 to October 2017 were retrospectively analyzed and divided into resection and retention subpatellar fat pad group. There were 23 patients in resection subpatellar fat pad group, including 9 males and 14 females aged from 48 to 69 years old with an average of(55.83±5.65) years old; subpatellar fat pad were resected during opertaion. There were 25 patients in retention subpatellar fat pad group, including 6 males and 19 femlaes aged from 49 to 70 years old with an average age of (55.52± 6.28) years old;subpatellar fat pad were retentedduring opertaion. Postopertaive complications were observed between two groups, visual analogue scale (VAS) and Hospital for Special Surgery (HSS) at 1 year after operation were used to evaluate relieve pain degree and clnical effect of knee joint, Insall-Salvati ratio(I-S ratio) was used to compare changes of postoperative patella height at 1 year after operation. RESULTS: All patients were followed up from 12 to 39 months with an average of (23.85± 8.82) months. The postoperative wound healed well without infection complications and no prosthetic loosening or revision. Postoperative VAS score at 1 year between two groups was lower than that of before opertaion(P<0.05), but no statistical difference between two groups at 1 year after operation(P>0.05). Postopertaive HSS score between two groups was higer than that of before operation(P<0.05), while no difference in HSS score at 1 year after operation between two groups (P>0.05). I-S ratio of subpatellar fat pad resection group (1.03±0.04) was lower than that of subpatellar fat pad retention group (1.06±0.06), and difference was statistically significant (P<0.05). CONCLUSION: Resection or retention subpatellar fat pad in rheumatoid knee replacement have advantages of relieving postoperative pain and improving functional recovery, however, retention of infrapatellar fat pad is beneficial to restoration of patellar height.


Assuntos
Artroplastia do Joelho , Patela , Tecido Adiposo , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Patela/cirurgia , Estudos Retrospectivos
7.
BMJ ; 371: m3576, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051212

RESUMO

OBJECTIVE: To evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty. DESIGN: Parallel group randomised controlled trial. SETTING: 13 secondary and tertiary care centres in the UK providing postoperative physiotherapy. PARTICIPANTS: 334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol. INTERVENTIONS: All participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist). MAIN OUTCOME MEASURES: Primary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery. RESULTS: 334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval -0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, -0.78 to 0.28, P=0.36) or worst pain (0.22 points, -0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval -14.25 to 4.96, P=0.34). CONCLUSIONS: Outpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures. TRIALS REGISTRATION: Current Controlled Trials ISRCTN23357609 and ClinicalTrials.gov NCT01849445.


Assuntos
Artroplastia do Joelho/reabilitação , Terapia por Exercício/métodos , Osteoartrite do Joelho/reabilitação , Dor Pós-Operatória/reabilitação , Modalidades de Fisioterapia , Idoso , Artroplastia do Joelho/efeitos adversos , Protocolos Clínicos , Feminino , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Cooperação do Paciente , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
8.
PLoS One ; 15(9): e0239341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976534

RESUMO

BACKGROUND: It is unclear whether there are individual differences in the long-term efficacy of computer-assisted and traditional total knee arthroplasty. The purpose of this study was to perform a meta-analysis comparing the same individuals undergoing computer-assisted and traditional total knee arthroplasty separately to determine whether computer-assisted total knee arthroplasty can provide better lower extremity radiographic results and clinical outcomes. METHODS: We searched literatures to identify relevant randomized controlled trials comparing the effects of computer-assisted and traditional methods in bilateral total knee arthroplasty. After screening, quality evaluation and data extraction according to inclusion and exclusion criteria, the quality and bias risks of the included studies were evaluated. The meta-analysis compared the radiographic results, functional outcomes and complications of the two techniques. RESULTS: Six clinical controlled trials were included, with total of 1098 patients. The meta-analysis showed that the accuracy in terms of the mechanical axis of the lower extremity, the sagittal alignment of the femoral component and the coronal alignment of the tibial component in computer-assisted total knee arthroplasty was significantly better than those in traditional total knee arthroplasty. There were no differences in the functional results, revision rates or aseptic loosening rates between the two techniques. CONCLUSION: After excluding individual differences such as bone development and bone quality, although computer-assisted techniques can better accurately correct the mechanical axis of the lower extremity and the position of prosthesis implantation than traditional techniques, there is no significant difference in the functional results and revision rate of bilateral total knee arthroplasty in the same individual.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cirurgia Assistida por Computador/estatística & dados numéricos , Artroplastia do Joelho/efeitos adversos , Humanos , Cirurgia Assistida por Computador/efeitos adversos , Análise de Sobrevida , Resultado do Tratamento
9.
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
10.
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
11.
PLoS One ; 15(9): e0239239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941539

RESUMO

BACKGROUND: Postoperative stroke is a rare but potentially devastating complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of the current study was to determine the incidence, independent risk factors, and timing of stroke following THA and TKA utilizing the National Surgical Quality Improvement (NSQIP) database. METHODS: Patients who underwent elective primary THA and TKA were identified in the 2005-2016 NSQIP database. Thirty-day postoperative strokes were identified, timing was characterized, and an incidence curve was created. Multivariate analyses determined the independent predictors of these strokes. RESULTS: Of 333,117 patients identified, 286 (0.09%) experienced a stroke. Given that THA vs TKA was not a univariate predictor of stroke, the two procedures were considered together. The majority (65%) of strokes occurred before discharge. Of the strokes observed, 25% occurred by postoperative day one, 50% by postoperative day two, and 75% by postoperative day nine. Independent risk factors for postoperative stroke were: age (60-69 years old odds ratio [OR] = 4.2; 70-79 years old OR = 8.1; ≤80 years old OR = 16.1), higher American Society of Anesthesiologists (ASA) score (ASA≥3 OR = 1.7), and smoking [OR = 1.6). CONCLUSION: The incidence of stroke after THA/TKA was low at 0.09%, with the majority occurring prior to discharge and half occurring by postoperative day two. Patients who were older, sicker, or who were smokers were at greater risk of postoperative stroke. These findings can be used to council patients and to optimize patient care. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fumar/epidemiologia , Acidente Vascular Cerebral/etiologia
12.
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
13.
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
14.
J Am Acad Orthop Surg ; 28(21): 874-883, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32796365

RESUMO

With an increasing number of total hip and knee arthroplasties being done at surgical centers and vascular surgeons often not immediately available in this setting, it is critical for orthopaedic surgeons to be comfortable with the acute surgical management of vascular injuries. Although they are fortunately uncommon in primary total hip and knee arthroplasties, damage to a major artery or vein can have potentially devastating consequences. Surgeons operating both in a hospital and an ambulatory surgical setting should be familiar with techniques to gain proximal control of massive bleeding because the principles can be helpful in primary and revision arthroplasties. In this study, we review the vascular anatomy around the hip and knee and the surgical management of these potentially catastrophic complications.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/etiologia , Amputação , Fasciotomia , Hemorragia/etiologia , Quadril/irrigação sanguínea , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Joelho/irrigação sanguínea , Lacerações/diagnóstico , Lacerações/patologia , Lacerações/cirurgia , Neuropatias Fibulares/etiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/patologia , Lesões do Sistema Vascular/cirurgia
15.
Medicine (Baltimore) ; 99(34): e21816, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846821

RESUMO

BACKGROUND: Due to the soft tissue injury and large amount of bone destruction involved, undesirable postoperative pain remains a challenge for both patients and surgeons after unicompartmental knee replacement (UKR). However, there are no studies comparing the effectiveness of oral and intravenous acetaminophen as part of a standard multimodal perioperative pain regimen after UKR. Thus, this prospective randomized study was conducted to compare pain control outcomes with postoperative oral versus intravenous acetaminophen use in adults undergoing UKR. METHODS: The institutional review board of the Traditional Chinese Medicine- western Medicine Hospital of Cangzhou approved the study protocol. This blinded and randomized study was carried out in accordance with the principles of the Helsinki Declaration. We included patients who were scheduled for UKR with an American Society of Anesthesiologists status of I to III, who were mentally competent, and who were able to give consent for enrolment in the study. Patients were randomly assigned on a 1:1 basis to receive either intravenous acetaminophen or oral acetaminophen. We ensured that the patients, care providers, and outcome assessors were blinded to the group assignment during the study period. Primary outcomes were postoperative pain at rest and during motion (knee flexion of 45°) measured using a visual analog scale score. Secondary outcomes included morphine consumption at 24, 48, and 72 hours after surgery, length of hospital stay, range of motion, daily ambulation distance, and adverse events occurrence. All statistical analyses were performed using SPSS 25.0. Differences associated with a P value of <.05 were considered statistically significant. RESULTS: It was hypothesized that patients receiving intravenous acetaminophen would exhibit similar postoperative outcomes compared with patients receiving oral acetaminophen. TRIAL REGISTRATION: This study was registered in Research Registry (researchregistry5825).


Assuntos
Acetaminofen/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Acetaminofen/efeitos adversos , Administração Intravenosa , Administração Oral , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Humanos , Articulação do Joelho/fisiopatologia , Tempo de Internação , Morfina/uso terapêutico , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Projetos de Pesquisa , Caminhada
16.
Medicine (Baltimore) ; 99(34): e21867, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846841

RESUMO

BACKGROUND: Barbed suture is a novel type of suture introduced in different surgical specialties. Nevertheless, its effect in total knee replacement is still unclear in terms of wound complications and cost effectiveness. The purpose of the present work is to evaluate the safety and efficacy of bidirectional barbed suture in reducing postoperative wound complications in the patients undergoing total knee replacement. METHODS: This prospective, randomized, and controlled study was performed from January 2017 to December 2018. It was authorized via institutional review committee of Yuebei People's Hospital (GDYB1002189). Hundred participants were divided randomly into 2 groups, namely, control group (n = 50) and the study group (n = 50), respectively. All operations were performed using the Miller-Galante prosthesis (Zimmer; Warsaw, IN). For study groups, the joint capsule (Stratafix1-0) and subcutaneous (Stratafix2-0) and intracutaneous (Stratafix3-0) tissues were sutured by a bidirectional barbed suture. At the end, extra 4 to 5 stitches were made to avoid detachment and incision rupture. For control group: the joint capsule was sutured by a traditional absorbable suture (Ethicon VICRYL* Plus 1-0), and the subcutaneous tissue was sutured by an absorbable suture (Ethicon VICRYL* Plus 2-0). The skin was sutured by staples. Incision length, suture time, operation time, postoperative length of hospital stay, and incision complications (such as effusion, infection, hematoma, and skin necrosis) were recorded. All data analyses are implemented through utilizing SPSS for Windows Version 20.0. RESULTS: The results will be shown in Table 1. CONCLUSION: This study can reach a reliable evidence for utilizing bidirectional barbed suture in wound closure in total knee replacement. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5823).


Assuntos
Artroplastia do Joelho/métodos , Complicações Pós-Operatórias/prevenção & controle , Suturas/efeitos adversos , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Análise Custo-Benefício , Humanos , Cápsula Articular/cirurgia , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Segurança , Tela Subcutânea/cirurgia , Grampeamento Cirúrgico/efeitos adversos , Técnicas de Sutura/tendências , Suturas/tendências , Resultado do Tratamento
17.
Bone Joint J ; 102-B(8): 1016-1024, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731825

RESUMO

AIMS: Although bone cement is the primary mode of fixation in total knee arthroplasty (TKA), cementless fixation is gaining interest as it has the potential of achieving lasting biological fixation. By 3D printing an implant, highly porous structures can be manufactured, promoting osseointegration into the implant to prevent aseptic loosening. This study compares the migration of cementless, 3D-printed TKA to cemented TKA of a similar design up to two years of follow-up using radiostereometric analysis (RSA) known for its ability to predict aseptic loosening. METHODS: A total of 72 patients were randomized to either cementless 3D-printed or a cemented cruciate retaining TKA. RSA and clinical scores were evaluated at baseline and postoperatively at three, 12, and 24 months. A mixed model was used to analyze the repeated measurements. RESULTS: The mean maximum total point motion (MTPM) at three, 12, and 24 months was 0.33 mm (95% confidence interval (CI) 0.25 to 0.42), 0.42 mm (95% CI 0.33 to 0.51), and 0.47 mm (95% CI 0.38 to 0.57) respectively in the cemented group, versus 0.52 mm (95% CI 0.43 to 0.63), 0.62 mm (95% CI 0.52 to 0.73), and 0.64 mm (95% CI 0.53 to 0.75) in the cementless group (p = 0.003). However, using three months as baseline, no difference in mean migration between groups was found (p = 0.497). Three implants in the cemented group showed a > 0.2 mm increase in MTPM between one and two years of follow-up. In the cementless group, one implant was revised due to pain and progressive migration, and one patient had a liner-exchange due to a deep infection. CONCLUSION: The cementless TKA migrated more than the cemented TKA in the first two-year period. This difference was mainly due to a higher initial migration of the cementless TKA in the first three postoperative months after which stabilization was observed in all but one malaligned and early revised TKA. Whether the biological fixation of the cementless implants will result in an increased long-term survivorship requires a longer follow-up. Cite this article: Bone Joint J 2020;102-B(8):1016-1024.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cimentos para Ossos/farmacologia , Osteoartrite do Joelho/cirurgia , Impressão Tridimensional , Falha de Prótese , Análise Radioestereométrica/métodos , Idoso , Artroplastia do Joelho/métodos , Feminino , Seguimentos , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Osteoartrite do Joelho/diagnóstico por imagem , Desenho de Prótese , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo
18.
Bone Joint J ; 102-B(8): 1033-1040, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731833

RESUMO

AIMS: To report mid- to long-term results of Oxford mobile bearing domed lateral unicompartmental knee arthroplasty (UKA), and determine the effect of potential contraindications on outcome. METHODS: A total of 325 consecutive domed lateral UKAs undertaken for the recommended indications were included, and their functional and survival outcomes were assessed. The effects of age, weight, activity, and the presence of full-thickness erosions of cartilage in the patellofemoral joint on outcome were evaluated. RESULTS: Median follow-up was seven years (3 to 14), and mean age at surgery was 65 years (39 to 90). Median Oxford Knee Score (OKS) was 43 (interquartile range (IQR) 37 to 47), with 260 (80%) achieving a good or excellent score (OKS > 34). Revisions occurred in 34 (10%); 14 (4%) were for dislocation, of which 12 had no recurrence following insertion of a new bearing, and 12 (4%) were revised for medial osteoarthritis (OA). Ten-year survival was 85% (95% confidence interval (CI) 79 to 90, at risk 72). Age, weight, activity, and patellofemoral erosions did not have a significant effect on the clinical outcome or survival. CONCLUSION: Domed lateral UKA provides a good alternative to total knee arthroplasty (TKA) in the management of lateral compartment OA. Although dislocation is relatively easy to treat successfully, the dislocation rate of 4% is high. It is recommended that the stability of the bearing is assessed intraoperatively. If the bearing can easily be displaced, the fixed rather than the mobile bearing version of the Oxford lateral tibial component should be inserted instead. Younger age, heavier weight, high activity, and patellofemoral erosions did not detrimentally affect outcome, so should not be considered contraindications. Cite this article: Bone Joint J 2020;102-B(8):1033-1040.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Osteoartrite do Joelho/cirurgia , Desenho de Prótese/métodos , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Bases de Dados Factuais , Feminino , Seguimentos , Hemiartroplastia/efeitos adversos , Humanos , Luxações Articulares/cirurgia , Prótese do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Falha de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Bone Joint J ; 102-B(8): 1025-1032, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731836

RESUMO

AIMS: Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. METHODS: Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2 (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up. RESULTS: At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001). CONCLUSION: Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025-1032.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Cimentos para Ossos/farmacologia , Osteoartrite do Joelho/cirurgia , Desenho de Prótese/métodos , Falha de Prótese , Idoso , Feminino , Seguimentos , Humanos , Masculino , Metais/uso terapêutico , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Reoperação/estatística & dados numéricos , Medição de Risco , Método Simples-Cego , Tantálio/uso terapêutico , Tíbia/cirurgia , Fatores de Tempo , Resultado do Tratamento
20.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 1-5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856433

RESUMO

Two-stage exchange in infected total knee arthroplasty is a reliable technique, but it has a high rate of blood loss. The study aims to compare the pre-operative and post-operative haemoglobin levels, the rate of transfusion, and the blood loss in two-stage exchange. From July 2018 to July 2019, eighteen patients underwent two-stage exchange of their infected total knee arthroplasty. Local and systemic tranexamic acid was administered in both surgical stages. Calculated blood loss was 2246 mL (range 1528 - 2850) in the first stage and 2388 mL (1873 - 2829) during reimplantation, respectively. The corresponding transfusion rate was 55 % and 67%, respectively. With the numbers available, these differences were not significant. In conclusion, this study shows that the blood loss and transfusion rate are similar during the two stages of exchange knee arthroplasty for infection.


Assuntos
Artroplastia do Joelho , Transfusão de Sangue , Antifibrinolíticos , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica , Humanos , Ácido Tranexâmico
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