Home About us Contact
|
Home About us Contact | ||
|
|
||
Total Knee Arthroplasty (total + knee_arthroplasty)
Selected AbstractsAltered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplastyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2005Ryan L. Mizner Abstract Purpose: Total knee arthroplasty (TKA) successfully reduces pain, but has not achieved comparable improvements in function. We hypothesized that quadriceps strength affects performance by altering loading and movement patterns during functional tasks. Methods: Fourteen subjects with isolated, unilateral TKA were tested three months after surgery. Quadriceps strength was assessed isometrically and kinematics, kinetics, and EMG were collected during level walking and sit-to-stand (STS). Function was assessed using the timed up and go test (TUG), stair climbing test (SCT), and the 6 min walk test (6MW). Results: Functional performance was significantly related to the quadriceps strength of both legs, but was more strongly related to the uninvolved strength (involved rho = ,0.43 with TUG; ,0.65 with SCT; 0.64 with 6MW) (uninvolved rho = ,0.63 with TUG; ,0.68 with SCT; 0.77 with 6MW). During STS, subjects shifted weight away from the operated limb (p <0.01). Quadriceps muscle activity and the extension moments at the knee and hip were smaller in the involved compared to the uninvolved (p <0.05). The amount of asymmetry in knee excursion during weight acceptance in gait, the asymmetry in weight bearing from sit-to-stand, and the uninvolved hip extension moment during STS were related to the amount of asymmetry in quadriceps strength (rho > 0.56, p < 0.05). Conclusions: Quadriceps weakness in patients with TKA has a substantial impact on the movement patterns and performance of the knee during functionally important tasks. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplastiesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2008Satoshi Hamai Abstract Kneeling is an important function of the knee for many activities of daily living. In this study, we evaluated the in vivo kinematics of kneeling after total knee arthroplasty (TKA) using radiographic based image-matching techniques. Kneeling from 90 to 120° of knee flexion produced a posterior femoral rollback after both cruciate-retaining and posterior-stabilized TKA. It could be assumed that the posterior cruciate ligament and the post-cam mechanism were functioning. The posterior-stabilized TKA design had contact regions located far posterior on the tibial insert in comparison to the cruciate-retaining TKA. Specifically, the lateral femoral condyle in posterior-stabilized TKA translated to the posterior edge of the tibial surface, although there was no finding of subluxation. After posterior-stabilized TKA, the contact position of the post-cam translated to the posterior medial corner of the post with external rotation of the femoral component. Because edge loading can induce accelerated polyethylene wear, the configuration of the post-cam mechanism should be designed to provide a larger contact area when the femoral component rotates. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:435,442, 2008 [source] Trends of spinal fusion surgery in Australia: 1997 to 2006ANZ JOURNAL OF SURGERY, Issue 11 2009Ian Andrew Harris Abstract Background:, This study aims to explore the trend in spine fusion surgery in Australia over the past 10 years, and to explore the possible influence of health insurance status (private versus public) on the rate of surgery. Methods:, Data pertaining to the rate of lumbar spine fusion from 1997 to 2006 were collected from Inpatient Statistics Collection of NSW Health, Medicare Australia Statistics and the Australian Bureau of Statistics. Data on total hip and total knee arthroplasties were collected to provide a comparator. Results:, The number of publicly performed spinal fusion procedures increased by 2% from 1997 to 2006. In comparison, privately performed spinal fusion procedures increased by 167% over the same 10-year period. In 2006, spine fusion surgery was 10.8 times more likely to be done in the private sector than in the public sector, compared with corresponding figures of 4.2 times and 3.0 times for knee replacement and hip replacement, respectively. Waiting list data showed no increase in demand for spine fusion surgery in the public sector. Conclusion:, There is a disproportionately high rate of lumbar spine fusion surgery performed in the private sector, given the rate of private insurance. The rate of increase was found to be higher than that for hip or knee arthroplasty procedures. Possible explanations for this difference include: over-servicing in the private sector, under-servicing in the public sector, differences in medical referral patterns, surgeon and patient preferences and financial incentives. [source] The role of selective angiographic embolization of the musculo-skeletal system in haemophiliaHAEMOPHILIA, Issue 4 2009E. C. RODRIGUEZ-MERCHAN Summary., The incidence of haemarthrosis as a result of a spontaneous periarticular aneurysm in haemophilia is very low. In these circumstances, angiographic embolization might be considered as a promising therapeutic and coagulation factor saving option in joint bleeds not responding to replacement of coagulation factor to normal levels. Moreover, embolization should be considered as a possible treatment for postoperative pseudoaneurysms complicating total knee arthroplasty in haemophilia. However, the pathological process of aneurysmal bleeding and clotting factor replacement is entirely different. While embolization is the treatment of choice for some periarticular complications that may occur, it is by no means a panacea for all resistant periarticular bleeds in haemophilia or for postoperative bleeding which usually settles with clotting factor replacement. Another use of arterial embolization is for the treatment of haemophilic tumours of the pelvis, because they can act as a focus for infection and cause cutaneous fistulas. When they present perforations and infections of endogenous origin, their course is usually fatal. Suitable treatment has been investigated on numerous occasions, most of the literature agreeing that the only curative treatment is surgical resection. However, surgical resection after performing arterial embolization to reduce the vascularization of the pseudotumour is a good alternative, thereby reducing the size of the pseudotumour and the risk of bleeding complications during surgery. It is important to bear in mind that despite its efficacy, arterial embolization is an invasive procedure with a reported rate of complications up to 25% (16% minor, 7% serious, 2% death). [source] Total joint arthroplasty in haemophiliaHAEMOPHILIA, Issue 5 2000Beeton In severely affected haemophilic patients arthropathy is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total joint arthroplasty, can be undertaken if conservative management fails. A search of the literature showed that a number of studies describing the use of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in haemophilia have been published, whereas shoulder, elbow and ankle arthroplasties are confined to case reports. This paper reviews the functional outcome of arthroplasty in the different joints, the postoperative and long-term complications, and the impact of HIV. Although complications are commonly described and the surgery is technically demanding, the results suggest that arthroplasty, particularly of the hip and knee, can be a valuable option in the management of severe haemophilic arthropathy. [source] Analgesic efficacy of subcutaneous local anaesthetic wound infiltration in bilateral knee arthroplasty: a randomised, placebo-controlled, double-blind trialACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010L. Ø. ANDERSEN Background: High-volume wound local infiltration analgesia is effective in knee arthroplasty, but the analgesic efficacy of subcutaneous wound infiltration has not been evaluated. Methods: In a randomised, double-blind, placebo-controlled trial in 16 patients undergoing bilateral knee arthroplasty with high-volume local infiltration analgesia in the deeper layers, saline or ropivacaine 2 mg/ml was infiltrated into the subcutaneous part of the wound in each knee along with the placement of multi-fenestrated catheters in the subcutaneous wound layers in both knees. Pain was assessed for 6 h post-operatively and for 3 h after a bolus injection given through the catheter 24 h post-operatively. Results: Visual analogue scale (VAS) pain scores were significantly lower from the knee infiltrated with ropivacaine compared with the knee infiltrated with saline in the subcutaneous layer of the wound, at rest (P<0.02), with flexion of the knee (P<0.04) and when the leg was straight and elevated (P<0.04). Twenty-four hours post-operatively, a decline in the VAS pain scores was observed in both groups, with no statistically significant difference between injection of ropivacaine or saline in the subcutaneously placed catheters (P>0.05). Conclusion: As part of a total wound infiltration analgesia intraoperative subcutaneous infiltration with ropivacaine in bilateral total knee arthroplasty is effective in early post-operative pain management, while a post-operative subcutaneous bolus administration through a multiholed catheter 24 h post-operatively did not show improved analgesia compared with the administration of saline. [source] Continuous femoral nerve block after total knee arthroplasty?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009L. KADIC Background: A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits. Methods: In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients' numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score. Results: The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P<0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90° flexion than the control group. However, after 3 months, there were no significant functional differences between the groups. Conclusion: A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90° knee flexion after 6 days. However, after 3 months, no significant functional benefits were found. [source] Precise landmarking in computer assisted total knee arthroplasty is critical to final alignmentJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 10 2010Yaron S. Brin Abstract Image-free computer navigation systems build a frame of reference of a patient's knee from anatomical landmarks entered by the surgeon during the initial stage of total knee arthroplasty. We performed tibial cuts on 70 sawbones using computer navigation. All landmarks were marked identically except for the tibial mechanical entry point, which was marked correctly in 10 bones and with offsets of 5, 10, and 15,mm medially and laterally in the others. The actual coronal angle of the tibial cuts was measured directly and compared to the final angle given by the navigation system. Significant deviations of the coronal angle were observed in the trial groups. Landmarking errors during navigated TKA can lead to inaccurate tibial bone cuts. This navigation system did not have an iterative software method to verify landmarking errors that can lead to inaccurate tibia bone cuts. Published by Wiley Periodicals, Inc. J Orthop Res 28:1355,1359, 2010 [source] Joint line elevation in revision TKA leads to increased patellofemoral contact forcesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2010Christian König Abstract One difficulty in revision total knee arthroplasty (TKA) is the management of distal femoral bone defects in which a joint line elevation (JLE) is likely to occur. Although JLE has been associated with inferior clinical results, the effect that an elevated joint line has on knee contact forces has not been investigated. To understand the clinical observations and elaborate the potential risk associated with a JLE, we performed a virtual TKA on the musculoskeletal models of four subjects. Tibio- and patellofemoral joint contact forces (JCF) were calculated for walking and stair climbing, varying the location of the joint line. An elevation of the joint line primarily affected the patellofemoral joint with JCF increases of as much as 60% of the patient's body weight (BW) at 10-mm JLE and 90% BW at 15-mm JLE, while the largest increase in tibiofemoral JCF was only 14% BW. This data demonstrates the importance of restoring the joint line, as it plays a critical role for the magnitudes of the JCFs, particularly for the patellofemoral joint. JLE caused by managing distal femoral defects with downsizing and proximalizing the femoral component could increase the patellofemoral contact forces, and may be a contributing factor to postoperative complications such as pain, polyethylene wear, and limited function. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1,5, 2010 [source] Three-dimensional knee joint kinematics during golf swing and stationary cycling after total knee arthroplastyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 12 2008Satoshi Hamai Abstract The expectation of returning to sports activities after total knee arthroplasty (TKA) has become more important to patients than ever. To our knowledge, no studies have been published evaluating the three-dimensional knee joint kinematics during sports activity after TKA. Continuous X-ray images of the golf swing and stationary cycling were taken using a large flat panel detector for four and eight post-arthroplasty knees, respectively. The implant flexion and axial rotation angles were determined using a radiographic-based, image-matching technique. Both the golf swing from the set-up position to the top of the backswing, and the stationary cycling from the top position of the crank to the bottom position of the crank, produced progressive axial rotational motions (p,=,0.73). However, the golf swing from the top of the backswing to the end of the follow-through produced significantly larger magnitudes of rotational motions in comparison to stationary cycling (p,<,0.01). Excessive internal,external rotations generated from the top of the backswing to the end of the follow-through could contribute to accelerated polyethylene wear. However, gradual rotational movements were consistently demonstrated during the stationary cycling. Therefore, stationary cycling is recommended rather than playing golf for patients following a TKA who wish to remain physically active. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplastiesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2008Satoshi Hamai Abstract Kneeling is an important function of the knee for many activities of daily living. In this study, we evaluated the in vivo kinematics of kneeling after total knee arthroplasty (TKA) using radiographic based image-matching techniques. Kneeling from 90 to 120° of knee flexion produced a posterior femoral rollback after both cruciate-retaining and posterior-stabilized TKA. It could be assumed that the posterior cruciate ligament and the post-cam mechanism were functioning. The posterior-stabilized TKA design had contact regions located far posterior on the tibial insert in comparison to the cruciate-retaining TKA. Specifically, the lateral femoral condyle in posterior-stabilized TKA translated to the posterior edge of the tibial surface, although there was no finding of subluxation. After posterior-stabilized TKA, the contact position of the post-cam translated to the posterior medial corner of the post with external rotation of the femoral component. Because edge loading can induce accelerated polyethylene wear, the configuration of the post-cam mechanism should be designed to provide a larger contact area when the femoral component rotates. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:435,442, 2008 [source] Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetryJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 10 2007Axel Hempfing Abstract Patellofemoral complications following knee arthroplasty are a well-known problem. Patellar ischemia has been suspected to be causative for fracture, anterior knee pain, and patella component failure. The purpose of this study was to assess the influence of knee arthroplasty surgical dissection on patellar blood flow. Patellar blood flow was measured by means of intraosseous laser Doppler flowmetry (LDF) in 10 patients undergoing total knee arthroplasty by a standard medial parapatellar approach. The initial blood flow was 121.6,±,114.7 AU. The signal significantly decreased by 71% (p,=,0.0051) when the knee was flexed and lost the pulsatile signal pattern in 80%. After arthrotomy, the signal was 100.1,±,120.3 AU in extension. The lowest signal was found in flexion and eversion of the patella (mean, 18,±,10.7 AU) and all signals lost pulsatility. As compared to the initial values, completion of the soft tissue dissection did not lead to a significant change of the blood flow signal (121.3,±,104.8; p,=,0.6835). Flexion of the knee joint markedly reduced patellar perfusion. Standard medial parapatellar approach did not significantly change patellar blood flow. This study does not support the theory of postoperative patellar ischemia as a cause of anterior knee pain or patellofemoral problems. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1389,1394, 2007 [source] Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplastyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2005Ryan L. Mizner Abstract Purpose: Total knee arthroplasty (TKA) successfully reduces pain, but has not achieved comparable improvements in function. We hypothesized that quadriceps strength affects performance by altering loading and movement patterns during functional tasks. Methods: Fourteen subjects with isolated, unilateral TKA were tested three months after surgery. Quadriceps strength was assessed isometrically and kinematics, kinetics, and EMG were collected during level walking and sit-to-stand (STS). Function was assessed using the timed up and go test (TUG), stair climbing test (SCT), and the 6 min walk test (6MW). Results: Functional performance was significantly related to the quadriceps strength of both legs, but was more strongly related to the uninvolved strength (involved rho = ,0.43 with TUG; ,0.65 with SCT; 0.64 with 6MW) (uninvolved rho = ,0.63 with TUG; ,0.68 with SCT; 0.77 with 6MW). During STS, subjects shifted weight away from the operated limb (p <0.01). Quadriceps muscle activity and the extension moments at the knee and hip were smaller in the involved compared to the uninvolved (p <0.05). The amount of asymmetry in knee excursion during weight acceptance in gait, the asymmetry in weight bearing from sit-to-stand, and the uninvolved hip extension moment during STS were related to the amount of asymmetry in quadriceps strength (rho > 0.56, p < 0.05). Conclusions: Quadriceps weakness in patients with TKA has a substantial impact on the movement patterns and performance of the knee during functionally important tasks. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Circulating and synovial levels of IGF-I, cytokines, physical function and anthropometry differ in women awaiting total knee arthroplasty when compared to menJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2005Sonia M. C. Pagura Abstract Purpose: Determine if gender differences in osteoarthritis relate to cytokine and growth factor levels. Methods: Cross-sectional comparison of serum and synovial concentrations of cytokines (IL-1,,, TNF-,, IL-6), growth factors (IGF-I, TGF-,, IRAP), physical performance and perceived function in total knee arthroplasty candidates (TKAC) (n = 17) and healthy controls (n = 21) was done. Results: Serum IGF-I values were reduced in female (TKAC 137.6 ± 7.2; Controls 160.2 ± 26.2) but not male TKAC (TKAC 182.6 ± 18.4; Controls 184.0 ± 18.4) (p < 0.05). Serum and synovial levels of cytokines and growth factors did not differ significantly by group or gender. Physical performance testing (SPW, TUG) revealed significant group and gender differences (p = 0.001) with women demonstrating greater functional impairment. Discussion: A systemic, not local component to OA pathophysiology may exist for female TKAC. Male TKAC were less impaired, and their IGF-I levels differ little from Control values. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Spatially-localized correlation of dGEMRIC-measured GAG distribution and mechanical stiffness in the human tibial plateauJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2005Joseph T. Samosky Abstract The concentration of glycosaminoglycan (GAG) in articular cartilage is known to be an important determinant of tissue mechanical properties based on numerous studies relating bulk GAG and mechanical properties. To date limited information exists regarding the relationship between GAG and mechanical properties on a spatially-localized basis in intact samples of native tissue. This relation can now be explored by using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC,a recently available non-destructive magnetic resonance imaging method for measuring glycosaminoglycan concentration) combined with non-destructive mechanical indentation testing. In this study, three tibial plateaus from patients undergoing total knee arthroplasty were imaged by dGEMRIC. At 33,44 test locations for each tibial plateau, the load response to focal indentation was measured as an index of cartilage stiffness. Overall, a high correlation was found between the dGEMRIC index (T) and local stiffness (Pearson correlation coefficients r = 0.90, 0.64, 0.81; p < 0.0001) when the GAG at each test location was averaged over a depth of tissue comparable to that affected by the indentation. When GAG was averaged over larger depths, the correlations were generally lower. In addition, the correlations improved when the central and peripheral (submeniscal) areas of the tibial plateau were analyzed separately, suggesting that a factor other than GAG concentration is also contributing to indentation stiffness. The results demonstrate the importance of MRI in yielding spatial localization of GAG concentration in the evaluation of cartilage mechanical properties when heterogeneous samples are involved and suggest the possibility that the evaluation of mechanical properties may be improved further by adding other MRI parameters sensitive to the collagen component of cartilage. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] In vivo kinematics of total knee arthroplasty: Flat compared with concave tibial joint surfaceJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2000J. Uvehammer This study evaluated the influence of the geometric configuration of the tibial joint area on the kinematics of the knee. Twenty-two patients with noninflammatory arthritis and minor preoperative deformity were studied. They each received an AMK total knee replacement with retention of the posterior cruciate ligament. Eleven patients without any knee abnormalities were used as controls. The patients were stratified to either the flat (terminology of the manufacturer: standard) or concave (terminology of the manufacturer: constrained) polyethylene insert (n = 11 in each group). Knee kinematics were assessed 1 year after the operation by having the patient ascend a platform corresponding to an extension of the knee from 50 to 70° of flexion. During this motion, two film-exchangers simultaneously exposed six to 13 pairs of serial stereoradiographs. The concave geometric configuration of the tibial insert resulted paradoxically in increased anterior-posterior translations compared with the flat insect but no significant change of rotations and translations in the other directions. Compared with normal knees, the most obvious abnormality was increased anterior-posterior translations (p < 0.004). At 50° of flexion, the implants with the flat tibial polyethylene insert had displaced 2 times and the concave ones had displaced 2.5 times more posteriorly than the normal knees (p , 0.001). Less internal tibial rotation was also recorded in the flexed positions for both types of inserts compared with the normal knees (p < 0.02). Four knees in four patients, who reported symptoms of instability and abnormal knee function, showed significantly increased proximal displacement of the center of the tibial plateau in the flexed position. The findings suggest that current prosthetic designs and surgical technique do not restore normal knee kinematics and indicate that design improvements should rely on in vivo kinematic studies. [source] The safety and outcome of joint replacement surgery in liver transplant recipientsLIVER TRANSPLANTATION, Issue 4 2003Josh Levitsky A small group of patients may require total hip arthroplasty, total knee arthroplasty, or other joint replacement surgery after OLT for osteoporotic fractures, osteonecrosis, and osteoarthritis. Although arthroplasty is safe in the general population, its safety in liver transplant recipients is unclear. The aim of the study was to determine the safety and outcome of joint replacement surgery in our liver transplant recipients. A retrospective analysis was performed on all liver transplant recipients who had total joint arthroplasty at a single teaching institution between 1986 and 2002. Data regarding major intraoperative and postoperative complications was obtained from the medical charts and a hospital-based computer system. Of over 1,200 liver transplant recipients, we identified 7 patients who underwent 12 total arthroplasties (8 knee, 3 hip, 1 ankle). Joint replacements were performed electively for osteonecrosis (5 of 12) and osteoarthritis (5 of 12), whereas two hip arthroplasties were performed emergently for fractures. All patients with osteonecrosis or hip fracture had been treated with prolonged corticosteroids. There were no deaths or major complications in the intraoperative and postoperative periods. On long-term follow-up, no patients have had pain, dislocation, or infection in the postsurgical joint. No joint revision surgery has been required. In conclusion, a small number of stable liver transplant recipients at our institution underwent joint replacement surgery without major short-term or long-term complications. Our study suggests that joint replacement surgery may be safely and successfully performed in this population, although larger, randomized, prospective trials are needed to confirm our findings. [source] Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2010Thomas Linding Jakobsen Abstract Background and Purpose.,Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience.,Method.,The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC2,1) and smallest real difference (SRD) were calculated.,Results.,The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6° and 10° (except active knee flexion) and knee joint circumference of more than 1.0,cm and 1.63,cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester.,Conclusions.,In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. Copyright © 2009 John Wiley & Sons, Ltd. [source] Computer-assisted tibia preparation for total ankle arthroplasty: a cadaveric studyTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 4 2007Samuel B. Adams Jr Abstract Background Most surgeons performing total ankle arthroplasty (TAA) suggest that accurate tibial preparation perpendicular to the tibial shaft axis improves outcomes. Recent studies demonstrate that computerized surgical navigation significantly improves the accuracy of tibial preparation in total knee arthroplasty (TKA). Methods We performed the tibial preparation for TAA in seven matched pairs of cadaver lower extremities. One set of matched pairs was prepared using the conventional external tibial alignment guide/cutting block from the Scandanavian Total Ankle Replacement system (STAR, Waldemar Link GmbH & Co., Hamburg, Germany) under fluoroscopic guidance. The second set of matched pairs was prepared using the VectorVision® navigation system (BrainLAB, Munich, Germany), with currently available computed tomography (CT)-based TKA software. Pre-operative CT data were used to assess the tibial mechanical axis. In both groups, accuracy of the tibial plafond preparation relative to the tibial shaft axis in both the coronal and sagittal planes was determined by fluoroscopic, radiographic and CT analysis. Results Mean values of the tibial cut for the set of matched-pair tibiae prepared by the conventional surgical method ranged across the three imaging assessment techniques in the ranges 89.3,89.6° (coronal plane, anteroposterior) and 90.3,90.4° (sagittal plane, lateral). For the computer-navigated set, the values were 89.7,89.9° (coronal) and 89.1,89.4° (sagittal). Comparison between the conventional and computer-navigated tibial measurements were not different at the 95% confidence interval (CI) for CT, fluoroscopy or radiographic assessments. Conclusions Our results demonstrate that accuracy of TAA tibial preparation using computer-navigation equals that of the conventional technique performed by a foot and ankle surgeon experienced in TAA. We anticipate that this investigation will encourage the development of computer-navigation applications specific to TAA, with the potential of improving accuracy over conventional methods. Copyright © 2008 John Wiley & Sons, Ltd. [source] Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentrationANAESTHESIA, Issue 10 2010L. Ø. Andersen Summary Wound administration of local anaesthetic may be effective for postoperative pain management in knee arthroplasty, but the analgesic efficacy of local anaesthetic in relation to volume vs concentration has not been determined. In a double-blinded trial, 48 patients scheduled for total knee arthroplasty were randomly assigned to receive either a high volume/low concentration solution of ropivacaine (20 ml, 0.5%) or a low volume/high concentration solution of ropivacaine (10 ml, 1%), 6 and 24 h postoperatively through an intracapsular catheter. Pain was assessed for 2 h after administration. Pain was reduced in both groups with ropivacaine administration 24 h postoperatively (p < 0.02), but with no difference in analgesia between groups at all time intervals. No reduction in pain scores was observed with ropivacaine injection 6 h postoperatively. The median (IQR [range]) dose of oxycodone administered was 12.5 (10,19 [0,35]) mg in the high volume/low concentration group, and 20 mg (16,40 [0,65]) mg in the low volume/high concentration group (p = 0.005). In conclusion, intracapsular administration of local anaesthetic may have limited analgesic efficacy with no volume vs concentration relationship after total knee arthroplasty. [source] ORIGINAL ARTICLE: Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplastyANAESTHESIA, Issue 9 2010L. Ø. Andersen Summary The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra-articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. Analgesic efficacy was assessed for 3 h after each injection, using a visual analogue score, where 0 = no pain and 100 = worst pain. There was no statistically significant difference between groups. Maximum pain relief (median (IQR [range])) at rest observed in the 3 h after the 6 and 24 h postoperative injections was 17 (7,31 [0,80]) and 10 (4,27 [0,50]) p = 0.27 for 6,9 h; and 17 (7,33 [0,100]) and 13 (3,25 [0,72]) p = 0.28 for 24,27 h, for intracapsular and intra-articular, respectively. Intracapsular local anaesthetic has similar analgesic efficacy to intra-articular after total knee arthroplasty. [source] Subacute pain and function after fast-track hip and knee arthroplastyANAESTHESIA, Issue 5 2009L. Ø. Andersen Summary In a well-defined fast-track setup for total hip and knee arthroplasty, with a multimodal analgesic regimen consisting of intra-operative local anaesthetic infiltration and oral celecoxib, gabapentin and paracetamol for 6 days postoperatively, we conducted a prospective, consecutive, observational study. The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects, use of analgesics and functional ability 1,10 and 30 days postoperatively. Fast-track total hip and knee arthroplasty with early discharge (< 3 days) resulted in acceptable levels of pain and postoperative nausea and vomiting with concomitant low use of opioids in > 95% of patients after discharge before day 10 after total hip arthroplasty. However, after total knee arthroplasty 52% patients reported moderate pain (VAS 30,59 mm), and 16% severe pain (VAS , 60 mm) when walking 1 month after surgery with a concomitant increase in the use of strong opioids. These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty, to facilitate rehabilitation. [source] Target driven analgesia for total knee arthroplastyANAESTHESIA, Issue 3 2009D. H. Morfey No abstract is available for this article. [source] The need for patellar resurfacing in total knee arthroplasty: a literature reviewANZ JOURNAL OF SURGERY, Issue 4 2010John D. Swan Abstract The controversy over whether or not to routinely resurface the patella during a total knee arthroplasty has persisted despite three decades of successful joint replacement procedures. Advocates for routine patellar resurfacing admit the occasional need for secondary patellar resurfacing and declare increased incidence of anterior knee pain in patients with non-resurfaced patellae as a cause for worry. Surgeons that leave the patella unresurfaced cite avoidance of complications that include patellar fracture, avascular necrosis, patellar tendon injury and instability. This review discusses the available literature on patellar resurfacing through an evidence-based analysis of randomized and pseudo-randomized controlled trials and published meta-analyses to date. The published literature seems to favour resurfacing the patellar routinely. Selective patellar resurfacing would be the ideal solution if sound pre-operative criteria could be established. So far, a method for accurately predicting which patients can avoid patellar resurfacing has not been found. Future research looking at patellar resurfacing should concentrate on developing criteria for selecting those patients that would benefit from patellar resurfacing and those that would do as well without resurfacing, and thus, limiting potential surgical complications. [source] Clinical and radiological outcomes after revision to the low-contact-stress mobile-bearing total knee arthroplastyANZ JOURNAL OF SURGERY, Issue 5 2009David J. Whitehead Abstract Background:, The aim of the present study was to investigate the short,medium-term clinical and radiological outcomes in revision total knee arthroplasty using a mobile-bearing implant. Methods:, Forty patients (42 knees) who had revisions using the New Jersey low-contact-stress (LCS) mobile-bearing total knee arthroplasty between 1996 and 2000 were reviewed. Results:, The average age at revision was 71 years (range, 38,86 years) and the average follow up was 6 years (range, 5,9 years). Of the 34 patients reviewed clinically, six had excellent results, and 20 had good results, to give a total of 76% excellent or good results. There were five (15%) fair results and three (9%) poor results. Seven patients required revision of the components. There was one case of instability within the first year of revision, which required only exchange of the polyethylene bearing to achieve a satisfactory clinical outcome. Of the 31 knees reviewed radiologically, progressive radiolucent lines were seen at the bone,cement interface in five (16%) of the femoral components and in two (6%) of the tibial components. Conclusion:, Unconstrained LCS mobile-bearing total knee arthroplasty can be used in revision surgery with satisfactory results after medium-term follow up (level of evidence: therapeutic level III). [source] Fate of the infrapatellar branch of the saphenous nerve post total knee arthroplastyANZ JOURNAL OF SURGERY, Issue 9 2005Dinshaw Mistry Background:, The infrapatellar branch of the saphenous nerve is a known cause of morbidity following knee surgery. The incidence of sensory changes following total knee arthroplasty, and its effect on patient satisfaction with arthroplasty surgery remain undocumented. Our aim was to document the incidence of infrapatellar nerve palsy following total knee arthroplasty and its effect on patient satisfaction. Methods:, Between 1 January 2002 and 31 December 2003 all patients attending outpatients clinic for primary total knee joint arthroplasty were prospectively tested for sensory defects. Patients were then assessed postoperatively and satisfaction was measured using the British Orthopaedic Satisfaction Score and a visual analogue scale. Results:, Thirty-one patients satisfied inclusion criteria of which 21 agreed to participate. One patient was excluded later in the study leaving 20 patients. Seventy per cent of patients had sensory changes in the area supplied by the infrapatellar branch of the saphenous nerve. Patient satisfaction scores did not correlate to the presence of a sensory deficit. Two patients stated that the sensory deficit was a significant factor in their dissatisfaction with their arthroplasty surgery. Conclusions:, Sensory changes due to damage to the infrapatellar branch of the saphenous nerve during total knee joint arthroplasty is a common occurrence and can interfere with patient satisfaction. Patients should be informed of this risk in the preoperative discussion. [source] The arterial supply of the patellar tendon: Anatomical study with clinical implications for knee surgeryCLINICAL ANATOMY, Issue 3 2009Jack Pang Abstract The middle-third of the patellar tendon (PT) is well-established as a potential graft for cruciate ligament reconstruction, but there is little anatomical basis for its use. Although studies on PT vascular anatomy have focused on the risk to tendon pedicles from surgical approaches and knee pathophysiology, the significance of its blood supply to grafting has not been adequately explored previously. This investigation explores both the intrinsic and extrinsic arterial anatomy of the PT, as relevant to the PT graft. Ten fresh cadaveric lower limbs underwent angiographic injection of the common femoral artery with radio-opaque lead oxide. Each tendon was carefully dissected, underwent plain radiography and subsequently schematically reconstructed. The PT demonstrated a well-developed and consistent vascularity from three main sources: antero-proximally, mainly by the inferior-lateral genicular artery; antero-distally via a choke-anastomotic arch between the anterior tibial recurrent and inferior medial genicular arteries; and posteriorly via the retro-patellar anastomotic arch in Hoffa's fat pad. Two patterns of pedicles formed this arch: inferior-lateral and descending genicular arteries (Type-I); superior-lateral, inferior-lateral, and superior-medial genicular arteries (Type-II). Both types supplied the posterior PT, with the majority of vessels descending to its middle-third. The middle-third PT has a richer intrinsic vascularity, which may enhance its ingrowth as a graft, and supports its conventional use in cruciate ligament reconstruction. The pedicles supplying the PT are endangered during procedures where Hoffa's fat pad is removed including certain techniques of PT harvest and total knee arthroplasty. Clin. Anat. 22:371,376, 2009. © 2009 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||