Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements

Background: Range of motion is an important indicator of the success of total knee arthroplasty. To our knowledge there are no studies assessing the factors affecting the range of motion after total knee arthroplasty on Indian population which prompted us to undertake this study. Method: The present prospective study for all those patients with advanced arthritis of knee satisfying inclusion criteria, between August 2009 to June 2011. A total of 430 total knee replacements were done among 327 patients during this period out of which 354 primary total knee replacements among 254 patients were included in the study. Follow ups were done at 3 months, 6 months, one year and 2 years following procedure. Result: The average age was 63.8 years with a range of 50 – 80 years. 66.1% of the patients were female and 33.9% were male. The preoperative diagnosis was osteoarthritis in 81.1% of patients and 18.9% had rheumatoid arthritis. All poly implant was used in 83.1% of patients and in 16.9% of patients metal backed was used. The posterior tibial slope had no correlation with the postoperative range of motion at all the points of follow up. The preoperative range of motion had a statistical correlation with the postoperative range of motion at all the points of follow up and in all the age groups, p <0.0001. Conclusion: A more keen watch has to be kept in all young female patients with early onset of arthritis and mange them aggressively with conservative therapy.

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Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

BMC Anesthesiology ◽

10.1186/s12871-021-01442-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mark C. Kendall ◽

Alexander D. Cohen ◽

Stephanie Principe-Marrero ◽

Peter Sidhom ◽

Patricia Apruzzese ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Adverse Events ◽

General Anesthesia ◽

Knee Arthroplasty ◽

Anesthetic Management ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Short Term ◽

Knee Replacements ◽

Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

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Decreasing Incidence of Postoperative Ileus following Total Knee Arthroplasty: A 17-Year Retrospective Review of 38,007 Knee Replacements at One Institution

The Journal of Knee Surgery ◽

10.1055/s-0039-1684013 ◽

2019 ◽

Vol 33 (08) ◽

pp. 750-753

Author(s):

Bob H. Nguyen ◽

Olivia J. Bono ◽

James V. Bono

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Postoperative Ileus ◽

Length Of Hospital Stay ◽

Joint Arthroplasty ◽

Fiscal Year ◽

Knee Replacements ◽

Total Knee ◽

Preventable Complication

AbstractIleus following total knee arthroplasty is a clinically and financially significant postoperative complication that has not been extensively described in the orthopaedic joint literature. Ileus has been found to occur in 0.7 to 4.0% of patients after total joint arthroplasty. In a 17-year period (2001 fiscal year through 2017 fiscal year) at one institution, we found an incidence of 0.500% (190/38,007) following knee arthroplasty. In addition, the incidence of ileus following total knee arthroplasty (TKA) has drastically declined over this 17-year period, from 1.593% (13/816) in 2001 to 0.120% (4/3,332) in 2017. This decrease may be attributed to a reduction in narcotic use postoperatively, earlier ambulation following surgery, and reduction in length of hospital stay. Though postoperative ileus is not yet a preventable complication, recognition of risk factors may permit earlier intervention to ameliorate some of the morbidity associated with this condition.

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