scholarly journals The Future is Non-cemented Total Knee Arthroplasty: Volume Trends at the Hospital for Special Surgery

2021 ◽  
Author(s):  
Samuel Rodriguez ◽  
Amar S. Ranawat
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
The Future ◽  
Special Surgery ◽  
Total Knee ◽  
Hospital For Special Surgery

Total Knee Arthroplasty: What to Expect? A Survey of the Members of the Dutch Knee Society on Long-Term Recovery after Total Knee Arthroplasty

2016 ◽  
Vol 30 (06) ◽  
pp. 612-616 ◽  
Author(s):  
Marieke van der Steen ◽  
Rob Janssen ◽  
Max Reijman ◽  
Jaap Tolk
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Dutch Version ◽  
Web Based ◽  
Orthopedic Surgeons ◽  
Special Surgery ◽  
Total Knee ◽  
Hospital For Special Surgery

AbstractThe rate of satisfaction after total knee arthroplasty (TKA) is consistently reported around 80%, leaving one in five patients unsatisfied to some extent. Fulfillment of expectations is reported as the strongest predictor of treatment satisfaction. In this study, we aimed to evaluate what Dutch orthopedic surgeons assume are realistic expectations for recovery 1 year after TKA. We invited the members of the Dutch Knee Society (DKS) to fill out a web-based questionnaire. For expectation measurement, the validated Dutch version of the Hospital for Special Surgery (HSS) knee replacement expectations survey was used. A total of 150 invitations were successfully sent; 84 orthopedic surgeons responded (56%). The overall HSS knee replacement expectation score was 66.0 (standard deviation, 14.0) on a 0 to 100 scale. Most improvement was predicted for the items “pain relief” and “walking short distances.” Expectations related to patients' ability to kneel or squat after TKA were scored poorly. To the opinion of the members of the DKS, after TKA improvement can be expected in domains of pain, function, activities, and psychological wellbeing. Return to normal is not likely to occur, especially in demanding physical activities.

The Future of High Performance Total Knee Arthroplasty

2006 ◽  
Vol 17 (2) ◽  
pp. 80-87 ◽  
Author(s):  
Michael A. Mont ◽  
Peter M. Bonutti ◽  
Thorsten M. Seyler ◽  
Johannes F. Plate ◽  
Ronald E. Delanois ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
High Performance ◽  
The Future ◽  
Total Knee

scholarly journals Exposure in Difficult Total Knee Arthroplasty Using Coronal Tibial Tubercle Osteotomy

2000 ◽  
Vol 8 (1) ◽  
pp. 61-65 ◽  
Author(s):  
WJ Bruce ◽  
J Rooney ◽  
SR Hutabarat ◽  
MC Atkinson ◽  
JA Goldberg ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Special Surgery ◽  
Total Knee ◽  
Tibial Cortex ◽  
Fixed Flexion Deformity

Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion.3,6,12 When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized.15,16 We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside.15,16 It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy.10,11,17 The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS). The scores averaged 43.6 preoperatively (range, 29–57) and 79.2 postoperatively (range, 67–90), and the mean range of motion was 59.5° preoperatively and 78.0° postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.

Operative Times in Primary Total Knee Arthroplasty: Can We Predict the Future Based on Contemporary Nationwide Data

2019 ◽  
Author(s):  
Assem A. Sultan ◽  
Linsen T. Samuel ◽  
Jaret M. Karnuta ◽  
Alexander J. Acuña ◽  
Mustafa Mahmood ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Primary Total Knee Arthroplasty ◽  
Final Analysis ◽  
National Database ◽  
Improvement Project ◽  
The Future ◽  
Total Knee ◽  
Primary Total Knee

AbstractRecently, the Centers for Medicare & Medicaid Services announced its decision to review “potentially misvalued” Current Procedural Terminology (CPT) codes, including those for primary total knee arthroplasty (TKA). CPT 27447 is being reevaluated to determine contemporary relative value units for work value, with operative time considered a primary factor in this revaluation. Despite broader indications for TKA, including extension of the procedure to more complex patient populations, it is unknown whether operative times may remain stable in the future. Therefore, the purpose of this study was to specifically evaluate future trends in TKA operative times across a large sample from a national database. The American College of Surgeons National Surgical Quality Improvement Project database was queried from January 1, 2008 to December 31, 2017 to identify 286,816 TKAs using the CPT code 27447. Our final analysis included 140,890 TKAs. Autoregressive integrated moving average forecasting models were built to predict 2- and 10-year operative times. While operative times were significantly different between American Society of Anesthesiologists (ASA) classes 1 and 2 (p = 0.035), there were not enough patients in ASA class 1 to perform rigorous inference. Additionally, operative times were not significantly different between ASA classes 3 and the combined ASA classes 4 and 5 cohort (p = 0.95). Therefore, we were only able to perform forecasts for ASA classes 2 and 3. Operative time was found to be nonstationary for both ASA class 2 (p = 0.08269) and class 3 (p = 0.2385). As a whole, the projection models indicated that operative time will remain within 2 minutes of the present operative time, up to the year 2027. Our projections indicate that operative times will remain stable over the next decade. This suggests that there is a lack of evidence for reducing the valuation of CPT code 27477 based on intraservice time for TKA. Further study should examine operative time trends in the setting of evolving alternative payment models, increasing patient complexity, and governmental restrictions.

scholarly journals Total knee arthroplasty in advanced active tuberculous arthritis of the knee

2020 ◽  
Author(s):  
Jingsheng Wang ◽  
Tingting Liu ◽  
Apeng Zou ◽  
Qingpeng Shi ◽  
Baisui Zhou ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Symptomatic Relief ◽  
Functional Improvement ◽  
Tuberculous Infection ◽  
Safe Procedure ◽  
Tuberculous Arthritis ◽  
Special Surgery ◽  
Total Knee

Abstract Background: While studies have indicated that total knee arthroplasty (TKA) is effective to treat the patients with advanced tuberculosis (TB) of the knee joint a consensus of views regarding surgical timing, prosthesis selection, and peri-operative antitubercular therapy has not been reached. The purpose of this study was to evaluate the safety of TKA in the patients with advanced active tuberculous arthritis of the knee. Methods: Eight patients with advanced active tuberculous arthritis of the knee were reviewed in this study from 2010 to 2017. The diagnosis of each patient was confirmed by postoperative histopathology revealing granulomatous lesions with epithelioid histiocytes surrounded by lymphocytes and positive acid-fast staining. Antitubercular medications and TKA with primary prosthesis were performed in all patients with one-stage TKA in six and two-stage in two. Local symptoms, erythrocyte sedimentation rate (ESR) values were used for detecting the recurrence of tuberculosis. The hospital for special surgery knee score (HSS) system was used to evaluate the function outcomes of the involved knees. Results: Within an average follow-up period of 48.8 months, no recurrence of tuberculous infection was found in any of the patients. The ESR became normal (below 20 mm/h) within six months after TKA in all patients. The average HSS score improved from 32.4 ± 8.6(18-42) points preoperatively to 85.6 ± 9.7(68-94) points 1.5-2.0 years after surgery (p<0.001). All knees showed good integrity and no loosening of prosthesis was found. Conclusions: TKA for advanced active tuberculosis of the knee is a safe procedure providing symptomatic relief and functional improvement. A long infection-free interval is not a prerequisite for TKA. Wide surgical debridement and adequate post-operative antitubercular chemotherapy are the mainstay to eradicate the infection.

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