A Current Procedural Terminology Code for “Knee Conversion” Is Needed to Account for the Additional Surgical Time Required Compared to Total Knee Arthroplasty

This retrospective study was to determine if patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM) tibial guide (group 1, n=48), PSI with EM tibial guide (group 2, n=68), and conventional instrumentation (CI) group (group 3, n=50). Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9±13.6 min) compared to the CI group (group 3, 82.8±24.9 min) (P<0.001). However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3±18.8 min). This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

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Customized Cutting Blocks Reduce Surgical Time for Total Knee Arthroplasty

MD Conference Express ◽

10.1177/1559897715586386 ◽

2015 ◽

Vol 15 (7) ◽

pp. 15-15

Author(s):

N. Parry ◽

N. Tammachote

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Surgical Time ◽

Total Knee

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Early Experience with CAOS Enhanced Total Knee Arthroplasty – A Global, Multi-surgeon Evaluation

10.29007/9nkg ◽

2019 ◽

Author(s):

Yifei Dai ◽

Valerie Bauler ◽

Stephan Delpech ◽

Ian Gradisar ◽

Phillip Lewandowski ◽

...

Keyword(s):

Physical Activity ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Task Complexity ◽

Early Experience ◽

Surgical Time ◽

Surgical Practice ◽

Conventional Instrumentation ◽

Total Knee ◽

High Level

This study investigated surgeons’ perceptions of their experience while adopting a novel CAOS enhanced mechanical instrument system for TKA, including ease of usage, task complexity, and demands of surgical time and physical activity. A group of 9 surgeons from multiple countries with no experience in the investigated system used the CAOS enhanced mechanical instrument system during their surgical practice. After performing each TKA case, the surgeon independently completed a 6-section questionnaire formulated to survey his/her experience with the case. The results demonstrated high level of surgeons’ experiences with the adoption of the CAOS enhanced conventional instrumentation, with particularly satisfying experiences in minimum demand of time in landmark acquisition and disruption of the existing surgical process.

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Efficacy of Additional Corticosteroids to Multimodal Cocktail Periarticular Injection in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.3.rs-77021/v1 ◽

2020 ◽

Author(s):

Qi Li ◽

Guo Mu ◽

Xiangbo Liu ◽

Milian Chen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Periarticular Injection ◽

Randomized Controlled ◽

Total Knee ◽

Time Required

Abstract Background: As the ultimate method for the treatment of osteoarthritis, total knee arthroplasty (TKA) has been widely used in clinic. Local injection of multimodal cocktails, including corticosteroids, is commonly used for pain management after TKA. This meta-analysis aims to systematically evaluate the effect of periarticular injection of corticosteroids on postoperative pain relief and knee functional recovery in patients undergoing TKA.Methods: PubMed, Cochrane Library, EMBASE and Web of Science databases were comprehensively searched for all randomized controlled trials (RCTs) published before July 1st, 2020 that investigated the efficacy of corticosteroids for TKA.Results: Ten RCTs involving a total of 829 patients were assessed in the meta-analysis. Compared with the control group, the Visual Analogue Scale (VAS) score at rest of the corticosteroids group decreased significantly at postoperative day 1(POD1), POD2 and POD3(P<0.05). Besides, the range of flexion motion of the knee joint in corticosteroids group at POD1 and POD2 was significantly increased(P<0.05), at the same time, the range of extension motion at POD2 and POD3 showed the opposite trend between the two groups(P<0.05). The morphine equivalent of postoperative analgesia was significantly reduced(P<0.05), and the time required for straight leg raising(SLR) was significantly shortened(P<0.05). There was no significant difference between the two groups in terms of postoperative drainage, length of hospital stay, and complications such as infection, nausea and vomiting(P>0.05).Conclusion: The additional corticosteroids to multimodal cocktail periarticular injection can relieve the early pain intensity at rest after TKA, increase the early range of motion(ROM) of the knee joint, reduce the dosage of postoperative analgesics, and shorten the duration of time required for SLR.However, it has no effect on reducing postoperative complications and shortening the length of hospital stay.

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Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02144-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Qi Li ◽

Guo Mu ◽

Xiangbo Liu ◽

Milian Chen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Periarticular Injection ◽

Randomized Controlled ◽

Total Knee ◽

Time Required

Abstract Background As the ultimate method for the treatment of osteoarthritis, total knee arthroplasty (TKA) has been widely used in the clinic. Local injection of multimodal cocktails, including corticosteroids, is commonly used for pain management after TKA. This meta-analysis aims to systematically evaluate the effect of periarticular injection of corticosteroids on postoperative pain relief and knee functional recovery in patients undergoing TKA. Methods PubMed, Cochrane Library, EMBASE, and Web of Science databases were comprehensively searched for all randomized controlled trials (RCTs) published before July 1, 2020, that investigated the efficacy of corticosteroids for TKA. Results Ten RCTs involving a total of 829 patients were assessed in the meta-analysis. Compared with the control group, the visual analogue scale (VAS) score at rest of the corticosteroid group decreased significantly at postoperative day 1 (POD1), POD2, and POD3 (p < 0.05). Besides, the range of flexion motion of the knee joint in the corticosteroid group at POD1 and POD2 was significantly increased (p < 0.05); at the same time, the range of extension motion at POD2 and POD3 showed the opposite trend between the two groups (p < 0.05). The morphine equivalent of postoperative analgesia was significantly reduced (p < 0.05), and the time required for straight leg raising (SLR) was significantly shortened (p < 0.05). There was no significant difference between the two groups in terms of postoperative drainage, length of hospital stay, and complications such as infection, nausea, and vomiting (p > 0.05). Conclusion The additional corticosteroids to multimodal cocktail periarticular injection can relieve the early pain intensity at rest after TKA, increase the early range of motion (ROM) of the knee joint, reduce the dosage of postoperative analgesics, and shorten the duration of time required for SLR. However, it has no effect on reducing postoperative complications and shortening the length of hospital stay.

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The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain

The Journal of Knee Surgery ◽

10.1055/s-0041-1735313 ◽

2021 ◽

Author(s):

Stephen Gerard Zak ◽

David Yeroushalmi ◽

Alex Tang ◽

Morteza Meftah ◽

Erik Schnaser ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Opioid Consumption ◽

Perioperative Outcomes ◽

Computer Assisted ◽

Surgical Time ◽

Pain Scores ◽

Pain Outcomes ◽

Total Knee

AbstractThe use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.

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