The Use of a High-Tech Knee Pad for Reduction of the Postoperative Effusion after Total Knee Arthroplasty

Purpose After total knee arthroplasty (TKA), pain and swelling, especially in older and less cooperative patients, can limit the retrieval of a good range of motion and muscle tone and consequently the achievement of an optimal function outcome. A high-tech knee pad made of metal fibers emitting infrared energy was used in a group of patients undergoing TKA to assess its efficacy in the postoperative period with respect to a group with a placebo. Methods Twelve patients used knee pads after surgery for 3 weeks and were evaluated using visual analog scale (VAS), Knee Society Rating Score, Cincinnati Knee Rating Score, and painkillers at specific timings. Results At 3 weeks, all scores improved in a significant manner in the treated group compared with the placebo group. At 2 months after surgery, VAS was better in the study group than the control group, whereas other parameters were similar. However, the use of rescue drugs was less in the study group than in the placebo group. Conclusion A high-tech knee pad may contribute to a faster recovery within the first week after a knee replacement, limiting the use of painkillers and allowing a quick functional recovery by the control of pain and postoperative effusion. Level of Evidence Level II, randomized prospective study with small sample size.

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Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1718597 ◽

2020 ◽

Author(s):

Thomas A. Novack ◽

Christopher J. Mazzei ◽

Jay N. Patel ◽

Eileen B. Poletick ◽

Roberta D'Achille ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Care Pathway ◽

Primary Total Knee Arthroplasty ◽

Cost Savings ◽

Patient Discharge ◽

Control Group ◽

Study Group ◽

Bundled Payment ◽

Total Knee

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

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The Impact of Pre-emptive Large Dose of Methylprednisolone Combined With Gabapentin on Pain Treatment and Convalescence After Total Knee Arthroplasty in Elderly. A Randomized Control Study

10.21203/rs.3.rs-149103/v1 ◽

2021 ◽

Author(s):

Henryk Liszka ◽

Małgorzata Zając ◽

Artur Gądek

Keyword(s):

Total Knee Arthroplasty ◽

Single Dose ◽

Knee Arthroplasty ◽

Opioid Analgesic ◽

Control Group ◽

Study Group ◽

Intensity Level ◽

Old Patients ◽

Total Knee ◽

The Impact

Abstract Background The aim of the study was to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). Material and Methods One hundred seventy, above 65 years old patients were qualified for the study, and 10 patients were excluded due to clinical situation. One hundred sixty patients were double-blind randomized into two groups: the study (eighty patients) and controls (eighty patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral gabapentin and 125 mg intravenous methylprednisolone, while the others placebo. Perioperatively, all the patients received opioid and nonopioid analgesic agents calculated for 1 kg of body weight. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein - CRP), pain intensity level at rest (numerical rating scale - NRS), the life parameters and all complications. Results Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia CRP values being lower on all postoperative days ( 1, 2 days - p<0,00001, 3 day – p=000538), leukocytosis on day 2 (p<0,0086) and 3 (p<0,00042), the NRS score at rest 6, 12 (p<0,000001), 18 (p<0,00004) and 24 (p=0,005569) hours postoperatively . Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p=0,000006). The duration time of analgesia was significantly longer in study group (p<0,000001). No infectious complications were observed; in the control group, one patient manifested transient ischaemic attack (TIA). Conclusion The use of gabapentin and methylprednisolone at a single dose decreases the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, the level of inflammatory parameters without infectious processes.

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AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study

BioMed Research International ◽

10.1155/2017/1262108 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Feng-Chih Kuo ◽

Bradley Chen ◽

Mel S. Lee ◽

Shih-Hsiang Yen ◽

Jun-Wen Wang

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Minimally Invasive ◽

Knee Arthroplasty ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Site Infection ◽

Randomized Controlled ◽

Total Knee

The use of modern surgical dressings to prevent wound complications and surgical site infection (SSI) after minimally invasive total knee arthroplasty (MIS-TKA) is lacking. In a prospective, randomized, controlled study, 240 patients were randomized to receive either AQUACEL Ag Surgical dressing (study group) or a standard dressing (control group) after MIS-TKA. The primary outcome was wound complication (SSI and blister). The secondary outcomes were wear time and number of dressing changes in the hospital and patient satisfaction (pain, comfort, and ease of use). In the intention-to-treat analysis, there was a significant reduction in the incidence of superficial SSI (0.8%, 95% CI∶ 0.00–2.48) in the study group compared to 8.3% (95% CI∶ 3.32–13.3) in the control group (p=0.01). There were no differences in blister and deep/organ-space SSIs between the two groups. Multivariate analysis revealed that AQUACEL Ag Surgical dressing was an independent risk factor for reduction of SSI (odds ratio: 0.07, 95% CI: 0.01–0.58, p=0.01). The study group had longer wear time (5.2±0.7 versus 1.7±0.4 days, p<0.0001) and lower number of dressing changes (1.0±0.2 versus 3.6±1.3 times, p<0.0001). Increased patient satisfaction (p<0.0001) was also noted in the study group. AQUACEL Ag Surgical dressing is an ideal dressing to provide wound care efficacy, patient satisfaction, reduction of SSI, and cost-effectiveness following MIS-TKA.

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The effect of oral tranexamic acid administration on blood loss and hospital costs in patients undergoing total knee arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00062 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0006

Author(s):

Budak Akman ◽

Burak Çağrı Aksu ◽

Çağatay Uluçay ◽

Volkan Kılınçoğlu ◽

Turhan Özler ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Hospital Costs ◽

Oral Dosage ◽

Control Group ◽

Study Group ◽

Total Knee ◽

Acid Administration

Aim: Total knee arthroplasty is a kind of major orthopaedic operation that may go with serious amount of peroperative blood loss. Tranexamic acid administration (an antifibrinolytic agent) is one of the most common strategy among the various blood preserving strategies used in major surgeries associated with high volume blood loss. The aim of this study is to evaluate effectiveness of oral tranexamic acid in reducing blood loss and blood transfusion in total knee arthroplasty procedures. In addition hospital costs were also compared. Materials-Methods: Between 2013-2016, 256 total knee arthroplasty procedure performed by six different staff surgeons in our clinic. 125 patients appropriate for our study criteria were included in our study and retrospectively evaluated. 49 patients in study group were administered 15 mg/kg tranexamic intravenous infusion before relasing intraoperative tourniquet and continued as oral 500 mg tranexamic acid three times with 6 hours interval in the first postoperative 24 hours.76 patients were not administered tranexamic acid and compromised the control group. Information on pateints’s demographics, preoperative and postoperative 24th hour hemoglobin and hematocrit values, postoperative 24th hour drain volumes and blood transfusions were obtained from patient files retrospectively. Results: Postoperative 24th hour drain volumes were significiantly less in tranexamic acid administered group (283 130 cc) than that of control group (383 135 cc) (p<0,001). Decrease in hemoglobin and hematocrit values in the postoperative 24th hour were significiantly less in study group (1,73 g/dL-%6,13) than those of control group (2,92 g/dL -%8,63) (P<0,001). Both number of total erythrocyte suspensions (ES) transfused and number of patients transfused were higher in control group than those of study group. (52 ES and 45 patients versus 18 ES and 14 patients) Calculated average ES per patient were 0.37 in study group and 0.68 in control group. (P=0,009). As a result blood bank costs were reduced %50 in study group as compared to control group. Conclusions: Tranexamic acid administered as single intraoperative intravenous dose and sequentially continued as 500 mg oral dosage 3 times with six hours interval in the first postoperatve24 hours is a significiantly effective approach in preventing bloos loss and reducing hospital costs in total knee arthroplasty procedures. In addition easiness and convinience of oral administration of tranexamic acid makes the approach more advantageous.

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Analgesic Effects of Intra-Articular Bupivacaine/Intravenous Parecoxib Combination Therapy versus Intravenous Parecoxib Monotherapy in Patients Receiving Total Knee Arthroplasty: A Randomized, Double-Blind Trial

BioMed Research International ◽

10.1155/2015/450805 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Shih-Jyun Shen ◽

Pei-Yu Peng ◽

Hsiu-Pin Chen ◽

Jr-Rung Lin ◽

Mel S. Lee ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Pain Relief ◽

Confidence Interval ◽

Knee Arthroplasty ◽

Rating Scale ◽

Group Versus ◽

Control Group ◽

Study Group ◽

Double Blind ◽

Total Knee

Objectives. The purpose of this double-blind, randomized study was to investigate whether the addition of intra-articular bupivacaine to intravenous parecoxib could improve pain relief in patients undergoing total knee arthroplasty.Methods. A total of 36 patients undergoing total knee arthroplasty were enrolled into our study. These patients were randomly allocated either to a placebo-controlled group or study group. Postoperative pain scores and analgesic consumption were evaluated.Results. Numeric rating scale (NRS) data of bupivacaine group in postoperative room were significantly lower than that of control group (control group versus bupivacaine group, 7.9 (6.7–9.1) (mean and 95% confidence interval) versus 4.5 (3.2–5.8) (mean and 95% confidence interval),p=0.001). NRS data of bupivacaine group in ward were also significantly lower than that of control group. A significantly lower dose of meperidine was used in the study group postoperatively during the first 24 hours (control group versus bupivacaine group, 3.08 ± 0.80 mg/Kg versus 2.34 ± 0.42 mg/Kg,p=0.001).Conclusion. Intra-articular bupivacaine in combination with intravenous parecoxib may improve pain relief and reduce the demand for rescue analgesics in patients undergoing total knee arthroplasty. The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12615000463572).

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Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

10.21203/rs.2.15386/v1 ◽

2019 ◽

Author(s):

Yifan Huang ◽

Yuhang Gao ◽

Lu Ding ◽

Bo Liu ◽

Jianguo Liu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Implant Design ◽

Control Group ◽

Study Group ◽

Design Modification ◽

Total Knee ◽

Anterior Knee

Abstract Background: The incidence of dissatisfaction that due to multiple factors especially anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA) are still required concern. Improvements of femoral component in traditional prosthesis could reduce the incidence of these complications in TKA with patella resurfacing. This study aimed to explore whether TKA without patella resurfacing benefit from this femoral implant design modification in the aspects of AKP and patellar crepitus.Methods: Sixty-two patients (85 knees) using the modern prosthesis and 62 age-matched and sex-matched patients (90 knees) using the traditional prosthesis were enrolled in this study. The incidences of AKP and patellar crepitus, Knee Society Scores were recorded. Statistical analyses were accomplished to determine if there were differences between the two groups. Results: The incidence of AKP was significantly lower in the study group compared with those in the control group at 3-month and 1-year follow-up (4.7% vs. 13.3%, p = 0.048; 3.5% vs. 13.3%, p = 0.021, respectively). The incidence of patellar crepitus was significantly lower in the study group compared with those in the control group at 3-month and 1-year follow-up (34.4% vs. 15.3%, p = 0.004; 28.9% vs. 10.6% at 1 year, p = 0.002, respectively). There was no significant difference in Knee Society Scores between two groups.Conclusion: The results showed that TKA without patella resurfacing benefited from this femoral implant design modification in the aspects of AKP and patellar crepitus. This study may provide meaningful information for surgeons who use the modern prosthesis and selectively not resurfacing the patella in their patients.

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The Effect of Preoperative Video Based Pain Training on Postoperative Pain and Analgesic Use in Patients Undergoing Total Knee Arthroplasty: A Non-randomized Control Group Intervention Study

Clinical Nursing Research ◽

10.1177/1054773820983361 ◽

2020 ◽

pp. 105477382098336

Author(s):

Ceyda Su Gündüz ◽

Nurcan Çalişkan

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Group Intervention ◽

Intervention Study ◽

Intervention Group ◽

Control Group ◽

Total Knee ◽

Randomized Control ◽

Analgesic Use

This non-randomized control group intervention study was conducted to determine the effect of preoperative video based pain training on postoperative pain and analgesic use in patients undergoing total knee arthroplasty. During the study, the patients in the control ( n = 40) received routine care and the patients in the intervention group ( n = 40) received video based pain training. İt was determined that the mean postoperative pain scores of the intervention group were significantly lower and their pain management was better compared to the control group ( p < .05). The intervention group was found to use significantly less paracetamol on operation day compared to the control group ( p < .05). The intervention group was determined to benefit from non-pharmacological methods more than the control group did ( p < .05). Providing video based pain training to patients undergoing total knee arthroplasty is recommended since it reduces postoperative pain levels and increases the use of non-pharmacological pain control methods.

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Intravenous patient-controlled analgesia vs nurse administered oral oxycodone after total knee arthroplasty: a retrospective cohort study

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0012 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Katarina Lahtinen ◽

Elina Reponen ◽

Anne Vakkuri ◽

Riku Palanne ◽

Mikko Rantasalo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Pain Medication ◽

Secondary Outcome ◽

Control Group ◽

Patient Controlled Analgesia ◽

Total Knee Arthroplasty Patient ◽

Opioid Dose ◽

Total Knee

AbstractShort CommunicationsSevere post-operative pain is common after total knee arthroplasty. Patient-controlled analgesia is an alternative method of pain management, whereby a patient administers his or her own pain medication. Patients seem to prefer this method over nurse-administered analgesia. However, it remains unclear whether patients using patient-controlled analgesia devices use higher or lower doses of opioids compared to patients treated with oral opioids.Objectives and MethodsThis retrospective study examined 164 patients undergoing total knee arthroplasty. Post-operatively, 82 patients received oxycodone via intravenous patient-controlled analgesia devices, while the pain medication for 82 patients in the control group was administered by nurses. The main outcome measure was the consumption of intravenous opioid equivalents within 24 h after surgery. Secondary outcome measures were the use of anti-emetic drugs and the length of stay. Furthermore, we evaluated opioid-related adverse event reports.ResultsThe consumption of opioids during the first 24 h after surgery and the use of anti-emetic drugs were similar in both groups. The median opioid dose of intravenous morphine equivalents was 41.1 mg (interquartile range (IQR): 29.5–69.1 mg) in the patient-controlled analgesia group and 40.5 mg (IQR: 32.4–48.6 mg) in the control group, respectively. The median length of stay was 2 days (IQR: 2–3 days) in the patient-controlled analgesia group and 3 days (IQR: 2–3 days) in the control group (p=0.02). The use of anti-emetic drugs was similar in both groups.ConclusionsThe administration of oxycodone via intravenous patient-controlled analgesia devices does not lead to increased opioid or anti-emetic consumptions compared to nurse-administered pain medication after total knee arthroplasty. Patient-controlled analgesia might lead to shortened length of stay.

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When can total knee arthroplasty be safely performed following prior arthroscopy?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03859-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jin-Ning Ma ◽

Xiao-Lin Li ◽

Pan Liang ◽

Sheng-Li Yu

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Acl Injury ◽

Control Group ◽

Optimal Timing ◽

Complication Rates ◽

Increased Risk ◽

Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.007515 ◽

2016 ◽

Vol 15 (2) ◽

pp. 120-125 ◽

Cited By ~ 1

Author(s):

Ari Zekcer ◽

Ricardo Del Priori ◽

Clauber Tieppo ◽

Ricardo Soares da Silva ◽

Nilson Roberto Severino

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Intravenous Administration ◽

Knee Arthroplasty ◽

Duplex Ultrasound ◽

Control Group ◽

Perioperative Bleeding ◽

Total Knee

Abstract Background Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. Objectives To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. Methods All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a “topical group” (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an “intravenous group” (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. Results Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). Conclusions Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.

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