Early Outpatient Physical Therapy May Improve Range-of-Motion in Primary Total Knee Arthroplasty

2017 ◽  
Vol 30 (07) ◽  
pp. 618-621 ◽  
Author(s):  
Tanner McGinn ◽  
Morad Chughtai ◽  
Anton Khlopas ◽  
Paige Grasmick ◽  
Arun Mullaji ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Therapy ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Manipulation Under Anesthesia ◽  
Total Knee ◽  
Primary Total Knee ◽  
Flexion And Extension

AbstractKnee stiffness is a relatively common complication following a primary total knee arthroplasty (TKA). Following this procedure, rehabilitation is essential to maintain, improve, and prevent the loss of knee range-of-motion (ROM). Currently, there is a paucity of studies describing whether the timing of physical therapy (PT) post-TKA plays a role in ROM outcomes. Therefore, the purpose of this study was to compare (1) flexion and (2) extension ROM at final follow-up of TKA patients who either began outpatient physical therapy (OPT) within 6 weeks or after 6 weeks of their TKA. Surgical records from all TKAs performed at one institution (three surgeons) between January 2013 and December 2014 (n = 485) were analyzed. Their mean age was 63 years (range, 32–90 years). Patients were stratified into two cohorts: patients who had OPT within 6 weeks (n = 411) and those who started after 6 weeks (n = 74). The t-tests were used to compare mean flexion and extension ROM at final follow-up. The patients who attended OPT within 6 weeks had a significantly higher mean flexion ROM at their final clinical visit ([mean, 114 degrees; range, 60–140 degrees] versus [mean, 111degrees; range, 80–130 degrees]). There was a lower mean extension in the patients who attended PT earlier as compared with those who attended it later (0.7 vs. 1.5 degrees). Patients who attended OPT within 6 weeks of TKA had a better mean flexion and extension ROM as compared with those who started after 6 weeks. Attending PT earlier may allow a patient to have better ROM and decreased stiffness. Because stiffness recalcitrant to PT is usually treated with manipulation under anesthesia (MUA), attending PT earlier and improving ROM may potentially allow post-TKA patients to avoid undergoing manipulation under anesthesia. Further work is needed to validate these findings. Future studies should be prospective with larger cohorts.

Manipulation under Anesthesia after Knee Arthroplasty Is Associated with Worse Long-Term Clinical Outcomes and Survivorship

2019 ◽  
Author(s):  
David A. Crawford ◽  
Joanne B. Adams ◽  
Michael J. Morris ◽  
Keith R. Berend ◽  
Adolph V. Lombardi
Keyword(s):  
Total Knee Arthroplasty ◽  
Relative Risk ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Long Term Outcomes ◽  
Manipulation Under Anesthesia ◽  
Total Knee ◽  
Primary Total Knee

AbstractThe literature is mixed on the long-term fate of knees that undergo manipulation under anesthesia (MUA). The purpose of this study is to evaluate the long-term outcomes and survivorship of patients who required a MUA after primary total knee arthroplasty (TKA) compared with a cohort of patients who did not undergo a MUA. Between 2003 and 2007, 2,193 patients (2,783 knees) underwent primary TKA with 2-year minimum follow-up; 182 knees (6.5%) had a MUA. Patients who had a manipulation were younger (p < 0.001) and had worse preoperative range of motion (ROM) (p < 0.001). Postoperative ROM, Knee Society clinical (KSC), functional, and pain (KSP) scores, revisions, and survivorship were compared between MUA and no MUA. Mean follow-up was 9.7 years. MUA patients had lower postoperative ROM (p < 0.001), change in ROM (p < 0.001), KSC (p < 0.001), KSP (p < 0.001), and change in KSP scores (0.013). Revisions occurred in 18 knees (9.9%) in the MUA group compared with 77 knees (3%) without a MUA (p < 0.001). Most common reason for revision after MUA was continued stiffness (50%). Relative risk for revision after one MUA was 2.01 (95% confidence interval [CI], 1.1–3.8, p < 0.001) and after three or more MUAs were 27.02 (95% CI, 16.5–44.1, p < 0.001). Ten-year survival after MUA was 89.4% (95% CI, 87.1–91.7%) compared with 97.2% (95% CI, 96.9–97.5%) without a MUA (p < 0.001). Patients who undergo a MUA after primary TKA may have a knee at risk with higher revision rates, worse long-term clinical scores, ROM and survivorship.

scholarly journals Factors determining the range of motion in primary total knee arthroplasty

2019 ◽  
Vol 6 (1) ◽  
pp. 12
Author(s):  
Mallesh Rathod ◽  
Sandeep Kumar Kanugula ◽  
Venugopal S. M. ◽  
Jagadeesh Gudaru
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Tibial Slope ◽  
Implant Design ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Total knee arthroplasty (TKA) ­­­­­­is one of the most successful surgical procedure with over 90% survival rate at 10 to 15 years. It provides a stable, pain free range of motion (ROM) for day to day activities. The aim of this study is to evaluate various factors determining ROM after TKA.</p><p class="abstract"><strong>Methods:</strong> 348 patients with 390 knees treated with TKA using cruciate retaining (CR) and posterior stabilized (PS) prosthesis were included and analysed. Mean follow up period was 18 months. Patients were analysed for factors like age, sex, diagnosis, body mass index (BMI), pre-operative exercises, ROM, deformity, posterior femoral condylar offset (PFCO), posterior tibial slope (PTS), post-operative rehabilitation and implant design (CR vs PS). Statistical analysis of above factors on knee ROM was done. Patients were assessed pre-operatively, at 6 weeks, 3, 6, 12 and 18 months post-operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Age and sex did not affect the final ROM. The mean knee ROM improved from 86.87° to 96.95°. Factors like BMI, deformity had negative correlation and Pre-operative diagnosis, exercises, knee scores, good preoperative ROM, PFCO, PTS had positive correlation on ROM.</p><p class="abstract"><strong>Conclusions:</strong> Pre-operative exercises, diagnosis, ROM, deformity, BMI, PFCO and PTS were important factors which influence ROM in TKA. Patient selection and preoperative counselling are important for good clinical outcome.</p>

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

2020 ◽  
Vol 34 (01) ◽  
pp. 115-120
Author(s):  
Ali Utkan ◽  
Emrah Caliskan ◽  
Batuhan Gencer ◽  
Bulent Ozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Histopathological Analysis ◽  
Knee Score ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

scholarly journals Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

2014 ◽  
Vol 473 (1) ◽  
pp. 143-147 ◽  
Author(s):  
Kimona Issa ◽  
Aiman Rifai ◽  
Matthew R. Boylan ◽  
Sina Pourtaheri ◽  
Vincent K. McInerney ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Manipulation Under Anesthesia ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals Early outcomes of posterior cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in Indian population

2018 ◽  
Vol 4 (3) ◽  
pp. 463
Author(s):  
Sunil Kumar Dash ◽  
Sanket Mishra ◽  
Sumanyu Tripathy ◽  
Manish Sharma ◽  
Aurobinda Das
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Indian Population ◽  
Primary Total Knee Arthroplasty ◽  
Walking Distance ◽  
Cruciate Retaining ◽  
Functional Parameters ◽  
Total Knee ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Total knee replacement arthroplasty today has become the final treatment option for patients with unsalvageable, severely arthritic, painful and deformed knees. In India the numbers of such surgeries are steadily on the rise with bulk of the patients being relatively younger group. Amongst several factors affecting the kinematics of knee, variations in surface geometry and the retention or sacrificing the posterior cruciate ligament is considered especially important. The role of the retaining a PCL on the demographic, clinical and functional parameters of a patient undergoing TKA remains controversial. The aim of the study was to evaluate the outcomes of cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in relation to demographic, clinical and functional parameters.</p><p class="abstract"><strong>Methods:</strong> 20 knees from 12 patients of osteoarthritis including 8 females and 4 males in age group 45-80 years were operated with cruciate retaining implants. The pre and postoperative evaluations were done radiologicaly and clinically using new knee society score. Patients were followed up for minimum 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> evaluations of patients revealed good postoperative improvements at subsequent follow up in comparison to preoperative scores. The average range of movement improved by 43.3 degree. The objective, patients satisfaction and functional score improved with scores of 89, 34 and 89.7 at 1 year follow up. The walking distance and staircase climbing, squatting scores also did well. Age did not seem to affect overall outcomes with males having slightly better postoperative scoring overall.</p><p class="abstract"><strong>Conclusions:</strong> In Indian population when the patient is young, high demanding, the retention of cruciate ligaments gives excellent postoperative functionality and objectivity and should be always considered as first choice surgery.</p>

Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

2019 ◽  
Vol 33 (07) ◽  
pp. 678-684 ◽  
Author(s):  
Fahad Hossain ◽  
Sujith Konan ◽  
Babar Kayani ◽  
Christina Kontoghiorghe ◽  
Toby Barrack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractThe use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

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