The Role of Surgical Closure Position in Total Knee Arthroplasty: Flexion versus Extension—A Randomized Prospective Study

AbstractWe aimed to investigate the effect of the knee position during the surgical closure on isokinetic muscle strength, clinical score, and range of motion in total knee arthroplasty. Seventy-five eligible patients were enrolled in the study and randomly divided into two groups; wound closure was performed with the knee flexed at 90° in group 1 and knee extended in group 2. All the surgeries were performed by the same surgeon and by the same prosthesis type. All the patients received the same rehabilitation program postoperatively. The primary outcomes were the knee flexion degrees and the American Knee Society Score values at preoperative and postoperative 6 weeks, 3, and 6 months. The secondary outcome was the isokinetic muscle strength measurements of both knees before the surgery and after 6 months. There were no significant differences in the American Knee Society Scores and knee flexion degrees between the flexion and extension groups. However, a significant decrease was found in the extensor muscle strength in the extension group after 6 months of the surgery. The findings of our study are that the closing of the knee in flexion or extension does not affect the postoperative knee flexion degrees and scores in total knee arthroplasty. However, quadriceps strength recovers early if the knee closure is performed in flexion position.

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The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes

The Journal of Knee Surgery ◽

10.1055/s-0040-1701454 ◽

2020 ◽

Cited By ~ 1

Author(s):

Omer Ayik ◽

Mehmet Demirel ◽

Fevzi Birisik ◽

Ali Ersen ◽

Halil I. Balci ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Muscle Strength ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Peak Torque ◽

Thigh Muscle ◽

Controlled Study ◽

Total Work ◽

Isokinetic Muscle Strength ◽

Total Knee

AbstractThe present randomized controlled study aims to evaluate whether tourniquet application during total knee arthroplasty (TKA) has an effect on (1) thigh muscle strength (quadriceps and hamstring muscle strength) and (2) clinical outcomes (postoperative knee range of motion [ROM], postoperative pain level, and Knee Society Score [KSS]). The effects of tourniquet application during TKA were investigated in 65 patients randomly allocated to one of two groups: TKA with a tourniquet and TKA without a tourniquet. Patients in both groups were comparable in terms of the demographic and clinical data (p > 0.05 for age, number of patients, sex, radiographic gonarthrosis grade, American Society of Anesthesiologists [ASA] classification, and body mass index [BMI]). All patients in both groups were operated by the same surgeon using one type of prosthesis. Isokinetic muscle strength (peak torque and total work) of knee extensors (quadriceps) and flexors (hamstrings) was measured in Newton meters (Nm) using a CYBEX 350 isokinetic dynamometer (HUMAC/CYBEX 2009, Stoughton, MA). The combined KSS (knee score + function score), visual analog scale (VAS), and knee ROM were measured preoperatively and at 1 and 3 months postoperatively to evaluate clinical outcomes. There were no significant differences between the two groups in preoperative and postoperative values of isokinetic muscle strength (peak torque and total work) and aforementioned clinical outcomes (p < 0.05). The present study has shown that quadriceps strength and clinical outcomes were not improved in the early postoperative period (3 months) when a tourniquet was not used during TKA.

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A prospective randomized trial examining the use of a closed suction drain shows no influence on strength or function in primary total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b7.bjj-2018-1420.r1 ◽

2019 ◽

Vol 101-B (7_Supple_C) ◽

pp. 84-90 ◽

Cited By ~ 3

Author(s):

J. M. Jennings ◽

B. J. Loyd ◽

T. M. Miner ◽

C. C. Yang ◽

J. Stevens-Lapsley ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Lower Limb ◽

Quadriceps Strength ◽

Secondary Outcome ◽

Closed Suction ◽

Suction Drain ◽

Closed Suction Drain ◽

Total Knee ◽

Secondary Outcomes

Aims The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications. Patients and Methods A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction (‘sham drain’). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student’s t-tests or Wilcoxon’s signed-rank tests. Results No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery. Conclusion The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84–90

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Methods for Improving Quadriceps Femoris Strength after Total Knee Arthroplasty

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v2i15.706 ◽

2019 ◽

Vol 2 (15) ◽

Author(s):

Toma Petkutė ◽

Eglė Lendraitienė

Keyword(s):

Total Knee Arthroplasty ◽

Muscle Strength ◽

Knee Arthroplasty ◽

Neuromuscular Electrical Stimulation ◽

Quadriceps Strength ◽

Quadriceps Femoris ◽

Resistance Exercises ◽

Total Knee ◽

The Impact ◽

Femoris Muscle

Research background. The recovery of quadriceps femoris muscle strength after total knee arthroplasty is suboptimal. Quadriceps weakness is associated with decreased gait speed, balance, stair–climbing and chair rise ability, as well as increased risk for falls. Scientifc data about the impact of physiotherapy methods for quadriceps strength is ambiguous. The goal of research was to review and analyse studies evaluating effectiveness of physiotherapy for quadriceps femoris strength after total knee arthroplasty. Methods. Fourteen full articles in English, published in 2006–2016, were selected and analysed; the articles met the following criteria: randomised controlled trials were reviewed if they assessed quadriceps strength, and compared two or more physiotherapy methods after primary total knee arthroplasty for osteoarthritis. Results. In total 1011 people after total knee arthroplasty participated in the analysed studies. The impact of progressive strength training, aquatic physical therapy, and resistance exercises using vibration plate, neuromuscular electrical stimulation, preoperative physiotherapy, traditional physiotherapy and telerehabilitation were assessed. It has been specifed that quadriceps strength significantly increases and functional status improves using various physiotherapy methods, but the most effcient methods are unclear, the data of the studies are ambiguous. Conclusions. Various physiotherapy methods are used for the improvement of the quadriceps muscle strength after total knee arthroplasty: preoperative physiotherapy, resistance exercises, aquatic physiotherapy, whole body vibration, neuromuscular electrical stimulation. Telerehabilitation is as effective as traditional rehabilitation in patients after total knee arthroplasty. There is a lack of scientific research that would deny or confrm the advantages of less frequently used physiotherapy methods against traditional physiotherapy, as well as the recommendations of their use after total knee arthroplasty.Keywords: total knee arthroplasty, physiotherapy, quadriceps femoris, muscle strength.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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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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