scholarly journals Steroids Significantly Decrease Postoperative Postural Hypotension in Total Knee Replacement

2021 ◽  
Author(s):  
Gloria H. M. Cheng ◽  
Gabriel K. Y. Tan ◽  
Muhammad F. B. Kamarudin ◽  
Bryan W. W. Lee ◽  
Yap Yan Mei ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Postural Hypotension ◽  
Enhanced Recovery ◽  
Postoperative Nausea And Vomiting ◽  
Binary Logistic Regression ◽  
Vagal Activity ◽  
Level Of Evidence ◽  
Surgical Data ◽  
Total Knee

AbstractTotal knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is associated with lower rates of early postoperative PH following TKR surgery. In our institution, patients who undergo elective primary TKR are admitted on the day of surgery and follow a standardized ERAS protocol. Data on patients who underwent elective primary TKR under a single adult reconstruction team from September 2017 to March 2020 were reviewed and analyzed. A review of demographic characteristics, surgical data, postoperative medications, and postoperative notes was performed. Binary logistic regression was used to assess the effect of the use of dexamethasone on PH, with an adjusted odds ratio (OR) calculated after accounting for potential confounders. Of the 149 patients were included in the study, 78 had dexamethasone postoperatively, and 71 did not. Patients who had received dexamethasone were statistically less likely to suffer from PH (OR = 0.31, p = 0.03) and less likely to develop PONV (OR = 0.21, p = 0.006). Patients who had received dexamethasone were more likely able to participate in early physiotherapy (OR = 2.42, p = 0.14), and this result was statistically insignificant. The use of postoperative intravenous dexamethasone is significantly associated with lower rates of postoperative PH after TKR. However, more studies are required to assess the optimal dosing amount and frequency, as well as to assess other factors which can enhance early postoperative patient mobilization as part of our goals for ERAS. This therapeutic study reflects level of evidence III.

scholarly journals Degree of Coronal Alignment Correction Can’t Predict Knee Function in Total Knee Replacement

2020 ◽  
Author(s):  
Shibai Zhu ◽  
Xi Chen ◽  
Yiou Wang ◽  
Wenwei Qian ◽  
Huiming Peng ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Functional Score ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Correction Rate ◽  
Alignment Correction ◽  
Total Knee ◽  
Grouping Method ◽  
Neutral Alignment

Abstract Background: Whether neutral alignment brings better clinical outcomes is controversial. Consideration of the preoperative knee condition of patients and some limitations of previous studies, we suggested that other index may be more important than a generic target of 0° ± 3° of a neutral axis to reflect changes in coronal alignment after total knee replacement (TKR). The purpose of this study was to explore the relationship between alignment and functional outcome with a new grouping method and the concept of correction rate. Methods: A new grouping method was adopted to divide patients into three groups based on the degree of correction of mechanical femoral-tibial angle (MFTA): neutral, under and over-correction. Hospital for Special Surgery (HSS) score were compared among the 3 groups. In addition, we also attempt to further explore whether the concept of correction rate can predict postoperative functional score. Results: HSS showed significant improvement in all groups. There was no difference in HSS or incremental scores based on the postoperative alignment category for the degree of correction of MFTA. The correlational analyses also didn’t find any relevant results.Conclusion: TKR is a soft tissue procedure and clinical outcome depends on many factors, only reaching neutral alignment after surgery may not mean a good clinical result. Therefore, categorization of optimal coronal alignment after TKR may be impractical. But we still believe that the concept of correction rate and new grouping method are worthy of research which can reflects the preoperative knee condition and the change of coronal alignment. Perhaps it can be better used in TKR in the future. Level of evidence: III.

scholarly journals Enhanced recovery programmes can reduce length of stay after total knee replacement without sacrificing functional outcome at one year

2015 ◽  
Vol 97 (8) ◽  
pp. 563-567 ◽  
Author(s):  
JF Maempel ◽  
PJ Walmsley
Keyword(s):  
Length Of Stay ◽  
Total Knee Replacement ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Knee Replacement ◽  
Enhanced Recovery ◽  
District General Hospital ◽  
Significant Difference ◽  
Total Knee ◽  
One Year

Introduction Enhanced recovery programmes (ERPs) are being widely adopted in total knee replacement (TKR) procedures but studies confirming that they have no adverse effects on functional outcomes are lacking. The aim of this study was to compare length of stay, postoperative functional outcome and range of motion at one year postoperatively between patients undergoing TKR with an ERP and those with traditional rehabilitation. Methods A total of 165 consecutive patients undergoing primary unilateral TKR were included in the study. Overall, 84 patients undergoing TKR with an ERP were compared with a series of 81 patients undergoing primary unilateral TKR with traditional rehabilitation, immediately before the introduction of the ERP. Results The median postoperative length of stay was 3 days in the ERP cohort and 4 in the traditionally rehabilitated cohort (p<0.001). There were no significant differences in the preintervention characteristics of the groups and there was no significant difference in operative time, transfusion or rates of manipulation under anaesthesia. There was no difference in magnitude of improvement in American Knee Society score (p=0.12) or range of motion (p=0.81) between the groups. Conclusions ERP can reduce length of stay after TKR while offering improvements in knee function equivalent to those experienced by patients undergoing TKR with traditional rehabilitation. Furthermore, ERP can be implemented successfully in the setting of a district general hospital.

scholarly journals Osteoporosis in brazilian patients awaiting knee arthroplasty

2017 ◽  
Vol 25 (3) ◽  
pp. 74-77 ◽  
Author(s):  
David Sadigursky ◽  
Luiz Alberto Barretto Junior ◽  
Diogo Maciel Vieira Lobão ◽  
Rogério Jamil Fernandes Carneiro ◽  
Paulo Oliveira Colavolpe
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Serum Vitamin ◽  
Primary Objective ◽  
Level Of Evidence ◽  
Female Population ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Total Knee

ABSTRACT OBJECTIVE: The primary objective of this study was to determine the prevalence of osteoporosis and osteopenia prior to total knee arthroplasty (TKA) in female patients. As a secondary objective, we evaluated the incidence of hip fractures, types of drugs to treat osteoporosis and serum vitamin D levels. METHOD: This is a transversal, descriptive and observational study which evaluated 60 women above age 55 prior to total knee replacement. RESULTS: Mean patient age was 71.4 years. Osteoporosis was present in 16.7% of the sample and osteopenia in 15%. In the patients with osteoporosis, femur fracture (20%) was most frequent. Most of the group with osteopenia did not take any medication to treat this condition (55.6%), while most patients with osteoporosis took alendronate (30%) and 30% did not take any medication. CONCLUSION: The female population awaiting total knee replacement should be considered at risk for osteoporosis, confirming recent findings in the literature. Level of Evidence III, Control Case Study.

scholarly journals Total Hip Replacement and Total Knee Replacement outcomes in the elderly - An opportunity for further improvement of ERAS pathways.

2020 ◽  
Author(s):  
Louise Burgess ◽  
Thomas Wainwright
Keyword(s):  
Length Of Stay ◽  
Total Knee Replacement ◽  
Elderly Patients ◽  
Total Hip Replacement ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Enhanced Recovery ◽  
The Elderly ◽  
Very Elderly ◽  
Total Knee

Introduction Postoperative outcomes of total hip replacement (THR) and total knee replacement (TKR) have been improved by Enhanced Recovery after Surgery (ERAS) guidelines. The elderly population is increasing and successful fast-track rehabilitation can be achieved amongst this cohort. However, the cohorts studied in previous literature are generally younger, healthy patients, who would be expected to recover well from a multidisciplinary pathway. Literature to assess the role of enhanced recovery in the very elderly is limited. The aim of this study is to assess the current outcomes for elderly patients post THR and TKR and explore the opportunity for further application of ERAS pathways. Methods This retrospective study was completed by collecting UK acute NHS hospital data through Hospital Episode Statistics (HES), accessed via the Dr. Foster Healthcare Intelligence Portal. Length of stay, readmission rates, complication of care and mortality were recorded for all THR and TKR cases. Results Length of stay, readmission and complication of care rates increased linearly with age for both THR and TKR patients. For over 85s, average length of stay was 5.0 and 4.5 days (THR and TKR respectively), 30 day re-admission was 9.4% and 9.9%, complication of care was 13.3% and 11.9% and mortality rate was 0.5% and 0.4%. Conclusions The very elderly have the most to gain from an ERAS programme but still have the longest stay in hospital and the greatest post-operative complications. Further work is required to determine how to reduce the risk of complications and increase functional recovery in elderly patients.

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