Tourniquet Use Does Not Affect Pain and Function after Total Knee Arthroplasty: Patient Evaluation According to Pain Threshold

2021 ◽  
Author(s):  
Savaş Çamur ◽  
Serkan Bayram ◽  
Adnan Kara ◽  
Mustafa Faik Seçkin ◽  
Necdet Sağlam ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Pain Threshold ◽  
Early Stage ◽  
Significant Difference ◽  
Total Knee ◽  
Group 2 ◽  
Without Tourniquet ◽  
Group 1

AbstractWe evaluated the effect of using a tourniquet on early-stage pain and 1-year postoperative functional outcomes when patients were divided into two groups according to the pain threshold (PT). Overall, 120 patients who were assessed preoperatively with an algometer were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo total knee arthroplasty (TKA) with a tourniquet (group 1, 60 patients) and without tourniquet (group 2, 60 patients). Primary outcome measures were visual analog scale (VAS) pain scores at 24, 36, and 48 hours postoperatively and functional assessment with Knee Society Score (KSS) test at 1 year postoperatively. No significant differences were observed between groups in terms of gender (49 females and 8 males in group 1 vs. 53 females and 6 males in group 2; p = 0.201) and age (68.9 years in group 1 vs. 68.7 years in group 2; p = 0.811). There was no significant difference between groups in all the VAS and KSS 1 and KSS 2 scores. PT measurements ranged from 2.5 to 11.5 with a mean of 7.69 ± 1.70 and a median of 8. Total 54 patients with a median value of < 8 were defined as the low-PT group, and 62 patients with a median value of ≥ 8 were defined as the high-PT group. When the groups were evaluated according to using the tourniquet, 21 patients were operated on with a tourniquet and 33 patients without it in the low-PT group, while 36 patients were operated on with a tourniquet and 26 patients without it in the high-PT group. There was no significant difference in pain or functional scores between patients when comparing with-tourniquet and without-tourniquet or when comparing the low- and high-PT groups. This showed that the use of a tourniquet during TKA was not associated with either early-stage pain or 1-year postoperative functional outcomes according to algometer evaluation.Level of evidence: Level 1 prospective randomized study.

scholarly journals Preemptive Analgesia in Total Knee Arthroplasty: Comparing the Effects of Single Dose Combining Celecoxib with Pregabalin and Repetition Dose Combining Celecoxib with Pregabalin: Double-Blind Controlled Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Andri M. T. Lubis ◽  
Rangga B. V. Rawung ◽  
Aida R. Tantri
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Preemptive Analgesia ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Significant Difference ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with preemptive analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given preemptive analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as preemptive analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 (ClinicalTrials.gov).

scholarly journals The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Oh-Ryong Kwon ◽  
Kyoung-Tak Kang ◽  
Juhyun Son ◽  
Dong-Suk Suh ◽  
Dong Beom Heo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Surgical Time ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

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.

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

2021 ◽  
Author(s):  
Mohammadreza Minator Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
Yaser Safaei ◽  
Behrooz Faramarzi ◽  
Reza Zandi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Soft Tissue Release ◽  
Varus Knee ◽  
Significant Difference ◽  
Leg Alignment ◽  
Total Knee ◽  
Group 2

AbstractThe aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

Bipolar Sealers Do not Improve Blood Loss or Functional Outcomes of Primary Total Knee Arthroplasty

2018 ◽  
Vol 33 (01) ◽  
pp. 062-066
Author(s):  
Stefano Pasqualotto ◽  
Guillaume Demey ◽  
Aude Michelet ◽  
Luca Nover ◽  
Mo Saffarini ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Transfusion Rate ◽  
Significant Difference ◽  
Functional Scores ◽  
Bipolar Sealer ◽  
Total Knee ◽  
Without Tourniquet

AbstractSeveral methods were introduced to limit perioperative blood loss in total knee arthroplasty (TKA). By transcollation of soft tissues below 100°C, bipolar sealers intend to reduce bleeding and tissue damage, compared with conventional electrocautery. Existing studies report contradictory findings about the performance of bipolar sealers. The purpose of this study was to evaluate the effect of a bipolar sealer on blood loss, transfusions, hospital length of stay (LOS), and functional scores in primary TKA. In this single-center prospective study, 101 patients, undergoing primary TKA in a fast-track setting without tourniquet use, were randomly assigned to either (1) the study group which was operated with a bipolar sealer or (2) the control group operated with conventional electrocautery. The study cohort comprised 49 men and 52 women, aged 71.1 ± 8.8 years. There was no significant difference between the bipolar sealer group and the control group in terms of blood loss at day 3 (1,240 ± 547.4 vs. 1,376 ± 584.4 mL; p = ns [not significant]), transfusion rate (10 vs. 4%; p = ns), surgery time (48.2 ± 10.8 vs. 46.6 ± 9.1 minute; p = ns) or LOS (4.1 ± 2.7 vs 4.3 ± 2.0 days; p = ns). At a mean follow-up of 63.3 ± 4.9 days, there was no significant difference between the bipolar sealer group and the control group in terms of net improvement of Knee Society Score (KSS) knee (26.0 ± 16.7 vs. 23.7 ± 12.3; p = ns) and KSS function (20.4 ± 19.3 vs. 20.8 ± 19.9; p = ns). Compared with the use of conventional electrocautery in primary TKA without tourniquet, we found no effect of bipolar sealer use on blood loss, transfusion rates, LOS, or functional recovery. This is a Level II, prospective cohort study.

scholarly journals Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 661 ◽  
Author(s):  
Zekeriya Okan Karaduman ◽  
Ozan Turhal ◽  
Yalçın Turhan ◽  
Zafer Orhan ◽  
Mehmet Arican ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Thermal Camera ◽  
Prosthesis Infection ◽  
Total Knee ◽  
Group 3 ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Background and objectives: Cryotherapy is a method of treatment using cold application. This study aimed to evaluate postoperative clinical and hematological parameters and pain associated with total knee arthroplasty in patients and compared cryotherapy to the conventional method of cold ice pack compressions. Materials and Methods: Between January 2015 and January 2016, 90 patients who underwent total knee arthroplasty for grade 4 gonarthrosis were prospectively evaluated. The patients were divided into three groups (n = 30, each): Group 1, cryotherapy was applied in the pre- and postoperative periods; Group 2, cryotherapy was applied only in the postoperative period; and Group 3 (control group), only a cold pack (gel ice) was applied postoperatively. In all groups, pre- and postoperative evaluations at 6, 24, and 48 h, hemorrhage follow-up, knee circumference measurement, visual analog scale pain score, knee circumference, and temperature measured by thermal camera were recorded. Results: Of the 90 patients, 10% were men and 90% were women. The mean age was 64.3 ± 8.1 (range: 46–83) years. The patella upper end diameter values were significantly lower in the postoperative period in Groups 1 and 2 than in Group 3 (p = 0.003). Hemoglobin levels at 24 and 48 h postoperatively were significantly lower in Group 3 than in Group 1 (p < 0.001, each) and Group 2 (p = 0.038, p < 0.001). At 6, 24, and 48 h follow-ups, pain values were significantly lower in Group 2 than in Group 3 (p < 0.001). Preoperative 6, 24, and 48 h temperature values were significantly lower in Group 1 than in Group 3 (p < 0.001 for each). It was found that the difference between preoperative and postoperative knee flexion measurements was significantly different in both groups or the difference between the groups was changed in each period (p < 0.001). Conclusions: Postoperative cryotherapy is a potentially simple, noninvasive option and beneficial for the reduction of reducing pain, bleeding, length of stay, analgesic requirement and swelling after total knee arthroplasty. Moreover, there was no early or late prosthesis infection in cryotherapy groups, which may be considered as an additional measure to prevent prosthesis infection.

scholarly journals Survival rate after septic total knee arthroplasty- a comparison of two treatment algorithms

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0014
Author(s):  
Clemens Baier ◽  
Günther Maderbacher ◽  
Joachim Grifka ◽  
Hans-Robert Springorum
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Persistent Infection ◽  
Tissue Samples ◽  
Articulating Spacer ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Aims and Objectives: To date there exists no golden standard of treatment of late periprosthetic joint infection. Different forms of treatment comprise single-stage or two-stage or multiple revisions. Respectively, mid- to long-term results are rare. Materials and Methods: We retrospectively analysed 66 patients with septic total knee arthroplasty treated by two different therapy algorithms: Until 2009 patients were treated routinely by implant removal and implantation of an articulating spacer in combination with at least 6 weeks of antibiotic administration. After an antibiotic-free period of two weeks persistent infection was ruled out by punctation. In case of negative antimicrobial cultures after another 14 days patients were treated by reimplantation (n=36, group 1). After 2009 persistent infection was ruled out by open revision and change of the articulating spacer instead of a punctuation. In case of negative antimicrobial cultures after another 14 days patients were treated by reimplantation (n=30, group 2). After a follow-up of 61 months (group 1), respectively 36 months (group 2), patients and their family doctors were contacted by phone concerning the survival rate of the new implant. Results: In group 1 persistent infection was ruled out in every patient by punctuation. During reimplantation tissue samples of 8 patients (22%) showed positive microbiological results again, within 4 patients with a change of the underlying bacteria. After a follow-up of 61 months 31 patients showed no signs of reinfection of their implant and were not operatively revised (86%). In group 2 all patients were treated with open revision and change of the articulating spacer for at least once. 8 patients showed a change of the underlying bacteria during these procedures. During reimplantation tissue samples of 8 patients (27%) showed positive microbiological results again. After a follow-up of 36 months 27 patients showed no signs of reinfection of their implant and were not operatively revised (90%). The difference between both groups was not significant (p>0.05). Concerning the overall complication rate no significant differences between both groups could be found (p>0.05). Conclusion: Concerning reinfection rate we could not detect significant differences between both groups. Patients of group 2 were treated operatively significantly more often and showed a significantly more frequent change of the underlying bacteria. If these results are confirmed in big cohort studies the elaborate treatment algorithm of open revision and change of the articulating spacer might become dispensable.

scholarly journals Use of a Spacer Block Tool for Assessment of Joint Line Position during Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
Harun R. Gungor ◽  
Nusret Ok
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Computer Software ◽  
Revision Total Knee Arthroplasty ◽  
Joint Line ◽  
Contralateral Knee ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

AbstractThere is a tendency of orthopaedic surgeons to elevate joint line (JL) in revision total knee arthroplasty (RTKA). Here, we ascertain the use of the spacer block tool (SBT) to determine JL more accurately for less experienced RTKA surgeons. To perform more precise restoration of JL, an SBT with markers was developed and produced using computer software and three-dimensional printers. The study was planned prospectively to include patients who received either condylar constrained or rotating hinge RTKA between January 2016 and December 2019. To determine JL, distance from fibular head (FH), adductor tubercle (AT), and medial epicondyle (ME) were measured on contralateral knee preoperative radiographs and on operated knee postoperative radiographs. Patients were randomized and grouped according to the technique of JL reconstruction. In Group 1, conventional methods by evaluating aforementioned landmarks and preoperative contralateral knee measurements were used to determine JL, whereas in Group 2, the SBT was used. The main outcome measure was the JL change in revised knee postoperatively in contrast to contralateral knee to compare effective restoration of JL between the groups. Twenty-five patients in Group 1 (3 males, 22 females, 72 years, body mass index [BMI] 32.04 ± 4.45) and 20 patients (7 males, 13 females, 74 years, BMI 30.12 ± 5.02) in Group 2 were included in the study. JL measurements for the whole group were FH-JL = 18.3 ± 3.8 mm, AT-JL = 45.8 ± 4.6 mm, and ME-JL = 27.1 ± 2.8 mm preoperatively, and FH-JL = 20.7 ± 4.2 mm, AT-JL = 43.4 ± 5.2 mm, and ME-JL = 24.7 ± 3.1 mm postoperatively. JL level differences in reference to FH, AT, and ME in Group 1 were 3.6 ± 3.1, 3.6 ± 3.5, and 3.4 ± 3.1 mm, respectively, and in Group 2 were 1.0 ± .0.9, 1.3 ± 1.3, and 1.1 ± 1.3 mm, respectively. There were statistically significant differences between the two groups in JL changes referenced to all of the specific landmarks (p < 0.05). The use of the SBT helped restore JL effectively in our cohort of RTKA patients. Therefore, this tool may become a useful and inexpensive gadget for less experienced and low-volume RTKA surgeons.

scholarly journals Incidence of Suture-Method Catheter Dislocation with Femoral Nerve Block and Femoral Triangle Block after Total Knee Arthroplasty

2021 ◽  
Vol 18 (13) ◽  
pp. 6687
Author(s):  
Bulat Tuyakov ◽  
Mateusz Kruszewski ◽  
Lidia Glinka ◽  
Oksana Klonowska ◽  
Michal Borys ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Opioid Consumption ◽  
Total Knee ◽  
Group 2 ◽  
Femoral Triangle ◽  
Group 1

Catheter dislocation with continuous peripheral nerve blocks represents a major problem in clinical settings. There is a range of factors affecting the incidence of catheter dislocation, including catheter type. This study aimed to assess the incidence of suture-method catheter (SMC) dislocation 24 h after total knee arthroplasty (TKA), with continuous femoral nerve block (CFNB) and continuous femoral triangle block (CFTB), respectively. In the prospective randomized trial, 40 patients qualified for TKA with SMC and were divided into two groups, those who received CFNB (Group 1, n = 20) and those who received CFTB (Group 2, n = 20). After 24 h, the degree of catheter displacement (cm), pain intensity (NRS) and opioid consumption (mg) was assessed. The catheter dislocation rates were found to be 15% in Group 1 versus 5% in Group 2, with the catheter dislocated by 0.83 cm (SD = ±0.87) and 0.43 cm (SD = ±0.67), respectively. There were no differences in NRS score (p = 0.86) or opioid consumption (p = 0.16) between the groups. In each case, a displaced catheter was successfully repositioned by pulling, which clinically resulted in a lower NRS score. The results of the study suggest that CFTB with SMC may be used after TKA with a good effect, as it is associated with low catheter dislocation rates and an adequate analgesic effect.

scholarly journals Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

2020 ◽  
Author(s):  
Uğur Tiftikçi ◽  
Sancar Serbest ◽  
Hacı Bayram Tosun ◽  
Seyyid İsa Keskinkılıç ◽  
Cem Yalın Kılınc ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Bone Resection ◽  
Tibial Bone ◽  
Number Of Patients ◽  
Joint Gap ◽  
Measured Resection ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Abstract PurposeThe aim of this study was to demonstrate that measuring the medial gap before bone resection during total knee arthroplasty (TKA) provides an optimum gap adjustment in varus knees.MethodsPatients were separated into two groups, Group 1 being those whose medial joint gap was measured prior to bone resection and Group 2 comprising those who underwent conventional measured resection technique without measuring. The medial joint gap was measured with a custom-made gap measuring device up to the point that the knee was corrected and aligned along its mechanical axis. Medial joint gap distances, distal medial femoral bone cut thicknesses, amounts of tibial resection calculated, gap internal distances measured after cutting, and the thicknesses of the trial inserts were recorded. A comparison was made between the groups in terms of the number of patients requiring an additional tibial bone cut and the distribution of insert thicknesses.ResultsExtra tibial bone resections performed in two (5.7%) patients in Group 1 and in 10 (28.6%) patients in Group 2. In Group 1, where the medial joint gap was measured, the need for an additional bone resection was statistically less. (p=0.018). In the comparison of distribution of insert size by group, the number of patients on whom an 8 mm insert had been used was significantly greater in Group 1 (p=0.024). ConclusionMeasuring the medial joint gap prior to bone resection in total knee arthroplasty may prevent repeated bone recutting and additional bone resections. Furthermore, we can use this method to avoid the disadvantages of the measured resection technique.

scholarly journals The Effect of Intra- vs. Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes following Total Knee Arthroplasty: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Mohammadreza Razzaghof ◽  
SM Javad Mortazavi ◽  
Alireza Moharrami ◽  
Pouya Tabatabaei Irani ◽  
Abbas Noori
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Definitive Treatment ◽  
Normal Ranges ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Abstract Background: Total knee arthroplasty (TKA) has been known as a definitive treatment of advanced knee osteoarthritis. Both intra- (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique. We aimed to compare their functional outcomes and accuracy in providing neutral alignment after TKA. Methods: In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed functional outcomes at the last follow-up. Finally, we compared these outcomes between groups. Results: Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females; mean age: 63.9±8.6 years; mean follow-up: 27±2.9 months). The mean postoperative alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between groups. However, the mean ROM increase was significantly higher in VAs within ±3° of normal than those outside it (30.8 vs. 27.4, respectively; P=0.039). Conclusions: We conclude that both techniques were not different in terms of the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with IM. A postoperative mechanical axis within ±3° of neutral can result in a more ROM increase after one year. Trial registration: IRCT, IRCT20160809029286N5. Registered 21 April 2020, https://www.irct.ir/trial/46976

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