Quadriceps muscle group function and after total knee arthroplasty—asystematic narrative update

2021 ◽  
Author(s):  
Ilaria Morelli ◽  
Nicola Maffulli ◽  
Lorenzo Brambilla ◽  
Marco Agnoletto ◽  
Giuseppe Maria Peretti ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Balance Training ◽  
Cost Effective ◽  
Quadriceps Muscle ◽  
Muscle Group ◽  
Group Function ◽  
Total Knee ◽  
High Level ◽  
Meta Analyses

Abstract Background This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies). Sources of data Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected. Areas of agreement Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals. Areas of disagreement Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants. Growing points and areas timely for developing research Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients’ optimization protocols before TKA should include standardized nutraceuticals intake.

scholarly journals MAFbx, MuRF1, and the stress-activated protein kinases are upregulated in muscle cells during total knee arthroplasty

2012 ◽  
Vol 303 (4) ◽  
pp. R376-R386 ◽  
Author(s):  
Ashley N. Bailey ◽  
Austin D. Hocker ◽  
Benjamin R. Vermillion ◽  
Keith Smolkowski ◽  
Steven N. Shah ◽  
...  
Keyword(s):  
Older Adults ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Muscle Protein ◽  
Vastus Lateralis ◽  
Cost Effective ◽  
Mrna Levels ◽  
Tourniquet Time ◽  
Total Knee ◽  
Expanding Population

Total knee arthroplasty (TKA) is the most common and a cost-effective surgical remediation for older adults with long-standing osteoarthritis. In parallel with the expanding population of older adults, the number of TKAs performed annually is projected to be 3.48 million by 2030. During this surgery, a tourniquet is used to stop blood flow to the operative leg. However, the molecular pathways that are affected by tourniquet use during TKA continue to be elucidated. We hypothesized that components of the catabolic FoxO3a (i.e., MuRF1, MAFbx, and Bnip3) pathway, as well as the cellular stress pathways [i.e., stress-activated protein kinase (SAPK)/JNK and MAPKs], are upregulated during TKA. The purpose of this study was to measure changes in transcripts and proteins involved in muscle cell catabolic and stress-activated pathways. We obtained muscle biopsies from subjects, 70 ± 1.3 yr, during TKA, from the vastus lateralis at baseline (before tourniquet inflation), during maximal ischemia (just before tourniquet release), and during reperfusion. Total tourniquet time was 43 ± 2 min and reperfusion time was 16 ± 1. Significant increases in FoxO3a downstream targets, MAFbx and MuRF1, were present for mRNA levels during ischemia (MAFbx, P = 0.04; MuRF1, P = 0.04), and protein expression during ischemia (MAFbx, P = 0.002; MuRF1, P = 0.001) and reperfusion (MuRF1, P = 0.002). Additionally, stress-activated JNK gene expression ( P = 0.01) and protein were elevated during ischemia ( P = 0.001). The results of this study support our hypothesis that protein degradation pathways are stimulated during TKA. Muscle protein catabolism is likely to play a role in the rapid loss of muscle volume measured within 2 wk of this surgery.

scholarly journals High Level of Residual Symptoms in Young Patients After Total Knee Arthroplasty

2013 ◽  
Vol 472 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Javad Parvizi ◽  
Ryan M. Nunley ◽  
Keith R. Berend ◽  
Adolph V. Lombardi ◽  
Erin L. Ruh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Young Patients ◽  
Residual Symptoms ◽  
Total Knee ◽  
High Level

scholarly journals Should the patella be everted during primary total knee arthroplasty? A systematic review of overlapping meta-analyses

2019 ◽  
Vol 27 (1) ◽  
pp. 230949901982855
Author(s):  
Alberto Grassi ◽  
Riccardo Compagnoni ◽  
Paolo Ferrua ◽  
Stefano Pasqualotto ◽  
Carlo Zaolino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Total Knee ◽  
Meta Analyses ◽  
Primary Total Knee

scholarly journals Outpatient total knee arthroplasty: is it worth considering?

2020 ◽  
Vol 5 (3) ◽  
pp. 172-179
Author(s):  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Discharge Planning ◽  
Young Patients ◽  
Cost Effective ◽  
Medical Outcomes ◽  
Vein Thrombosis ◽  
Cost Effective Treatment ◽  
Total Knee ◽  
Deep Vein

Some authors have reported that outpatient total knee arthroplasty (TKA) is a successful, safe and cost-effective treatment in the management of advanced osteoarthritis. The success obtained has been attributed to the coordination of the multidisciplinary team, standardized perioperative protocols, optimal hospital discharge planning and careful selection of patients. One study has demonstrated a higher risk of perioperative surgical and medical outcomes in outpatient TKA than inpatient TKA, including component failure, surgical site infection, knee stiffness and deep vein thrombosis. There remains a lack of universal criteria for patient selection. Outpatient TKA has thus far been performed in relatively young patients with few comorbidities. It is not yet clear whether outpatient TKA is worth considering, except in very exceptional cases (young patients without associated comorbidities). Outpatient TKA should not be generally recommended at the present time. Cite this article: EFORT Open Rev 2020;5:172-179. DOI: 10.1302/2058-5241.5.180101

Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Yasutaka Kondo ◽  
Yoshihiro Yoshida ◽  
Takashi Iioka ◽  
Hideki Kataoka ◽  
Junya Sakamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Visual Feedback ◽  
Knee Arthroplasty ◽  
Acute Pain ◽  
Intervention Group ◽  
Quadriceps Muscle ◽  
Control Group ◽  
Muscle Exercise ◽  
Short Term ◽  
Total Knee

AbstractSevere acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.

scholarly journals The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Jianda Xu ◽  
Huan Li ◽  
Chong Zheng ◽  
Bin Wang ◽  
Pengfei Shen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Physiological Mechanism ◽  
Cost Effective ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Total Knee ◽  
End Stage

Abstract Total knee arthroplasty (TKA) is considered a cost-effective and efficacious treatment for patients with end-stage knee arthritis. Meanwhile, TKA has been regarded as one of the most painful orthopaedic surgeries. Pain control after TKA remains a challenging task. Many analgesic innovations are used to reduce the level of pain, but none has been proven to be the optimum choice till now. Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. This approach is a preferable choice in relieving postoperative pain with minimum side effects. This paper aims to review pre-emptive analgesia for pain management in TKA. We reviewed the application of pre-emptive analgesia, its physiological mechanism, and the techniques.

scholarly journals Comparative study between continuous adductor canal block and intravenous morphine for postoperative analgesia in total knee arthroplasty

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Hithem Mohammed Gamil Mohammed Ali ◽  
Bassel Mohammed Essam Nour Eldin ◽  
Heba Abd Elazim Labib Ahmed ◽  
Ramy Mounir Wahba Gobran ◽  
Diaa Eldin Mahmoud Heiba
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Quadriceps Muscle ◽  
Saphenous Nerve ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Intravenous Morphine ◽  
Group A ◽  
Total Knee

Abstract Background Postoperative pain after total knee arthroplasty (TKA) is known to range from moderate (30% of patients) to severe (60% of patients). Inadequate management for postoperative pain may induce various immobility-related complications, muscle weakness, and chronic pain. Therefore, post-TKA analgesia is crucial, not only for patients’ satisfaction, but for improving surgical outcomes and reducing complications. The present study aims to compare the effect of ultrasound-guided adductor canal block ACB (saphenous nerve block) versus incremental dose of intravenous morphine after total knee arthroplasty surgery. Results The results of this study revealed no difference between group A and group B as regards postoperative quadriceps muscle strength; maximal knee flexion, total distance ambulated, and postoperative vital data (heart rate per minute and respiratory rate per minute). However, group A showed better postoperative pain control, lower doses of intravenous morphine consumption and lower incidence of nausea and vomiting. Conclusion Continuous adductor canal block (saphenous nerve block) is superior to intravenous morphine in decreasing postoperative pain and decreasing total morphine consumption and adverse effects as nausea and vomiting, but both are equivalent in preserving quadriceps muscle power.

Aseptic Loosening of Porous Metaphyseal Sleeves and Tantalum Cones in Revision Total Knee Arthroplasty: A Systematic Review

2020 ◽  
Author(s):  
Ryan P. Roach ◽  
Andrew J. Clair ◽  
Omar A. Behery ◽  
Savyasachi C. Thakkar ◽  
Richard Iorio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Search Terms ◽  
Mesh Terms ◽  
Total Knee ◽  
Meta Analyses ◽  
Revision Tkas

AbstractBone loss often complicates revision total knee arthroplasty (TKA). Management of metaphyseal defects varies, with no clearly superior technique. Two commonly utilized options for metaphyseal defect management include porous-coated metaphyseal sleeves and tantalum cones. A systematic review was conducted according to the international Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We combined search terms “Total knee arthroplasty” AND/OR “Sleeve,” “Cone” as either keywords or medical subject heading (MeSH) terms in multiple databases according to PRISMA recommendations. All retrieved articles were reviewed and assessed using defined inclusion and exclusion criteria. A total of 27 studies (12 sleeves and 15 cones) of revision TKAs were included. In the 12 studies on sleeve implantation in revision TKAs, 1,617 sleeves were implanted in 1,133 revision TKAs in 1,025 patients. The overall rate of reoperation was 110/1,133 (9.7%) and the total rate of aseptic loosening per sleeve was 13/1,617 (0.8%). In the 15 studies on tantalum cone implantation in revision TKAs, 701 cones were implanted into 620 revision TKAs in 612 patients. The overall rate of reoperation was 116/620 (18.7%), and the overall rate of aseptic loosening per cone was 12/701 (1.7%). Rates of aseptic loosening of the two implants were found to be similar, while the rate of reoperation was nearly double in revision TKAs utilizing tantalum cones. Variability in the selected studies and the likely multifactorial nature of failure do not allow for any definitive conclusions to be made. This review elucidates the necessity for additional literature examining revision TKA implants.

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