The contribution of parecoxib to postoperative function recovery after total knee arthroplasty

2006 ◽  
Vol 23 (Supplement 37) ◽  
pp. 241
Author(s):  
A. Menten ◽  
M. Claeys ◽  
F. Camu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Function ◽  
Function Recovery ◽  
Total Knee

scholarly journals Design and Cadaveric Validation of a Novel Device to Quantify Knee Stability During Total Knee Arthroplasty

2012 ◽  
Vol 134 (11) ◽  
Author(s):  
Robert A. Siston ◽  
Thomas L. Maack ◽  
Erin E. Hutter ◽  
Matthew D. Beal ◽  
Ajit M. W. Chaudhari
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Load Cell ◽  
Knee Stability ◽  
Joint Stability ◽  
Postoperative Function ◽  
New Device ◽  
Total Knee

The success of total knee arthroplasty depends, in part, on the ability of the surgeon to properly manage the soft tissues surrounding the joint, but an objective definition as to what constitutes acceptable postoperative joint stability does not exist. Such a definition may not exist due to lack of suitable instrumentation, as joint stability is currently assessed by visual inspection while the surgeon manipulates the joint. Having the ability to accurately and precisely measure knee stability at the time of surgery represents a key requirement in the process of objectively defining acceptable joint stability. Therefore, we created a novel sterilizable device to allow surgeons to measure varus-valgus, internal-external, or anterior-posterior stability of the knee during a total knee arthroplasty. The device can be quickly adjusted between 0 deg and 90 deg of knee flexion. The device interfaces with a custom surgical navigation system, which records the resultant rotations or translations of the knee while the surgeon applies known loads to a patient’s limb with a handle instrumented with a load cell. We validated the performance of the device by having volunteers use it to apply loads to a mechanical linkage that simulated a knee joint; we then compared the joint moments calculated by our stability device against those recorded by a load cell in the simulated knee joint. Validation of the device showed low mean errors (less than 0.21 ± 1.38 Nm and 0.98 ± 3.93 N) and low RMS errors (less than 1.5 Nm and 5 N). Preliminary studies from total knee arthroplasties performed on ten cadaveric specimens also demonstrate the utility of our new device. Eventually, the use of this device may help determine how intra-operative knee stability relates to postoperative function and could lead to an objective definition of knee stability and more efficacious surgical techniques.

scholarly journals Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty: a meta-analysis and systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiahao Li ◽  
Zijian Yan ◽  
Yan Lv ◽  
Yijin Li ◽  
Pengcheng Ye ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Collateral Ligament ◽  
Postoperative Function ◽  
Significant Difference ◽  
Total Knee ◽  
The Impact

Abstract Background As an uncommon but severe complication, medial collateral ligament (MCL) injury in total knee arthroplasty (TKA) may be significantly under-recognized. We aimed to determine whether MCL injury influences postoperative outcomes of patients undergoing TKA. Methods Two independent reviewers searched PubMed, Cochrane Library, and EMBASE from their inception to July 1, 2021. The main outcomes were postoperative function, and secondary outcomes included the incidences of revision and complications. Results A total of 403 articles yielded 15 studies eligible for inclusion with 10 studies used for meta-analysis. This study found that there was a statistically significant difference in postoperative functional scores, range of motion (ROM), complications, and revision rates, with adverse outcomes occurring more commonly in patients with MCL injury. Conclusions This meta-analysis highlights the complexity of MCL injury during TKA and shows the impact on postoperative function, joint mobility, complications, and revision. Surgeons need to prevent and put more emphasis on MCL injury during TKA.

Discontinuation of the liposomal delivery of bupivacaine has no effect on pain management after primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 102-107
Author(s):  
James E. Feng ◽  
Chibuokem P. Ikwuazom ◽  
Siddharth A. Mahure ◽  
Daniel P. Waren ◽  
James D. Slover ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Function ◽  
Periarticular Injection ◽  
Pain Scores ◽  
Management Protocol ◽  
Significant Difference ◽  
Opioid Administration ◽  
Injection Protocol ◽  
Total Knee

Aims Liposomal bupivacaine (LB) as part of a periarticular injection protocol continues to be a highly debated topic in total knee arthroplasty (TKA). We evaluated the effect of discontinuing the use of LB in a periarticular protocol on immediate postoperative pain scores, opioid consumption, and objective functional outcomes. Methods On 1 July 2019, we discontinued the use of intraoperative LB as part of a periarticular injection protocol. A consecutive group of patients who received LB as part of the protocol (Protocol 1) and a subsequent group who did not (Protocol 2) were compared. All patients received the same opioid-sparing protocol. Verbal rating scale (VRS) pain scores were collected from our electronic data warehouse and averaged per patient per 12-hour interval. Events relating to the opiate administration were derived as morphine milligram equivalences (MMEs) per patient per 24-hour interval. The Activity Measure for Post-Acute Care (AM-PAC) tool was used to assess the immediate postoperative function. Results A total of 888 patients received Protocol 1 and while 789 received Protocol 2. The mean age of the patients was significantly higher in those who did not receive LB (66.80 vs 65.57 years, p = 0.006). The sex, BMI, American Society of Anesthesiologists physical status score, race, smoking status, marital status, operating time, length of stay, and discharge disposition were similar in the two groups. Compared with the LB group, discontinuing LB showed no significant difference in postoperative VRS pain scores up to 72 hours (p > 0.05), opioid administration up to 96 hours (p > 0.05), or AM-PAC scores within the first 24 hours (p > 0.05). Conclusion The control of pain after TKA with a multimodal management protocol is not improved by the addition of LB compared with traditional bupivacaine. Cite this article: Bone Joint J 2021;103-B(6 Supple A):102–107.

Total Knee Arthroplasty

2019 ◽  
pp. 68-82
Author(s):  
Rishi Chokshi ◽  
Nabil Elkassabany
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Anesthetic Management ◽  
Postoperative Function ◽  
Key Concepts ◽  
Perioperative Pain Management ◽  
Total Knee ◽  
Case Based

This chapter reviews key concepts regarding acute pain management in patients undergoing total knee arthroplasty (TKA). Patients presenting to TKA often have multiple relevant comorbidities that may complicate perioperative pain management. Furthermore, the pain resulting from this procedure is particularly challenging to address with otherwise common systemic analgesics, necessitating more advanced interventions that consider both pain intensity alongside patient function and rehabilitation. Many intraoperative anesthetic management decisions carry important implications for both early and longer-term postoperative function and pain management in this patient population. This chapter will provide a broad, case-based, evidence-supported review of modern approaches to enhanced recovery after surgery (ERAS) principles for patients presenting for total knee arthroplasty.

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