scholarly journals Perioperative Nerve Injury after Total Knee Arthroplasty

2011 ◽  
Vol 114 (2) ◽  
pp. 311-317 ◽  
Author(s):  
Adam K. Jacob ◽  
Carlos B. Mantilla ◽  
Hans P. Sviggum ◽  
Darrell R. Schroeder ◽  
Mark W. Pagnano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Knee Arthroplasty ◽  
Outcome Variable ◽  
Tourniquet Time ◽  
Nerve Blockade ◽  
Neurologic Recovery ◽  
Peripheral Nerve Blockade ◽  
Total Knee

Background Perioperative nerve injury (PNI) is one of the most debilitating complications after total knee arthroplasty (TKA). Although regional anesthesia (RA) techniques reduce pain and improve functional outcomes after TKA, they may also contribute to PNI. The objective of this study was to test the hypothesis that PNI risk differs among patients according to RA use during TKA. Methods All patients aged at least 18 yr who underwent elective TKA from January 1988 to July 2007 were retrospectively identified. The primary outcome variable was the presence of a new PNI documented within 3 months of the procedural date. Age, sex, body mass index, type of procedure, tourniquet time, type of anesthesia, and use of peripheral nerve blockade were evaluated as potential risk factors for PNI using multivariable logistic regression. Results Ninety-seven cases of PNI were identified among 12,329 patients. Overall incidence of PNI was 0.79% (95% CI, 0.64-0.96%). PNI was not associated with peripheral nerve blockade (odds ratio [OR], 0.97) or type of anesthesia (OR, 1.10 [neuraxial vs. general]; OR, 1.82 [combined vs. general]). Risk for PNI decreased with age (OR, 0.68 [per decade]; P < 0.001) but increased with tourniquet time (OR, 1.28 [per 30-min increase]; P = 0.003) and bilateral procedures (OR, 2.51; P < 0.001). Patients with PNI who underwent peripheral nerve blockade were less likely to have complete neurologic recovery (OR, 0.37; P = 0.03). Conclusions Risk for PNI after TKA was unchanged by the use of RA techniques. This finding supports the notion that the known benefits of RA for patients undergoing TKA can be achieved without increasing risk of neurologic injury. However, in rare situations when PNI occurs, complete recovery may be less likely if it develops after peripheral nerve blockade.

Contemporary Perioperative Analgesia in Total Knee Arthroplasty: Multimodal Protocols, Regional Anesthesia, and Peripheral Nerve Blockade

2018 ◽  
Vol 31 (07) ◽  
pp. 600-604 ◽  
Author(s):  
Jonathan Neilio ◽  
Lisa Kunze ◽  
Jacob Drew
Keyword(s):  
Total Knee Arthroplasty ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Knee Arthroplasty ◽  
Critical Evaluation ◽  
Nerve Blockade ◽  
Considerable Uncertainty ◽  
Perioperative Analgesia ◽  
Peripheral Nerve Blockade ◽  
Total Knee

AbstractPerioperative care of the total knee arthroplasty (TKA) patient has evolved considerably over the past decade. Among the changes driving this evolution toward shorter hospitalization and accelerated rehabilitation have been regional anesthesia, peripheral nerve blockade, and multimodal analgesia protocols. These complementary techniques are increasingly supported by scientific evidence, though considerable uncertainty persists regarding the optimal combination of strategies. Continued refinement of technique and critical evaluation is trending toward greater characterization of the comparative effectiveness of myriad options. Contemporary interdisciplinary arthroplasty care teams have the opportunity to individualize the TKA patient's perioperative pain control to optimize not only the clinical outcome but also patient satisfaction.

scholarly journals Perioperative Nerve Injury after Total Hip Arthroplasty

2011 ◽  
Vol 115 (6) ◽  
pp. 1172-1178 ◽  
Author(s):  
Adam K. Jacob ◽  
Carlos B. Mantilla ◽  
Hans P. Sviggum ◽  
Darrell R. Schroeder ◽  
Mark W. Pagnano ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Hip Arthroplasty ◽  
Female Gender ◽  
Nerve Blockade ◽  
Neurologic Recovery ◽  
Total Hip ◽  
Peripheral Nerve Blockade ◽  
Clinical Benefits

Background Perioperative nerve injury (PNI) is a recognized complication of total hip arthroplasty (THA). Regional anesthesia (RA) techniques may increase the risk of neurologic injury. Using a retrospective cohort study, the authors tested the hypothesis that use of RA increases the risk for PNI after elective THA. Methods All adult patients who underwent elective THA at Mayo Clinic during a 20-yr period were included. The primary outcome was the presence of a new PNI within 3 months of surgery. Multivariable logistic regression was used to evaluate patient, surgical, and anesthetic risk factors for PNI. Results Of 12,998 patients undergoing THA, 93 experienced PNI (incidence = 0.72%; 95% CI 0.58-0.88%). PNI was not associated with type of anesthesia (OR = 0.72 for neuraxial-combined vs. general; 95% CI 0.46-1.14) or peripheral nerve blockade (OR = 0.65; 95% CI 0.34-1.21). The risk for PNI was associated with younger age (OR = 0.79 per 10-yr increase; 95% CI 0.69-0.90), female gender (OR = 1.72; 95% CI 1.12-2.64), longer operations (OR = 1.10 per 30-min increase; 95% CI 1.03-1.18) or posterior surgical approach (OR = 1.91 vs. anterior approach; 95% CI 1.22-2.99). Neurologic recovery was not influenced by the use of RA techniques in patients with PNI. Conclusions The risk for PNI after THA was not increased with the use of neuraxial anesthesia or peripheral nerve blockade. Neurologic recovery in patients who experienced PNI was not affected by the use of RA. These results support the use of RA techniques in patients undergoing elective THA given their known functional and clinical benefits.

Peripheral Nerve Injury in Total Knee Arthroplasty

2021 ◽  
pp. 297-323
Author(s):  
Benjamin A. McArthur ◽  
Steven L. Henry ◽  
Alexander Rothy ◽  
Laura E. Bashour
Keyword(s):  
Total Knee Arthroplasty ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Knee Arthroplasty ◽  
Peripheral Nerve Injury ◽  
Total Knee

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 Slight femoral under-correction versus neutral alignment in total knee arthroplasty with preoperative varus knees: a comparative study

Arthroplasty ◽  
2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Kai Lei ◽  
Li-Ming Liu ◽  
Peng-Fei Yang ◽  
Ran Xiong ◽  
De-Jie Fu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Tourniquet Time ◽  
Patient Reported ◽  
Total Knee ◽  
Neutral Alignment

Abstract Background This study aimed to compare the short-term clinical results of slight femoral under-correction with neutral alignment in patients with preoperative varus knees who underwent total knee arthroplasty. Methods The medical records and imaging data were retrospectively collected from patients who had undergone total knee arthroplasty in our hospital from January 2016 to June 2019. All patients had varus knees preoperatively. Upon 1:1 propensity score matching, 256 patients (256 knees) were chosen and divided into a neutral alignment group (n=128) and an under-correction group (n=128). The patients in the neutral group were treated with the neutral alignment. In the under-correction group, the femoral mechanical axis had a 2° under-correction. The operative time, tourniquet time and the length of hospital stay in the two groups were recorded. The postoperative hip-knee-ankle angle, frontal femoral component angle and frontal tibial component angle were measured. Patient-reported outcome measures were also compared. Results The operative time, tourniquet time and the length of hospital stay in the under-correction group were significantly shorter than the neutral alignment group (P<0.05). At the 2-year follow-up, the under-correction group had a larger varus alignment (P<0.05) and a larger frontal femoral component angle (P<0.05), and the frontal tibial component angles of the two groups were comparable. Compared with the neutral alignment group, the slight femoral under-correction group had significantly better patient-reported outcome measures scores (P<0.05). Conclusion For varus knees treated with total knee arthroplasty, alignment with a slight femoral under-correction has advantages over the neutral alignment in terms of the shorter operative time and better short-term clinical results. Level of evidence III

scholarly journals Comparison of Alignment and Prosthesis Positioning Accuracy Between Robotics and Personalized 3D Preoperative Planning in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Kai Lei ◽  
LiMing Liu ◽  
PengFei Yang ◽  
Ran Xiong ◽  
Liu Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Preoperative Planning ◽  
Operation Time ◽  
Consecutive Series ◽  
Clinical Trial Registry ◽  
Tourniquet Time ◽  
Positioning Accuracy ◽  
Total Knee

Abstract Purpose: Lower limb alignment is crucial in total knee arthroplasty (TKA). Previous studies have shown that robotics and personalized three-dimensional (3D) preoperative planning could improve postoperative alignment accuracy compared with conventional TKA, but comparison between the above two techniques has never been reported. The purpose of this study was to compare the alignment and prosthesis positioning accuracy between robotics and personalized 3D preoperative planning in TKA.Methods: A consecutive series of patients who received TKA in our Center from September 2020 to January 2021 were enrolled. After 1:2 matching, 52 and 104 patients were eventually included in robotics group and personalized 3D preoperative planning group, respectively. Multiple postoperative alignment variables, operation time, tourniquet time, length of hospital stay, hemoglobin (Hb) decrease at 1 and 3 days after operation were recorded and compared.Results: Compared with personalized 3D preoperative planning, robotics had significantly lower frontal tibial component (FTC) angle absolute deviation (P<0.001) and less FTC outliers (P<0.05). The postoperative hip-knee-ankle (HKA) angle and frontal femoral component (FFC) angle were different between two groups, while the absolute deviations were similar. Hb decreases of robotics were significantly lower than those of personalized 3D preoperative planning (P<0.001), while the operation time and tourniquet time were longer (P<0.001).Conclusion: Compared with personalized 3D preoperative planning, robotics has more accurate tibial component coronal alignment and less postoperative Hb decrease, while the operation time is significantly longer.Trial registration: The Chinese Clinical Trial Registry, ChiCTR2000036235. Registered 22 August 2020, http://www.chictr.org.cn/showproj.aspx?proj=59300

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