scholarly journals Knee Flexion and Daily Activities in Patients following Total Knee Replacement: A Comparison with ISO Standard 14243

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Markus A. Wimmer ◽  
William Nechtow ◽  
Thorsten Schwenke ◽  
Kirsten C. Moisio
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Flexion ◽  
Daily Activities ◽  
Wear Testing ◽  
Significant Difference ◽  
Flexion Extension ◽  
Total Knee ◽  
Stair Walking ◽  
The Many

Walking is only one of many daily activities performed by patients following total knee replacement (TKR). The purpose of this study was to examine the hypotheses (a) that subject activity characteristics are correlated with knee flexion range of motion (ROM) and (b) that there is a significant difference between the subject’s flexion/extension excursion throughout the day and the ISO specified input for knee wear testing. In order to characterize activity, the number of walking and stair stepping cycles, the time spent with dynamic and stationary activities, the number of activity sequences, and the knee flexion/extension excursion of 32 TKR subjects were collected during daily activity. Flexion/extension profiles were compared with the ISO 14243 simulator input profile using a level crossing classification algorithm. Subjects took an average of 3102 (range: 343–5857) walking cycles including 65 (range: 0–319) stair stepping cycles. Active and passive ROMs were positively correlated with stair walking time, stair step counts, and stair walking sequences. Simulated knee motion according to ISO showed significantly fewer level crossings at the flexion angles 20–40° and beyond 50° than those measured with the monitor. This suggests that implant wear testing protocols should contain more cycles and a variety of activities requiring higher knee flexion angles with incorporated resting/transition periods to account for the many activity sequences.

Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

2013 ◽  
Vol 135 (2) ◽  
Author(s):  
Lauren A. Ferris ◽  
Linda M. Denney ◽  
Lorin P. Maletsky
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Flexion ◽  
Total Force ◽  
Strong Trend ◽  
Significant Difference ◽  
Within Subjects ◽  
Reaction Forces ◽  
Total Knee ◽  
Flexion And Extension

Functional activities in daily life can require squatting and shifting body weight during transverse plane rotations. Stability of the knee can be challenging for people with a total knee replacement (TKR) due to reduced proprioception, nonconforming articular geometry, muscle strength, and soft tissue weakness. The objective of this study was to identify strategies utilized by individuals with TKR in double-stance transferring load during rotation and flexion. Twenty-three subjects were recruited for this study: 11 TKR subjects (age: 65 ± 6 years; BMI 27.4 ± 4.1) and 12 healthy subjects (age: 63 ± 7; BMI 24.6 ± 3.8). Each subject completed a novel crossover button push task where rotation, flexion, and extension of the knee were utilized. Each subject performed two crossover reaching tasks where the subject used the opposite hand to cross over their body and press a button next to either their shoulder (high) or knee (low), then switched hands and rotated to press the opposite button, either low or high. The two tasks related to the order they pressed the buttons while crossing over, either low-to-high (L2H) or high-to-low (H2L). Force platforms measured ground reaction forces under each foot, which were then converted to lead force ratios (LFRs) based on the total force. Knee flexion angles were also measured. No statistical differences were found in the LFRs during the H2L and L2H tasks for the different groups, although differences in the variation of the loading within subjects were noted. A significant difference was found between healthy and unaffected knee angles and a strong trend between healthy and affected subject's knee angles in both H2L and L2H tasks. Large variations in the LFR at mid-task in the TKR subjects suggested possible difficulties in maintaining positional stability during these tasks. The TKR subjects maintained more of an extended knee, which is a consistent quadriceps avoidance strategy seen by other researchers in different tasks. These outcomes suggest that individuals with a TKR utilize strategies, such as keeping an extended knee, to achieve rotary tasks during knee flexion and extension. Repeated compensatory movements could result in forces that may cause difficulty over time in the hip joints or low back. Early identification of these strategies could improve TKR success and the return to activities of daily living that involve flexion and rotation.

Wear testing of materials and surfaces for total knee replacement

1996 ◽  
Vol 33 (3) ◽  
pp. 159-175 ◽  
Author(s):  
Peter S. Walker ◽  
Gordon W. Blunn ◽  
Peter A. Lilley
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Wear Testing ◽  
Total Knee

scholarly journals Use of Enoxaparin and Dabigatran for Thrombosis Prevention After Total Knee Replacement

2012 ◽  
Vol 19 (2) ◽  
pp. 61-64
Author(s):  
V. Yu Murylev ◽  
Y. A Rukin ◽  
P. M Elizarov ◽  
A. G Zhuchkov ◽  
D. I Terentiev
Keyword(s):  
Total Knee Replacement ◽  
Enoxaparin Sodium ◽  
Knee Replacement ◽  
Vena Cava ◽  
Preventive Measure ◽  
Early Postoperative Period ◽  
Peroral Administration ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Total Knee

Comparative analysis of dabigatran etaxilate and enoxaparin sodium use for prevention of vena cava inferior system thrombosis in patients after total knee replacement in early postoperative period was performed. In 74 patients (1 st group) dabigatran etaxilate and in 127 (2 nd group) enoxaparin sodium was used as a preventive measure. The rate of thrombosis made up 1.35% and 2.4% in the first and second groups, respectively. No significant difference in the volume of perioperative blood loss between the groups was noted. No other hemorrhagic complications were observed. It was shown that in more convenient peroral administration the dabigatran etaxilate efficacy and safety was comparable to enoxaparin sodium.

Does a mobile-bearing, high-flexion design increase knee flexion after total knee replacement?

2012 ◽  
Vol 94-B (8) ◽  
pp. 1051-1057 ◽  
Author(s):  
R. W. Nutton ◽  
F. A. Wade ◽  
F. J. Coutts ◽  
M. L. van der Linden
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Flexion ◽  
Mobile Bearing ◽  
High Flexion ◽  
Total Knee

scholarly journals The effect of musical interventions in improving short-term pain outcomes following total knee replacement: a meta-analysis and systematic review

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rongguo Yu ◽  
Youguang Zhuo ◽  
Eryou Feng ◽  
Wulian Wang ◽  
Wentao Lin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Continuous Passive Motion ◽  
Cochrane Library ◽  
Short Term ◽  
Significant Difference ◽  
Pain Outcomes ◽  
Total Knee

Abstract Background A growing number of patients continue to receive total knee replacement (TKR) surgery. Nevertheless, such surgeries result in moderate to severe postoperative pain and difficulty in managing it. Musical interventions are regarded as a type of multimodal analgesia, achieving beneficial results in other clinical treatments. This study aims to evaluate the effect of musical interventions in improving short-term pain outcomes following TKR in order to determine a more reasonable and standard way of delivering musical intervention. Methods A systematic search was conducted to identify available and relevant randomized controlled trials (RCTs) regarding musical interventions compared against non-musical interventions in patients treated with TKR in Embase, MEDLINE, Cochrane Library, Web of Science, CNKI, and Wanfang Med Online up to 8 January 2020. The authors independently assessed study eligibility and risk of bias and collected the outcomes of interest to analyze. The statistical analysis was conducted using the Review Manager (RevMan) version 5.30 software. Results Eight RCTs comprised of 555 patients satisfied the inclusion criteria and were enrolled in the present study. The results showed no significant difference between the music and control groups in pain of the visual analog scale (VAS), during postoperative recovery room, back to the ward after surgery; anxiety degree of VAS; heart rate; respiratory rate; oxygen saturation; blood pressure, systolic blood pressure, and diastolic blood pressure. Nevertheless, significant differences were observed between the two groups in average increase in continuous passive motion (CPM) angles and LF/HF ratio (one kind index of heart rate variability). Conclusions Musical interventions fail to demonstrate an obvious effect in improving short-term pain outcomes following TKR. A reasonable standardization of musical interventions, including musical type, outcome measures used, outcomes measured, duration, timing and headphones or players, may improve pain outcomes with certain advantages and should be further explored after TKR.

scholarly journals Platypnoea–orthodeoxia after left total knee replacement

2019 ◽  
Vol 12 (10) ◽  
pp. e230771
Author(s):  
Taha Almufti ◽  
Franz Eversheim ◽  
Brett Johnson ◽  
Gabriel Ayonmigbesimi Akra
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Unusual Case ◽  
Medical Intervention ◽  
Colour Doppler ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Significant Difference ◽  
Severe Hypoxaemia ◽  
Total Knee

Platypnoea–orthodeoxia syndrome (POS) is a rare disorder characterised by both dyspnoea (platypnoea) and arterial desaturation (orthodeoxia) in the upright position, with improvement in the supine position. We report an unusual case in which an 82-year-old woman developed severe hypoxaemia with POS after left total knee replacement. A significant difference in alveolar–arterial blood gas oxygen tension was demonstrated, and hypoxaemia failed to respond to 100% oxygen supply. A patent foramen ovale with a right-to-left shunt was evident on transoesophageal echocardiogram employing colour Doppler and agitated normal saline studies. Interestingly, the patient’s symptoms resolved within 6 months with ongoing chest physiotherapy, without surgical or medical intervention.

Preoperative Low Back Pain Affects Recovery in Knee Flexion Range of Motion Following Total Knee Replacement

2016 ◽  
Vol 28 (1-2) ◽  
pp. 47-55
Author(s):  
Hannah M. Ashworth ◽  
Christian N. Warner ◽  
Saurabh P Mehta ◽  
Franklin D. Shuler ◽  
Ali Oliashirazi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Total Knee Replacement ◽  
Range Of Motion ◽  
Knee Replacement ◽  
Knee Flexion ◽  
Low Back ◽  
Total Knee

A Performance Test to Assess Strategies to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

2012 ◽  
Author(s):  
Lauren Ferris ◽  
Linda Denney ◽  
Lorin Maletsky
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Performance Test ◽  
Knee Stability ◽  
Vertical Projection ◽  
Single Plane ◽  
Flexion Extension ◽  
Weight Shift ◽  
Total Knee ◽  
Supporting Base

Stability has been defined as the ability to transfer the vertical projection of the center of gravity to the supporting base and keep the knee as still as possible1. The transfer of weight (load) to a single limb while still in double-stance is functional and simulates every day activities such as loading the dishwasher, transferring laundry, or reaching to pick up an item. Adding rotation in a transverse plane to this weight shift challenges knee stability, especially those with a total knee replacement (TKR). A clinical sign of laxity in mid-flexion indicates a risk for developing symptomatic instability; a common reason for TKR revision2. Laxity is usually measured clinically in a single plane (anterior-posterior) and functionally with added turning maneuvers. Single-leg weight acceptance has been analyzed during athletic activities such as hopping, landing with cutting as well as in the older population with stair ascent and descent3–5. Although single-leg performance tests are a good indicator of knee stability, weight shift during double-stance may be more functional for individuals with a TKR. A functional double-stance test should include both flexion/extension with rotation and loading. Our study utilizes a novel approach (Target Touch Task) in order to facilitate transfer of load to one extremity during squatting or extending while still in double-stance. The objective of this study was to identify strategies utilized by individuals with a TKR while in double-stance transferring load during rotational activities.

Evaluation of the relationship of tibiofemoral kinematics before and after total knee replacement in an in vitro model of cranial cruciate deficiency in the dog

2016 ◽  
Vol 29 (06) ◽  
pp. 484-490 ◽  
Author(s):  
Rebecca Howie ◽  
Timothy Foutz ◽  
Curtis Cathcart ◽  
Jeff Burmeister ◽  
Steve Budsberg
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee ◽  
Tibiofemoral Kinematics ◽  
The Relationship

SummaryObjective: To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro.Animals: Eight canine hemipelves.Methods: A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage. Joint angles and translations of the femur relative to the tibia, including flexion-extension versus adduction-abduction, flexion-extension versus internal-external rotation, as well as flexion-extension versus each translation (cranial-caudal and lateral-medial) were calculated.Results: Significant differences were identified in kinematic data from limbs following TKR implantation as compared to the unaltered stifle. The TKR resulted in significant decreases in external rotation of the stifle during flexion-extension compared to the limb prior to any intervention, as well as increasing the abduction. The TKR significantly increased the caudal translation of the femur relative to the tibia compared to the unaltered limb. When compared with the cranial cruciate ligament-transection stage, TKR significantly decreased the ratio of the external rotation to flexion.Discussion: All three test periods showed significant differences from the unaltered stifle. The TKR did not completely restore the normal kinematics of the stifle.

scholarly journals Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery

2020 ◽  
Author(s):  
Ahmad H Alghadir ◽  
Zaheen A Iqbal ◽  
Shahnawaz Anwer ◽  
Dilshad Anwar
Keyword(s):  
Total Knee Replacement ◽  
Knee Osteoarthritis ◽  
Pain Intensity ◽  
Knee Replacement ◽  
Functional Capacity ◽  
Recovery Of Function ◽  
Significant Difference ◽  
Reduction Of Pain ◽  
Total Knee ◽  
Bilateral Total Knee Replacement

Abstract Background Total knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function. Methods A total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5-7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 post-operatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data. Results Both groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p<0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p<0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p>0.05). Conclusion Simultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.

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