scholarly journals Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Maolin Sun ◽  
Ying Zhang ◽  
Yang Peng ◽  
Dejie Fu ◽  
Huaquan Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Swing Phase ◽  
Flexion Angle ◽  
Gait Parameters ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B

Background. With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods. Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results. The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P<0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P<0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion. 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

scholarly journals Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Sanjay Bhalchandra Londhe ◽  
Ravi Vinod Shah ◽  
Amit Pankaj Doshi ◽  
Shubhankar Sanjay Londhe ◽  
Kavita Subhedar ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Forgotten Joint Score ◽  
Group A ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Group B ◽  
Discharge From Hospital

Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.

scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals ROLE OF PREGABALIN IN POSTOPERATIVE PAIN MANAGEMENT IN PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY

2020 ◽  
pp. 1-4
Author(s):  
Shibila Shirin K. C ◽  
Balu C Babu ◽  
Anila K N ◽  
Jayasree P M ◽  
Premila Hari Mohan
Keyword(s):  
Total Knee Arthroplasty ◽  
Neuropathic Pain ◽  
Knee Arthroplasty ◽  
Postoperative Pain Management ◽  
Treated Group ◽  
Satisfaction Level ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B

Acute pain is the most common complication after total knee arthroplasty(TKA) causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Generally opioids and NSAIDs are used but the adverse effects limit their use. So a non-opioid agent like pregabalin is often recommended. Pregabalin can significantly improve pain scores, physical functions, satisfaction and reducing chronic neuropathic pain and the requirement of other analgesics in patient undergoing TKA. Patients received either standard analgesics as per the existing hospital policy (group A) or pregabalin added to the standard analgesics(group B). Pregabalin(75mg) was given as one capsule, the last night before the surgery and continued one capsule twice a day until end of postoperative day (POD)14 and one capsule at bedtime POD15, POD16. The group B showed significant reduction in pain score after 2 weeks of the surgery. It was 3.20±1.03 in group A and 2.48±0.77 in group B. The mean comparison of satisfaction level in group A and group B was found to be 7.80±0.96 and 9.52±1.04 respectively. The mean comparison of incidence of neuropathic pain in group A and group B was found to be 6.70±4.01 and 4.24±4.14 respectively. Our study concluded that pregabalin is effective in reducing pain after 2 weeks post TKA, and incidence of neuropathic pain. Increased patient satisfaction level and the quality of life of patients were observed in pregabalin treated group.

Comparison the Postoperative Blood Loss in Total Knee Arthroplasty with and without Perioperative Tourniquet Release

2021 ◽  
Vol 15 (5) ◽  
pp. 1142-1143
Author(s):  
S. Aziz ◽  
S. Ahmed ◽  
S. A. Mahar ◽  
S. Ali ◽  
J. Kumar
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Postoperative Blood Loss ◽  
Keywords Total Knee Arthroplasty ◽  
Significant Difference ◽  
Tourniquet Release ◽  
Group A ◽  
Total Knee ◽  
Group B

Objective: To compare the postoperative blood loss in total knee arthroplasty with and without perioperative tourniquet release. Study Design: Randomized control trial Place & Duration of Study: Department of Orthopaedic, M. Islam Teaching Hospital Gujranwala 1st January 2020 to 31st December 2020. Methodology: Ninety patients of both genders undergoing total knee arthroplasty were included in this study. Patient’s demographics were recorded after written consent. Patients were equally divided into two groups. Group A (45 patients) received total knee arthroplasty with tourniquet while group B (45 patients) received total knee arthroplasty without tourniquet. Postoperative blood loss was measured by suction drain, levels of haemoglobin were examined and compare between two groups. Results: The mean age of the patients in group A was 57.76±2.4 years while in group B it was 58.16±7.8 years. 32 (71.11%) and 34 (75.56%) were males while 13 (28.89%) and 11 (24.44%) were females in group A and B. We observed patients at the three different points and found lower blood loss in patients who received total knee arthroplasty with tourniquet as compared to no tourniquet group (p-value <0.05). No significant difference was observed regarding hemoglobin at 2 hours and significant differences were observed at 24 and 48 hour postoperatively. Conclusion: Tourniquet is useful to decrease loss of blood in patients undergoing total knee arthroplasty. Keywords: Total knee arthroplasty (TKA), Tourniquet, Blood loss

Early Aseptic Loosening with Increased Presence and Severity of Backside Burnishing in the Optetrak Logic Posterior-Stabilized Total Knee Arthroplasty Femoral Component

2021 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
David A. Iacobelli ◽  
Lisa Torres ◽  
Carolena Rojas Marcos ◽  
Allina A. Nocon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Severe Degree

AbstractConcerns persist that the Optetrak Logic posterior-stabilized (PS) total knee arthroplasty (TKA) femoral component might correlate with early failures due to aseptic loosening. The primary aim of this study was to examine if the use of the Optetrak Logic PS femoral component is associated with early (<5 years) and more extensive aseptic loosening compared with other PS femoral components. This is a single-institution retrieval analysis and revision registry study (based on prospectively collected data) of 27 failed primary PS TKA patients with loose femoral components that underwent revision TKAs between 2016 and 2019. Patients were stratified by components type: Group A (n = 16) received the Optetrak Logic PS femoral component, while Group B (n = 11) received other PS femoral components. Burnishing (macroscopic polishing of the component's backside) was observed and graded as a marker for relative motion at the cement-implant interface. No significant differences were found between the two groups regarding the baseline demographic, radiographic, and clinical characteristics. Mean length of implantation for Group A (3.8 ± 2.9 years) was significantly shorter (p < 0.001) than that of Group B (12.0 ± 6.7 years). A significant difference (p = 0.009) was found in presence of backside femoral burnishing between Group A (15 of 16 patients; 93.8%) and group B (5 of 11 patients; 45.6%). Furthermore, we found a significant difference (p < 0.001) in the severity of burnishing between Group A (13 of 16 patients with severe degree of burnishing; 81.3%) and Group B (1 of 11 patients with severe degree of burnishing; 9.1%). In contrast to Group B, a distinctive macroscopic pattern found in Logic retrieved femoral components (Group A) was the total absence of cement in the backside surface. The use of the Optetrak Logic PS TKA femoral component was associated with early aseptic loosening and increased presence and severity of backside burnishing with early cement-implant interface debonding compared with other commercially available types of PS TKA femoral components. The earlier failure rate with this implant is of concern.

scholarly journals Does intraoperative mechanical prophylaxis prevent venous thromboembolism in total knee arthroplasty? – effectiveness of passive-assisted ankle motion in surgical/non-surgical side

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Toshiyuki Tateiwa ◽  
Tsunehito Ishida ◽  
Toshinori Masaoka ◽  
Takaaki Shishido ◽  
Yasuhito Takahashi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Compression Stocking ◽  
Mechanical Prophylaxis ◽  
Ankle Motion ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background Gradual compression stocking (GCS) and intermittent pneumatic compression device (IPCD) are used for intraoperative mechanical prophylaxis against venous thromboembolism (VTE) during total knee arthroplasty (TKA). In this study, we applied a passive-assisted ankle motion in combination with GCS and IPCD during TKA and evaluated its effectiveness in preventing postoperative VTE. Methods We included 77 patients who underwent primary unilateral TKA. Patients were divided into group A (53 patients who underwent GCS and IPCD on their non-surgical side limb) and group B (24 patients who underwent passive ankle dorsiflexion motion in addition to GCS and IPCD on their non-surgical side limb). Deep vein thrombosis (DVT) was assessed using lower extremity ultrasonography (US). The incidence of VTE in each affected limb was compared between the two groups. Results US was performed 4 days after surgery on average. The incidence of DVT in groups A and B was 47.2 and 70.8 %, respectively. In group A, 22.6 % of DVTs were found only on the surgical side, 11.3 % on the non-surgical side, and 13.2 % on both sides. On the other hand, in group B, 41.7 % of DVTs were found only on the surgical side, 4.2 % on the non-surgical side, and 25.0 % on both sides. No significant difference in the incidence of VTE was noted between the 2 groups. Conclusions The intraoperative application of passive ankle motion plus GCS and IPCD might not further reduce the incidence of postoperative DVT in TKA patients.

scholarly journals The influence of previous arthroscopic treatment on subsequent primary total knee arthroplasty: the comparison between bilateral knees of the same patient

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuishuai Xu ◽  
Liang Zhang ◽  
Rui Shen ◽  
Cailin Wang ◽  
Tianyu Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Arthroscopic Treatment ◽  
Functional Scores ◽  
Group A ◽  
Vas Scores ◽  
Total Knee ◽  
Group B

Abstract Background To explore whether previous arthroscopic knee surgery affects future total knee arthroplasty (TKA) results or not. Methods A total of 56 patients with the previous arthroscopic treatment on one knee underwent subsequent bilateral total knee arthroplasty in our hospital from September 2012 to July 2018. Data on each patient were collected in regards to changes in postoperative clinical and functional scores, various other scores, as well as postoperative functional recovery and complications. We defined the knees with a previous arthroscopic history as group A, and the counter side as group B. The Knee Society clinical score, functional scores, range of motion (ROM), finger joint size (FJS), visual analogue scale (VAS) scores were assessed before and after surgery. Using the Kolmogorov-Smirnov Test to test the normality of continuous variables, and the chi-square test to compare the rate of reoperation and complications between two groups. For all statistical comparisons, P < 0.05 was considered significant. Results There were no statistically significance differences found in postoperative Knee Society clinical scores and functional scores between group A and group B, as well as in ROM, FJS, VAS scores and local complications. Conclusion There were no statistically significant differences found in postoperative functional recovery and complications in patients, who underwent total knee arthroplasty with previous knee arthroscopy.

scholarly journals Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 30 ◽  
Author(s):  
Zi-Yang Chia ◽  
Hee-Nee Pang ◽  
Mann-Hong Tan ◽  
Seng-Jin Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Social Functioning ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Computer Calculation ◽  
Bodily Pain ◽  
Significant Difference ◽  
Flexion Extension ◽  
Total Knee ◽  
The Mean

Introduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty. Methods: We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension. Results: At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with p-value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with p-value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years. Conclusions: Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months.

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

2019 ◽  
Author(s):  
Fardin Mirzatolooei ◽  
Ali Tabrizi ◽  
Hassan Taleb ◽  
Mohammad Khalegi Hashemian ◽  
Mir Bahram Safari
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Stress Test ◽  
Varus Deformity ◽  
Contralateral Side ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean ◽  
Medial Release ◽  
Varus Angle

Background Total knee arthroplasty is a challenging task in patients with severe varus deformity. In most of these patients, an extensive medial release is needed that may lead to instability. Medial epicondylar osteotomy may be a better substitute for complete medial collateral release. Materials and Methods Fourteen patients with bilateral knee osteoarthritis and severe varus deformity were enrolled in this study. In one side, the patients underwent medial epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial collateral ligament (MCL) release. In contralateral side, the extensive medial release was performed and MCL was released either by pie-crusting technique or by subperiosteally release. The results of the two sides were compared. Patients were followed up for 12 months after the operation. Physical examination, clinical questionnaires, and radiography findings were recorded. Union of the osteotomies fragment and complications was evaluated. Results The mean varus angle before surgery was 21.6 ± 4.7 degrees, which was corrected to 8.6 ± 2.9 degrees after operation with an extensive medial release. The mean varus angle of contralateral side was 22.6 ± 1.7 degrees, which was corrected to 7.5 ± 2.3 degrees following medial femoral epicondyle osteotomy. There was no significant difference in varus correction (p = 0.1). Medial joint line opening in valgus stress test was 2.7 ± 0.4 mm in the osteotomized side and 3.5 ± 0.9 mm in contralateral side. Mean range of motion for the osteotomized side was 97.8 ± 4.3 degrees and 100.7 ± 2.7 degrees for contralateral side (p = 0.6). Nonunion occurred in a case in the osteotomized side and no medial instability was observed in medial release or osteotomies sides. No statistical difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] scores). Conclusion Medial epicondylar osteotomy is a safe technique with the well-controlled medial extensive release in the patients with severe varus deformity during total knee arthroplasty.

scholarly journals Correlation Between Asymmetric Resection of Posterior Femoral Condyles and Femoral Component Rotation in Total Knee Arthroplasty

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Harun Reşit Güngör ◽  
Nusret Ök ◽  
Kadir Ağladıoğlu ◽  
Semih Akkaya ◽  
Esat Kıter
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Trochlear Groove ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean ◽  
The Asymmetry

Objectives: Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty. Methods: We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured. Results: The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (p<0.0001, r=0.803). Linear regression analyses revealed that 0.8 mm of difference between the anteroposterior dimensions of medial and lateral PCO corresponds to 1 degree of surgical FRA (p<0.0001, R2=0.645). Conclusion: Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.

Sign in / Sign up

Export Citation Format

Share Document