Hip and knee arthroplasty

2017 ◽  
Vol 11 (1) ◽  
pp. 20-27
Author(s):  
Dominic Marley ◽  
Nomaan Sheikh ◽  
John Taylor ◽  
Amit Kumar
Keyword(s):  
Primary Care ◽  
Knee Pain ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
National Joint Registry ◽  
Knee Replacement Surgery ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty

The incidence of hip and knee replacement surgery has risen dramatically in recent years. The latest National Joint Registry figures indicate that almost 190 000 total hip and knee replacements were performed in 2015. The aim of this article is to discuss the management of hip and knee pain in primary care, the indications for hip and knee arthroplasty and surgical considerations.

scholarly journals The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling

2019 ◽  
Vol 23 (32) ◽  
pp. 1-216 ◽  
Author(s):  
Andrew Price ◽  
James Smith ◽  
Helen Dakin ◽  
Sujin Kang ◽  
Peter Eibich ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Absolute Threshold ◽  
Cost Effective ◽  
Measurement Properties ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Hip And Knee Arthroplasty ◽  
The Absolute

Background There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS. Objectives/research questions Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery? Methods A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process. Results From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient’s preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of < £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores. Limitations The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery. Conclusion The OHS and OKS can be used in the ACHE tool to assess an individual patient’s suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility. Future work Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Assessing the non-inferiority of prosthesis constructs used in total and unicondylar knee replacements using data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man: a benchmarking study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026736 ◽  
Author(s):  
Kevin C Deere ◽  
Michael R Whitehouse ◽  
Martyn Porter ◽  
Ashley W Blom ◽  
Adrian Sayers
Keyword(s):  
Relative Risk ◽  
Knee Replacement ◽  
National Joint Registry ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Kaplan Meier ◽  
Knee Replacements ◽  
Total Knee ◽  
The Difference ◽  
Using Data

ObjectivesTo investigate the relative performance of knee replacement constructs compared with the best performing construct and illustrate the substantial variability in performance.DesignA non-inferiority study.SettingEngland and Wales.ParticipantsAll primary total and unicondylar knee replacements performed and registered in the National Joint Registry between 1 April 2003 and 31 December 2016.Main outcome measuresKaplan-Meier failure function for knee replacement constructs. Failure difference between best performing construct (the benchmark) and other constructs.MethodsUsing a non-inferiority analysis, the performance of knee replacement constructs by brand were compared with the best performing construct. Construct failure was estimated using the 1-Kaplan Meier method, that is, an estimate of net failure. The difference in failure between the contemporary benchmark construct and all other constructs were tested.ResultsOf the 449 different knee replacement constructs used, only 27 had ≥500 procedures at risk at 10 years postprimary, 18 of which were classified as inferior to the benchmark by at least 20% relative risk of failure. Two of these 18 were unicondylar constructs that were inferior by at least 100% relative risk. In men, aged 55–75 years, 12 of 27 (44%) constructs were inferior by at least 20% to the benchmark at 7 years postprimary. In women, aged 55–75 years, 8 of 32 (25%) constructs were inferior at 7 years postprimary. Very few constructs were classified as non-inferior to the contemporary benchmark.ConclusionsThere are few knee replacement constructs that can be shown to be non-inferior to a contemporary benchmark. Unicondylar knee constructs have, almost universally, at least 100% worse revision outcomes compared with the best performing total knee replacement. These results will help to inform patients, clinicians and commissioners when considering knee replacement surgery.

scholarly journals Anatomy of the Infrapatellar Branch in Relation to Skin Incisions and as the Basis to Treat Neuropathic Pain by Percutaneous Cryodenervation

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E339-E348 ◽  
Author(s):  
Thomas Ackmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Skin Incision ◽  
Knee Surgery ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Infrapatellar Branch ◽  
Total Knee

Background: Neuropathic knee pain, particularly of the infrapatellar branch, is an important complication of knee replacement surgery, with an incidence as high as 70%. The increasing number of elderly patients requiring knee surgery, including total knee arthroplasty (TKA), has contributed to an increase in the number of patients with this pathology. Treatment includes neurectomy, infiltration therapy, and cryodenervation. Percutaneous cryodenervation of the infrapatellar branch is a promising option. Objective: To provide the necessary anatomical analysis to optimize percutaneous cryodenervation of the infrapatellar branch by defining sections of the unbranched ramus infrapatellaris to demonstrate the risk of nerve injury through 3 different skin incisions typically used during TKA. Study Design: Anatomical study. Methods: Cadavers were used for assessment. Exclusion criteria were scars from knee surgery, deep wounds, and a flexion angle of no more than 90°. We compared 3 frequently used skin incisions with the course of the infrapatellar branch and identified sections of the unbranched nerves that were suitable for percutaneous cryodenervation. Results: In total, 18 formalin-fixed cadavers (mean age, 78.9 years) contributed 30 knees (15 pairs) for dissection. We identified the following 4 anatomical variations of the ramus infrapatellaris in relation to the sartorius muscle: anterior, posterior, penetrating, and pes anserinus types. Sections were then found to treat the nerve branch types. The nerve sections were localized using the medial pole of the patella as a palpable landmark and varied in length between 15 mm and 40 mm. The medial parapatellar skin incision showed the highest risk of lesions to the infrapatellar branch (53.3%) followed by the midline skin incision (46.7%) and the lateral parapatellar skin incision (30.0%). Limitations: This was an observational study, performed using a limited number of cadavers. This therefore precluded generalization and statistical analysis. Significantly more female (13) cadavers were examined compared to male (5). Further studies in human populations, and with larger samples, are necessary to confirm these results. Conclusion: Based on our findings, the surgeon can localize the unbranched main nerve. Compared with the current practice, our approach should allow for a lower impact on tissues and should facilitate complete pain relief through a single cryodenervation. Furthermore, we propose that the lateral parapatellar skin incision is an acceptable alternative surgical approach in knee replacement surgery because it is associated with the lowest risk of damage to the infrapatellar branch. Key words: Percutaneous cryodenervation, infrapatellar branch, neuropathic knee pain, knee surgery, skin incisions knee surgery, total knee arthroplasty

scholarly journals The Self-Administered Patient Satisfaction Scale for Primary Hip and Knee Arthroplasty

Arthritis ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
N. Mahomed ◽  
Rajiv Gandhi ◽  
Lawrence Daltroy ◽  
J. N. Katz
Keyword(s):  
Patient Satisfaction ◽  
Knee Replacement ◽  
Internal Consistency ◽  
Knee Arthroplasty ◽  
Cronbach’S Alpha ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Cronbach's Alpha ◽  
Hip And Knee Arthroplasty ◽  
One Year

Introduction. The objective of this study was to develop a short self-report questionnaire for evaluating patient satisfaction with the outcome of hip and knee replacement surgery. Methods. This scale consists of four items focusing on satisfaction with the extent of pain relief, improvement in ability to perform home or yard work, ability to perform recreational activities, and overall satisfaction with joint replacement. This instrument does not measure satisfaction with process of care. The responses are scored on a Likert scale, with the total score ranging from 25 to 100 per question. The instrument was tested on 1700 patients undergoing primary total hip and total knee replacement surgery, evaluated preoperatively, at 12 weeks, and one year postoperatively. Psychometric testing included internal consistency, measured with Cronbach's alpha, and convergent validity, measured by correlation with changes in measures of health status between the preoperative, 12-week, and one-year evaluations. Results. The internal consistency (reliability) of the scale, measured by the Cronbach's alpha, ranged from 0.86 to 0.92. The scale demonstrated substantial ceiling effects at 1 year. The scale scores correlated modestly with the absolute SF-36 PCS and WOMAC scores (ρ=0.56–0.63 and also with the WOMAC change scores (ρ=0.38–0.46) at both 12-week and 1-year followups. Conclusions. This instrument is valid and reliable for measuring patient satisfaction following primary hip and knee arthroplasty and could be further evaluated for use with other musculoskeletal interventions.

scholarly journals Is adding intra-articular steroid in total knee arthroplasty cocktail obligatory?

2019 ◽  
Vol 5 (2) ◽  
pp. 260
Author(s):  
Sundar Suriyakumar ◽  
Ganesan G. Ram ◽  
Faraz Ahmed
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Group I ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> The patients can undergo total knee replacement surgery either under general anaesthesia, combined spinal and epidural anaesthesia, nerve root block, spinal combined with intra-articular knee cocktail. There is an ongoing debate amongst Arthroplasty surgeons whether to include steroid in the cocktail or not. The aim of this study is to assess whether there is an added benefit of including steroid in the intraarticular mixture.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted at Sri Ramachandra Institute of Higher education, Chennai between December 2017 to December 2018. The study was conducted in the Arthroplasty unit, Department of Orthopaedics. SRIHER ethics committee clearance was obtained prior to the start of the study. The inclusion criteria were patients who underwent total knee replacement surgery under combined spinal and intra-articular knee cocktail. Patients were divided into two groups based on the use of steroid in the intra-articular mixture. Patients were evaluated using Visual analogue scale, opioids usage as primary endpoint while any joint infection within six months of the surgery and knee society score at 1 month and 6 months as the secondary endpoint.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean visual analogue score for the 0 pod for the group I and group II were 2.3 and 2.4 respectively. There was no case of infection in both groups.</p><p class="abstract"><strong>Conclusions:</strong> There is no fringe benefit of adding steroid to the knee cocktail. So it is not obligatory to add steroid in intra-articular total knee arthroplasty cocktail.</p>

Use of Kinesiology Taping in Rehabilitation after Knee Arthroplasty: a Randomised Clinical Study

2017 ◽  
Vol 19 (5) ◽  
pp. 0-0 ◽  
Author(s):  
Weronika Woźniak-Czekierda ◽  
Kamil Woźniak ◽  
Anna Hadamus ◽  
Dariusz Białoszewski
Keyword(s):  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Functional Performance ◽  
Position Sense ◽  
Joint Position Sense ◽  
Control Group ◽  
Body Balance ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Experimental Group

Summary Background. Proprioception and body balance after knee arthroplasty have a considerable impact on restoration of joint function and a normal gait pattern. Kinesiology Taping (KT) is a method that may be able to influence these factors. The aim of this study was to assess the effects of KT application on sensorimotor efficiency, balance and gait in patients undergoing rehabili­ta­­tion after knee replacement surgery. Material and methods. The study involved 120 male and female patients (mean age was 69 years) after total knee repla­cement. The patients were randomly assigned to one of two groups: Experimental Group (n=51) and Control Group (n=60). Both groups underwent standard rehabilitation lasting 20 days. In addition, the Experimental Group received KT applications. Treat­ment outcomes were assessed based on tests evaluating balance, joint position sense and functional gait performance, conducted both before and after the therapy. Results. Statistically significant improvements were noted across all the parameters assessed in the Experimental Group (p<0.005). Significant improvements were also seen in the Control Group (p<0.005), but, in percentage terms, the improvement was higher in the Experimental Group. The only exception was the right/left foot load distribution, whose symmetry improved proportionally in both groups. Conclusions. 1. Patients after knee replacement surgery have considerable proprioception deficits, impaired body balance and reduced functional performance, which may increase the risk of falls in this group of patients. 2. Both standard physiotherapy and combination therapy with Kinesiology Taping (modified by the present authors) used in patients after knee arthroplasty may considerably improve the level of proprioception, body balance and overall functional performance. 3. The technique of dynamic taping proposed in this paper may optimise standard physiotherapy used in patients after knee arthroplasty and increase its clinical efficacy. Further studies are required.

scholarly journals Hip and knee arthroplasty implants contraindicated in obesity

2016 ◽  
Vol 98 (5) ◽  
pp. 295-299 ◽  
Author(s):  
JD Craik ◽  
MD Bircher ◽  
M Rickman
Keyword(s):  
Knee Arthroplasty ◽  
Obese Patients ◽  
National Joint Registry ◽  
Surgical Practice ◽  
Joint Registry ◽  
Hip And Knee Arthroplasty ◽  
Total Knee ◽  
The Mean ◽  
Product Literature ◽  
Primary Total Hip Arthroplasty

IntroductionHigh patient weight is a risk factor for mechanical implant failure and some manufacturers list obesity as a contraindication for implant use. We reviewed data from the 2012–2013 UK National Joint Registry to determine whether surgical practice reflects these manufacturer recommendations.MethodsThe product literature for the most commonly used hip and knee implants was reviewed for recommendations against use in obese patients (body mass index [BMI] ≥ 30kg/m2). The total number of obese patients undergoing hip and knee arthroplasty was calculated, as was the proportion receiving implants against manufacturer recommendations.ResultsOut of 200,054 patient records, 147,691 (74%) had a recorded BMI. The mean BMI for patients undergoing primary total hip arthroplasty was 29kg/m2, compared with 31kg/m2for total knee arthroplasty. Of the 25 components reviewed, 5 listed obesity as a contraindication or recommended against implant use in obese patients. A total of 10,745 patients (16% of all obese patients) received implants against manufacturer recommendations.ConclusionsA high proportion of patients are receiving implants against manufacturer recommendations. However, there are limitations to using BMI for stratifying risk of implant fatigue failure and manufacturers should therefore provide more detailed guidelines on size specific implant load limits to facilitate surgical decisions.

Balance Confidence and Function after Knee-Replacement Surgery

2006 ◽  
Vol 14 (2) ◽  
pp. 181-191 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller ◽  
Joanne E. Wittwer
Keyword(s):  
Knee Replacement ◽  
Self Efficacy ◽  
Functional Performance ◽  
Knee Replacement Surgery ◽  
Balance Confidence ◽  
Replacement Surgery ◽  
Knee Replacements ◽  
And Function ◽  
The Relationship ◽  
General Self Efficacy

This study examined the relationship between balance confidence and function in older adults after knee-replacement surgery. Thirty-six adults (20 men and 16 women age 58–84 years) completed measures of balance confidence, general self-efficacy, and function. Results showed that participants with greater balance confidence had better functional performance and reported fewer difficulties with activities of daily living. General self-efficacy and age were not related to any of the functional measures. Women scored lower than men for all balance-confidence and function measures. These findings highlight the potential value of studying balance-related self-efficacy beliefs in people with knee replacements. Longitudinal studies are now needed to determine whether a change in balance confidence is associated with a change in function and to further explore gender differences.

Sign in / Sign up

Export Citation Format

Share Document