scholarly journals The advantage of navigation for knee with lateral femoral bowing in total knee arthroplasty

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096567
Author(s):  
Jun Ho Nam ◽  
Suk-Kyoon Song ◽  
Myung-Rae Cho ◽  
Dae-Won Kang ◽  
Won-Kee Choi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Occurrence Rate ◽  
Computer Assisted ◽  
Coronal Alignment ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Femoral Bowing ◽  
Group 1

Purpose: We have analyzed the surgical outcomes of primary total knee arthroplasty (TKA) using computer-assisted (CA) navigation in terms of postoperative coronal alignment depending on preoperative lateral femoral bowing. Methods: We conducted a retrospective study of patients who have undergone navigated primary TKA from January 2016 through January 2020. Two hundred and ninety-nine cases with lateral femoral bowing of 3° or less were assigned to group 1, 95 cases of lateral femoral bowing between 3° and 5° were assigned to group 2, and 89 cases with lateral femoral bowing of more than 5° were assigned to group 3. The postoperative mechanical hip–knee–ankle (mHKA) angle was measured from scanograms, which were taken 3 months after surgery. The appropriate range of coronal alignment was set as 0 ± 3°. Results: The number of outliers of mHKA occurred was 31 cases (10.4%) in group 1, 17 cases (17.9%) in group 2, and 17 cases (19.1%) in group 3. There was a significant correlation between the degree of lateral femoral bowing and the occurrence rate of mHKA outliers. Multiple variables logistic regression analysis showed occurrence rate of outliers in group 3 to be 2.04 times higher than group 1. After adjusting the patient’s age, sex, body mass index, and preoperative HKA deformity, the occurrence rate of outliers in group 3 was still 1.96 times higher than group 1. Conclusion: The benefit of CA navigation during TKA in obtaining coronal alignment within 0 ± 3° may be lessened when the preoperative lateral femoral bowing is severely advanced.

scholarly journals Acquisition of coronal alignment according to the degree of varus deformity in total knee arthroplasty using computer-assisted navigation

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092626 ◽  
Author(s):  
Suk Kyoon Song ◽  
Myung Rae Cho ◽  
Seo Ho Lee ◽  
Hee Chan Kim ◽  
Dae won Kang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Occurrence Rate ◽  
Computer Assisted ◽  
Coronal Alignment ◽  
Assisted Navigation ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Purpose: We have analyzed the surgical outcomes of primary total knee arthroplasty (TKA) using computer-assisted navigation that were performed by a single surgeon in terms of postoperative coronal alignment depending on preoperative varus deformity. Methods: We conducted a retrospective study of patients who have undergone navigated primary TKA from January 2016 through December 2019. Two hundred and fifty-six cases with varus deformity of 10° or less were assigned to group 1, and 216 cases with varus deformity of more than 10° were assigned to group 2. The postoperative mechanical hip–knee–ankle (mHKA) angle was measured from scanograms which were taken preoperatively and 3 months after surgery. The postoperative mHKA angle was targeted to be 0°, and the appropriate range of coronal alignment was set as 0 ± 3°. Results: The Pearson correlation showed a significant correlation with the degree of preoperative varus deformity and with the absolute error of postoperative mHKA ( p = 0.01). Among all patients, 64 cases (13.6%) were detected as outliers (mHKA > 0° ± 3°) at 3 months after surgery. Of the 64 cases, 25 cases (9.8%) were affiliated to group 1 and 39 cases (18.1%) were affiliated to group 2. Group 2 showed significantly higher occurrence of outliers than group 1 ( p = 0.01). Multiple variables logistic regression analysis, which analyzed the difference in the occurrence rate of outliers (mHKA > 0° ± 3°), showed that the occurrence rate of group 2 was 2.04 times higher than group 1. After adjusting for patient’s age, gender, and body mass index, the occurrence rate of outliers in group 2 was 2.01 times higher than group 1. Conclusion: The benefit of computer-assisted navigation during TKA in obtaining coronal alignment within 0 ± 3° may be lessened when the preoperative varus deformity is severely advanced.

scholarly journals Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 661 ◽  
Author(s):  
Zekeriya Okan Karaduman ◽  
Ozan Turhal ◽  
Yalçın Turhan ◽  
Zafer Orhan ◽  
Mehmet Arican ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Thermal Camera ◽  
Prosthesis Infection ◽  
Total Knee ◽  
Group 3 ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Background and objectives: Cryotherapy is a method of treatment using cold application. This study aimed to evaluate postoperative clinical and hematological parameters and pain associated with total knee arthroplasty in patients and compared cryotherapy to the conventional method of cold ice pack compressions. Materials and Methods: Between January 2015 and January 2016, 90 patients who underwent total knee arthroplasty for grade 4 gonarthrosis were prospectively evaluated. The patients were divided into three groups (n = 30, each): Group 1, cryotherapy was applied in the pre- and postoperative periods; Group 2, cryotherapy was applied only in the postoperative period; and Group 3 (control group), only a cold pack (gel ice) was applied postoperatively. In all groups, pre- and postoperative evaluations at 6, 24, and 48 h, hemorrhage follow-up, knee circumference measurement, visual analog scale pain score, knee circumference, and temperature measured by thermal camera were recorded. Results: Of the 90 patients, 10% were men and 90% were women. The mean age was 64.3 ± 8.1 (range: 46–83) years. The patella upper end diameter values were significantly lower in the postoperative period in Groups 1 and 2 than in Group 3 (p = 0.003). Hemoglobin levels at 24 and 48 h postoperatively were significantly lower in Group 3 than in Group 1 (p < 0.001, each) and Group 2 (p = 0.038, p < 0.001). At 6, 24, and 48 h follow-ups, pain values were significantly lower in Group 2 than in Group 3 (p < 0.001). Preoperative 6, 24, and 48 h temperature values were significantly lower in Group 1 than in Group 3 (p < 0.001 for each). It was found that the difference between preoperative and postoperative knee flexion measurements was significantly different in both groups or the difference between the groups was changed in each period (p < 0.001). Conclusions: Postoperative cryotherapy is a potentially simple, noninvasive option and beneficial for the reduction of reducing pain, bleeding, length of stay, analgesic requirement and swelling after total knee arthroplasty. Moreover, there was no early or late prosthesis infection in cryotherapy groups, which may be considered as an additional measure to prevent prosthesis infection.

scholarly journals The benefits of computer-assisted total knee arthroplasty on coronal alignment with marked femoral bowing in Asian patients

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Chien-Yin Lee ◽  
Shih-Jie Lin ◽  
Liang-Tseng Kuo ◽  
Kuo-Ti Peng ◽  
Kuo-Chin Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Assisted ◽  
Coronal Alignment ◽  
Asian Patients ◽  
Total Knee ◽  
Femoral Bowing

scholarly journals The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Oh-Ryong Kwon ◽  
Kyoung-Tak Kang ◽  
Juhyun Son ◽  
Dong-Suk Suh ◽  
Dong Beom Heo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Surgical Time ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

This retrospective study was to determine if patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM) tibial guide (group 1, n=48), PSI with EM tibial guide (group 2, n=68), and conventional instrumentation (CI) group (group 3, n=50). Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9±13.6 min) compared to the CI group (group 3, 82.8±24.9 min) (P<0.001). However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3±18.8 min). This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

Clinical Efficacy of Preoperative CT-Assisted Planning for Primary Total Knee Arthroplasty: A Pilot Randomized Clinical Trial

2021 ◽  
Author(s):  
Ahmed Saeed Younis ◽  
Mohammed El Sayed Awad ◽  
Tarek M. Samy ◽  
Wael Samir Osman ◽  
Sherif Mostafa Abdeldayem ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Ct Scan ◽  
Knee Arthroplasty ◽  
Functional Score ◽  
Coronal Alignment ◽  
Preoperative Ct ◽  
Total Knee ◽  
The Mean ◽  
Group 2 ◽  
Group 1

AbstractThis study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of the included patients showed 5 patients with valgus deformity and 45 patients with varus deformity with the mean coronal alignment of 7.5 degrees. CT scan showed the mean PCA of 3.7 degrees (1.3 degrees). The axial knee postoperative X-ray showed the mean patellar tilt angle of 2.1 degrees (0.5 degrees) and 1.9 degrees (0.5 degrees) in groups 1 and 2, respectively. The congruence angle was 4 degrees (2.6 degrees) in group 1 and 5.5 degrees (3.2 degrees) in group 2. The median Knee Society functional score in group 1 was 85 (12), while it was 84 (7.5) in group 2. The median postoperative Western Ontario and McMaster Universities Arthritis Index score in group 1 was 84 (18.6) whereas 80.2 (13.6) in group 2. The median postoperative Bartlett score in group 1 was 30 (5), while it was 30 (6) in group 2. The use of preoperative CT scan did not improve the patient functional scores after TKA.

scholarly journals Preemptive Analgesia in Total Knee Arthroplasty: Comparing the Effects of Single Dose Combining Celecoxib with Pregabalin and Repetition Dose Combining Celecoxib with Pregabalin: Double-Blind Controlled Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Andri M. T. Lubis ◽  
Rangga B. V. Rawung ◽  
Aida R. Tantri
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Preemptive Analgesia ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Significant Difference ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with preemptive analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given preemptive analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as preemptive analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 (ClinicalTrials.gov).

scholarly journals Survival rate after septic total knee arthroplasty- a comparison of two treatment algorithms

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0014
Author(s):  
Clemens Baier ◽  
Günther Maderbacher ◽  
Joachim Grifka ◽  
Hans-Robert Springorum
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Persistent Infection ◽  
Tissue Samples ◽  
Articulating Spacer ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Aims and Objectives: To date there exists no golden standard of treatment of late periprosthetic joint infection. Different forms of treatment comprise single-stage or two-stage or multiple revisions. Respectively, mid- to long-term results are rare. Materials and Methods: We retrospectively analysed 66 patients with septic total knee arthroplasty treated by two different therapy algorithms: Until 2009 patients were treated routinely by implant removal and implantation of an articulating spacer in combination with at least 6 weeks of antibiotic administration. After an antibiotic-free period of two weeks persistent infection was ruled out by punctation. In case of negative antimicrobial cultures after another 14 days patients were treated by reimplantation (n=36, group 1). After 2009 persistent infection was ruled out by open revision and change of the articulating spacer instead of a punctuation. In case of negative antimicrobial cultures after another 14 days patients were treated by reimplantation (n=30, group 2). After a follow-up of 61 months (group 1), respectively 36 months (group 2), patients and their family doctors were contacted by phone concerning the survival rate of the new implant. Results: In group 1 persistent infection was ruled out in every patient by punctuation. During reimplantation tissue samples of 8 patients (22%) showed positive microbiological results again, within 4 patients with a change of the underlying bacteria. After a follow-up of 61 months 31 patients showed no signs of reinfection of their implant and were not operatively revised (86%). In group 2 all patients were treated with open revision and change of the articulating spacer for at least once. 8 patients showed a change of the underlying bacteria during these procedures. During reimplantation tissue samples of 8 patients (27%) showed positive microbiological results again. After a follow-up of 36 months 27 patients showed no signs of reinfection of their implant and were not operatively revised (90%). The difference between both groups was not significant (p>0.05). Concerning the overall complication rate no significant differences between both groups could be found (p>0.05). Conclusion: Concerning reinfection rate we could not detect significant differences between both groups. Patients of group 2 were treated operatively significantly more often and showed a significantly more frequent change of the underlying bacteria. If these results are confirmed in big cohort studies the elaborate treatment algorithm of open revision and change of the articulating spacer might become dispensable.

Oral tranexamic acid for an additional 24 hours postoperatively versus a single preoperative intravenous dose for reducing blood loss in total knee arthroplasty: results of a randomized controlled trial (TRAC-24)

2021 ◽  
Vol 103-B (10) ◽  
pp. 1595-1603
Author(s):  
Paul Magill ◽  
Janet C. Hill ◽  
Leeann Bryce ◽  
Una Martin ◽  
Al Dorman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Blood Loss ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
History Of ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aims In total knee arthroplasty (TKA), blood loss continues internally after surgery is complete. Typically, the total loss over 48 postoperative hours can be around 1,300 ml, with most occurring within the first 24 hours. We hypothesize that the full potential of tranexamic acid (TXA) to decrease TKA blood loss has not yet been harnessed because it is rarely used beyond the intraoperative period, and is usually withheld from ‘high-risk’ patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease, a patient group who would benefit greatly from a reduced blood loss. Methods TRAC-24 was a prospective, phase IV, single-centre, open label, parallel group, randomized controlled trial on patients undergoing TKA, including those labelled as high-risk. The primary outcome was indirect calculated blood loss (IBL) at 48 hours. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional 24-hour postoperative oral regime of four 1 g doses, while Group 2 only received the intraoperative dose and Group 3 did not receive any TXA. Results Between July 2016 and July 2018, 552 patients were randomized to either Group 1 (n = 241), Group 2 (n = 243), or Group 3 (n = 68), and 551 were included in the final analysis. The blood loss did differ significantly between the two intervention groups (733.5 ml (SD 384.0) for Group 1 and 859.2 ml (SD 363.6 ml) for Group 2; mean difference -125.8 ml (95% confidence interval -194.0 to -57.5; p < 0.001). No differences in mortality or thromboembolic events were observed in any group. Conclusion These data support the hypothesis that in TKA, a TXA regime consisting of IV 1 g perioperatively and four oral 1 g doses over 24 hours postoperatively significantly reduces blood loss beyond that achieved with a single IV 1 g perioperative dose alone. TXA appears safe in patients with history of thromboembolic, cardiovascular, and cerebrovascular disease. Cite this article: Bone Joint J 2021;103-B(10):1595–1603.

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