scholarly journals Difference in patient-reported outcomes of various patellar component designs in total knee arthroplasty: A randomized clinical study

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199606
Author(s):  
Takeshi Mochizuki ◽  
Koichiro Yano ◽  
Katsunori Ikari ◽  
Ken Okazaki
Keyword(s):  
Knee Osteoarthritis ◽  
Clinical Effects ◽  
Patellar Component ◽  
American College Of Rheumatology ◽  
Randomized Clinical Study ◽  
Component Design ◽  
Patient Reported ◽  
Total Knee ◽  
The Difference ◽  
And Function

Purpose: This study investigated the clinical effects of different patellar components without being affected by the femoral component design in total knee arthritis (TKA) for patients with knee osteoarthritis (OA). Methods: In total, 48 patients with OA who met the criteria of the American College of Rheumatology for OA were enrolled and randomly assigned in a 1:1 ratio to two groups according to the usage of patellar component design for TKA (medialized dome type [dome group] or medialized anatomic type [anatomic group]). To evaluate the clinical outcomes for TKA, knee range of motion (ROM), pain intensity of 0–100 mm visual analog scale (pain VAS), and the Japanese Knee Osteoarthritis Measure (JKOM) score were obtained at baseline and year 1. Results: The difference in knee ROM, pain VAS, or total JKOM score at year 1 was not significant between the dome and anatomic groups ( p = 0.398, 0.733 and 0.536, respectively). Moreover, similar results were obtained for changes in knee ROM, pain VAS, or total JKOM scores from baseline. In both groups, the pain VAS and total JKOM scores were significantly improved at year 1. Conclusion: Both dome and anatomic groups in TKA are significantly effective for pain and function using the JKOM score. However, their efficacy did not differ, according to the JKOM score. Results of this study are rare information focusing on the patellar component design and provide one of the insights into the TKA clinical management.

scholarly journals Comparison of Short-Term Efficacy of Total Knee Arthroplasty Versus Arthroscopy in Chinese Patients with Knee Osteoarthritis

2020 ◽  
Author(s):  
Xiaolin Jia ◽  
San Cai ◽  
Wei Hu ◽  
Qiang Gan ◽  
Mingquan Zhou
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Scientific Basis ◽  
Knee Function ◽  
Chinese Patients ◽  
Control Group ◽  
Total Knee ◽  
The Difference ◽  
Experimental Group

Abstract Background: The purpose of this study was to compare the improvement of knee function in patients with knee osteoarthritis who underwent total knee arthroplasty and arthroscopy in China, and to provide a scientific basis for the application of clinical total knee arthroplasty in knee osteoarthritis.Methods: A total of 160 patients with knee osteoarthritis who were admitted to Chinese hospital from January 2017 to December 2018 were studied. They were divided into experimental group and control group according to their willingness of treatment. The control group was treated with arthroscopy and the experimental group was treated with total knee arthroplasty. All patients were followed for a period of 6 months. The knee joint function score (HSS), visual analog scale (VAS), and anxiety self-assessment scale (SAS) scores before and after surgery were compared between the two groups. Results: The proportion of "excellent or good" in the efficacy of the experimental group (91.25%) was higher than that of the control group (72.50%), and the difference was statistically significant (χ2=9.476, P<0.05). The HSS score of the experimental group was higher than that of the control group (P<0.05), while the VAS and SAS scores were lower than those of the control group (P<0.05). The scores of various SF-36 scales in the experimental group were higher than those in the control group after operation (P<0.05).Conclusions: Total knee arthroplasty was considered effective in treating patients with knee osteoarthritis that meet the indications, and is beneficial to improve knee function and reduce pain in patients. The surgical treatment also reduced the level of anxiety and effectively improve the quality of life of patients. Further investigation of its clinical application on treatment of knee osteoarthritis is warranted.

Evaluation of a 3D-printed total knee arthroplasty using radiostereometric analysis

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 40-47 ◽  
Author(s):  
S. Sporer ◽  
L. MacLean ◽  
A. Burger ◽  
M. Moric
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Radiostereometric Analysis ◽  
Biological Fixation ◽  
Implant Surface ◽  
Patellar Component ◽  
Patient Reported ◽  
3D Printed ◽  
Total Knee ◽  
Highly Porous

AimsOur intention was to investigate if the highly porous biological fixation surfaces of a new 3D-printed total knee arthroplasty (TKA) achieved adequate fixation of the tibial and patellar components to the underlying bone.Patients and MethodsA total of 29 patients undergoing primary TKA consented to participate in this prospective cohort study. All patients received a highly porous tibial baseplate and metal-backed patella. Patient-reported outcomes measures were recorded and implant migration was assessed using radiostereometric analysis.ResultsPatient function significantly improved by three months postoperatively (p < 0.001). Mean difference in maximum total point motion between 12 and 24 months was 0.021 mm (-0.265 to 0.572) for the tibial implant and 0.089 mm (-0.337 to 0.758) for the patellar implant. The rate of tibial and patellar migration was largest over the first six postoperative weeks, with no changes in mean tibia migration occurring after six months, and no changes in mean patellar migration occurring after six weeks. One patellar component showed a rapid rate of migration between 12 and 24 months.ConclusionBiological fixation appears to occur reliably on the highly porous implant surface of the tibial baseplate and metal-backed patellar component. Rapid migration after 12 months was measured for one patellar component. Further investigation is required to assess the long-term stability of the 3D-printed components and to determine if the high-migrating components achieve fixation. Cite this article: Bone Joint J 2019;101-B(7 Supple C):40–47

scholarly journals Total versus partial knee replacement in patients with medial compartment knee osteoarthritis: the TOPKAT RCT

2020 ◽  
Vol 24 (20) ◽  
pp. 1-98
Author(s):  
David J Beard ◽  
Loretta J Davies ◽  
Jonathan A Cook ◽  
Graeme MacLennan ◽  
Andrew Price ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Replacement ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Medial Compartment ◽  
Knee Score ◽  
Patient Reported ◽  
Total Knee ◽  
Partial Knee Replacement

Background Late-stage medial compartment knee osteoarthritis can be treated using total knee replacement or partial (unicompartmental) knee replacement. There is high variation in treatment choice and insufficient evidence to guide selection. Objective To assess the clinical effectiveness and cost-effectiveness of partial knee replacement compared with total knee replacement in patients with medial compartment knee osteoarthritis. The findings are intended to guide surgical decision-making for patients, surgeons and health-care providers. Design This was a randomised, multicentre, pragmatic comparative effectiveness trial that included an expertise component. The target sample size was 500 patients. A web-based randomisation system was used to allocate treatments. Setting Twenty-seven NHS hospitals (68 surgeons). Participants Patients with medial compartment knee osteoarthritis. Interventions The trial compared the overall management strategy of partial knee replacement treatment with total knee replacement treatment. No specified brand or subtype of implant was investigated. Main outcome measures The Oxford Knee Score at 5 years was the primary end point. Secondary outcomes included activity scores, global health measures, transition items, patient satisfaction (Lund Score) and complications (including reoperation, revision and composite ‘failure’ – defined by minimal Oxford Knee Score improvement and/or reoperation). Cost-effectiveness was also assessed. Results A total of 528 patients were randomised (partial knee replacement, n = 264; total knee replacement, n = 264). The follow-up primary outcome response rate at 5 years was 88% and both operations had good outcomes. There was no significant difference between groups in mean Oxford Knee Score at 5 years (difference 1.04, 95% confidence interval –0.42 to 2.50). An area under the curve analysis of the Oxford Knee Score at 5 years showed benefit in favour of partial knee replacement over total knee replacement, but the difference was within the minimal clinically important difference [mean 36.6 (standard deviation 8.3) (n = 233), mean 35.1 (standard deviation 9.1) (n = 231), respectively]. Secondary outcome measures showed consistent patterns of benefit in the direction of partial knee replacement compared with total knee replacement although most differences were small and non-significant. Patient-reported improvement (transition) and reflection (would you have the operation again?) showed statistically significant superiority for partial knee replacement only, but both of these variables could be influenced by the lack of blinding. The frequency of reoperation (including revision) by treatment received was similar for both groups: 22 out of 245 for partial knee replacement and 28 out of 269 for total knee replacement patients. Revision rates at 5 years were 10 out of 245 for partial knee replacement and 8 out of 269 for total knee replacement. There were 28 ‘failures’ of partial knee replacement and 38 ‘failures’ of total knee replacement (as defined by composite outcome). Beyond 1 year, partial knee replacement was cost-effective compared with total knee replacement, being associated with greater health benefits (measured using quality-adjusted life-years) and lower health-care costs, reflecting lower costs of the index surgery and subsequent health-care use. Limitations It was not possible to blind patients in this study and there was some non-compliance with the allocated treatment interventions. Surgeons providing partial knee replacement were relatively experienced with the procedure. Conclusions Both total knee replacement and partial knee replacement are effective, offer similar clinical outcomes and have similar reoperation and complication rates. Some patient-reported measures of treatment approval were significantly higher for partial knee replacement than for total knee replacement. Partial knee replacement was more cost-effective (more effective and cost saving) than total knee replacement at 5 years. Future work Further (10-year) follow-up is in progress to assess the longer-term stability of these findings. Trial registration Current Controlled Trials ISRCTN03013488 and ClinicalTrials.gov NCT01352247. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 20. See the NIHR Journals Library website for further project information.

scholarly journals One and Two Year Postoperative Patient Reported Outcomes of Robotic-Assisted Total Knee Arthroplasty

10.29007/n4qv ◽  
2019 ◽  
Author(s):  
Christopher Blum ◽  
Christopher Plaskos ◽  
Adil Hussein ◽  
Jan A Koenig
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Computer Assisted ◽  
Robotic Assisted ◽  
Post Surgery ◽  
Patient Reported ◽  
National Cohort ◽  
Total Knee ◽  
And Function

Total knee arthroplasty is a successful procedure. However, there is still area for improvement as up to 15-20% of patients remain unsatisfied. Robotic-assisted surgery (RAS) may improve patient outcomes by providing a reproducible way of obtaining neutral mechanical alignment of the limb, which has been shown to reduce early revisions and correlate with patient reported outcomes after surgery.We prospectively enrolled 106 patients undergoing robotic-assisted TKA by a single surgeon performing a measured-resection femur-first technique using the OMNIBotic system. Patients completed a KOOS and New Knee Society Score (KSS) pre-operatively and at 3, 6, 12, and 24 months (M) postoperatively. Changes in the five KOOS sub-scales were compared to available literature data from the FORCE – TJR cohort, as well as to individual studies reporting on conventional and computer-assisted TKA.When compared to FORCE-TJR 6-month (M) and 2-year (Y) data, the RAS cohort had significantly higher improvements at 6M for pain (40.5 vs. 31.1, p&lt;.001) and at 2Y for all five KOOS sub-scores. The larger improvement was due to the RAS cohort having lower baseline KOOS scores than the FORCE-TJR cohort, except for the Sports-Recreation sub-score, which was similar pre- operatively but significantly higher post-operatively for the robotic cohort. Rates of dissatisfaction with knee pain level and function using the KSS after RAS were 3.0%, 1.0%, and 2.7% at 6, 12, and 24M postoperatively, respectively.Despite having poorer joint function and higher pain pre-operatively, robotic-assisted TKA patients achieved excellent self-reported outcomes, with significantly higher levels of improvement through two years post-surgery when compared with large national cohort studies. Further controlled clinical studies are warranted to determine if these results translate to other groups of surgeons, centers and patients.

scholarly journals Therapeutic Effect Analysis of Sodium Aescinate Tablets on Knee Osteoarthritis Combined with Synovitis

2021 ◽  
Vol 5 (6) ◽  
pp. 1-6
Author(s):  
Xueqin Zeng ◽  
Baohui Wang ◽  
Liang Li ◽  
Tao Lei ◽  
Huajian Liu ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Therapeutic Effect ◽  
Knee Pain ◽  
Clinical Efficacy ◽  
Intervention Group ◽  
Control Group ◽  
Clinical Effects ◽  
Joint Function ◽  
Routine Treatment ◽  
The Difference

Objective: To observe therapeutic effect of sodium aescinate Tablets on knee osteoarthritis complicated with synovitis. Methods: 86 patients with knee osteoarthritis combined with synovitis treated in the Honghui Hospital Affiliated to Xi’an Jiaotong University from January 2018 to December 2019 were randomly divided into control group and intervention group, with 43 cases in each group. The control group was given routine treatment, and the intervention group was given sodium aescinate Tablets orally on the basis of routine treatment, twice a day, 2 tablets each time. The curative effect was evaluated after 2 weeks of treatment. The knee pain and joint function of the two groups were evaluated by Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the clinical effects of the two groups were compared. Results: Before treatment, there was no significant difference in general information, VAS and WOMAC scores between the two groups (P > 0.05). After treatment, the VAS and WOMAC scores of the two groups were both lower than those before treatment, and the difference was statistically significant (P < 0.05). The vas and WOMAC scores of the intervention group were lower than those of the control group (VAS, 1.87 ± 0.79 vs 3.38 ± 0.81. In this study, sodium aescinate tablets were applied to the treatment of KOA combined with synovitis. The results showed that the intervention group was better than the control group in alleviating knee pain, improving joint function and improving clinical efficacy, and the difference was statistically significant. The total effective rate of the intervention group was higher than that of the control group (100% vs 86.05%), and the difference was statistically significant (P < 0.05). Conclusion: Sodium aescinate tablet in the treatment of knee osteoarthritis combined with synovitis can effectively alleviate knee pain, improve joint function and improve clinical efficacy.

scholarly journals Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis

2019 ◽  
Vol 54 (5) ◽  
pp. 263-271 ◽  
Author(s):  
Andrew Craig Hislop ◽  
Natalie J Collins ◽  
Kylie Tucker ◽  
Margaret Deasy ◽  
Adam Ivan Semciw
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Patient Reported ◽  
Randomised Controlled ◽  
And Function ◽  
Hip Strengthening

ObjectivesTo determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.DesignSystematic review with meta-analysis.Data sourcesMedline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.Eligibility criteria for selecting studiesRandomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.ResultsEight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).ConclusionWalking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.

scholarly journals Multidimensional minimal clinically important differences in knee osteoarthritis after comprehensive rehabilitation: a prospective evaluation from the Bad Zurzach Osteoarthritis Study

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000685 ◽  
Author(s):  
Felix Angst ◽  
Thomas Benz ◽  
Susanne Lehmann ◽  
André Aeschlimann ◽  
Jules Angst
Keyword(s):  
Knee Osteoarthritis ◽  
Short Form ◽  
Effect Sizes ◽  
Minimal Detectable Change ◽  
Before And After ◽  
Comprehensive Rehabilitation ◽  
The Difference ◽  
Mean Differences ◽  
Almost All ◽  
And Function

ObjectiveTo determine minimal clinically important differences (MCIDs) for improvement and worsening in various health dimensions in knee osteoarthritis under conservative therapy.MethodsHealth, symptoms and function were assessed by the generic Short Form 36 and the condition-specific Western Ontario and McMaster Universities Osteoarthritis Index in n=190 patients with knee osteoarthritis before and after comprehensive rehabilitation intervention (3-month follow-up). By means of construct-specific transition questions, MCIDs were defined as the difference between the ‘slightly better/worse’ and the ‘almost equal’ transition response categories according to the ‘mean change method’. The bivariate MCIDs were adjusted for sex, age and baseline score to obtain adjusted MCIDs by multivariate linear regression. They were further standardised as (baseline) effect sizes (ESs), standardised response means (SRMs) and standardised mean differences (SMDs) and compared with the minimal detectable change with 95% confidence (MDC95).ResultsMultivariate, adjusted MCIDs for improvement ranged from 2.89 to 16.24 score points (scale 0–100), corresponding to ES=0.14 to 0.63, SRM=0.17 to 0.61 and SMD=0.18 to 0.72. The matching results for worsening were –5.80 to –12.68 score points, ES=–0.30 to –0.56, SRM=–0.35 to –0.52 and SMD=–0.35 to –0.58. Almost all MCIDs were larger than the corresponding MDC95s.ConclusionsThis study presents MCIDs quantified according to different methods over a comprehensive range of health dimensions. In most health dimensions, multivariate adjustment led to higher symmetry between the MCID levels of improvement and worsening. MCIDs expressed as standardised effect sizes (ES, SRM, SMD) and adjusted by potential confounders facilitate generalisation to the results of other studies.

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