scholarly journals Comparison of two different models of rehabilitation programs following total knee replacement operations

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Rabab S. Zaghlol ◽  
Sahar S. Khalil ◽  
Ahmed M. Attia ◽  
Ghada A. Dawa
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
High Intensity ◽  
Rating Scale ◽  
Rehabilitation Program ◽  
Low Intensity ◽  
Rehabilitation Programs ◽  
Patient Reported ◽  
Total Knee ◽  
Functional Gain

Abstract Background Total knee replacement operation (TKR) is the treatment of choice in severe knee osteoarthritis (OA). Rehabilitation post-TKR is still not well studied. The aim of this study was to compare between the high-intensity (HI) rehabilitation program and the low-intensity (LI) rehabilitation program following TKR. Results At 1 month following the TKR operations, significant improvements were found in the first group compared to the second group in all the measured parameters except for the knee range of motion (ROM). At 3 and 12 months follow-up periods, there were statistically significant differences between both groups in all the evaluated parameters except for the numeric pain rating scale and the knee ROM. Conclusions Both high-intensity and low-intensity rehabilitation programs are effective; however, HI program had superior functional gain and patient-reported outcomes compared to the LI program. Moreover, HI group has a long-term functional gain.

scholarly journals Bicompartmental Knee Arthroplasty (BKA) in comparison to unicompartmental (UKA), Patellofemoral (PFA) ans total knee arthroplasty (TKA) – Early Clinical Results

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Johannes Holz ◽  
Stefan Schneider ◽  
Ansgar Ilg ◽  
Rene Kaiser
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Clinical Results ◽  
Single Center ◽  
Patient Reported ◽  
Total Knee ◽  
Bicompartmental Arthroplasty

Aims and Objectives: The purpose was to evaluate the clinical outcomes of patients with knee osteoarthritis treated with bicompartmental arthroplasty (BKA) in comparison to unicompartmental (UKA), patellofemoral (PFA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 396 patients from two surgeons in a single center. In 191 men and 205 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. In 238 patients UKA, in 125 TKA, in 21 PFA and in 11 patients BKA was performed. Implants were cemented and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 202 patients have thus far completed the 12 months follow-up time point. Results: All mean KOOS and OKS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49,0±14,1 to 74,3±17,8 in UKA, from 44,1±12,9 to 67,5±9,4 in PFA, from 46,1±15,1 to 71,0±14,8 in TKA and from 45,7±13,8 to 72,6±9,7 in BKA (p<0.05). Mean preoperative aggregated OKS improved from 25,1±7,6) to 38,5±9,7 in UKA, from 23,0±7,6 to 36,8±3,8 in PFA, from 23,4±8,2 to 37,3±8,1 in TKA and from 22,9±9,6 to 37,0±1,5 in BKA (p<0.05). The mean pain level (VAS)decreased from pre-treatment to 12 months after surgery in UKA from 5,5 to 1,6, in PFA from 6,1 to 2,5, in TKA from 6,0 to 1,9 and in BKA from 6,6 to 2,6. One patient (0.4%) underwent revision (at 3 month for inlay dislocation). Conclusion: This study shows excellent early clinical results of patients treated with unicompartmental, bicompartmental and total knee arthroplasty. Adherence to strict indications lead to a significant improvement of patient reported outcomes and a low revision rate one year postoperatively. The reported results for BKA are comparable to those of patients treated with unicompartmental arthroplasty. We conclude that bicompartmental arthroplasty is a safe and reliable surgery for patients with bicompartmental osteoarthritis.

scholarly journals Prospective, observational study to evaluate the relation between patient-reported outcomes and component rotation in total knee replacement: protocol for the CRACK study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031166
Author(s):  
Hans-Peter van Jonbergen ◽  
Ellie Landman ◽  
Maarten Horst ◽  
Robin Westerbeek ◽  
Ydo Kleinlugtenbelt
Keyword(s):  
Total Knee Replacement ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Knee Replacement ◽  
Tibial Component ◽  
Patient Reported Outcomes ◽  
Persistent Pain ◽  
Component Rotation ◽  
Patient Reported ◽  
Total Knee

IntroductionTotal knee replacement (TKR) for osteoarthritis results in a satisfactory outcome in the majority of patients, although up to one in five patients may be dissatisfied with the outcome. Persistent pain is a main contributor to patient dissatisfaction, and femoral and tibial component malrotation have been identified as a potential cause for both persistent pain and patellofemoral problems. Based on the assumption that component malrotation is the causative factor for persistent pain, early revision for patients with symptomatic malrotated components has been advocated in the literature. However, convincing evidence that component malrotation indeed results in less than optimal outcomes is lacking. This study aims to assess the relation between knee prosthesis component rotation and patient-reported outcomes in a large group of patients and to determine the range of femoral, tibial and combined rotation that results in the best clinical outcomes.Methods and analysisIn this single-centre, prospective observational cohort study, a total of 500 patients will undergo TKR. All patients will have a 3D-CT assessment of femoral and tibial component rotation within 8 weeks after surgery. Outcome measures will include the Oxford Knee Score, the Knee Injury and Osteoarthritis Outcome Score, EQ-5D, visual analogue scale for pain, the American Knee Society Score and the knee joint range of motion. We will assess the relation between femoral, tibial and combined component rotation and patient-reported outcome measures at 8 weeks and 1 year of follow-up, and we will determine the range of femoral, tibial and combined rotation that results in the best clinical outcomes.Ethics and disseminationEthical approval for this study has been granted by the Isala Hospital ethics committee. The results will be published in a peer-reviewed journal and presented at relevant meetings.Trial registration numberNL7635.

scholarly journals Association Between Preoperative Radiographic Severity of Osteoarthritis and Patient-Reported Outcomes of Total Knee Replacement

2020 ◽  
Vol 5 (3) ◽  
pp. e19.00073-e19.00073
Author(s):  
Jeffrey K. Lange ◽  
Heidi Y. Yang ◽  
Jamie E. Collins ◽  
Elena Losina ◽  
Jeffrey N. Katz
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Patient Reported Outcomes ◽  
Radiographic Severity ◽  
Patient Reported ◽  
Total Knee

scholarly journals Multiple joint involvement in total knee replacement for osteoarthritis: Effects on patient-reported outcomes

2012 ◽  
Vol 64 (6) ◽  
pp. 838-846 ◽  
Author(s):  
A. V. Perruccio ◽  
J. D. Power ◽  
H. M. K. Evans ◽  
S. R. Mahomed ◽  
R. Gandhi ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Patient Reported Outcomes ◽  
Joint Involvement ◽  
Patient Reported ◽  
Total Knee

scholarly journals PROMs in total knee replacement: analysis of negative outcomes

2021 ◽  
Vol 103 (1) ◽  
pp. 64-73
Author(s):  
F Begum ◽  
A Panagiotidou ◽  
C Park ◽  
T Ashdown ◽  
S El-Tawil
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Replacement Policy ◽  
Health Gains ◽  
Patient Reported ◽  
Post Operation ◽  
Total Knee

Introduction NHS England uses the Oxford Knee Score (OKS) as part of patient-reported outcome measures (PROMs) to evaluate ‘health gains’ following total knee replacement. Policy makers use this to guide healthcare funding and resource allocation. Our study aims to undertake a qualitative and quantitative analysis of OKS among patients who experienced a negative outcome after a total knee replacement at our centre. Materials and methods Between April 2017-March 2018, 19 of 189 (10%) patients had a worsened OKS at our centre. We retrospectively and prospectively reviewed 14 of these patients. Structured telephone interviews with a repeat OKS were carried out in September 2019 (18–29 months post-operation). Results Eight patients were female and the total age range was 57–95, mean average 75.6 (SD 9.9 years). Of 48 (higher scores meaning better outcomes), the average preoperative OKS was 24.2 and the average postoperative OKS at 6 months was 19.4 (decrease of 20%). The average postoperative OKS at 18–29 months was 35.6 (an increase of 83.5% from 6 months). Discussion The OKS was developed and validated over 20 years ago in Oxford. In our study, four patients asked for clarification of questions 4, 6 and 10 owing to ambiguous language. All 14 patients who had negative OKS outcomes had positive outcomes when retested after 18 months, depicting ‘health gains’ not conveyed in PROMs analysis. Conclusion The OKS needs to be revalidated on current patient groups for accurate and reliable data. Further prospective studies should be undertaken on larger cohorts to understand the recovery course and whether PROMs should be carried out later.

scholarly journals Spinal Cord Stimulation for the Treatment of Chronic Knee Pain Following Total Knee Replacement

2010 ◽  
Vol 3;13 (3;5) ◽  
pp. 251-256
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Spinal Cord Stimulation ◽  
Management Options ◽  
Chronic Knee Pain ◽  
Patient Reported ◽  
Total Knee

Background: Chronic pain after total knee replacement is common but remains poorly understood. Management options for patients with this condition are traditionally limited to pharmacological approaches. Objective: This article presents a case of using spinal cord stimulation in the management of chronic knee pain following total knee replacement. Design: Case report Setting: Pain management clinic Methods: A 68-year old patient presented with a 3-year history of persistent knee pain following total knee replacement. After failing to respond to medications and nerve blocks, a trial of spinal cord stimulation and subsequent permanent implantation of a spinal cord stimulator (SCS) were performed. The Oxford knee score (OKS) was used to assess her pain and functionality before and after SCS implantation. Results: The patient reported improvement in her pain and function. Her baseline OKS was 39 and fell to 26 one year post implantation of an SCS representing a reduction of pain and disability from severe to moderate. Limitations: A case report. Conclusion: Spinal cord stimulation might be an option in the management of refractory knee pain following total knee replacement. Key Words: total knee replacement, knee pain, spinal cord stimulation

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 A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Sensors ◽  
2020 ◽  
Vol 20 (21) ◽  
pp. 6118
Author(s):  
Kevin M. Bell ◽  
Chukwudi Onyeukwu ◽  
Clair N. Smith ◽  
Adrianna Oh ◽  
Annette Devito Dabbs ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Physical Therapists ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Training System ◽  
Outpatient Rehabilitation ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Total Knee

Rehabilitation has been shown to improve functional outcomes following total knee replacement (TKR). However, its delivery and associated costs are highly variable. The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study’s objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after TKR and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Specifically, we tested post-operative outpatient rehabilitation supplemented with interACTION (n = 13) by comparing it to a standard post-operative outpatient rehabilitation program (n = 12) using a randomized design. Attrition rates were relatively low and not significantly different between groups, indicating that participants found both interventions acceptable. A small (not statistically significant) decrease in the number of physical therapy visits was observed in the interACTION Group, therefore no significant difference in total cost could be observed. All patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial. Trial registration: ClinicalTrials.gov NCT02646761 “interACTION: A Portable Joint Function Monitoring and Training System for Remote Rehabilitation Following TKA” 6 January 2016.

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