Wound closure after total knee replacement: Comparison between staples and sutures

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Mansoor Ali Khan ◽  
M. Waseem Memon ◽  
Amin Chinoy ◽  
Salman Javed ◽  
Rahil Barkat ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
P Value ◽  
Incision Length ◽  
Total Knee ◽  
The Mean ◽  
The Right

Background and Objective: Total Knee Arthroplasty is a commonly performed procedure for arthritic knees. Preventing complications is of utmost importance for good functional outcomes and preventing morbidity. Wound closure after the procedure is as important as the replacement aspect of surgery.The objective of this study was to provide subjective and objective evidence of better closure technique and material; we conducted the study so that the outcome of TKA can be further improved. Methods: We conducted a randomized trial at The Indus Hospital, Karachi, from December 2018 to June 2020. All patients from age 40 to 70 years who underwent total knee arthroplasty were included in the study. The wound of one knee was closed with Polypropylene (Prolene) sutures, and the other with staples. The wound was assessed independently by two assessors using Hollander’s score; lower score means a worse outcome. All data was entered and analyzed using STATA version 16. Results: Thirty patients who underwent bilateral total knee replacement were included in the analysis, among which 71.8% were female. The average age of participants was 57.3 (± 7.5) years. The mean incision length on the right knee was 17.6 ± 1.1 cm, while on the left the incision length was 18.3 ± 1.2 cm. Overall, the mean Hollander score was significantly different among participants in the sutures and staples group in both the right (p-value=0.001) and left knees (p-value=0.001). The score was significantly higher in knees closed with sutures as compared to staples. Also, the mean Hollander score is significantly higher in females than males in both the right knee (B=0.56, p-value=0.049) and the left knee (B=0.38, p-value=0.044). Conclusion: The study has shown that Hollander’s score was significantly higher in knees closed with sutures as compared to the patients in whom staples were used for wound closure. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5782 How to cite this:Khan MA, Memon MW, Chinoy A, Javed S, Barkat R, Jiwani A. Wound closure after total knee replacement: Comparison between staples and sutures. Pak J Med Sci. 2022;38(2):340-344. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5782 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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>

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 One Stage Conversion of an Infected Fused Knee to Total Knee Replacement - A Surgical Challenge

2013 ◽  
Vol 7 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Mukartihal Ravikumar ◽  
Daniel Kendoff ◽  
Mustafa Citak ◽  
Stefan Luck ◽  
Thorsten Gehrke ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Revision Arthroplasty ◽  
Preoperative Assessment ◽  
Stage Conversion ◽  
One Stage ◽  
Common Technique ◽  
Total Knee ◽  
The Right

Background and Purpose: Two-stage revision arthroplasty is a common technique for the treatment of infected total knee replacement. Few reports have addressed the conversion of a fused knee into a total knee replacement. However, there is no case reported of converting an infected fused knee into a hinge knee using a one-stage procedure. Methods: We report on a 51-year old male patient with an infected fused knee after multiple surgeries. Results and Interpretation: A one-stage conversion of septic fused knee into total knee arthroplasty by a rotational hinge prosthesis was performed. The case highlights that with profound preoperative assessment, meticulous surgical technique, combined antibiotic treatment and the right implant, one-stage revision in a surgical challenge may have a role as a treatment option with good functional outcome.

scholarly journals Arthroscopic Treatment of Patients with Arthrofibrosis Following Total Knee Replacement

2018 ◽  
Vol 69 (11) ◽  
pp. 3292-3294
Author(s):  
Daniel Oltean Dan ◽  
Gabri Jozsef Zsolt ◽  
Dragos Apostu ◽  
Mihai Gheorghe Paiusan ◽  
Cristian Paul Dan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Range Of Motion ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Knee Society Score ◽  
Arthroscopic Treatment ◽  
Arthroscopic Arthrolysis ◽  
Total Knee

The main objective of the current study was to evaluate the success of arthroscopic arthrolysis treatment of patients with knee stiffness after total knee arthroplasty. Six patients who underwent arthroscopic arthrolysis were evaluated retrospectively, all of them being treated conservatively before going for surgery. Results showed significant improvement of range of motion and Knee Society Score at the latest follow up compared to the preoperative values. This study concludes that arthroscopic arthrolysis is an effective and reproductible technique for the treatment of knees stiffness after total knee arthroplasty.

scholarly journals Fungal Prosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Baraa W Mafrachi ◽  
Ashraf H Al Debei ◽  
Farah M Al Muhtaseb ◽  
Jihad M Al Ajlouni ◽  
Yazan S Hammad
Keyword(s):  
Total Knee Arthroplasty ◽  
Case Report ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Rare Complication ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
Total Knee

Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan. Keywords: Fungal prosthetic joint infection, fungal infection, total knee replacement, total knee replacement complication.

Interdisciplinary Management for Total Knee Replacement in Patients with Hemophilia and Severe Arthropathy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4063-4063
Author(s):  
Andrea Gerhardt ◽  
Kristina Stahlschmidt ◽  
Andreas Werner ◽  
Ruediger Krauspe ◽  
Ruediger E. Scharf
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Total Knee Replacement ◽  
Factor Viii ◽  
Replacement Therapy ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Severe Hemophilia ◽  
Total Knee ◽  
Custom Made Prostheses

Abstract Severe hemophilia is complicated by spontaneous joint bleedings, leading to severe secondary arthrosis. Hemophilic arthropathy with symptoms of incapacitating knee pain, not responding to medical treatment, associated with an impaired function is a clear indication for total knee replacement (TKR). Primary goals of total knee arthroplasty (TKA) are pain relief and satisfactory function which depends on adequate joint stability and motion. A well-balanced hemostasis is a basic requirement for successful interventions in hemophilic patients. Furthermore, the postoperative range of motion (ROM) depends on many factors, including surgical technique, preoperative motion, and appropriate rehabilitation. We report on our experience with 7 arthroplasties of knee joint arthropathies in 7 patients with severe hemophilia A (n = 4) and severe hemophilia B (n = 3). Indication for total knee replacement was arthropathy in stage III–V, progressive joint destruction, flexion contracture, axial malalignment, and pain refractory to conservative treatment. The average age of the patients at the time of arthroplasty was 35 years (range 18–42 years). Three patients were seropositive for HIV and HCV, 1 patient for HIV, 1 patient for HCV, and 2 patients had no viral infections. Mean hospitalization was 16.7 days (range 14 – 21 days). Six of 7 patients received a non-constrained bicondylar TKA (LCS complete n=5, Rotaglide n=1) and one patient a constrained bicondylar TKA (custom-made prostheses). The TKAs were inserted using bone cement containing gentamycin. Implantation was performed after arterial closure via medial dissection. Surgery was covered by appropriate factor VIII or IX replacement therapy with episodic bolus injections (factor VIII activity aimed at 100%). Median consumption of coagulation factor was 113.742 units (range 55.000 – 157.000 units). The postoperative blood loss was approximately 831 ml blood (range 250–1200 ml) in the low-vacuum drainage systems, the mean range of preoperative and postoperative haemoglobin (13.8 g/dl vs. 9.3 g/dl) was 4.5 g/dl. Transfusion of red blood cells was not required in any of the 7 individuals. Postoperative thromboembolic prophylaxis with low molecular weight heparin (4000 IE/day) was performed in all patients. The short-term results after a mean follow-up interval of 22 month (range 2–59 months) revealed no peri- and postoperative thromboembolic or bleeding complications and no infections. In 6 of 7 patients the knee extension improved with an average from 29.3° preoperatively to 5° postoperatively. One patient with reduced compliance (left hospital contrary to medical advice, rejected rehabilitation) suffered from postoperative articular fibrosis which made an open arthrolysis 3 and 8 month postoperative necessary and brought benefit in ROM from flexion/extension pre-operative 100/30/0 to 80/0/0 postoperative. In summary, our interdisciplinary treatment protocol demonstrates that total knee arthroplasty can be performed in high- risk hemophilic patients with a low rate of complications and in improvement in quality of life because of pain-relief and increase of motility and function in all patients. The high-dose replacement therapy is justified by the clinical outcome and benefit to the patients.

scholarly journals Comparison of canine stifle kinematic analysis after two types of total knee arthroplasty: A cadaveric study

2020 ◽  
Vol 13 (5) ◽  
pp. 956-962
Author(s):  
Chaiyakorn Thitiyanaporn ◽  
Nattapon Chantarapanich ◽  
Somchai Sompaisarnsilp ◽  
Naris Thengchaisri
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Cruciate Ligament ◽  
Testing Machine ◽  
Cranial Cruciate Ligament ◽  
Total Knee ◽  
Canine Stifle

Background and Aim: Osteoarthritis is a common consequence of cranial cruciate ligament rupture (CCLR) in the canine stifle. Total knee replacement is a valuable method for managing end-stage osteoarthritis. Materials and Methods: Two new designs of total knee replacement implants were fabricated with information from computed tomography scans. Canine hind limbs of cadavers were tested with a biomechanical testing machine with C-arm fluoroscopy. The four groups tested were as follows: Intact stifles (INTACT), CCLR, total knee arthroplasty (TKA) with a peg on top of the tibial component (TKAP), and TKA with no peg on top of the tibial component (TKAN). Extension, flexion, adduction, abduction, internal rotation, external rotation, cranial translation, caudal translation, and range of motion were measured. Results: The cranial translation of the tibia relative to the femur increased significantly after cutting off the cranial cruciate ligament. After arthroplasty, adduction/abduction and cranial/caudal translation within the TKAN group was increased compared with the intact stifle group. In the TKAP group, only adduction was greater than it was in the intact stifle group. Conclusion: The design of the prosthesis used for the TKAP group was more appropriate for total knee replacement in dogs than the design of the prosthesis for the TKAN group.

scholarly journals Treating Stiffness After Total Knee Arthroplasty: A Technical Note and Preliminary Results

2012 ◽  
Vol 6 (1) ◽  
pp. 276-280 ◽  
Author(s):  
Parag K Jaiswal ◽  
Jonathan R Perera ◽  
Wasim Khan ◽  
Sudhir G Rao
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Daily Living ◽  
Technical Note ◽  
Range Of Movement ◽  
Total Knee ◽  
Patient Series ◽  
Small Patient

Total Knee Replacement is used to treat pain, stiffness and reduced range of movement. It has been estimated that a minimum of 90 degrees of range of motion in the knee is required for normal activities of daily living. In this article we demonstrate a technical note with a small patient series about the methods of treating knee stiffness after Total Knee Replacement.

scholarly journals Total Knee Arthroplasty after Correction of Tibial Diaphyseal Nonunion with Clamshell Osteotomy

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Pingal Desai ◽  
Vivek Sharma ◽  
Karanvir Prakash
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Lower Extremity ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
Osteotomy Site ◽  
Relieve Pain ◽  
Total Knee ◽  
Made In

Total knee arthroplasty is mostly done to relieve pain and disability from a severe and degenerated knee. Deformities in the coronal and sagittal plane could be corrected with the help of cuts made in tibia and femur during total knee replacement as well as with ligament release. However, large deformities in the lower extremity particularly in the diaphysis region need correction prior to the total knee replacement. It helps to limit the amount of bone that will be cut and helps the ligament release. Several extra articular and intra-articular methods for the correction of diaphyseal deformity have been described. We present the case of clamshell osteotomy for the correction of diaphyseal deformity in the tibia and a total knee replacement after the osteotomy site healed.

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