scholarly journals Medial subvastus versus the medial parapatellar approach for total knee replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 78-84 ◽  
Author(s):  
James R. Berstock ◽  
James R. Murray ◽  
Michael R. Whitehouse ◽  
Ashley W. Blom ◽  
Andrew D. Beswick
Keyword(s):  
Visual Analogue Score ◽  
Deep Infection ◽  
Subvastus Approach ◽  
Vein Thrombosis ◽  
Total Knee Replacements ◽  
Knee Movement ◽  
Total Knee ◽  
One Year ◽  
Straight Leg Raise ◽  
Deep Vein

Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review. The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% confidence interval [CI] 1.0 to 2.3), visual analogue score for pain on day one (0.8 points on a scale out of 10, 95% CI 0.2 to 1.4) and total range of knee movement at one week (7°, 95% CI 3.2 to 10.7). The subvastus approach also resulted in fewer lateral releases (odds ratio 0.4, 95% CI 0.2 to 0.7) and less peri-operative blood loss (MD 57 mL, 95% CI 10.5 to 106.4) but prolonged surgical times (MD 9.7 min, 95% CI 3.9 to 15.6). There was no difference in Knee Society Score at six weeks or one year, or the rate of adverse events including superficial or deep infection, deep vein thrombosis or knee stiffness requiring manipulation under anaesthesia. This review demonstrates evidence of early post-operative benefits following the subvastus approach with equivalence between approaches thereafter. Cite this article: EFORT Open Rev 2018;3:78-84. DOI: 10.1302/2058-5241.3.170030.

scholarly journals Beware of the hot swollen calf following knee replacement surgery: it might not be a deep vein thrombosis

2019 ◽  
Vol 12 (11) ◽  
pp. e227830
Author(s):  
Benedict Lotz ◽  
Antony Palmer ◽  
Sunny D Deo
Keyword(s):  
Knee Replacement ◽  
Replacement Surgery ◽  
Vein Thrombosis ◽  
Total Knee Replacements ◽  
Joint Infections ◽  
History Of ◽  
Radical Debridement ◽  
Total Knee ◽  
Cement Removal ◽  
Deep Vein

We report the case of a 77-year-old woman who presented with a 10-day history of increasing swelling and erythema of her right calf and popliteal areas 12 years after bilateral total knee replacements. Deep venous thrombosis (DVT), cellulitis or possible deep sepsis as a result of the knee replacement were the initial differential diagnoses. Due to clinical deterioration, exploration and radical debridement were performed and a 1.5 L collection of pus was identified through a small posteromedial proximal tibial bone defect adjacent to the tibial component, extending between gastrocnemius, soleus and into the distal calf. The procedure was extended to a first stage revision (complete implant and cement removal). Although leg swelling is common in joint infections secondary to knee swelling as a result of the inflammation, synovitis and/or knee effusion response, this case highlights the need to consider additional pathology such as deep abscess formation or DVT in these types of presentations.

EFFECTS OF EPIDURAL ANESTHESIA ON THE INCIDENCE OF DEEP VEIN THROMBOSIS FOLLOWING TOTAL KNEE ATHROPLASTY

1989 ◽  
Vol 71 (Supplement) ◽  
pp. A1158
Author(s):  
N. E. Sharrook ◽  
Mary Jean Hargelt ◽  
B. Urquhart ◽  
J. N. Insall ◽  
S. Haas
Keyword(s):  
Deep Vein Thrombosis ◽  
Epidural Anesthesia ◽  
Vein Thrombosis ◽  
Total Knee ◽  
Deep Vein

Costs of unicompartmental compared with total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 23-31
Author(s):  
Robert A. Burnett III ◽  
JaeWon Yang ◽  
P. Maxwell Courtney ◽  
E. Bailey Terhune ◽  
Charles P. Hannon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Healthcare Costs ◽  
Cost Savings ◽  
Vein Thrombosis ◽  
Total Knee ◽  
The Mean ◽  
One Year ◽  
Surgery Rates

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.

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