Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

Abstract Purpose: We hypothesized that patellar positioning during minimally invasive total knee arthroplasty (MIS-TKA) would affect soft tissue balance and postoperative outcome.Methods: From December 2018 to February 2019, 55 patients receiving primary MIS-TKA were enrolled. The gap-balance technique was used, with patients randomly assigned to undergo osteotomy and balance of soft tissue with the patella reduced (group A; n = 27) or with the patella subluxated (group B; n = 28). The soft tissue balance achieved with the patella reduced and subluxated were compared. Femoral prosthesis rotation, mechanical femoral axis–to–tibial axis angle, Knee Society Score (KSS), pain score, and range of flexion were compared between the groups. Follow-up was for 6 months.Results: The flexion gap and the varus angle were significantly greater after patella reduction than before reduction, but the extension joint gap and varus angle were comparable before and after patella reduction. The femoral prosthesis tended to be internally rotated in group B. Range of flexion was better in the group A than in group B at 1 month after surgery, but the differences were not significant at 3 and 6 months. KSS and pain score were comparable between the groups after surgery.Conclusion: During MIS-TKA, as far as possible, soft tissue balance should be achieved with the patella reduced; otherwise, the femoral prosthesis may be installed more internally and, after patella reduction, the flexion gap and varus would increase.

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Comparison of minimally invasive total knee arthroplasty with standard approach total knee arthroplasty in terms of length of post-operative hospital stay.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3552 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1246-1250

Author(s):

Muhammad Usman Haider ◽

Raja Umar Liaqat ◽

Junaid Khan ◽

Islam Ud Din ◽

Muhammad Imran Aftab

Keyword(s):

Total Knee Arthroplasty ◽

Minimally Invasive ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Standard Approach ◽

Invasive Technique ◽

Group A ◽

Total Knee ◽

Group B

To compare the minimally invasive total knee arthroplasty with standard approach total knee arthroplasty in terms of mean length of post-operative hospital stay. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi. Period: 06 months i.e. from 21st March 2018 to 20th September 2018. Materials and Methods: A total of one hundred (n=100) patients between age 30-80 years who were planned to undergo total knee arthroplasty (TKA) were enrolled and randomly allocated to two groups. The patients in group A were operated through minimally invasive technique and in group B, were operated through standard approach. Outcome was measured in terms of mean length of hospital stay in both groups. Results: Baseline characteristics were comparable in both the groups. In group A, mean length of hospital stay was 4.4±0.64 days while in group B it was 5.6±0.63 days (p=0.001). Similar trend was noted when data was stratified with respect to age, gender, anatomical side and BMI. Conclusion: Minimally invasive TKA resulted in shorter length of hospital stay following when compared with standard approach TKA.

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Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Arthroplasty ◽

10.1186/s42836-020-00063-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Sanjay Bhalchandra Londhe ◽

Ravi Vinod Shah ◽

Amit Pankaj Doshi ◽

Shubhankar Sanjay Londhe ◽

Kavita Subhedar ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Forgotten Joint Score ◽

Group A ◽

Manipulation Under Anaesthesia ◽

Total Knee ◽

The Mean ◽

Group B ◽

Discharge From Hospital

Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.

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The influence of previous arthroscopic treatment on subsequent primary total knee arthroplasty: the comparison between bilateral knees of the same patient

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04003-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kuishuai Xu ◽

Liang Zhang ◽

Rui Shen ◽

Cailin Wang ◽

Tianyu Li ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Functional Recovery ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Arthroscopic Treatment ◽

Functional Scores ◽

Group A ◽

Vas Scores ◽

Total Knee ◽

Group B

Abstract Background To explore whether previous arthroscopic knee surgery affects future total knee arthroplasty (TKA) results or not. Methods A total of 56 patients with the previous arthroscopic treatment on one knee underwent subsequent bilateral total knee arthroplasty in our hospital from September 2012 to July 2018. Data on each patient were collected in regards to changes in postoperative clinical and functional scores, various other scores, as well as postoperative functional recovery and complications. We defined the knees with a previous arthroscopic history as group A, and the counter side as group B. The Knee Society clinical score, functional scores, range of motion (ROM), finger joint size (FJS), visual analogue scale (VAS) scores were assessed before and after surgery. Using the Kolmogorov-Smirnov Test to test the normality of continuous variables, and the chi-square test to compare the rate of reoperation and complications between two groups. For all statistical comparisons, P < 0.05 was considered significant. Results There were no statistically significance differences found in postoperative Knee Society clinical scores and functional scores between group A and group B, as well as in ROM, FJS, VAS scores and local complications. Conclusion There were no statistically significant differences found in postoperative functional recovery and complications in patients, who underwent total knee arthroplasty with previous knee arthroscopy.

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Soft Tissue Balance Changes Depending on Joint Distraction Force in Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2013.07.025 ◽

2014 ◽

Vol 29 (3) ◽

pp. 520-524 ◽

Cited By ~ 23

Author(s):

Kanto Nagai ◽

Hirotsugu Muratsu ◽

Tomoyuki Matsumoto ◽

Hidetoshi Miya ◽

Ryosuke Kuroda ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Soft Tissue Balance ◽

Joint Distraction ◽

Total Knee ◽

Distraction Force

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Soft-Tissue Balance in Revision Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200400001-00011 ◽

2004 ◽

Vol 86 ◽

pp. 81-86 ◽

Cited By ~ 8

Author(s):

MICHAEL D. RIES ◽

STEVEN B. HAAS ◽

RUSSELL E. WINDSOR

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Soft Tissue Balance ◽

Total Knee

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Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2885-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Hao-Yang Wang ◽

Liu Wang ◽

Ze-Yu Luo ◽

Duan Wang ◽

Xin Tang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Total Blood ◽

Significant Difference ◽

Group A ◽

Total Knee ◽

Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

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Acute normovolemic hemodilution in total knee arthroplasty, a prospective study

International Surgery ◽

10.9738/intsurg-d-15-00149.1 ◽

2016 ◽

Author(s):

Jin Kyu Lee ◽

Mi Ae Cheong ◽

Choong Hyeok Choi

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Allogeneic Blood ◽

Acute Normovolemic Hemodilution ◽

Allogeneic Transfusion ◽

Group A ◽

Total Knee ◽

Normovolemic Hemodilution ◽

Group B

Abstract Objective: In this prospective, randomized, controlled trial we sought to evaluate the effectiveness of acute normovolemic hemodilution (ANH) in terms of decreasing the need for allogeneic transfusion after conventional unilateral total knee arthroplasty (TKA). Summary of Background Data: TKA is often performed with an occlusive tourniquet, and thus, it could be considered ideally suited for ANH, because the chief benefit of ANH is red blood cell loss reduction and the shedding of whole blood perioperatively at lower hematocrit levels. Methods: Between January 2012 and May 2012, 40 consecutive patients scheduled to undergo elective, primary, cemented, unilateral TKA for knee osteoarthritis were enrolled. Patients were randomized to either a study (ANH) group (n=20) (Group A) or a control group (n=20) (Group B). Unit of allogeneic blood transfused was considered the primary outcomes. Results : In the ANH group, less allogeneic blood transfusion (6 units in Group A vs 15 units in Group B) was required after operation. Six patients, who required a transfusion in Group A received 1 unit of allogeneic blood. In contrast, 6 of 9 patients, who required transfusion in Group B, received at least 2 units of allogeneic blood (p<0.05). There was no complication related to the methods of the protocol. Conclusions: ANH is likely to reduce postoperative allogeneic transfusion requirement in patients undergoing unilateral TKA. However, adjunctive strategies are required to further reduce allogeneic blood transfusion requirements.

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