Nociceptin is Present in Synovial Fluid of Patients Undergoing Total Knee Arthroplasty

Abstract BackgroundNociceptin, an endogenous neuropeptide with similar structure to classical opioids, is involved in a variety of systemic modulatory responses. Osteoarthritis, a chronic neuroinflammatory condition, appears to have both pro- and anti-inflammatory processes that are possibly linked to nociceptin. The presence of nociceptin in human synovial fluid has been documented in some studies; however, in others it was not detected. The goal of this pilot study was to determine whether nociceptin was present in the synovial fluid of osteoarthritic knees. MethodsPatients undergoing primary total knee arthroplasty were enrolled after Institutional Review Board approval was obtained. Synovial fluid was aspirated from patients’ operative knee joints and blood samples were obtained. A commercially available enzyme Immunoassay kit was used to test for nociceptin. A linear mixed-effects model was developed to account for the repeated measurements and baseline covariates. Least squares (adjusted) means were derived from the model to compare the sample types and to compare subgroups.ResultsTwenty patients were included in this study. Nociceptin was detected in the synovial fluid and plasma of all patients. The mean concentration (± standard deviation) of nociceptin in synovial fluid was 28.7 ± 18.2 pg/ml. The mean concentration of nociceptin in plasma were 45.2 ± 24.3 pg/ml pre-procedure, and 40.1 ± 20.6 pg/ml post-tourniquet deflation. The nociceptin concentration in synovial fluid was significantly lower than the nociceptin concentration in plasma, both pre-procedure and post-tourniquet deflation (p=0.002 and p=0.016 respectively). The nociceptin concentration in both plasma and synovial fluid was significantly lower in females versus males (p=0.012).ConclusionWe demonstrated that nociceptin is present in synovial fluid and plasma of patients undergoing total knee arthroplasty. This implies a potential role for nociceptin in modulating inflammation in osteoarthritis.Trial registrationClinicalTrials.gov, NCT02528916. Retrospectively registered on 19 August 2015, https://clinicaltrials.gov/ct2/show/NCT02528916

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Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

The Bone & Joint Journal ◽

10.1302/0301-620x.101b11.bjj-2019-0576.r1 ◽

2019 ◽

Vol 101-B (11) ◽

pp. 1356-1361 ◽

Cited By ~ 2

Author(s):

Brian P. Chalmers ◽

Kapil G. Mehrotra ◽

Rafael J. Sierra ◽

Mark W. Pagnano ◽

Michael J. Taunton ◽

...

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Aseptic Loosening ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Cox Regression Analysis ◽

Primary Tkas ◽

Total Knee ◽

The Mean

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

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Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1709181 ◽

2020 ◽

Vol 34 (01) ◽

pp. 115-120

Author(s):

Ali Utkan ◽

Emrah Caliskan ◽

Batuhan Gencer ◽

Bulent Ozkurt

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Oxford Knee Score ◽

Primary Total Knee Arthroplasty ◽

Histopathological Analysis ◽

Knee Score ◽

Total Knee ◽

The Mean ◽

Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

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Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1683976 ◽

2019 ◽

Vol 33 (07) ◽

pp. 678-684 ◽

Cited By ~ 1

Author(s):

Fahad Hossain ◽

Sujith Konan ◽

Babar Kayani ◽

Christina Kontoghiorghe ◽

Toby Barrack ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Prosthesis ◽

Oxford Knee Score ◽

Primary Total Knee Arthroplasty ◽

Primary Tkas ◽

Total Knee ◽

The Mean ◽

Primary Total Knee

AbstractThe use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

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Managing Superficial Distal Medial Collateral Ligament Insufficiency in Primary Total Knee Arthroplasty Using Bone Staples

The Journal of Knee Surgery ◽

10.1055/s-0038-1669954 ◽

2018 ◽

Vol 32 (09) ◽

pp. 900-905 ◽

Cited By ~ 1

Author(s):

Kevin T. White ◽

Andrew Fleischman ◽

Colin T. Ackerman ◽

Antonia F. Chen ◽

Richard H. Rothman

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Medial Collateral Ligament ◽

Primary Total Knee Arthroplasty ◽

Patient Questionnaire ◽

Primary Control ◽

Collateral Ligament ◽

Intraoperative Complication ◽

Total Knee ◽

The Mean

AbstractSuperficial medial collateral ligament (MCL) injury is an occasional intraoperative complication during total knee arthroplasty (TKA) that can lead to failure. Although previous studies have recommended complex repair or conversion to a constrained implant, the authors evaluated results of superficial distal MCL reapproximation using bone staples. Records of 31 patients who underwent staple reapproximation for superficial MCL avulsion from the tibial attachment during primary TKA from 2005 to 2015 were reviewed. They were compared with 685 patients who underwent uncomplicated TKA (primary control) and 18 who underwent revision TKA for instability (secondary control). Subjective knee instability was assessed with a patient questionnaire, and other end points included revision for instability or stiffness and manipulations under anesthesia. The authors prospectively collected Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale satisfaction scores. The mean follow-up was 2.6 years. No patients treated with staple repair required revision for instability, whereas two patients were revised in the primary control. Subjective instability was reported in 19.2% of staple repair patients compared with 24.2 and 46.2% of patients in the primary and secondary controls. The mean KOOS for the staple group was 71.7 points, 77.3 for the primary control, and 49.3 for the secondary. KOOSs for the staple group were 5.6 points lower than the primary control, but 22.4 points higher than the secondary. Staple reapproximation is a simple and effective method for repairing the superficial distal MCL in primary TKA. The rate of instability and functional outcomes was comparable to uncomplicated primary TKA.

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Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-020-00561-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Fabio Mancino ◽

Ivan De Martino ◽

Aaron Burrofato ◽

Carmine De Ieso ◽

Maristella F. Saccomanno ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Consecutive Series ◽

Radiographic Outcomes ◽

First Choice ◽

Total Knee ◽

The Mean ◽

Primary Total Knee

Abstract Background The purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability. Materials and methods A consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees. Results At a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension. Conclusion CCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants. Level of evidence Therapeutic study, level IV.

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Analysis of differences in bone removal during femoral box osteotomy for primary total knee arthroplasty

Joints ◽

10.11138/jts/2014.2.2.076 ◽

2014 ◽

Vol 02 (02) ◽

pp. 76-80 ◽

Cited By ~ 2

Author(s):

Angelo Graceffa ◽

Pier Indelli ◽

Kaitlyn Basnett ◽

Massimiliano Marcucci

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Clinical Relevance ◽

Primary Total Knee Arthroplasty ◽

Mean Difference ◽

Medium Size ◽

Bone Removal ◽

Implant Size ◽

Total Knee ◽

The Mean

Purpose: this study was conducted to compare the quantity of intercondylar bone removed during femoral box osteotomy for implantation of three contemporary posterior stabilized (PS) total knee arthroplasty designs: Sigma PS (DePuy), Vanguard (Biomet) and Persona (Zimmer). Methods: we compared the maximum volumetric bone resection required for the housing of the PS mechanism of these three designs. Bone removal by each PS box cutting jig was three-dimensionally measured. The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test was used for pairwise comparisons. The level of significance was set at p<0.05. Results: for small-size implants, the average box osteotomy volume of Persona was significantly smaller than the Vanguard and Sigma PS volumes (p=0.003). The mean difference between Vanguard and Sigma PS (p=0.01) was also significant. For medium size implants, the mean difference between Persona and Sigma PS (p=0.008) and the mean difference between Vanguard and Sigma PS (p=0.01) were statistically significant. For large size implants, the mean difference between Vanguard and Sigma PS (p=0.01) and the mean difference between Sigma PS and Persona (p=0.008) were statistically significant. Conclusions: irrespective of implant size, the Persona cutting jig always resected significantly less bone than did Vanguard and Sigma PS. Clinical Relevance: although this study does not establish any clinical relevance of removing more or less bone at primary TKA, its results suggest that if a PS design is indicated, it is preferable to select a model which resects less distal femoral bone.

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A STUDY OF PRIMARY TOTAL KNEE ARTHROPLASTY (TOTAL KNEE REPLACEMENT) IN SEVERE DEGENERATIVE OSTEO ARTHRITIS OF KNEE

10.36106/ijar/2404944 ◽

2021 ◽

pp. 56-58

Author(s):

Voligi Shekhar ◽

Sateesh Chandra P ◽

Gunda Veera Redd

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Computer Assisted ◽

Assisted Navigation ◽

Total Knee ◽

The Mean ◽

Lost To Follow Up ◽

Primary Total Knee

AIM: To assess the clinical outcome, to study radiological variable inuencing the outcome of total knee arthroplasty and to identity patient variable which signicantly inuence the outcome. Out MATERIALS&METHODS: of the 30 Arthroplasties performed in 28 patients with in the study period. 5 patients (5 knees) were lost to follow-up for various reasons and thus 23 patients (25 knees) were available for clinical review. The mean age of the patient RESULTS: at the time of surgery was 61.04 years. 76% of Knee had primary osteoarthritis and 25% had secondary OA. The average post-operative alignment as 4.3º valgus (range, 3º varus-10º valgus), the mean posterior slope of tibia (s) was 3.5º (range, 0-8º)c and the average femoral exion angle (?) 7.6º. In the assessment of post CONCLUSION: operative outcome of total knee arthroplasty, Knee Society Score is a very useful tool. Restoration of normal alignment of valgus (6 + 2º) is possible with conventional (without computer assisted navigation) surgical technique.

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Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

Advances in Orthopedics ◽

10.1155/2019/4096306 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Rohan Bhimani ◽

Fardeen Bhimani ◽

Preeti Singh

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Computer Navigation ◽

Primary Total Knee Arthroplasty ◽

P Value ◽

Mechanical Alignment ◽

Significant Difference ◽

Total Knee ◽

The Mean

Introduction. Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods. We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient’s pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results. The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion. Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.

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SMOC Approach for Total Knee Arthroplasty in Valgus Knees

10.21203/rs.3.rs-107449/v1 ◽

2020 ◽

Author(s):

Tao Li ◽

Yingzhen Wang ◽

Haiyan Li ◽

Pengcheng Guo ◽

Haining Zhang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Soft Tissues ◽

Primary Total Knee Arthroplasty ◽

Valgus Deformity ◽

Early Recovery ◽

Subvastus Approach ◽

Total Knee ◽

The Mean

Abstract Purpose The subvastus approach sometimes can not provide adequate exposure and lateral approach has disadvantages of closure of the soft tissues and patellar tracking. The hypothesis of this study was that SMOC approach could be used in valgus knees and would offer good function.Methods We retrospectively reviewed 25 patients (25 knees) with valgus deoformity undergoing primary total knee arthroplasty (TKA) with SMOC approach. Necessary soft tissue releases, Visual Analog Scale (VAS), straight leg raising (SLR), International Knee Society score (KSS), radiological alignment were assessed with average follow-up of 16 months.Results KSS improved significantly from 38.5 to 90.3. The mean range of motion increased from 89.5°to 121.8°.The mean tibiofemoral valgus was corrected from preoperative 17.1° to 6.3°. No instability, recurrent valgus deformity, or radiographic loosening was found during follow-up.Conclusions SMOC approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.

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Delayed Onset of Deep Infection after Total Knee Arthroplasty: Comparison Based on the Infecting Organism

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500205 ◽

2007 ◽

Vol 15 (2) ◽

pp. 154-158 ◽

Cited By ~ 10

Author(s):

S Joshy ◽

N Gogi ◽

B Thomas ◽

A Mahale ◽

BK Singh

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Deep Infection ◽

Control Measures ◽

Salvage Procedure ◽

Methicillin Resistant ◽

Infection Control Measures ◽

Total Knee ◽

The Mean

Purpose. To identify the organisms causing delayed deep infection following primary total knee arthroplasty (TKA) and to compare the differences in outcome based on the infecting organism. Methods. Between the period April 1998 and March 2004 inclusive, patients presenting with delayed deep infection following primary TKA and/or those who underwent a salvage procedure (amputation or arthodesis) were retrospectively studied. Results. Organisms were isolated in 27 patients; 44% were methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. When the organism was resistant, the mean number of surgical procedures per patient was significantly higher and the proportion of patients with satisfactory outcomes was significantly lower. Conclusion. Deep infection with methicillin-resistant S aureus or S epidermidis is increasing. Strict infection control measures must be in place to combat such problems.

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