scholarly journals Recent Advances and Developments in Knee Surgery: Principles of Periprosthetic Knee Fracture Management

2012 ◽  
Vol 6 (1) ◽  
pp. 301-304 ◽  
Author(s):  
Mukai Chimutengwende-Gordon ◽  
Wasim Khan ◽  
David Johnstone
Keyword(s):  
Risk Factors ◽  
Treatment Options ◽  
Revision Arthroplasty ◽  
Review Article ◽  
Total Knee Arthroplasties ◽  
Fracture Management ◽  
Wide Range ◽  
Total Knee ◽  
Patellar Fractures ◽  
Classification And Treatment

The management of distal femoral, tibial and patellar fractures after total knee arthroplasty can be complex. The incidence of these fractures is increasing as the number of total knee arthroplasties being performed and patient longevity is increasing. There is a wide range of treatment options including revision arthroplasty for loose implants. This review article discusses the epidemiology, risk factors, classification and treatment of these fractures.

Incidence and Risk Factors for Peripheral Nerve Injury After 383,000 Total Knee Arthroplasties Using a New York State Database (SPARCS)

2019 ◽  
Vol 34 (10) ◽  
pp. 2473-2478 ◽  
Author(s):  
Alexander B. Christ ◽  
Yu-fen Chiu ◽  
Amethia Joseph ◽  
Geoffrey H. Westrich ◽  
Stephen Lyman
Keyword(s):  
Risk Factors ◽  
New York ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
New York State ◽  
Total Knee Arthroplasties ◽  
York State ◽  
Total Knee

Colorectal anastomosis in rectal cancer surgery: methods of anastomotic leakage prevention

2021 ◽  
Vol 11 (2) ◽  
pp. 36-43
Author(s):  
S. G. Gaydarov ◽  
Z Z Mamedli ◽  
M. S. Lebedko ◽  
V. Yu. Selchuk ◽  
I. Sh. Tataev
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Surgical Complication ◽  
Treatment Options ◽  
Colorectal Anastomosis ◽  
Review Article ◽  
Rectal Cancer Surgery ◽  
Complication Rates ◽  
Preoperative Period ◽  
Minimum Risk

One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.

Recovering horses after general anaesthesia

UK-Vet Equine ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 174-182
Author(s):  
Kate Loomes ◽  
Luís Louro
Keyword(s):  
Risk Factors ◽  
General Anaesthesia ◽  
Treatment Options ◽  
Significant Risk ◽  
Recovery Phase ◽  
Review Article ◽  
Active Area ◽  
Study Results

The recovery phase after general anaesthesia in horses is associated with significant risk. Optimising recovery safety and improving outcomes is an active area of research in the equine veterinary literature. Several risk factors which may negatively influence recovery quality have been identified, but study results relating to treatment options have been conflicting in many cases. This review article describes the risks associated with recovery after equine anaesthesia and explores the evidence relating to physical and pharmacological options which may improve recovery quality.

scholarly journals Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty.

2020 ◽  
Author(s):  
Eiji Kijima ◽  
Tomohiro Thomas Kayama ◽  
Mitsuru Saito ◽  
Daisaburo Kurosaka ◽  
Ryo Ikeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Operative Management ◽  
Total Knee Arthroplasties ◽  
Preventative Measures ◽  
Total Knee ◽  
Sedative Hypnotics ◽  
Independent Risk Factors

Abstract Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%.Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

2019 ◽  
Vol 32 (08) ◽  
pp. 704-709 ◽  
Author(s):  
Adam S. Driesman ◽  
William Macaulay ◽  
Ran Schwarzkopf
Keyword(s):  
Treatment Options ◽  
Revision Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Mechanical Alignment ◽  
Future Directions ◽  
Press Fit ◽  
Implant Placement ◽  
History Of ◽  
Total Knee ◽  
Metaphyseal Bone

AbstractSuccessful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct. When placing a revision construct, there remains two options to assist with fixation, either fully cementing the entire implant or using a “hybrid” system, which combines an uncemented press-fit diaphyseal stem with cement in both the metaphysis and metaphysis–diaphysis junction of the keel. In this review, we discuss the history of these two techniques, evaluate the theoretical benefits and pitfalls, and assess the best evidence supporting each in the literature. To conclude, we will examine future directions and questions needed to better elucidate the best treatment options in a variety of revision scenarios.

scholarly journals Chronic pain after total knee arthroplasty

2018 ◽  
Vol 3 (8) ◽  
pp. 461-470 ◽  
Author(s):  
Vikki Wylde ◽  
Andrew Beswick ◽  
Julie Bruce ◽  
Ashley Blom ◽  
Nicholas Howells ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
General Health ◽  
Patient Reported Outcome Measures ◽  
Optimal Care ◽  
Wide Range ◽  
Patient Reported ◽  
Total Knee

Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Chronic pain after TKA can affect all dimensions of health-related quality of life, and is associated with functional limitations, pain-related distress, depression, poorer general health and social isolation. In both clinical and research settings, the approach to assessing chronic pain after TKA needs to be in-depth and multidimensional to understand the characteristics and impact of this pain. Assessment of this pain has been inadequate in the past, but there are encouraging trends for increased use of validated patient-reported outcome measures. Risk factors for chronic pain after TKA can be considered as those present before surgery, intraoperatively or in the acute postoperative period. Knowledge of risk factors is important to guide the development of interventions and to help to target care. Evaluations of preoperative interventions which optimize pain management and general health around the time of surgery are needed. The causes of chronic pain after TKA are not yet fully understood, although research interest is growing and it is evident that this pain has a multifactorial aetiology, with a wide range of possible biological, surgical and psychosocial factors that can influence pain outcomes. Treatment of chronic pain after TKA is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristics is advocated. To ensure that optimal care is provided to patients, the clinical- and cost-effectiveness of multidisciplinary and individualized interventions should be evaluated. Cite this article: EFORT Open Rev 2018;3:461-470. DOI: 10.1302/2058-5241.3.180004

scholarly journals Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty

2020 ◽  
Author(s):  
Eiji Kijima ◽  
Tomohiro Thomas Kayama ◽  
Mitsuru Saito ◽  
Daisaburo Kurosaka ◽  
Ryo Ikeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Operative Management ◽  
Total Knee Arthroplasties ◽  
Increased Risk ◽  
Total Knee ◽  
Sedative Hypnotics ◽  
Independent Risk Factors

Abstract Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, intra-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics have an increased risk for post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

scholarly journals Economic advantage of ‘self-made’ antibiotic-loaded spacer compared to prefabricated antibiotic-loaded spacer and spacer molds in two-staged revision arthroplasty

2021 ◽  
Vol 87 (3) ◽  
pp. 557-562
Author(s):  
K Moerenhout ◽  
S Steinmetz ◽  
M Vautrin ◽  
S Picarra ◽  
G Udin ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Treatment Options ◽  
Revision Arthroplasty ◽  
Economic Advantage ◽  
The Self ◽  
Anatomical Reconstruction ◽  
Preparation Time ◽  
Irrigation And Debridement ◽  
Total Knee

Infection after total hip or total knee arthroplasty is a serious complication implying great costs for the health care system. Amongst the different treatment options, the two-step exchange using a spacer in the interval is a valid option. We evaluate the economic impact of our self-made antibiotic-loaded hip and knee cement spacers compared with prefabricated spacers and spacer molds. Costs to prepare self-made cement spacers are detailed for each spacer type. We also assess the intraoperative time spent for fabricating our self-made hip and knee spacers. The price of these self-made knee spacer is 514 CHF (450 EUR / 505 USD) if non-articulated and 535 CHF (470 EUR / 525 USD) if articulated ; the price for the self-made hip spacer is 749 CHF (760 EUR / 735 USD). Our average preparation time is 14 minutes for our self-made knee spacers and 16 minutes for our self-made hip spacers. While the senior surgeon is fabricating the self-spacers, another surgeon of the team continues intensive irrigation and debridement. Thus, no time is lost waiting for the self-spacer to be fabricated. In our hands, self-made hip and knee spacers are at least 40-50% cheaper than prefabricated spacers and spacer-molds. This is a serious economic advantage in this already expensive surgery. When done in teamwork, self-spacer fabrication does not increase the surgery time. The economic advantage is added to the main and most important advantage of self- made spacers, which remains the possibility of patient adapted anatomical reconstruction of the joint.

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