scholarly journals Assessing Recovery and Establishing Prognosis Following Total Knee Arthroplasty

2008 ◽  
Vol 88 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Deborah M Kennedy ◽  
Paul W Stratford ◽  
Daniel L Riddle ◽  
Steven E Hanna ◽  
Jeffrey D Gollish
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Functional Status ◽  
Knee Arthroplasty ◽  
Rate Of Change ◽  
Change Over Time ◽  
Total Knee ◽  
Preoperative Status ◽  
And Gender ◽  
Over Time

Background and PurposeInformation about expected rate of change after arthroplasty is critical for making prognostic decisions related to rehabilitation. The goals of this study were: (1) to describe the pattern of change in lower-extremity functional status of patients over a 1-year period after total knee arthroplasty (TKA) and (2) to describe the effect of preoperative functional status on change over time.SubjectsEighty-four patients (44 female, 40 male) with osteoarthritis, mean age of 66 years (SD=9), participated.MethodsRepeated measurements for the Lower Extremity Functional Scale (LEFS) and the Six-Minute Walk Test (6MWT) were taken over a 1-year period. Data were plotted to examine the pattern of change over time. Different models of recovery were explored using nonlinear mixed-effects modeling that accounted for preoperative status and gender.ResultsGrowth curves were generated that depict the rate and amount of change in LEFS scores and 6MWT distances up to 1 year following TKA. The curves account for preoperative status and gender differences across participants.Discussion and ConclusionThe greatest improvement occurred in the first 12 weeks after TKA. Slower improvement continued to occur from 12 weeks to 26 weeks after TKA, and little improvement occurred beyond 26 weeks after TKA. The findings can be used by physical therapists to make prognostic judgments related to the expected rate of improvement following TKA and the total amount of improvement that may be expected.

scholarly journals Radiolucent lines are decreased at 3 years following total knee arthroplasty using trabecular metal tibial components

2018 ◽  
Vol 46 (5) ◽  
pp. 1919-1927 ◽  
Author(s):  
Hirotaka Mutsuzaki ◽  
Arata Watanabe ◽  
Tomonori Kinugasa ◽  
Kotaro Ikeda
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
X Rays ◽  
Trabecular Metal ◽  
Change Over Time ◽  
Radiolucent Lines ◽  
Total Knee ◽  
Over Time

Objective To analyse location and frequency, and change over time, of radiolucent lines (RLLs) around trabecular metal tibial components in total knee arthroplasty (TKA). Methods Osteoarthritic knees in patients who had undergone TKA were retrospectively evaluated via analysis of RLLs on anteroposterior and lateral X-rays obtained at 2 and 6 months, and 1, 2 and 3 years following TKA. Results In 125 osteoarthritic knees from 90 patients (mean age, 75.0 ± 6.2; 21 male/69 female), frequency of RLLs around trabecular metal tibial components was generally highest at 2 and 6 months, and 1 year following TKA, then gradually decreased over the 3-year follow-up. Frequency of RLLs around trabecular metal tibial components was greater at the tip of the two pegs, particularly the medial peg, and around the pegs, versus other zones. No postoperative revisions were performed for loosening. Conclusions Over 3 years following TKA, RLLs were most frequently observed up to 1 year, then gradually decreased. RLLs were significantly more frequent in the medial peg zone and zones close to the medial peg than in other zones.

Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position

2021 ◽  
Author(s):  
Pablo Besa ◽  
Rafael Vega ◽  
Gerardo Ledermann ◽  
Claudio Calvo ◽  
Manuela Angulo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Anatomical Landmark ◽  
Mechanical Alignment ◽  
Longus Tendon ◽  
Extensor Hallucis Longus ◽  
Tibial Cut ◽  
Total Knee

AbstractThis study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.

AB1284-HPR RELIABILITY OF STEP TEST IN SUBJECTS WITH TOTAL KNEE ARTHROPLASTY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1932.1-1933
Author(s):  
M. Eymir ◽  
E. Yuksel ◽  
B. Unver ◽  
K. Sevik ◽  
V. Karatosun
Keyword(s):  
Total Knee Arthroplasty ◽  
Motor Control ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Lower Limb ◽  
Standing Balance ◽  
Step Test ◽  
Retest Reliability ◽  
Total Knee ◽  
Test Retest Reliability

Background:Patients with TKA show impairments in standing balance up to 1 year after surgery. The impaired standing balance in TKA patients was found to be associated with falls risk and decreased functional level. Assessing of standing balance with objective and reliable assessments tools would therefore be extremely useful for determining accurate exercise program, and risks of falling, especially during the rehabilitative period when ambulation is at its most unsteady (1, 2). The stepping maneuver requires adequate strength and motor control to stabilize the body over the stance limb while the other leg is stepping, therefore the Step Test (ST) provides significant information for dynamic standing balance and lower limb motor control (3). The reliability of ST is reported in patient groups such as stroke, however, there is not any study that investigates the reliability of ST in patients with TKA in the current literature.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the ST in patients with TKA.Methods:40 patients with TKA due to knee osteoarthritis, operated by the same surgeon, were included in this study. Patients performed trials for ST twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The ST assesses an individual’s ability to place one foot onto a 7.5-cm-high step and then back down to the floor repeatedly as fast as possible for 15 seconds. The score is the number of steps completed in the 15-second period for each lower extremity. Scores for each lower extremity were recorded separately. Prior to the testing, the ST was demonstrated by the tester and all participants were allowed to a practice trial.Results:The ST showed an excellent test-retest reliability (ICC2,1=0.95) in this study. Standard error of measurement (SEM) and MDC95for ST were 0.37 and 1.02, respectively.Conclusion:This study found that the ST has an excellent test–retest reliability in patients with TKA. It is an effective and reliable tool for measuring dynamic standing balance and participant falls. As a performance-based clinical test, the ST is easy to score, can be applied in a short time as part of the routine medical examination. Therefore, inclusion of ST into a more comprehensive battery of performance-based measures of standing balance and lower limb motor control function in subjects with TKA should be considered.References:[1]Si, H. B., Zeng, Y., Zhong, J., et al. (2017). The effect of primary total knee arthroplasty on the incidence of falls and balance-related functions in patients with osteoarthritis. Scientific reports, 7(1), 1-9.[2]Moutzouri, M., Gleeson, N., Billis, E., et al. (2017). The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 25(11), 3439-3451.[3]Hill, K. D., Bernhardt, J., McGann, A. M., et al. (1996). A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiotherapy Canada, 48(4), 257-262.Disclosure of Interests:None declared

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

2020 ◽  
Author(s):  
Andrew D. Ardeljan ◽  
Teja S. Polisetty ◽  
Joseph Palmer ◽  
Rushabh M. Vakharia ◽  
Martin W. Roche
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Fall Risk ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Lower Extremity Fracture ◽  
Extremity Fracture ◽  
Total Knee ◽  
Primary Total Knee

AbstractDespite the high incidence of sarcopenia in the orthopaedic community, studies evaluating the influence of sarcopenia following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study is to determine if sarcopenic patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) implant-related complications; (4) fall risk; (5) lower extremity fracture risk; and (6) costs of care. Sarcopenia patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 90,438 patients with (n = 15,073) and without (n = 75,365) sarcopenia undergoing primary TKA. Primary outcomes analyzed included: in-hospital LOS, 90-day medical complications, 2-year implant-related complications, fall risk, lower extremity fracture risk, and costs of care. A p-value of less than 0.05 was considered statistically significant. Patients with sarcopenia undergoing primary TKA had greater in-hospital LOS (4 vs. 3 days, p < 0.0001). Sarcopenic patients were also found to have increased incidence and odds of 90-day medical complications (2.9 vs. 1.1%; odds ratio [OR] = 2.83, p < 0.0001), falls (0.9 vs. 0.3%; OR = 3.54, p < 0.0001), lower extremity fractures (1.0 vs. 0.2%; OR = 5.54, p < 0.0001), and reoperation (0.9 vs. 0.5%; OR = 1.87, p < 0.0001). Additionally, sarcopenic patients had greater 2-year implant-related complications (4.3 vs. 2.4%; OR = 1.80, p < 0.0001), as well as day of surgery ($52,900 vs. 48,248, p < 0.0001), and 90-day ($68,303 vs. $57,671, p < 0.0001) costs compared with controls. This analysis of over 90,000 patients demonstrates that patients with sarcopenia undergoing primary TKA have greater in-hospital LOS, increased odds of 90-day medical complications, falls, lower extremity fractures, and reoperations. Additionally, sarcopenia was associated with greater 2-year implant-related complications, day of surgery costs, and 90-day costs. The study is useful as it can allow orthopaedic surgeons to properly educate these patients of the potential complications which may occur following their surgery.

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