scholarly journals Assessing the Patient-Specific Functional Scale's Ability to Detect Early Recovery Following Total Knee Arthroplasty

2014 ◽  
Vol 94 (6) ◽  
pp. 838-844 ◽  
Author(s):  
Paul W. Stratford ◽  
Deborah M. Kennedy ◽  
Amy V. Wainwright
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Early Recovery ◽  
Functional Scale ◽  
Change Scores ◽  
Strength Change ◽  
Total Knee ◽  
Exercise Class

Background The Patient-Specific Functional Scale (PSFS) has received considerable attention over the last 2 decades; however, validation studies have not examined its performance in patients after total knee arthroplasty (TKA). Objective The purpose of this study was to investigate the ability of the PSFS to detect change in patients post-TKA by comparing PSFS change scores with Lower Extremity Functional Scale (LEFS) and pooled impairment change scores. Methods One hundred thirty-three patients participating in a post-TKA exercise class were assessed at their initial and discharge visits. Initial assessments occurred within 28 days of arthroplasty; follow-up assessments occurred within 80 days of surgery. At both assessments, participants completed the PSFS, LEFS, and the P4 pain measure, and their knee range of motion (ROM) and extensor strength were measured. The ability to detect change was expressed as the standardized response mean (SRM) and as a correlation between the PSFS change scores and 2 reference standards: (1) LEFS change scores and (2) pooled impairment change scores. The pooled impairment measure consisted of pain, ROM, and strength change scores. Results The SRMs were PSFS 4.60 (95% confidence interval [CI]=4.00, 5.36) for the PSFS and 2.28 (95% CI=2.04, 2.60) for the LEFS. The correlation between the PSFS and pooled impairment change scores was 0.12 (95% CI=−0.04, 0.25), and the correlation between the PSFS and LEFS changes scores was 0.18 (0.02, 0.34). Limitations The order of measure administration was not standardized, and fixed activity set does not reflect clinical application in many instances. Conclusions The results suggest that the PSFS is adept at detecting improvement in patients post-TKA but that the PSFS, like other patient-specific measures, is likely to be of limited value in distinguishing different levels of change among patients.

CLINICAL AND RADIOLOGICAL RESULTS OF TOTAL KNEE REPLACEMENT USING PATIENT-SPECIFIC POSITIONING GUIDES WITH AT LEAST 5 YEARS OF FOLLOW-UP

2020 ◽  
pp. 2050020
Author(s):  
Xabier Foruria ◽  
Jesús Moreta ◽  
Carlos Jaramillo ◽  
Ane Anton ◽  
Isidoro Calvo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Knee Score ◽  
Conventional Instrumentation ◽  
Total Knee ◽  
The Mean ◽  
Clinical And Radiological Results ◽  
Coronal Malalignment

Objective: Patient-specific positioning guides have been designed to improve precision in total knee arthroplasty. The aim of this study is to evaluate the medium-term clinical and radiological outcomes with magnetic resonance imaging-based patient-specific positioning guides. Material and methods: We retrospectively reviewed patients from two centers treated with total knee arthroplasty performed with patient-specific positioning guides. We enrolled patients operated on between January 2011 and December 2013, with a minimum follow-up of 5 years. Preoperative and postoperative hip knee angle (HKA) and position of each component in the coronal plane were assessed. Overall malalignment was defined as an outlier of more than [Formula: see text] from the neutral mechanical axis and specific malalignment as when any component showed more than [Formula: see text] of deviation. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee Score. Results: This study included 68 patients with a mean age of 72 years. The mean postoperative alignment (HKA) was [Formula: see text] and 26.5% of patients showed coronal malalignment [Formula: see text]. Regarding femoral components, 19.1% showed specific malalignment [Formula: see text], while 11.7% of tibial components were classified as outliers. The mean HSS Knee Score at final follow up was 89.2. Patients whose implants were mechanically aligned did not obtain better functional outcomes ([Formula: see text]). Conclusion: In our series, the use of patient-specific positioning guides resulted in a range of mechanical malalignment, similar to conventional instrumentation results reported in the literature.

scholarly journals The application of Patient specific Instrument （PSI ）in total knee arthroplasty with valgus knee

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Wang Yuehui ◽  
Zou Shiping ◽  
Cao Liangliang ◽  
Chen Wenzhong
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Valgus Knee ◽  
Specific Instrument ◽  
Guide Plate ◽  
Before And After ◽  
Total Knee ◽  
Surgery Department

Introduction: To invest the auxiliary role of Patient specific Instrument(PSI) used as osteotomy guide plate in total knee arthroplasty(TKA) with valgus knee. Hypotheses: PSI osteotomy guide plate is applicable for total knee arthroplasty with valgus knee. Methods: A retrospective analysis was performed on 21 patients with valgus knee, including 5 males and 16 females, who underwent TKA in joint surgery department I of ZhengZhou Orthopaedic Hospital from March 2016 to February 2018. All the operations were performed with the assistance of PSI, and the radiographic and clinical evaluations including femoral tibial joint ectropion angle(FTA) before and after operation, range of motion(ROM) and the Hospital for Special Surgery (HSS) knee score were reviewed, and surgical complications were recorded. Results: All the 21 patients werefollowed up for 10 ˜ 26 months (mean 16 months).All the incisions healed by first intention. The FTA was reduced significantly to 6.3 °±1.2° after operation from 17.6 ° + 5.7 °(P < 0.05), the ROM was improved significantly from preoperative 71.3° ±5.8° to postoperative 102.4°±7.5° (P < 0.05), the HSS score at the last follow-up was improved from 38.2±5.7 to 87.5-3.5(P < 0.05). During the follow-up, no complications such as infection, loosening, sinking and valgus were observed. Conclusion: Providing accurate osteotomy, effective correction of the force line, simple operation and satisfactory clinical effect, the PSI osteotomy guide plate is applicable for total knee arthroplasty with valgus knee.

scholarly journals Improved early recovery after TKA through an app-based, feedback-controlled active muscle training - A prospective randomized trial

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Sanjay Weber-Spickschen ◽  
Sebastian Hardt ◽  
Hauke Horstmann ◽  
Christian Krettek
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Training Group ◽  
Muscle Training ◽  
Active Muscle ◽  
Early Recovery ◽  
Early Outcome ◽  
Total Knee

The aim of this prospective randomized controlled trial was to evaluate if an app-based, feedback-controlled active muscle training can be used to improve the early outcome after total knee arthroplasty. Sixty patients (mean age 67.3 years, range 45 to 84) awaiting primary total knee arthroplasty (TKA) were randomized into a control- and training group. Both Groups followed an identical postoperative protocol. Additionally, the training group performed an appbased, feedback-controlled active muscle training multiple times daily postoperatively. Outcome measures were active and passive range of motion, pain at rest and in motion, knee extension strength, the Timed “Up and Go”, 10 Meter Walk Test, 30 Second Chair Stand Test, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and inpatient data. Mean time to follow-up was 6.88 days in the control group and 6.59 days in the training group for a total of 47 patients (78.3 percent follow-up). The training group used the GenuSport Knietrainer a total of 18.4 times (range 6 to 42 times) on average. Active range of motion was 11.4 degrees higher in the training group (p=0.038), while passive range of motion was almost the same (p=0.906). Mean pain was significantly lower in the training group both at rest (p=0.01) and in motion (p=0.002). The training group reported significantly better outcomes in the KOOS Activities of Daily Living Score (p=0.037). No significant differences were observed in KOOS pain, symptoms, sports and quality of life (p=219, p=0.625, p=0.204, p=0.452, respectively). The KSS Knee Score and KSS Function Score were significantly better in the training group (p<0.001, p=0.011, respectively). An app-based and feedback-controlled active muscle training can significantly improve the early outcome after total knee arthroplasty, particularly reduce pain and improve the range of motion. More training had better effects on the outcome than less training. Treatment costs could possibly be reduced. These findings are highly relevant regarding rising expectations from patients and the need to reduce costs in the health care system. Further studies with a longer follow up are necessary.

scholarly journals SMOC Approach for Total Knee Arthroplasty in Valgus Knees

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.

Manipulation under anaesthesia after primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 126-130
Author(s):  
Brian P. Chalmers ◽  
Enrique Goytizolo ◽  
Mithun D. Mishu ◽  
Geoffrey H. Westrich
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Pain Scores ◽  
Neuraxial Anaesthesia ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Sedation Group

Aims Manipulation under anaesthesia (MUA) remains an effective intervention to address restricted range of motion (ROM) after total knee arthroplasty (TKA) and occurs in 2% to 3% of primary TKAs at our institution. Since there are few data on the outcomes of MUA with different anaesthetic methods, we sought to compare the outcomes of patients undergoing MUA with intravenous (IV) sedation and neuraxial anaesthesia. Methods We identified 548 MUAs after primary TKA (136 IV sedation, 412 neuraxial anaesthesia plus IV sedation) from March 2016 to July 2019. The mean age of this cohort was 62 years (35 to 88) with a mean body mass index of 31 kg/m2 (18 to 49). The mean time from primary TKA to MUA was 10.2 weeks (6.2 to 24.3). Pre-MUA ROM was similar between groups; overall mean pre-MUA extension was 4.2° (p = 0.452) and mean pre-MUA flexion was 77° (p = 0.372). We compared orthopaedic complications, visual analogue scale (VAS) pain scores, length of stay (LOS), and immediate and three-month follow-up knee ROM between these groups. Results Following MUA, patients with IV sedation had higher mean VAS pain scores of 5.2 (SD 1.8) compared to 4.1 (SD = 1.5) in the neuraxial group (p < 0.001). The mean LOS was shorter in patients that received IV sedation (9.5 hours (4 to 31)) compared to neuraxial anaesthesia (11.9 hours (4 to 51)) (p = 0.009), but an unexpected overnight stay was similar in each group (8.6%). Immediate-post MUA ROM was 1° to 121° in the IV sedation group and 0.9° to 123° in the neuraxial group (p = 0.313). Three-month follow-up ROM was 2° to 108° in the IV sedation group and 1.9° to 110° in the neuraxial anaesthesia group (p = 0.325) with a mean loss of 13° (ranging from 5° gain to 60° loss), in both groups by three months. No patients in either group sustained a complication. Conclusion IV sedation alone and neuraxial anaesthesia are both effective anaesthetic methods for MUA after primary TKA. Surgeons and anaesthetists should offer these anaesthetic techniques to match patient-specific needs as the orthopaedic outcomes are similar. Also, patients should be counselled that ROM following MUA may decrease over time. Cite this article: Bone Joint J 2021;103-B(6 Supple A):126–130.

scholarly journals Kinematically Aligned Total Knee Arthroplasty or Mechanically Aligned Total Knee Arthroplasty

2018 ◽  
Vol 31 (10) ◽  
pp. 999-1006 ◽  
Author(s):  
Juned Ansari ◽  
Hemant Pandit ◽  
Tsuneari Takahashi
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Meta Analysis ◽  
Clinical Results ◽  
Patient Specific ◽  
Total Knee

AbstractKinematically aligned total knee arthroplasty (KATKA) was developed to more anatomically align the knee prosthesis to restore the native alignment of the knee and promote physiological kinematics. Even though there are concerns with implant survival, and follow-up at 10 years or more after KATKA has not been reported, there is a negligible incidence of failure of a tibial component at 2 to 9 years. Early clinical results with this technique are encouraging and demonstrate better functional outcomes compared with mechanically aligned TKA (MATKA). The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether there are any clinical differences between KATKA and MATKA. The authors conducted a systematic review of the English literature. Five randomized controlled trials (RCTs) which compared clinical outcomes of KATKA and MATKA were finally included. Four RCTs used patient-specific instrument, and one RCT used navigation. Data were extracted and meta-analysis was conducted. KATKA patients had better outcomes: Mean difference between KATKA and MATKA and p-value are presented in brackets after each variable: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (–12.5; p < 0.0001), Oxford Knee Score (OKS) (2.3; p = 0.030), combined Knee Society Score (C-KSS) (13.1; p < 0.0001), Knee Function Score (KFS) (6.4; p = 0.0070), and postoperative range of motion (ROM) (4.1°; p = 0.0010). There was no significant difference concerning the complication rates which needed reoperations or revision surgery (odds ratio, 1.01; p = 0.99). KATKA components had a more femoral valgus (–1.8°; p < 0.0001), more tibial varus (1.2°; p = 0.0001), and more tibial slope (1.2°; p = 0.0001), all being statistically significantly different. Better clinical outcomes were obtained in KATKA and component placement in KATKA is significantly different from that in MATKA. There was no increase of patients with poor clinical results due to implant position especially for varus placement of tibial component. This systematic review of five RCTs suggests that KATKA is of potential alternative method to MATKA since the risk of revision for tibial loosening is negligible compared with MATKA for the same follow-up period.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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