Evaluation of the early mobilization effectiveness after total knee and hip artroplasty

As a result of the introduction of early mobilization, it was possible to achieve early activation of patients, which includes breathing exercises, verticalization and early activation of the operated limb. The introduction of the method of early activation of patients after hip and knee arthroplasty operations allows to achieve a statistically significant reduction of the hospitalization period and allows to provide qualified high-tech assistance medical help to a greater number of patients.

Artificial intelligence and surgical innovation: lower limb arthroplasty

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0309 ◽

2020 ◽

Vol 81 (10) ◽

pp. 1-7

Author(s):

AA Magan ◽

B Kayani ◽

JS Chang ◽

M Roussot ◽

P Moriarty ◽

...

Keyword(s):

Artificial Intelligence ◽

Knee Arthroplasty ◽

Lower Limb ◽

Computer Assisted Surgery ◽

Later Life ◽

Computer Assisted ◽

Surgical Innovation ◽

Number Of Patients ◽

The number of patients requiring hip and knee arthroplasty continues to rise each year. Patients are living longer and expecting to remain active into later life following joint replacement. Developments in computer-assisted surgery and robotic technology may optimise surgical outcomes and patient satisfaction following lower limb arthroplasty. The use of artificial intelligence in healthcare is rapidly growing and has gained momentum in lower limb arthroplasty. This article reviews the use of artificial intelligence and surgical innovation in lower limb arthroplasty, with a particular focus on robotic-assisted surgery in total knee arthroplasty.

Does Aspirin Like Enoxaparin Effective to Reduce Thromboembolic Disease in Patients with Total Knee Arthroplasty Surgery?

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2019/v31i630370 ◽

2020 ◽

pp. 1-6

Author(s):

Gholamhossein Kazemian ◽

Alireza Manafi Rasi ◽

Mojtaba Baroutkoub ◽

Mohammad Mahdi Sarzaeem

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Knee Arthroplasty ◽

Thromboembolic Disease ◽

Treatment Groups ◽

Number Of Patients ◽

Total Knee ◽

Knee Arthroplasty Surgery

Background: Thromboembolic disease is a common complication among patients undergoing total hip and knee arthroplasty. There are a large number of clinical trials demonstrating the efficacy of aspirin and enoxaparin in preventing pulmonary emboli and deep venous thrombosis. This study aimed to investigate the preventive role of aspirin and enoxaparin after knee arthroplasty (TKA). Methods: In this retrospective study, 160 patients undergoing knee arthroplasty at Imam Hossein Hospital, Tehran, Iran between January 2010 and February 2012 were studied. Patients were divided into treatment groups receiving enoxaparin and aspirin and were evaluated within 28 days after surgery. After examining demographic factors including age and sex, variables such as DVT, pulmonary embolus, infection, transfusion RBCs and mortality were evaluated. Results: A total thrombosis rate of 0.0125% (one deep venous thrombosis) was observed. The two groups were not significantly different in the number of patients with complications such as DVT, pulmonary embolism, infection, average number of packed RBCs, and mortality. Conclusion: We believe that course aspirin is as effective and safe as enoxaparin for thromboprophylaxis.

Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Medicina ◽

10.3390/medicina57020188 ◽

2021 ◽

Vol 57 (2) ◽

pp. 188

Author(s):

Daniel C. Santana ◽

Matthew J. Hadad ◽

Ahmed Emara ◽

Alison K. Klika ◽

Wael Barsoum ◽

...

Keyword(s):

Knee Arthroplasty ◽

Perioperative Management ◽

Recent Literature ◽

Patient Specific ◽

Antithrombotic Agents ◽

Coronary Syndrome ◽

Risk Of Bleeding ◽

Post Operative Period ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

Clinical experience with fondaparinux in antiaggregate patients undergoing total hip and knee arthroplasty

Italian Journal of Medicine ◽

10.4081/itjm.2013.179 ◽

2013 ◽

pp. 179-182

Author(s):

Guido Grappiolo ◽

Marco Scardino ◽

Giuseppe Mazziotta ◽

Stefano Quaini ◽

Corrado Lodigiani ◽

...

Keyword(s):

Venous Thromboembolism ◽

Antiplatelet Therapy ◽

Knee Arthroplasty ◽

Operative Therapy ◽

Total Hip ◽

Vein Thrombosis ◽

Effective Prophylaxis ◽

Total Knee ◽

Deep Vein

Patients undergoing total hip arthroplasty or total knee arthroplasty have a high risk for post-operative venous thromboembolism. The current study addressed the use of fondaparinux post-operatively in 556 patients with antiplatelet therapy in order to prevent deep vein thrombosis as well as demonstrate efficacy in preventing arterial thrombotic events. Results provided evidence for a safe and effective prophylaxis strategy, involving the change from low molecular weight heparin pre-operatively to fondaparinux postoperatively. Also, fondaparinux proved effective as a unique post-operative therapy in the prevention of venous thromboembolism with no adverse effects, such as major bleeding or arterial thrombosis in patients with pre-operative antiplatelet therapy.

Proximal Fibular Osteotomy – Simplest and Most Effective Mean to Delay Total Knee Arthroplasty

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd10-3/011 ◽

2021 ◽

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Oxford Knee Score ◽

Joint Space ◽

Medial Compartment ◽

Knee Score ◽

Fibular Osteotomy ◽

Number Of Patients ◽

Background: Osteoarthritis involves degeneration of articular cartilage seen with increasing age. The knee joint, the most common joint that falls prey to attacks of osteoarthritis, has 30% incidence in population above 60 years. Total knee arthroplasty (TKA) is the main surgical option for orthopaedics. Though it corrects the deformity and relieves pain, yet it is not the treatment of choice in younger population. This study aimed to validate the effects of proximal fibular osteotomy (PFO) as a newer technique in managing medial compartment knee osteoarthritis. Methods: The diagnosed patients for medial compartment knee joint osteoarthritis were selected for study from Dr. Ziauddin University hospital of Karachi. Excluded were aged less than 40 years, or with BMI more than 30, and patients with tri-compartmental arthritis. Medial and lateral joint spaces along with Oxford knee score were measured and recorded pre- and post-operatively. Patients underwent PFO after giving written and informed consent. Results: Total number of patients selected was 30 for this study; 21 (70%) females, and 9 (30%) males (mean age 58.8 years). Mean pre-operative measured medial joint space on standard antero-posterior (AP) radiograph was 0.442± 0.04 cm. Mean recorded pre-operative Oxford knee score was 23.87±3.74 mm. Improvement was observed in mean postoperative medial joint space to 0.572± 0 .066 cm and mean post-operative Oxford knee score to 40.2±5.8mm. Conclusion: This study concludes that PFO significantly improves joint function in patients with medial compartment osteoarthritis knee and may delay the need for total knee arthroplasty, if carried out at an appropriate stage. Keywords: Osteotomy; Osteoarthritis; Total Knee Arthroplasty.

After Total Knee Arthroplasty Different Knee Position Bring Distinct Effects-a Prospective Study of One Hundred Patients

10.21203/rs.3.rs-588449/v1 ◽

2021 ◽

Author(s):

ke zheng ◽

Wen-xiang Liu ◽

Jie-bin Zhang

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Functional Recovery ◽

Knee Arthroplasty ◽

Randomized Study ◽

Osteoarthritis Of The Knee ◽

Total Blood ◽

Number Of Patients ◽

Extension Group ◽

Abstract Background Following total knee arthroplasty (TKA) blood loss is a major factor influencing functional recovery and quality of life in patients. The aim of this study was to determine the effect of postoperative leg position on blood loss and functional recovery after TKA.Methods One hundred consecutive patients were enrolled in this prospective randomized study, which with degenerative osteoarthritis of the knee. An equal number of patients were randomly allocated to either flexion or extension groups. In the flexion group, the affected leg was elevated 45° at the hip and with 45° of flexion at the knee, while patients in the extension group had the knee extended fully. Primary outcomes were calculated total blood loss (CBL), hidden blood loss(HBL), intraoperative blood loss(IBL),haemoglobin(HB) level and haematocrit(HCT).Results CBL, HBL, postoperative levels of HB and HCT, drop level of HB and HCT between the two groups after 72 hours were significantly different, with patients in the flexion group experiencing lower blood loss than those in the extension group (P < 0.05).However, there no difference between groups in the postoperative levels of HB and HCT, drop level of HB and HCT at 24 hours. Even though after 1 week range of motion (ROM) was statistical difference in groups, but after 6-week rehabilitation, patients from both groups attained a similar ROM in the knee. Conclusions The results of this study definite that after TKA execute the protocol，maintaining a position with the hip 45°flexion and the knee flexed at 45° prolong 48 hours, is an effective method for reducing blood loss and increasing functional ROM.

Elective orthopaedic cancellations due to the COVID-19 pandemic: where are we now, and where are we heading?

Bone & Joint Open ◽

10.1302/2633-1462.22.bjo-2020-0161.r1 ◽

2021 ◽

Vol 2 (2) ◽

pp. 103-110 ◽

Cited By ~ 3

Author(s):

Sam Oussedik ◽

Sam MacIntyre ◽

Joanne Gray ◽

Peter McMeekin ◽

Nick D. Clement ◽

...

Keyword(s):

Knee Arthroplasty ◽

Financial Burden ◽

Waiting Lists ◽

Waiting List ◽

Joint Registry ◽

Unmet Demand ◽

Number Of Patients ◽

Recovery Strategies ◽

The Cost

Aims The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers. Methods A model of referral, waiting list, and eventual surgery was created and calibrated using historical data from NHS England (April 2017 to March 2020) and was used to investigate the possible consequences of unmet demand resulting from fewer patients entering the treatment pathway and recovery strategies. NJR data were used to estimate the deficit of hip and knee arthroplasty by August 2020 and NHS tariff costs were used to calculate the financial burden. Results By November 2020, the elective waiting list in England is predicted to be between 885,286 and 1,028,733. If reduced hospital capacity is factored into the model, returning to full capacity by November, the waiting list could be as large as 1.4 million. With a 30% increase in productivity, it would take 20 months if there was no hidden burden of unreferred patients, and 48 months if there was a hidden burden, to return to pre-COVID-19 waiting list numbers. By August 2020, the estimated deficits of hip and knee arthroplasties from NJR data were 18,298 (44.8%) and 16,567 (38.6%), respectively, compared to the same time period in 2019. The cost to clear this black log would be £198,811,335. Conclusion There will be up to 1.4 million patients on elective orthopaedic waiting lists in England by November 2020, approximate three-times the pre-COVID-19 average. There are various strategies for recovery to return to pre-COVID-19 waiting list numbers reliant on increasing capacity, but these have substantial cost implications. Cite this article: Bone Jt Open 2021;2(2):103–110.

An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

Medicina ◽

10.3390/medicina56090416 ◽

2020 ◽

Vol 56 (9) ◽

pp. 416 ◽

Cited By ~ 1

Author(s):

Daniel C. Santana ◽

Ahmed K. Emara ◽

Melissa N. Orr ◽

Alison K. Klika ◽

Carlos A. Higuera ◽

...

Keyword(s):

Venous Thromboembolism ◽

Knee Arthroplasty ◽

High Volume ◽

Optimal Choice ◽

Slight Reduction ◽

Vte Prophylaxis ◽

Prophylactic Agent ◽

Total Hip ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

Robotic-assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty

Bone & Joint Open ◽

10.1302/2046-3758.12.bjo-2019-0004.r1 ◽

2020 ◽

Vol 1 (2) ◽

pp. 8-12 ◽

Cited By ~ 1

Author(s):

Samrath J. Bhimani ◽

Rohat Bhimani ◽

Austin Smith ◽

Christian Eccles ◽

Langan Smith ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Opioid Use ◽

Robotic Assisted ◽

Pain Scores ◽

Number Of Patients ◽

Lower Pain ◽

Clinical Benefits ◽

Total Knee ◽

Pain At Rest

Aims Robotic-assisted total knee arthroplasty (RA-TKA) has been introduced to provide accurate bone cuts and help achieve the target knee alignment, along with symmetric gap balancing. The purpose of this study was to determine if any early clinical benefits could be realized following TKA using robotic-assisted technology. Methods In all, 140 consecutive patients undergoing RA-TKA and 127 consecutive patients undergoing conventional TKA with minimum six-week follow-up were reviewed. Differences in visual analogue scores (VAS) for pain at rest and with activity, postoperative opiate usage, and length of stay (LOS) between the RA-TKA and conventional TKA groups were compared. Results Patients undergoing RA-TKA had lower average VAS pain scores at rest (p = 0.001) and with activity (p = 0.03) at two weeks following the index procedure. At the six-week interval, the RA-TKA group had lower VAS pain scores with rest (p = 0.03) and with activity (p = 0.02), and required 3.2 mg less morphine equivalents per day relative to the conventional group (p < 0.001). At six weeks, a significantly greater number of patients in the RA-TKA group were free of opioid use compared to the conventional TKA group; 70.7% vs 57.0% (p = 0.02). Patients in the RA-TKA group had a shorter LOS; 1.9 days versus 2.3 days (p < 0.001), and also had a greater percentage of patient discharged on postoperative day one; 41.3% vs 20.5% (p < 0.001). Conclusion Patients undergoing RA-TKA had lower pain levels at both rest and with activity, required less opioid medication, and had a shorter LOS.

The effects of physiotherapy using proprioceptive neuromuscular facilitation techniques on the gait of patients after hip and knee arthroplasty: a case report

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0015.0632 ◽

2021 ◽

Vol 15 (SUPPLEMENT 2) ◽

pp. 1

Author(s):

Antonina Kaczorowska ◽

Jolanta Kaboth ◽

Ewelina Lepsy ◽

Agata Mroczek

Keyword(s):

Case Report ◽

Knee Arthroplasty ◽

Sagittal Plane ◽

Lower Limbs ◽

Timed Up And Go ◽

Number Of Patients ◽

Proprioceptive Neuromuscular Facilitation ◽

Test Assessment ◽

Tinetti Test

Background Gait disturbances are a major problem for patients after arthroplasty. After the surgery, walking speed, the rhythm of locomotion, and the length of the steps are significantly reduced. One of the therapeutic methods used in gait re-education is proprioceptive neuromuscular facilitation (PNF). Aim of the study This study aimed to evaluate the effects of physiotherapy using PNF techniques on the gait of patients after hip and knee arthroplasty. Case report A 60-year-old woman with advanced osteoarthritis that received bilateral hip and right knee arthroplasties was examined. Before and after the therapy, the following tests were performed: measurement of the range of motion (ROM) of hip and knees joints in the sagittal plane using a goniometer, assessment of the symmetry of the lower limbs loading using the two scales test, assessment of the risk of falls using the “Timed Up and Go” test, assessment of balance and gait using the Tinetti test, and assessment of pain intensity using the visual analogue scale (VAS). Rehabilitation was comprised of 15 PNF therapies, including scapular and pelvic PNF patterns. The stabilization of the upper and lower trunk, lifting, shifting of the body’s weight from one foot to another, gait cycle (the stance phase and the swing phase), walking forward, backward, and sideways, and walking up/down the stairs were also used. After the therapy, the flexion ROM in both hip and knees joints was improved. The lower limb symmetry index decreased from 1.167 to 1.121, and the sum of the points obtained in the Tinetti test increased from 22 to 26. Pain in the joints also decreased from 6 on the VAS scale to 4. However, the result obtained in the “Timed Up and Go” test after the therapy was increased by 0.5 s compared to before the therapy. Conclusions After hip and knee arthroplasties, physiotherapy using PNF techniques improved the gait and functional status of the patient. Continuation of this research using a larger number of patients is needed.