scholarly journals Variability in Recommendations for Total Knee Arthroplasty Among Rheumatologists and Orthopedic Surgeons

2013 ◽  
Vol 41 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Liana Fraenkel ◽  
Lisa Suter ◽  
Lawrence Weis ◽  
Gillian A. Hawker
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Employment Status ◽  
Functional Limitations ◽  
Knee Oa ◽  
Orthopedic Surgeons ◽  
Physician Characteristics ◽  
Academic Settings ◽  
Total Knee

Objective.The most rapidly growing population of patients undergoing total knee arthroplasty (TKA) is under the age of 65. The objective of our study was to gain insight into the factors influencing physicians’ recommendations for persons in this age group with moderate osteoarthritis (OA).Methods.Rheumatologists and orthopedic surgeons attending national meetings were asked to complete a survey including a standardized scenario of a 62-year-old person with knee OA who has moderate knee pain limiting strenuous activity despite medical management. We used an experimental 2 × 2 × 2 design to examine the effects of sex, employment status, and severity of radiographic OA on physicians’ recommendations. Each physician was asked to rate a single scenario.Results.The percentage of physicians recommending TKA varied from 30% to 55% for scenarios describing a patient with mild radiographic OA, and from 39% to 71% for scenarios describing a patient with moderate radiographic OA. Surgeons were less likely to recommend TKA for women compared to men of the same age, employment status, symptom severity, and functional status, and radiographs. Rheumatologists practicing in academic settings were more likely to recommend TKA compared to those practicing in nonacademic settings, and American surgeons were more likely to recommend TKA compared to their European counterparts.Conclusion.Orthopedic surgeons and rheumatologists vary significantly in their recommendations for patients with moderate knee pain and functional limitations. Both patient and physician characteristics influence physicians’ recommendations, and rheumatologists and orthopedic surgeons display different patterns of decision making.

scholarly journals A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

2010 ◽  
Vol 4 (1) ◽  
pp. 201-203 ◽  
Author(s):  
Hans-Peter W. van Jonbergen ◽  
Alexander F.W. Barnaart ◽  
Cees C.P.M. Verheyen
Keyword(s):  
Total Knee Arthroplasty ◽  
The Netherlands ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Patellar Resurfacing ◽  
Orthopedic Surgeons ◽  
Unicompartmental Knee Arthroplasties ◽  
Total Knee ◽  
Anterior Knee

Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty.

Failure to Resurface the Patella during Total Knee Arthroplasty May Result in More Knee Pain and Secondary Surgery

2005 ◽  
Vol &NA; (438) ◽  
pp. 191-196 ◽  
Author(s):  
Javad Parvizi ◽  
Venkat R Rapuri ◽  
Khaled J Saleh ◽  
Michael A Kuskowski ◽  
Peter F Sharkey ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Secondary Surgery ◽  
Total Knee

Selective Denervation for Persistent Knee Pain After Total Knee Arthroplasty: A Report of 50 Cases

2017 ◽  
Vol 32 (3) ◽  
pp. 968-973 ◽  
Author(s):  
Shao-Min Shi ◽  
David W. Meister ◽  
Kelly C. Graner ◽  
James T. Ninomiya
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Total Knee

Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity

2020 ◽  
pp. 1-9
Author(s):  
Jereme B. Outerleys ◽  
Michael J. Dunbar ◽  
Glen Richardson ◽  
Cheryl L. Hubley-Kozey ◽  
Janie L. Astephen Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Patient Specific ◽  
Knee Biomechanics ◽  
Knee Oa ◽  
Joint Biomechanics ◽  
Total Knee

Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery.

Radiographs are not sufficient for evaluation of component fit in subtle knee pain after total knee arthroplasty

2020 ◽  
Vol 28 (6) ◽  
pp. 2015-2022
Author(s):  
Mehmet Emin Simsek ◽  
Safa Gursoy ◽  
Mustafa Akkaya ◽  
M. I. Safa Kapicioglu ◽  
Murat Bozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Total Knee

scholarly journals Crystal Arthropathy in the Setting of Total Knee Arthroplasty

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Joseph C. Brinkman ◽  
Kade S. McQuivey ◽  
Justin L. Makovicka ◽  
Joshua S. Bingham
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Ground Level ◽  
Fracture Dislocation ◽  
Acute Gout ◽  
Orthopedic Surgeons ◽  
History Of ◽  
Total Knee ◽  
Gout Flare

We present a case of an 82-year-old female with a history of right total knee arthroplasty 11 years prior. She was admitted after a ground-level fall and developed progressive pain and swelling of her right knee. She had no history of complications with her total knee replacement. Radiographs of the knee and hip were negative for acute fracture, dislocation, or hardware malalignment. Knee aspiration was performed and revealed inflammatory exudate, synovial fluid consistent with crystal arthropathy, and no bacterial growth. She was diagnosed with an acute gout flare, and her symptoms significantly improved with steroids and anti-inflammatory treatment. Orthopedic surgeons should be aware of the potential for crystal arthropathy in the setting of total joint arthroplasty and evaluate for crystals before treating a presumed periprosthetic joint infection.

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