Self-Management following Total Knee Arthroplasty: A concept to emphasize

2021 ◽  
Vol 15 (11) ◽  
pp. 2835-2835
Author(s):  
Samreen Sadiq ◽  
Rabiya Noor ◽  
Ashfaq Ahmed ◽  
Rizwan Akram ◽  
Izzat Hassan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
World Health ◽  
Self Management ◽  
Health Service Provider ◽  
Replacement Surgery ◽  
Successful Recovery ◽  
Total Knee

Knee Osteoarthritis (OA) is considered as one of the leading cause of disability around the world1. Total knee Arthroplasty is known to be the best treatment option available for reduction in pain and symptoms in case of failure of conservative management2. Recently enhanced recovery pathways have been followed after knee replacement surgery which includes a combination of early mobility, education of patient and care giver, nutritional and fluid support. These enhanced pathways lead to shorter hospital stay3. Due to the shortened hospital stay, the aspect of self-management by patient becomes fundamental. Post-operative self-management of patients following knee replacement is a crucial factor for successful recovery. Self-management as defined by World Health Organization is the ability of patients, care givers and community to effectively manage with the disease, either with the support of health service provider or independently. In knee replacement, self-management includes pain management, physical therapy exercises, daily self-activities and precautionary measures4.

scholarly journals Is adding intra-articular steroid in total knee arthroplasty cocktail obligatory?

2019 ◽  
Vol 5 (2) ◽  
pp. 260
Author(s):  
Sundar Suriyakumar ◽  
Ganesan G. Ram ◽  
Faraz Ahmed
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Group I ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> The patients can undergo total knee replacement surgery either under general anaesthesia, combined spinal and epidural anaesthesia, nerve root block, spinal combined with intra-articular knee cocktail. There is an ongoing debate amongst Arthroplasty surgeons whether to include steroid in the cocktail or not. The aim of this study is to assess whether there is an added benefit of including steroid in the intraarticular mixture.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted at Sri Ramachandra Institute of Higher education, Chennai between December 2017 to December 2018. The study was conducted in the Arthroplasty unit, Department of Orthopaedics. SRIHER ethics committee clearance was obtained prior to the start of the study. The inclusion criteria were patients who underwent total knee replacement surgery under combined spinal and intra-articular knee cocktail. Patients were divided into two groups based on the use of steroid in the intra-articular mixture. Patients were evaluated using Visual analogue scale, opioids usage as primary endpoint while any joint infection within six months of the surgery and knee society score at 1 month and 6 months as the secondary endpoint.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean visual analogue score for the 0 pod for the group I and group II were 2.3 and 2.4 respectively. There was no case of infection in both groups.</p><p class="abstract"><strong>Conclusions:</strong> There is no fringe benefit of adding steroid to the knee cocktail. So it is not obligatory to add steroid in intra-articular total knee arthroplasty cocktail.</p>

scholarly journals ACL status in arthroplasty patients, why not to preserve?

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 1 ◽  
Author(s):  
Ahmed Abdelbadie ◽  
Ahmed Ali Toreih ◽  
Mohamed Ahmed Radwan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Cruciate Ligaments ◽  
Normal Knee ◽  
Replacement Surgery ◽  
Total Knee ◽  
Grade 3

Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA) are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem. Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA) in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated. Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients. Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL) allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient-tailored prosthetic design.

scholarly journals Anatomy of the Infrapatellar Branch in Relation to Skin Incisions and as the Basis to Treat Neuropathic Pain by Percutaneous Cryodenervation

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E339-E348 ◽  
Author(s):  
Thomas Ackmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Skin Incision ◽  
Knee Surgery ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Infrapatellar Branch ◽  
Total Knee

Background: Neuropathic knee pain, particularly of the infrapatellar branch, is an important complication of knee replacement surgery, with an incidence as high as 70%. The increasing number of elderly patients requiring knee surgery, including total knee arthroplasty (TKA), has contributed to an increase in the number of patients with this pathology. Treatment includes neurectomy, infiltration therapy, and cryodenervation. Percutaneous cryodenervation of the infrapatellar branch is a promising option. Objective: To provide the necessary anatomical analysis to optimize percutaneous cryodenervation of the infrapatellar branch by defining sections of the unbranched ramus infrapatellaris to demonstrate the risk of nerve injury through 3 different skin incisions typically used during TKA. Study Design: Anatomical study. Methods: Cadavers were used for assessment. Exclusion criteria were scars from knee surgery, deep wounds, and a flexion angle of no more than 90°. We compared 3 frequently used skin incisions with the course of the infrapatellar branch and identified sections of the unbranched nerves that were suitable for percutaneous cryodenervation. Results: In total, 18 formalin-fixed cadavers (mean age, 78.9 years) contributed 30 knees (15 pairs) for dissection. We identified the following 4 anatomical variations of the ramus infrapatellaris in relation to the sartorius muscle: anterior, posterior, penetrating, and pes anserinus types. Sections were then found to treat the nerve branch types. The nerve sections were localized using the medial pole of the patella as a palpable landmark and varied in length between 15 mm and 40 mm. The medial parapatellar skin incision showed the highest risk of lesions to the infrapatellar branch (53.3%) followed by the midline skin incision (46.7%) and the lateral parapatellar skin incision (30.0%). Limitations: This was an observational study, performed using a limited number of cadavers. This therefore precluded generalization and statistical analysis. Significantly more female (13) cadavers were examined compared to male (5). Further studies in human populations, and with larger samples, are necessary to confirm these results. Conclusion: Based on our findings, the surgeon can localize the unbranched main nerve. Compared with the current practice, our approach should allow for a lower impact on tissues and should facilitate complete pain relief through a single cryodenervation. Furthermore, we propose that the lateral parapatellar skin incision is an acceptable alternative surgical approach in knee replacement surgery because it is associated with the lowest risk of damage to the infrapatellar branch. Key words: Percutaneous cryodenervation, infrapatellar branch, neuropathic knee pain, knee surgery, skin incisions knee surgery, total knee arthroplasty

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

scholarly journals Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanuel Noel ◽  
Luca Miglionico ◽  
Mickael Leclercq ◽  
Harold Jennart ◽  
Jean-François Fils ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multimodal Analgesia ◽  
Sublingual Tablet ◽  
Randomized Controlled ◽  
Total Knee ◽  
Median Pain

Abstract Purpose Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3

scholarly journals What is a balanced knee replacement?

2018 ◽  
Vol 3 (12) ◽  
pp. 614-619 ◽  
Author(s):  
Lucy C. Walker ◽  
Nick D. Clement ◽  
Kanishka M. Ghosh ◽  
David J. Deehan
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Current Evidence ◽  
Soft Tissue Envelope ◽  
Total Knee ◽  
Uneven Wear ◽  
Definition Of ◽  
Revision Tka

For multifactorial reasons an estimated 20% of patients remain unsatisfied after total knee arthroplasty (TKA). Appropriate tension of the soft tissue envelope encompassing the knee is important in total knee arthroplasty and soft tissue imbalance contributes to several of the foremost reasons for revision TKA, including instability, stiffness and aseptic loosening. There is debate in the literature surrounding the optimum way to achieve balancing of a total knee arthroplasty and there is also a lack of an accepted definition of what a balanced knee replacement is. It may be intuitive to use the native knee as a model for balancing; however, there are many difficulties with translating this into a successful prosthesis. One of the foundations of TKA, as described by Insall, was that although the native knee has more weight transmitted through the medial compartment this was to be avoided in a TKA as it would lead to uneven wear and early failure. There is a focus on achieving symmetrical tension and pressure and subsequent ‘balance’ in TKA, but the evidence from cadaveric studies is that the native knee is not symmetrically balanced. As we are currently trying to design an implant that is not based on its anatomical counterpart, is it possible to create a truly balanced prosthesis or to even to define what that balance is? The authors have reviewed the current evidence surrounding TKA balancing and its relationship with the native knee. Cite this article: EFORT Open Rev 2018;3:614-619. DOI: 10.1302/2058-5241.3.180008.

scholarly journals Osteoarthritis of the knee joint. Etiology, treatment, rehabilitation (analytical review of the literature)

TRAUMA ◽  
2021 ◽  
Vol 22 (3) ◽  
pp. 5-11
Author(s):  
Khaled Obeidat ◽  
O.D. Karpinska
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Gait Parameters ◽  
Total Knee ◽  
The Difference ◽  
Knee Pathology

According to epidemiological studies, osteoarthritis accounts for 10–12 % of all cases of musculoskeletal diseases. In the general structure of knee pathology, degenerative diseases make up 57.8 %. The urgency of the problems of gonarthrosis is due to not only its widespread prevalence, but also the high risk of developing knee dysfunction, accompanied by a significant reduction in the quality of life of patients and often leading to partial or permanent disability of patients. Gonarthrosis has significant gender features. Women account for about 70 % of the number of patients, while men had this disease almost 2 times less often, but other data indicate that the incidence of gonarthrosis in men under 60 years of age is higher, and in women it begins to increase after 65 years. Knee replacement is a leading method in the treatment of knee osteoarthritis stages III–IV. The tendency towards an increase in the total number of surgeries leads to an increase in the frequency of complications and unsatisfactory results: according to some authors, from 3.3 to 13.2 % of patients complain of knee replacement outcomes. Studies of long-term complaints after arthroplasty have shown that in addition to pain reduction, some patients had an increase in varus angle when bending the knee while walking but they didn’t mark an improvement in gait parameters compared to preoperative examination. After unilateral total knee arthroplasty, the load patterns of the frontal plane in the operated knee remain pathological in the long run. After knee arthroplasty, there is muscle weakness, and studies have shown changes in all muscles of the lower extremity. Weakening of some muscles led to compensatory strengthening of others. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low efficiency. Many studies have studied motor activity of patients after total knee arthroplasty in recent years. Not only gait features, but also movements of the pelvis, trunk and upper extremities are studied. Modern methods of diagnosing spatial oscillations of the body when walking have shown that disorders of body movements — excessive hand movements, pelvic loosening, asymmetrical flexion of the knee joints, etc., after arthroplasty are preserved in patients and restore slowly, and some disorders remain forever. Conclusions. Knee arthroplasty relieves pain, improves quality of life, but according to many authors, patients complain of incomplete restoration of the functionality of the prosthetic limb. According to the researchers, the main cause for incomplete reco-very of gait parameters is the difference in the frontal angles of the knee joint flexion and the difference in the length of the steps. Special training exercises can reduce the asymmetry of the steps, but it is difficult to completely restore the symmetry of the steps within 2 years. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low effectiveness.

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