scholarly journals Regional Analgesia for Knee Surgeries: Thinking beyond Borders

2021 ◽  
Author(s):  
Kartik Sonawane ◽  
Hrudini Dixit

Knee surgeries are the most commonly performed joint surgeries in the modern world, which help maintain the quality of life by improving joint functions. These include open trauma, sports injury, or joint replacement surgeries. Among various available regional analgesia options for knee surgeries, the goal is to choose motor-sparing, opioid-sparing, and procedure-specific modalities. Therefore, it is essential to know the complex anatomy of the knee joint, essential steps of various surgical procedures, and innervations of the pain-generating structures for a particular surgery. Background knowledge of all these essentials helps select the most appropriate regional analgesia technique for knee surgeries.

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rafael Fortuna ◽  
David A. Hart ◽  
Keith A. Sharkey ◽  
Rachel A. Schachar ◽  
Kelly Johnston ◽  
...  

Abstract Background Osteoarthritis (OA) is a chronic and painful condition where the articular cartilage surfaces progressively degenerate, resulting in loss of function and progressive disability. Obesity is a primary risk factor for the development and progression of knee OA, defined as the “metabolic OA” phenotype. Metabolic OA is associated with increased fat deposits that release inflammatory cytokines/adipokines, thereby resulting in systemic inflammation which can contribute to cartilage degeneration. There is currently no cure for OA. Prebiotics are a type of dietary fiber that can positively influence gut microbiota thereby reducing systemic inflammation and offering protection of joint integrity in rodents. However, no human clinical trials have tested the effects of prebiotics in adults with obesity suffering from knee OA. Therefore, the purpose of this double-blind, placebo-controlled, randomized trial is to determine if prebiotic supplementation can, through positive changes in the gut microbiota, improve knee function and physical performance in adults with obesity and knee OA. Methods Adults (n = 60) with co-morbid obesity (BMI > 30 kg/m2) and knee OA (Kellgren-Lawrence grade II–III) will be recruited from the Alberta Hip and Knee Clinic and the Rocky Mountain Health Clinic and surrounding community of Calgary, Canada, and randomized (stratified by sex, BMI, and age) to prebiotic (oligofructose-enriched inulin; 16 g/day) or a calorie-matched placebo (maltodextrin) for 6 months. Anthropometrics, performance-based tests, knee pain, serum inflammatory markers and metabolomics, quality of life, and gut microbiota will be assessed at baseline, 3 months, 6 months (end of prebiotic supplementation), and 3 months following the end of the prebiotic supplementation. Clinical significance There is growing pressure on health care systems for aggressive OA treatment such as total joint replacement. Less aggressive, yet effective, conservative treatment options have the potential to address the growing prevalence of co-morbid obesity and knee OA by delaying the need for joint replacement or ideally preventing its need altogether. The results of this clinical trial will provide the first evidence regarding the efficacy of prebiotic supplementation on knee joint function and pain in adults with obesity and knee OA. If successful, the results may provide a simple, safe, and easy to adhere to intervention to reduce knee joint pain and improve the quality of life of adults with co-morbid knee OA and obesity. Trial registration Clinical Trials.gov NCT04172688. Registered on 21 November 2019.


2015 ◽  
Vol 13 (4) ◽  
pp. 123-168 ◽  
Author(s):  
Magdalena Kapała

AbstractMy paper presents the results of a research study on the relationship between existential/spiritual resources, that is, spiritual sensitivity (a disposition to experience spirituality, manifested in the embracement of the nature of things in the transcendent and final perspective, in moral sensitivity, and the ability to find meaning in paradoxical and limiting situations), spiritual sensitivity components and subjective quality of life (a generalized attitude to one’s own life mode, in the four existential dimensions: psychophysical, psycho-social, subjective, and metaphysical). Study subjects were older adults (60+, n = 522) living in the current, dynamic, uncertain and fluid modern world conditions. The study had two phases – quantitative and qualitative (narrative interviews). To measure the phenomena, the Spiritual Sensitivity Inventory (Straś-Romanowska, Kowal, & Kapała, 2013) and the Quality of Life Questionnaire (Straś-Romanowska, Oleszkowicz, & Frąckowiak, 2004) were used. The results obtained confirmed a strong mutual relationship between spiritual resources and quality of life, also providing an answer to some questions about the nature of spiritual sensitivity, and its integrating, pro-development and pro-health role in the elderly adults’ life in the post-modern era.


2021 ◽  
Vol 15 (10) ◽  
pp. 3276-3280
Author(s):  
Şebnem Şarvan Cengiz ◽  
Büşra Yardimci ◽  
Aybüke Ulubaş

The aim of the study is to examine the effects of sports injuries experienced by adolescent athletes between the ages of 13 and 18 on their quality of life during training and competition. The universe of the study consists of licensed athletes between the ages of 13-18 who play sports at the Manisa Youth and Sports Provincial Directorate. In the study, purposeful sampling method was chosen, and the study sample consisted of 170 athletes (97 females, 73 males) with sports injuries and 90 athletes (49 females, 41 males) without sports injuries, totally 260 volunteers. The demographic information form developed by the researchers, the Adolescent Form of the Quality of Life for Children (PedsQL) developed by Varni et al. (1999), the Adolescent Form of the Age of 13-18, and the Causes of Injury in Sports Questionnaire prepared by Alkaabi (2015) were used as data collection methods. As a result, it was found that female athletes had more sports injuries in adolescent athletes than men. The number of athletes who suffered injuries in defense sports is higher than in other branches. As a result, it has been determined that sports injury negatively affects the quality of life. It was found as a result of the study data that they experienced more injuries in training than in competitions. Since the injury is mostly in the winter season and the athletes stated that they did not use protective equipment during the injury, the trainers should be informed, they should be thoughtful about taking the necessary precautions and precautions and should be offered the necessary supervision. Keywords: Adolescent athlete, injury, quality of life


TRAUMA ◽  
2021 ◽  
Vol 22 (3) ◽  
pp. 5-11
Author(s):  
Khaled Obeidat ◽  
O.D. Karpinska

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.


Author(s):  
Ruslan K. Urazbakhtin ◽  
Raushaniya N. Kildebekova ◽  
Lira T. Gilmutdinova ◽  
Vadim T. Kaybyshev ◽  
Ravil Sh. Mirkhaydarov ◽  
...  

Background. Osteoarthritis is characterized by a decrease in the quality of life, which is currently considered as the main measure of well-being of an individual and a criterion for the effectiveness of treatment and rehabilitation measures. Modern research emphasizes the need for an integrated approach to the treatment of osteoarthritis, which should include pharmacological and non-drug methods of treatment. Aim. The purpose of the study was to evaluate the effectiveness of pharmacopuncture administration of Alloplant biomaterial by patients with osteoarthritis of the knee joint from the standpoint of influencing the immunological mechanisms of the disease. Methods. The randomization methodology was divided into 3 groups, comparable in terms of clinical and functional characteristics. Group I patients (n = 39) have standard basic drug therapy according to the federal clinical guidelines Osteoarthritis approved by the Association of Rheumatologists of Russia (2013), with additions from 2016; in patients of group II (n = 39), in addition to drug therapy, dispersed Alloplant biomaterial was used according to the original method; group III patients (n = 39) against the background of basic drug therapy are additionally prescribed a combination of dispersed Alloplant biomaterial at biologically active points and magnetic therapy with a pulsed magnetic field. Results. Against the background of the treatment of patients with osteoarthritis using pharmacopuncture with Alloplant biomaterial and magnetotherapy, there was a positive dynamics in clinical data with a significant decrease in pain intensity when walking and at rest, stiffness, with the restoration of immune status parameters and an improvement in the quality of life in the field of physical and psychological health . A more pronounced and lasting positive dynamics was observed in patients of group III against the background of the combined effects of pharmacopuncture with Alloplant biomaterial and magnetotherapy. Conclusion. The Alloplant biomaterial has a positive effect in the treatment of patients with stage III osteoarthritis according to the KellgrenLawrens classification. The similarity of the mechanism of action with drugs with a structurally modifying effect on cartilage allows us to recommend pharmacopuncture with Alloplant biomaterial for widespread use in the treatment of osteoarthritis.


2021 ◽  
pp. 6-14
Author(s):  
О. О. Bespalova ◽  
P. F. Rybalko ◽  
A. M. Sitovskyi ◽  
T. Y. Tsjupak ◽  
I. V. Savchuk

Excessive training loads during sports cause chronic functional overload of the joints and their trauma, which reduces the quality of life of athletes, limits activity and participation, termination of sports careers, and in severe cases - disability. In sports practice, one of the most common sites of osteoarthritis is the knee joints (gonarthrosis). Gonarthrosis of the knee joint is a degenerative-dystrophic disease in which the destruction of hyaline cartilage, deformation of bone tissue and the qualitative composition of synovial fluid. A key link in the development of an individual program of rehabilitation intervention is the formulation of a rehabilitation diagnosis. The aim of the research: to determine the rehabilitation diagnosis of patients with gonarthrosis of the knee joints on the basis of the International Classification of Functioning, Restriction of Life and Health (ICF). Materials and methods: theoretical (analysis and generalization of scientific-methodical and clinical literature); clinical (analysis of medical records, communication, palpation, clinical and functional testing; physical examination); scale methods for assessing the condition of patients (Leken index, pain scale, depression scale (CES-D), assessment of quality of life according to the SF-36 questionnaire); instrumental (goniometry, manual-muscular testing). The research involved 7 veteran athletes aged 45 to 49 years with primary gonarthrosis stage II. Inclusion criteria: current athletes - men of different specializations; primary gonarthrosis of the second radiological stage according to Kellgren; duration of pain not less than 4 months; the level of pain when walking on the scale of YOUR 45 and more; age of patients older than 45 years; informational consent of patients to participate in the research. Inclusion criteria: secondary gonarthrosis of the knee joint; the presence of comorbidities; severe condition of the patient; knee surgery; planning of arthroplasty of the knee joint; intra-articular injections; lack of information consent. Rehabilitation diagnosis is the most complete reflection of the patient's current problems, which affect the level of his functioning, activity and participation, and are significant for him. It is established by all members of the multidisciplinary team, and is based on the results of comprehensive rehabilitation diagnostics. The main tool for establishing a rehabilitation diagnosis are the categories and domains of IFF. Rehabilitation diagnosis of patients with gonarthrosis: moderate structural changes in the knee joints (s750.2), episodic moderate pain (b28014.2), short-term morning stiffness (b7800.2), decreased mobility of the knee joint (b710.2), his stability (b7150.2) and support function, decrease in muscle tone (b7350.2) and strength of the quadriceps femoris (b7300.2), which limits domestic activity and prolongs it over time (d450.1); difficulties in changing body position (d410.2), moving up stairs and moving long distances (d460.3), which limits participation in active forms of recreation. Patients report poor mood, depression due to health and forced restriction of participation (b152. 1), and concerns about future careers. Conclusions. Rehabilitation care is provided to patients in several stages, one of which is the formulation of a rehabilitation diagnosis. Rehabilitation diagnosis was established, in which the current problems of patients at the level of structure and function, activity and participation, as well as contextual factors that contribute, limit or prevent the achievement of the desired level of functional independence, allow individualization of rehabilitation intervention to bring this level to the maximum possible.


2020 ◽  
Vol 26 (3) ◽  
pp. 109-118
Author(s):  
L. N. Solomin ◽  
E. A. Shchepkina ◽  
K. L. Korchagin ◽  
F. K. Sabirov

Relevance. Deep infection after knee arthroplasty requires radical surgical treatment of the infection site, removal of endoprosthesis components, and an antimicrobial spacer placement. If revision knee arthroplasty is impossible, the «gold standard» for this kind of patients is knee joint arthrodesis. The purpose of the study was the comparative analysis of knee joint fusion by external and internal fixation. Materials and Methods. The analysis of 60 cases of knee arthrodesis was carried out. The patients were divided into two groups with 30 patients in each. In the first group, knee arthrodesis was performed with long locking nail, in the second group — with external ring fixation. We compared the groups by intraoperative and drainage blood loss, the inpatient treatment duration, the terms of fusion and complications registered. The patients quality of life was evaluated using the SF-36 questionnaire before surgery, for the periods of 3, 6, and 12 months after the surgery. Results. The comparison of two methods of knee arthrodesis showed that blood loss in the internal fixation compared with external one, was 2.03 times more, the duration of inpatient treatment was 1.4 times less, and the total number of complications was 4.4 times less. However, the complications that affected the treatment outcome in long nail group were 1.5 times more. The differences in the average time of ankylosis formation were not statistically significant (p<0.05). The functional results of the treatment in 3 months after surgery in the group with internal fixation were much better. In 6 months after surgery the quality of life had no significant differences. In 12 months follow-up the indices in both groups were the same. Conclusion. The results of our study suggests us to think, knee joint arthrodesis by long fusion nail should be prefereble. If the nail insertion is technically impossible, and there is the high risk of deep infection recurrence, the external osteosynthesis should be used.


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