RETROSPECTIVE ANALYSIS OF FUNCTIONAL OUTCOME OF TOTAL KNEE REPLACEMENT IN RURAL TEACHING SETUP

Background:Indian population is mainly residing in two areas- urban and rural. The literature has shown consistent results following knee joint replacement surgeries, however these studies have been done in highly efficient and equipped hospitals in urban areas. Aim: The aim of this study was to compare outcome at a rural set-up with those at a high-end teaching or corporate hospital in urban set-up from published literature. Materials and Methods: This study was an observational and retrospective analysis. Observation data was collected from January, 2020 and April, 2021. This study included follow-up of 60 total knee joint replacements. Results: In our study of total knee joint replacement surgeries in rural teaching set- up, we achieved 95.39% results (excellent) while the remaining 4.61% results were good. Conclusion: This study confirmed that results of total knee replacement are comparable to any other highly well equipped urban center, if all basic surgical principles including aseptic precautions are stringently followed-up. Further the clinical outcomes in our cases was more surgeon dependent rather than technology dependent as all surgeries were performed by one single surgeon.

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Background: The goal of this research was to assess the effectiveness and safety of intra-articular tranexamic acid (TA) with intravenous (IV) TA in reducing perioperative blood loss, the severity of early postoperative problems, and venous thromboembolism in patients who have had a primary unilateral cemented total knee replacement. Patients and methods: This comparative study was undertaken using a non-probability purposive sampling technique at the Department of Orthopedic Surgery, King Edward Medical University / Mayo Hospital, Lahore, from July 1st, 2018 to October 30th, 2019. A total of number 71 patients, aged 35 to 75 years, who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. Patients who had known allergic reactions to tranexamic acid, risk factors of thromboembolism, severe kidney and heart diseases, and blood clotting disorders were excluded. The patients were divided into two groups, A and B. Pre-operatively, patients in Group A were given intraarticular tranexamic acid (3000mg). In Group B, intravenous tranexamic acid (10mg/kg) was given pre-operatively. Outcome parameters studied were drained blood (DB), level of hemoglobin (Hb), blood transfusion (BT), and hematocrit (Hct) after 48 hours of surgery and compared with the preoperative value. Data was entered and analyzed using SPSS version 21.0. Independent sample T-test was applied to compare the hematocrit and hemoglobin difference in the two groups, and the P-value was taken less than 0.05 as significant. Results: Out of the total 36 patients in Group A, there were 20 (55.5%) males and 16 (44.4%) females, while amongst 35 patients in Group B, there were 21 (60%) males and 14 (40%) females. The mean preoperative Haemoglobin (Hb) in Group A was 13.9+1.2 and 13.8+0.9 in Group B (p = 0.44). The mean postoperative Hb in Group A was 12.11±2.47 and 11.24 ± 3.52 in Group B (p = 0.002). The mean variation of Hct in Group A was 4.49 and 6.82 in Group B (p = 0.001). Conclusion: Intra-articular tranexamic acid during total knee joint replacement is a viable alternative to the established intravenous tranexamic acid with statistically significant high postoperative hemoglobin and hematocrit levels.

Patient-reported outcome measures following revision knee replacement: a review of PROM instrument utilisation and measurement properties using the COSMIN checklist

ObjectivesTo identify: (1) patient-reported outcome measures (PROMs) used to evaluate symptoms, health status or quality of life following discretionary revision (or re-revision) knee joint replacement, and (2) validated joint-specific PROMs, their measurement properties and quality of evidence.Design(1) Scoping review; (2) systematic review following the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist.Data sourcesMEDLINE, Embase, AMED and PsycINFO were searched from inception to 1 July 2020 using the Oxford PROM filter unlimited by publication date or language.Eligibility criteria for selecting studiesStudies reporting on the development, validation or outcome of a joint-specific PROM for revision knee joint replacement were included.Results51 studies reported PROM outcomes using eight joint-specific PROMs. 27 out of 51 studies (52.9%) were published within the last 5 years. PROM development was rated ‘inadequate’ for each of the eight PROMs studied. Validation studies were available for only three joint-specific PROMs: Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). 25 out of 27 (92.6%) measurement properties were rated insufficient, indeterminate or not assessed. The quality of supporting evidence was mostly low or very low. Each of the validated PROMs was rated ‘B’ (potential for recommendation but require further evaluation).ConclusionJoint-specific PROMs are increasingly used to report outcomes following revision knee joint replacement, but these instruments have insufficient evidence for their validity. Future research should be directed toward understanding the measurement properties of these instruments in order to inform clinical trials and observational studies evaluating the outcomes from joint-specific PROMs.

Survival and development of health conditions after iron depletion therapy in C282Y-linked hemochromatosis patients

Background: We report long-term survival and development of selected health conditions in Ontario-based referred and screened C282Y homozygotes for hemochromatosis treated by phlebotomy compared with an untreated control group known to be without HFE mutations. Methods: Patient characteristics and outcomes (all-cause mortality, liver cancer, diabetes, cirrhosis, hip or knee joint replacement, and osteoarthritis) were ascertained using a linked health administrative database held at ICES. Outcomes were assessed between groups without the outcome at baseline using Cox proportional hazards regression adjusted for age and sex. All C282Y homozygotes with elevated serum ferritin were treated by phlebotomy to reach serum ferritin of 50 µg/L. Our cohort included 527 C282Y homozygotes (311 men, 216 women, mean age 48 years) and 12,879 control participants (5,667 men and 7,212 women). Results: C282Y homozygotes had an increased risk of all-cause mortality (aHR 1.44 [1.19–1.75], p <0.001); hepatocellular carcinoma (aHR 8.30 [3.97–17.34], p <0.001); hip or knee joint replacement (aHR 3.06 [2.46–3.81], p <0.001); osteoarthritis (aHR 1.72 [1.47–2.01], p <0.001); and cirrhosis (aHR 3.87 [3.05–4.92], p <0.001). C282Y homozygotes did not have an increased risk for diagnosis of diabetes) (aHR 0.84 [0.67–1.07], p = 0.16) during follow-up (median 17.7 years). Conclusions: C282Y homozygotes experience higher death and complication rates than individuals without HFE mutations, despite treatment by phlebotomy. Diabetes did not increase after phlebotomy therapy.

1294 Online Education for Patients Undergoing Elective Orthopaedic Surgery During A Global Pandemic

Introduction lective hip and knee joint replacement patients at the East Lancashire Hospitals NHS Trust (ELHT) are required to attend the ‘Hip and Knee Joint School’. This is an award-winning patient education programme. Pre-pandemic, it was a day at the hospital dedicated to introducing patients to the specifics of a hip and knee joint replacement surgery. This takes the patient from the process of anaesthesia to post-operative ward care. Method Due to the virulent transmission of COVID-19, strict social distancing rules have been implemented. Therefore, it was decided that converting the joint school into online videos would be the best medium for patient education. Various healthcare professionals contributed to the videos included orthopaedic surgeons, anaesthetists, specialist nurses, healthcare assistants, occupational therapists, and physiotherapists. Results Eleven videos were filmed, edited, and approved by the trust’s communications team. These included, ‘Introduction to the Joint School’, ‘You and your surgery’, ‘Leading up to your operation’, ‘Your Operation Journey’, ‘Introducing the Anaesthetist’ ‘Total Hip Replacement Surgery’, ‘Total Knee Replacement Surgery’, ‘Post-op Wound Care’, ‘Your Safe Discharge Home’, ‘FAQ’s’ and ‘COVID-19 Green Pathway’. Conclusions The global pandemic has driven innovation and novel ideas in medicine. We have seen similar changes in our trust with the online patient education videos being a prime example. This joint school was originally started in our trust, but now as it had been converted to videos, we believe that it can be modified and used across all trusts in the NHS.

Graph Theory and Matrix Approach (GTMA) Model for the Selection of the Femoral-Component of Total Knee Joint Replacement

Total Knee Replacement (TKR) is the increasing trend now a day, in revision surgery which is associated with aseptic loosening, which is a challenging research for the TKR component. The selection of optimal material loosening can be controlled at some limits. This paper is going to consider the best material selected among a number of alternative materials for the femoral component (FC) by using Graph Theory. Here GTMA process used for optimization of material and a systematic technique introduced through sensitivity analysis to find out the more reliable result. Obtained ranking suggests the use of optimized material over the other existing material. By following GTMA Co_Cr-alloys (wrought-Co-Ni-CrMo) and Co_Cr-alloys (cast-able-Co-Cr-Mo)are on the 1st and 2nd position respectively.

A Descriptive Analysis of the Hip and Knee Joint Replacement Procedures of the University of the Philippines - Philippine General Hospital (UP-PGH) from 2012 to 2018

Objective. Hip and knee joint replacement procedures are an effective therapeutic intervention in treating severe joint disorders. Its use has been increasingly performed worldwide, including the Philippines, with its techniques constantly evolving and the science behind it improving. This study aims to describe the demographics, clinical profiles, and outcomes of arthroplasty patients by the Arthroplasty Service, Department of Orthopedics, University of the Philippines – Philippine General Hospital (UP-PGH). Methods. The study is a descriptive and retrospective review of patients who underwent joint replacement procedures, both primary and revision arthroplasty, from January 2012 to December 2018. Patient demographics and clinical data of patients who underwent total joint arthroplasty at the UP-PGH were collected and evaluated. Result. Data from 279 patients with 306 primary joint replacement procedures were analyzed. There were 195 total hip arthroplasty procedures (THAs) and 111 total knee arthroplasty procedures (TKAs) done. The mean age for THA patients was 55.6 years old, with more females (68.2%) with the left hip being more commonly affected (54.9%). The most common indication for THA was an untreated femoral neck fracture (23.1%) followed by avascular necrosis (20.5%). Cementless fixation was the most commonly used technique (61.5%). Meanwhile, the mean age for TKA was 64.5 years old, with the majority having degenerative osteoarthritis, and using cemented TKA fixation for all knees. A total of 37 revision arthroplasty cases were performed, with 34 in the hip and three in the knee, with infection being the most common overall indication (53%). Conclusion. The demographics, clinical profiles, and outcomes of the UP-PGH Arthroplasty Service are comparable to other centers internationally, and further emphasizes the satisfactory outcomes of these procedures. Meanwhile, suggested explanations for the subtle differences are discussed in this study.