On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Purpose Programs referred to as Fast-Track/Rapid Recovery/Enhanced Recovery After Surgery have proven both effective and safe in joint replacement surgery, to the degree where same-day discharge (SDD) has been attempted in carefully selected cases at specialized outpatient units. Therefore, the primary aim of this study was to evaluate a same-day surgery protocol regarding safety using the minor partial knee replacement (PKR) procedure by non-selectively recruiting patients at a public hospital for one consecutive year. Methods 33 unselected PKR cases were included in this open clinical trial. The inclusion/exclusion criteria were solely based on logistics, as all the procedures were medial PKRs, designated the first morning slots, and performed by one single-surgeon. Strict postoperative criteria based on vital parameters, urinary function, bleeding, and mobilization had to be met before discharge was considered. SDD rate, patient satisfaction, number of outpatient visits, adverse events and readmissions within 90 days were evaluated. A predetermined subgroup analysis was also conducted where patients <80 yrs. and with an American Society of Anesthesiologists (ASA) classification <III was compared with those aged ≥80 yrs. and/or ASA class ≥III. Results 29 of 33 (88%) successfully achieved SDD. In a univariate comparison, 100% of the patients <80 yrs. and ASA class <III achieved SDD, whereas a corresponding 43% applied for those aged ≥80 yrs. and/or ASA class ≥III (p = 0.001). A 93% overall satisfaction rate was reached. Only 8% extra outpatient visits were required, all occurring within the first 2 weeks (well in line with routine practice.) One plausible transient ischemic attack and one readmission caused by a penetrating trauma not affecting the knee were identified, both of which happened 10 weeks after surgery. No adverse events or readmissions occurred within the first 48 hours of surgery. Conclusion When following strict criteria for discharge, same-day partial knee replacement surgery may be both feasible and safe, even without preselection of patients.

Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing

Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects.

Oxford partial knee replacement by microplasty instrumentation: Indian evidence

<p class="abstract"><strong>Background:</strong> There is increasing evidence in support of unicondylar knee replacement (UKR) as a superior surgical modality in a select group of patients of osteoarthritis knee. Oxford knee is one type of UKR with fully congruent, mobile bearing designed to minimize wear. This prospective study describes 5-year results of partial medial compartment knee replacement in 92 Indian cases by microplasty instrumentation.</p><p class="abstract"><strong>Methods:</strong> All 92 cases were operated by a single surgeon. Mean follow up was 5 years. In all cases oxford mobile bearing medial unicondylar knee prosthesis was implanted using minimally invasive surgical technique and the cases followed up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean oxford score at the end of 5 year was 43. Patient satisfaction index at the end of 5 year was 98%. Mean maximum flexion was 125 degrees. Incidence of revision was 1.9. No deep or superficial infections were encountered. Average hospital stay was 3 days.</p><p class="abstract"><strong>Conclusions:</strong> There are variations in Indian patients as per size of implants, stay and similarities regarding less blood loss, improved oxford knee score, good range of motion, less morbidity, higher postoperative patient satisfaction and early getting back to work. Oxford partial knee replacement by microplasty instrumentation done in carefully selected patients with proper surgical technique gives excellent functional outcome and superior patient satisfaction.</p>

Orthopädie – Teilimplantat im Knie ist kostengünstiger als die totale Variante

Beard DJ. et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomized controlled trial. Lancet 2019; 394: 746–756 Als Operationsoptionen bei schwerer Knieosteoarthritis stehen entweder ein totaler oder ein partieller Knieersatz zur Wahl. Spezialisten sind sich uneins, welche der beiden operativen Methoden bessere Endresultate bringt. Beard et al. untersuchten die klinische und wirtschaftliche Effektivität beider Methoden und evaluierten auftretende Komplikationen, die Patientenzufriedenheit und die Kostenauswirkungen für Patienten und das Gesundheitswesen.