Objectives

This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only.

We sought to evaluate the early post-operative active range-of-motion (AROM) between robotic-assisted total knee arthroplasty (raTKA) and conventional TKA (cTKA). A secondary data analysis on a global prospective cohort study was performed. A propensity score method was used to select a matched control of cTKA from the same database using 1:1 ratio, based on age, sex, BMI, and comorbidity index. This resulted in 216 raTKA and cTKA matched cases. Multivariable longitudinal regression was used to evaluate difference in ROM over time and values are reported as least squares means (95% confidence interval). The longitudinal model tested the treatment effect (raTKA vs cTKA), time effect, and their interaction with control on covariance of patients ‘s age, sex, BMI, comorbidity and pre-operative flexion. Logistic regression was used to analyze the active flexion level at one month (cut by 90°) and three months (cut by 110°). At one-month postoperative the raTKA cases had more AROM for flexion by an average of 5.54 degrees (p<0.001). There was no difference at three months (p=0.228). The raTKA group had a greater improvement from pre-operative values at both one-month, with an average 7.07° (3.6°, 10.5°, p<0.001) more improvement, and at three-months with an average improvement of 4° more (1.61°, 7.24°, p=0.0115). AROM for extension was lower overall in the raTKA group by an average of 0.44° (p=0.029). The raTKA patients had higher odds of achieving ≥90° of flexion at one-month (OR 2.15, 95% CI 1.16, 3.99). raTKA resulted in greater AROM flexion gains in the early postoperative period than cTKA. Additional research is needed to understand if these earlier gains in AROM are associated with improved patient satisfaction and continued improvements with time

Aims. There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. Methods. A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints. Results. The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321). Conclusion. At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434–441

Introduction. Opioid abuse is a national epidemic. Traditional pain management after total knee arthroplasty (TKA) relied heavily on opioids. The evidence that in-hospital multimodal pain management (MMPM) is more effective than opioid-only analgesia is overwhelming. There has been little focus on post-discharge pain management. The purpose of this study was to determine whether MMPM after TKA could reduce opioid consumption in the 30-day period after hospital discharge. Methods. This was a prospective, two-arm, comparative study with a provider cross-over design. The first arm utilized a standard opioid-only (OO) prn regimen. The second arm utilized a 30-day MMPM regimen (standing doses of acetaminophen, metaxalone, meloxicam, gabapentin) and opioid medications prn. Surgeons crossed over protocols every four weeks. The primary outcome measure was VAS pain score. Secondary outcome measures included morphine milligram equivalents (MME) consumed, failure of the protocol, and manipulation under anesthesia (MUA). A pre-hoc power analysis was performed for the primary outcome measure and an intent-to-treat analysis was done utilizing a longitudinal mixed model. Results. There were 43 patients in the OO cohort and 39 patients in the MMPM cohort. There was no difference in the baseline demographics or preoperative scores (p=0.94). There was no clinically meaningful difference in VAS score between the two groups at any time. The average opioid consumption at 30-days was 469 and 344 MME's for the OO and MMPM cohorts, respectively (p=0.026). 19/43 (44.2%) patients in the OO cohort failed vs. 4/39 (10.3%) in the MMPM cohort (p=0.002). There was 1 MUA in the OO and none in the MMPM cohort (p=0.338). Discussion. A 30-day post-discharge multimodal pain regimen reduced opioid use after TKA. Opioid-only regimens are at an increased risk of failure to control pain. As a result of this study, multimodal pain management after hospital discharge is standard at our institution

Aims

The aims were to assess whether joint-specific outcome after total knee arthroplasty (TKA) was influenced by implant design over a 12-year follow-up period, and whether patient-related factors were associated with loss to follow-up and mortality risk.

Total knee arthroplasty (TKA) is an established and successful procedure. However, the design of prostheses continues to be modified in an attempt to optimise the functional outcome of the patient. . The aim of this study was to determine if patient outcome after TKA was influenced by the design of the prosthesis used. A total of 212 patients (mean age 69; 43 to 92; 131 female (62%), 81 male (32%)) were enrolled in a single centre double-blind trial and randomised to receive either a Kinemax (group 1) or a Triathlon (group 2) TKA. . Patients were assessed pre-operatively, at six weeks, six months, one year and three years after surgery. The outcome assessments used were the Oxford Knee Score; range of movement; pain numerical rating scales; lower limb power output; timed functional assessment battery and a satisfaction survey. Data were assessed incorporating change over all assessment time points, using repeated measures analysis of variance longitudinal mixed models. Implant group 2 showed a significantly greater range of movement (p = 0.009), greater lower limb power output (p = 0.026) and reduced report of ‘worst daily pain’ (p = 0.003) over the three years of follow-up. Differences in Oxford Knee Score (p = 0.09), report of ‘average daily pain’ (p = 0.57) and timed functional performance tasks (p = 0.23) did not reach statistical significance. Satisfaction with outcome was significantly better in group 2 (p = 0.001). These results suggest that patient outcome after TKA can be influenced by the prosthesis used. Cite this article: Bone Joint J 2015;97-B:64–70