Introduction. Enhanced pain and rehabilitation protocols have significantly improved patient recovery following primary TKR. Little has been written on how the protocols have affected the revision TKR patient. We report on a matched group of revision and primary TKR patients treated with the identical pain and rehab program. Materials and Methods. 40 aseptic RTKR patients who underwent a full femoral and tibial revision were matched by age, sex, and BMI to a group of patients who underwent a cemented tri-compartmental primary TKR. All revision knees had uncemented stemmed femurs and tibias. All 40 patients had either a metaphyseal sleeve on either the femur or tibia or both. Patients in both groups were treated with an identical post op pain protocol (Spinal anesthetic, local infiltrative analgesia and multimodal oral pain management along with rapid rehabilitation). All patients were mobilized on POD1 and allowed weight bearing as tolerated. Patients were followed for a minimum of 1 year. KSS at 6 weeks and 1 year were recorded for both groups. Results. There was no significant difference in length of stay between the RTKR and the primary TKR (1.2 days versus 1.1 days). Average oral morphine equivalents used during the hospitalization was 38 for the RTKR and 42 for the primary group. There was 1 readmission in each group: GI distress in the RTKR and urinary retention in the primary group. There no were reoperations, wound healing problems, identified thromboembolic events or manipulations under anesthesia in either group. KSS for the RTKR group averaged 87.3 at 6 weeks (range 45 to 99) and 89.1at minimum 1 year (range 52 to100). KSS for the primary group averaged 89.9 (range 71 to 100) at 6 week follow-up and 93.2 (range 54 to 100) at minimum follow-up. Range of motion at final follow up averaged1.2 (0–10) to 114.1 (55–135) for the RTKR group and 1 (0–8) to 121.3 (85–140) for the primary group. Conclusion. Despite more complex surgery in the revision
Background. Artificial
Introduction. Individuals with significant hip and knee trauma receive
Aims. In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip. Methods. The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary
Background. The JOURNEY™ II Cruciate-Retaining
Numerous papers present in-vivo knee kinematics data following total knee arthroplasty (TKA) from fluoroscopic testing. Comparing data is challenging given the large number of factors that potentially affect the reported kinematics. This paper aims at understanding the effect of following three different factors: implant geometry, performed activity and analysis method. A total of 30 patients who underwent TKA were included in this study. This group was subdivided in three equal groups: each group receiving a different type of posterior stabilized total knee prosthesis. During single-plane fluoroscopic analysis, each patient performed three activities: open chain flexion extension, closed chain squatting and chair-rising. The 2D fluoroscopic data were subsequently converted to 3D implant positions and used to evaluate the tibiofemoral contact points and landmark-based kinematic parameters. Significantly different anteroposterior translations and internal-external rotations were observed between the considered implants. In the lateral compartment, these differences only appeared after post-cam engagement. Comparing the activities, a significant more posterior position was observed for both the medial and lateral compartment in the closed chain activities during mid-flexion. A strong and significant correlation was found between the contact-points and landmarks-based analyses method. However, large individual variations were also observed, yielding a difference of up to 25% in anteroposterior position between both methods. In conclusion, all three evaluated factors significantly affect the obtained tibiofemoral kinematics. The individual implant design significantly affects the anteroposterior tibiofemoral position, internal-external rotation and timing of post-cam engagement. Both kinematics and post-cam engagement additionally depend on the activity investigated, with a more posterior position and associated higher patella lever arm for the closed chain activities. Attention should also be paid to the considered analysis method and associated kinematics definition: analyzing the tibiofemoral contact points potentially yields significantly different results compared to a landmark-based approach.
Background. Kinematic patterns in total knee arthroplasty (TKA) can vary considerably from the native knee. No study has shown a relation between a given kinematic pattern and patient satisfaction yet. Questions. The purpose of this study was to test whether the kinematical pattern, and more specifically the anteroposterior translation during (1) open kinetic chain flexion-extension, (2) closed kinetic chain chair rising and (3) squatting, is related to the level of patient satisfaction after TKA. Methods. Thirty TKA patients were tested using single plane fluoroscopy. Tibiofemoral kinematics were analyzed for 3 activities of daily living (open chain flexion-extension (FE) and closed chain chair rising (CH) and squatting(SQ)). A two- step cluster analysis was performed which resulted in two clusters of patients based on the KOOS and KSS questionnaires. Cluster 1 (CL1) contained patients with good PROMs, cluster 2 (CL2) contained patients with poorer PROMs. Tibiofemoral kinematics were compared between and within both clusters. Results. Significant worse PROMs were found in cluster 2 for all KOOS and KSS subscores (P<0.001). Open chain movement: Concerning the open chain flexion extension no significant difference was found between the two clusters. Closed chain movements: On the medial side, an initial anterior translation (femur relative to tibia) was found in cluster 1 during early flexion but in cluster 2 this translation was steeper and ran more anteriorly. In mid-flexion a stable medial compartment was found in cluster 1 where cluster 2 started moving posteriorly already. In deep flexion a posterior translation was evaluated in both clusters. Concerning the lateral side, a small initial anterior translation in early flexion was found followed by a posterior translation in mid flexion which continued in deep flexion Cluster 1 moved significantly more posterior in deep flexion. Conclusion. This is one of the first studies to evaluate the influence of
Introduction. One of the main considerations in the revision TKR setting is deciding on the level of constraint to be utilized once the bone defects have been reconstructed. There is a fear that employing a maximally constrained insert could compromise long term results. We report on a consecutive series of full tibial and femoral component revisions all treated with a maximally conforming insert and followed for a minimum of 5 years. Materials and Methods. The study group consisted of 76 consecutive revision TKR in 76 patients where both the femur and the tibia were revised. 4 patients died and 6 were lost to follow up. Final cohort had an average age of 70 years, average BMI of 31 and there were 39 males in the group. Average time to revision was 7 years (range 1–10 years) and the reasons for revision included infection in 28, aseptic loosening 26, osteolysis and poly wear in 9 and 13 other. All were treated with the same revision system and an identical maximally conforming tibial rotating platform insert and followed for an average of 7 years (range 5–14 years). Results. one patient required additional surgery during the study period for a patella fracture. There were no manipulations. Average Knee Society Scores increased from an average of 55 to 89 at final follow up. No implants were loose or at risk of loosening and no knee sustained any mechanical complications related to the insert. Conclusion. Despite fears to the contrary, we did not identify any issues in using a maximally constrained insert in this consecutive group of revision
Radiographically no radiolucent lines were visible and all patellar components were centered.
A large proportion of wait times for primary
Day-case success rates after primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and medial unicompartmental knee arthroplasty (mUKA) may vary, and detailed data are needed on causes of not being discharged. The aim of this study was to analyze the association between surgical procedure type and successful day-case surgery, and to analyze causes of not being discharged on the day of surgery when eligible and scheduled for day-case THA, TKA, and mUKA. A multicentre, prospective consecutive cohort study was carried out from September 2022 to August 2023. Patients were screened for day-case eligibility using well defined inclusion and exclusion criteria, and discharged when fulfilling predetermined discharge criteria. Day-case eligible patients were scheduled for surgery with intended start of surgery before 1.00 pm.Aims
Methods
Introduction. Achieving high flexion after total knee arthroplasty is very important for patients in Asian countries where deep flexion activities are an important part of daily life. The Bi-Surface
Introduction. Orthopaedic theatres can be noisy. Noise exposure is known to be related to reduced cognition, reduced manual dexterity and increased rates of post-operative wound infection. Up to 50% of orthopaedic theatre staff have features of Noise-Induced Hearing Loss (NIHL) with higher levels in consultants compared to registrars. Exposure to noise levels of 90dB(A) at work for a career of 40 years, equates to a 51% risk of hearing loss. Materials & methods. A Casella CEL-242 meter was positioned in the corner of the theatre tent. Recordings were taken for 17
Background. Patellofemoral complications have dwindled with contemporary
This study aims to evaluate the impact of metabolic syndrome in the setting of obesity on in-hospital outcomes and resource use after total joint replacement (TJR). A retrospective analysis was conducted using the National Inpatient Sample from 2006 to the third quarter of 2015. Discharges representing patients aged 40 years and older with obesity (BMI > 30 kg/m2) who underwent primary TJR were included. Patients were stratified into two groups with and without metabolic syndrome. The inverse probability of treatment weighting (IPTW) method was used to balance covariates.Aims
Methods
There are a wide variety of implant brands and types of knee replacement available to surgeons. With time, the options available within many implant brand portfolios has grown, with alternative tibial or femoral components, tibial insert materials or shapes and patella resurfacings. To investigate the effect of the expansion of implant brand portfolios, and to establish the potential numbers of compatible implant construct combinations.Abstract
Introduction
Aim
With respect to survivorship following total knee arthroplasty (TKA), joint registries consistently demonstrate higher revision rates for both sexes in those less than 55 years. The current study analyses the survivorship of 500 cementless TKAs performed in this age group in a high-volume primary joint unit where cementless TKA has traditionally been used for the majority of patients. This was a retrospective review of 500 consecutive TKAs performed in patients under the age of 55 between March 1994 and April 2017. The primary outcome measure for the study was all-cause revision. Secondary outcome measures included clinical, functional and radiological outcomes.Abstract
Introduction
Methods
This study aims to implement and assess the inter and intra-reliability of a modernised radiolucency assessment system; the Radiolucency In cemented Stemmed Knee (RISK) arthroplasty classification. Furthermore, we assessed the distribution of regions affected by radiolucency in patients undergoing stemmed cemented knee arthroplasty. Stemmed knee arthroplasty cases over 7-year period at a single institution were retrospectively identified and reviewed. The RISK classification system identifies five zones in the femur and five zones in the tibia in both the anteroposterior (AP) and lateral planes. Post-operative and follow-up radiographs were scored for radiolucency by four blinded reviewers at two distinct time points four weeks apart. Reliability was assessed using the kappa statistic. A heat map was generated to demonstrate the reported regions of radiolucency. 29 cases (63 radiographs) of stemmed knee arthroplasty were examined radiographically using the RISK system. Intra-reliability (0.83) and Inter-reliability (0.80) scores were both consistent with a strong level of agreement using the kappa scoring system. Radiolucency was more commonly associated with the tibial component (76.6%) compared to the femoral component (23.3%), and the tibial anterior-posterior (AP) region 1 (medial plateau) was the most affected (14.9%). The RISK classification system is a reliable assessment tool for evaluating radiolucency around stemmed knee arthroplasty using defined zones on both AP and lateral radiographs. Zones of radiolucency identified in this study may be relevant to implant survival and corresponded well with zones of fixation, which may help inform future research.
Debridement, antibiotics and implant retention (DAIR) are considered as an optimal curative treatment option for prosthetic joint infection (PJI) when the biofilm is still immature and radical debridement is achievable. There are two main groups of patients suitable for DAIR. Those with an early acute PJI and patients with acute hematogenous PJI. However, there is also a third group of early PJI resulting from a wound healing problem or leaking hematoma. These may be either high or low grade depending on the microorganisms that infected the artificial joint “ We retrospectively analysed 100 successive DAIR procedures on prosthetic hip and knee joints performed between January 2010 and January 2022, from total of 21000 primary arthroplasties implanted within the same time period. We only included PJI in primary total replacements with no previous surgeries on the affected joint. Patients data (demographics, biochemical, microbiological, histopathological results, and outcomes) were collected from hospital bone and joint infection registry. The aim of surgery was radical debridement and the mobile parts exchange. The standardized antibiotic regime based on antibiofilm antibiotics.Aim
Methods