Studies have shown that as many as 1 in 5 patients is dissatisfied following total knee replacement (TKA). There has also been a large reported disparity between surgeon and patient perception of clinical “success”. It has long been shown that surgeon opinion of procedural outcomes is inflated when compared with patient-reported outcomes. Additionally, TKA recipients have consistently reported higher pain levels, greater inhibition of function, and lower satisfaction than total hip replacement (THA) recipients. It is imperative that alternative methods be explored to improve TKA patient satisfaction. Therefore, the purpose of this study was to determine whether or not patients with a balanced TKA, as measured using intraoperative sensors, exhibit better clinical outcomes. 310 patients scheduled for TKA surgery were enrolled in a 6 center, randomized controlled trial, resulting in two patient groups: a sensor-guided TKA group and a surgeon-guided TKA group. Intraoperative load sensors were utilized in all cases, however in one group the surgeon used the feedback to assist in balancing the knee and in the other group the surgeon balanced without load data and the sensor was used to blindly record the joint balance. For this evaluation, the two groups were pooled and categorized as either balanced or unbalanced, as defined by a mediolateral load differential less than 15 lbf (previously described in literature). Clinical outcomes data were collected at 6 weeks, 6 months and 1 year post- operatively, including Knee Society Satisfaction and the Forgotten Joint Score. Using linear mixed models, these outcome measures were compared between the balanced and unbalanced patient groups.Introduction & Aims
Methods
The routine use of posterior hip dislocation precautions is typically utilized postoperatively following total hip arthroplasty via a posterior surgical approach. This has included use of an abduction pillow and limiting adduction, internal rotation and flexion more than 90 degrees for a minimum of 6 weeks postoperatively. This may slow the course of rehabilitation, increase the length of hospital stay and the total cost of the procedure, and add additional anxiety to the patient. We conducted this study to see if posterior hip precautions are necessary after total hip arthroplasty via a posterior approach when the hip meets certain intraoperative criteria for stability. All patients in our institute undergo routine hip stability testing during primary total hip arthroplasty via a posterior approach. Before October 2010, all of our primary total hip arthroplasty patients were placed on routine hip precautions. We stopped hip precautions in October 2010 for all the patients who were noted to meet hip stability criteria intraoperatively. We prospectively compared the consecutive patients who underwent this procedure without hip precautions with a retrospective control group of patients who had hip precautions.Introduction:
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