Aims. This Delphi study assessed the challenges of diagnosing soft-tissue knee injuries (STKIs) in
Abstract. Introduction. The incidence of significant
Abstract. The Coronavirus pandemic mandated an immediate and dramatic change in the delivery of
Abstract. Introduction. Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment for
Aims. The aim of this study was to determine if the local delivery of vancomycin and tobramycin in primary total knee arthroplasty (TKA) can achieve intra-articular concentrations exceeding the minimum inhibitory concentration thresholds for bacteria causing
Aims. Despite recent literature questioning their use, vancomycin and clindamycin often substitute cefazolin as the preoperative antibiotic prophylaxis in primary total knee arthroplasty (TKA), especially in the setting of documented allergy to penicillin. Topical povidone-iodine lavage and vancomycin powder (VIP) are adjuncts that may further broaden antimicrobial coverage, and have shown some promise in recent investigations. The purpose of this study, therefore, is to compare the risk of
Introduction. Diagnosing
Aims. To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an
Introduction. Periprosthetic infection (PJI) after primary total knee arthroplasty (TKA) remains a challenging issue affecting 1–2% of cases. Locally delivered prophylactic antibiotics, including tobramycin or gentamicin mixed in polymethylmethacrylate (PMMA) bone cement and vancomycin powder, are increasingly used despite a lack of high quality evidence for either practice. In this study, we report the antibiotic susceptibility of organisms recovered in culture from patients with
Abstract. Introduction. Fractures of the articular surface of the patella or the lateral femoral condyle usually occur following
We investigated the role of a functional brace worn for four months in the treatment of patients with an
The aim of this study was to report the outcome of the non-operative
treatment of high-grade posterior cruciate ligament (PCL) injuries,
particularly Hughston grade III injuries, which have not previously
been described. This was a prospective study involving 46 consecutive patients
who were athletes with MRI-confirmed isolated PCL injuries presenting
within four weeks of injury. All had Hughston grade II (25 athletes)
or III (21 athletes) injuries. Our non-operative treatment regimen
involved initial bracing, followed by an individualised rehabilitation
programme determined by the symptoms and physical signs. The patients
were reviewed until they had returned to sports-specific training,
and were reviewed again at a mean of 5.2 years (3 to 9).Aims
Patients and Methods
Multimodal pain management strategies are now commonplace in perioperative management of total knee arthroplasty (TKA), although controversy remains regarding the role of adductor canal blocks (ACB) in this algorithm. Proposed benefits include theoretical decreased role of perioperative narcotic pain medication, improved function with physical therapy postoperatively, shorter duration of hospital stay and improved patient satisfaction. Those opposed cite increased cost and risk of complications including inadvertent motor blockade. The purpose of this study was to independently evaluate the effect of adductor canal block on short-term post-operative outcomes including (1) length of stay (LOS), (2) post-operative narcotic utilization, and (3) function with physical therapy in the era of modern TKA. Our institutional database was utilized to retrospectively identify a cohort of consecutive patients from January 2014-January 2018 who had undergone unilateral primary TKA with a single surgeon utilizing a preoperative single-shot ACB in addition to a standardized multimodal pain regimen versus those that only received the same multimodal pain regimen (no-ACB). The primary reason that a patient did not receive a preoperative block was lack of availability of the block team The time period of interest was selected based on the implementation of our current pain protocols. The multimodal pain regimen consists of: preoperative Tylenol, a periarticular injection intraoperatively including 0.5% Marcaine and Toradol, IV Toradol postoperatively, Percocet, Celebrex and IV narcotic medication for breakthrough pain. These 2 groups were compared utilizing independent sample T-tests with primary endpoints of interest being LOS (in total hours and as %day 1 discharges (%POD1)), distance ambulated with inpatient therapy on postoperative day 1, and inpatient narcotic use as measured in morphine equivalents per hour. A sub-cohort of patients with adductor canal block was then selected based on time of surgery to control for time of discharge and hours in the hospital to isolate the effect of the block.Introduction
Methods
Patients with solid organ transplant have been shown to have increased risk of complications following TKA compared to non-transplant patients. The risk of AKI in KTx is reported to be as high as 15.6 % and associated with increased morbidity, and length of stay (LOS). Our aim was to determine the incidence of AKI in KTx undergoing primary and revision TKA and to identify risk factors for its occurrence and its effect on allograft function 1 year postoperatively. Using the orthopedic and transplant databases we designed a case-control study of 82 patients undergoing 101 TKA between 2000 and 2018 at our institution. The average age at surgery was 65 years (range 35–83); 58% male and 98% white. AKI was defined per KIDGO guidelines.Introduction
Methods
Aims. This study aims to determine the rate of and risk factors for total knee arthroplasty (TKA) after operative management of tibial plateau fractures (TPFs) in older adults. Methods. This is a retrospective cohort study of 182 displaced TPFs in 180 patients aged ≥ 60 years, over a 12-year period with a minimum follow-up of one year. The mean age was 70.7 years (SD 7.7; 60 to 89), and 139/180 patients (77.2%) were female. Radiological assessment consisted of fracture classification; pre-existing knee osteoarthritis (OA); reduction quality; loss of reduction; and post-traumatic OA. Fracture depression was measured on CT, and the volume of defect estimated as half an oblate spheroid. Operative management, complications, reoperations, and mortality were recorded. Results. Nearly half of the fractures were Schatzker II AO B3.1 fractures (n = 85; 47%). Radiological knee OA was present at fracture in 59/182 TPFs (32.6%). Primary management was fixation in 174 (95.6%) and
Aims. Debridement, antibiotics, and implant retention (DAIR) remains one option for the treatment of
Abstract. Introduction. A lipohaemarthrosis seen on Horizontal beam lateral X-ray in
Aims. This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection. Methods. This is a retrospective population-based cohort study using prospectively collected patient-level data between 1 January 2013 and 1 March 2020. The diagnosis of deep SSI was defined as per the Centers for Disease Control/National Healthcare Safety Network criteria. The Mann-Kendall Trend test was used to detect monotonic trends in annual rates of early-onset deep SSI over time. Multiple logistic regression was used to analyze the effect of different patient, surgical, and healthcare setting factors on the risk of developing a deep SSI within 90 days from surgery for patients with complete data. We also report 90-day mortality. Results. A total of 39,038 patients underwent primary TKA for osteoarthritis during the study period. Of these, 275 patients developed a deep SSI within 90 days of surgery, representing a cumulative incidence of 0.7%. The annual infection rate did not significantly decrease over the seven-year study period (p = 0.162). Overall, 13,885 (35.5%) cases were excluded from the risk analysis due to missing data. Risk factors associated with early-onset deep SSI included male sex, American Society of Anesthesiologists grade ≥ 3, blood transfusion,
Aims. Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised. Methods. This retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups. Results. A total of 663 cases were identified (486 index rTKAs and 177 multiply revised TKAs). There were no differences in demographics, rTKA type, or indication for revision. Multiply revised patients had significantly longer rTKA operative times (p < 0.001), and were more likely to be discharged to an
Aims. The rate of day-case total knee arthroplasty (TKA) in the UK is currently approximately 0.5%. Reducing length of stay allows orthopaedic providers to improve efficiency, increase operative throughput, and tackle the rising demand for joint arthroplasty surgery and the COVID-19-related backlog. Here, we report safe delivery of day-case TKA in an NHS trust via inpatient wards with no additional resources. Methods. Day-case TKAs, defined as patients discharged on the same calendar day as surgery, were retrospectively reviewed with a minimum follow-up of six months. Analysis of hospital and primary care records was performed to determine readmission and reattendance rates. Telephone interviews were conducted to determine patient satisfaction. Results. Since 2016, 301/7350 TKAs (4.1%) in 290 patients at our institution were discharged on the day of surgery. Mean follow-up was 31.4 months (6.2 to 70.0). In all, 28 patients (9.3%) attended the emergency department or other