Background:. Total knee replacement (TKR) is a frequent and effective surgery for knee osteoarthritis. Postoperative pain is under concern and can be relieved by different methods, including femoral nerve block (FNB). The efficacy of FNB on pain relief was associated with the absence of clinical impact when measured with the range of motion (ROM). Recent studies suggest that the quadriceps strength is the best indicator of functional recovery after TKR. The goal of this study is to compare the quadriceps strength recovery after TKR according to the kind of analgesia (patient control analgesia (PCA) with or without FNB) Hypothesis: the FNB delays the QSR at short and mid-term follow-up. Methods:. Prospective randomized trial with single-blind assessment involving 135 patients admitted for TKR in an academic center. Randomization into one of the three following groups: A) Continuous FNB 48h + PCA B) Single-shot FNB and PCA C) PCA alone. Groups were comparable for demographic and surgical data. The FNB was realised and controlled (electric stimulation) by an expert anesthesiologist before the surgery. Follow-up standardised in all groups with blinded assessors.
Our study is still in progress. The results mentioned in the abstract are preliminary results. The final results will be provided at the time of presentation. Over the past decade, the widespread availability of high-resolution ultrasonography coupled with advances in regional anaesthesia have popularised peripheral nerve blocks for anterior cruciate ligament reconstructions (ACLRs). The aim of this study is to investigate whether the femoral nerve block (FNB) administered at the time of ACLR has any long-term impact on the quadriceps strength as compared to patients who did not receive a FNB. This is a retrospective study. Four hundred charts of patients who underwent ACLR at our institution and had subsequent Biodex testing (an isokinetic rehabilitation test that provides objective information about muscle strength deficits and imbalances of the operated leg compared to the non-operated leg) from 2004 to 2015 were reviewed. Patients who had prior ipsilateral knee surgery, multi-ligament knee injury or at extreme ages were excluded from the study. The following baseline patient characteristics was recorded for each reviewed chart: age, sex, medical comorbidities, the date of the injury, date of the surgery, surgery technical notes and associated procedures, the surgeon, the hospital were the patient was operated, the Biodex test date and the Biodex test results. Data extraction assessed any association between the ACLR patients' who received FNB with the results of the Biodex test after completing the rehabilitation protocol. Descriptive statistics were used to compare the type of anaesthesia, mode of pain control and the results of the Biodex tests between patients grouped by the mode of anaesthesia used at the time of surgery (FNB versus no FNB). A multivariate regression model then compared quadriceps strength (inferred by Biodex test results) between groups while controlling for baseline differences between groups. Fifty five percent of the ACLR patients received FNB compared to 45% that did not receive FNB over the last 11 years of performing ACLRs (2004–2015) at our institute. Fifty percent of the patients that received FNB failed to achieve more than or equal to 80% quadriceps strength (compared to the contralateral non-operated leg) at 6 months on Biodex test. On the other hand, only 20% of the non-FNB group failed to achieve more than or equal to 80% quadriceps strength. This study lead us to think that ACLR patients that received FNB are significantly weaker in quadriceps strength at 6 months post ACLR in comparison to non-FNB ACLR patients. This finding subsequently might affect the time needed to return to sports and might indicate a considerable clinical consequence of the FNB on ACL-reconstruction patients.
Most of contemporary total knee systems address on improving of range of motion and bearing materials. Although new total knee designs in most systems accommodated the knee morphology according to gender differences, reestablishing of the same anterior offset of the distal femur during total knee arthroplasty (TKA) has not been well addressed. Furthermore, in most total knee systems, the anterior offset of the femoral component is constant regardless of the increment of the femoral size. We hypothesized that change of the anterior offset of the distal femur during TKA might affect the quadriceps strength and immediate clinical outcomes which may result in improved design of the future femoral component. To evaluate the peak quadriceps strength and immediate clinical outcomes related to the change of anterior offset of the distal femur during TKA.Background
Purpose
Introduction and Aim.
Introduction. A total knee replacement is a proven cost-effective treatment for end-stage osteoarthritis, with a positive effect on pain and function. However, only 80% of the patients are satisfied after surgery. It is known that high preoperative expectations and residual postoperative pain are important determinants of satisfaction, but also malalignment, poor function and disturbed kinematics can be a cause. The purpose of this study was to investigate the correlation between the preoperative function and the postoperative patient reported outcomes PROMs) as well as the influence of the postoperative functional rehabilitation on the PROMs. Methods. 57 patients (mean 62,9j ± 10,6j), who suffer from knee osteoarthritis and who were scheduled for a total knee replacement at our centre, participated in this study. The range of motion of the knee, the muscle strength of the M. Quadriceps and the M. Hamstrings and the functional parameters (‘stair climbing test’ (SCT), ‘Sit to stand’ (STS) and ‘6 minutes walking test’ (6MWT)) were measured the night before surgery, ±6 months and ±1 year after surgery. This happened respectively with the use of a goniometer, HHD 2, stopwatch and the ‘DynaPort Hybrid’. Correlations between pre- and postoperative values were investigated. Secondly, a prediction was made about the influence of the preoperative parameters on on the subjective questionnaires (KOOS, OXFORD and KSS) as well as a linear and logistic regression. Results. 6 Months after surgery, an improvement of all parameters for ROM, muscle strength and functional status was found. With a significant difference for the active and passive ROM toward knee flexion (p=0.007;p=0.008), asymmetry in active and passive ROM toward flexion between the healthy leg and the leg with the TKA (p=0.001;p=0.001), Quadriceps- and Hamstrings strength (p=0.001;p<0.001), time of the STS test (p=0.012), time sit-stand (p=0.002), time stand-sit (p=0.001;p<0.001), all parameters for the 6MWT and the time of the SCT (p=0.001). Regarding the prediction model, the 6month PROMs can be predicted by some parameters for the 6MWT (distance (p=0.001), gait steps (p=0.002) and step time TKA (p=0.007)). These parameters are predictors for the score on the subscales ‘symptoms’ and ‘pain’ of the KOOS questionnaire. 1 Year after surgery, there is an improvement of all parameters, except for the active and passive ROM toward knee extension. However, these differences are not significant. The 1 year PROMs can only be predicted by the muscle strength (Quadriceps- and Hamstrings strength (p=0.026; p=0.039) and the asymmetry in
This multicenter study compared computer-navigated TKA using either MIS or conventional surgical technique, using a CR fixed bearing knee, Stryker Navigation system and dedicated MIS instrumentation. It was hypothesized that patients would benefit from the MIS technique by shorter recovery periods, less blood loss, faster wound healing and improved mobility during early rehabilitation. A prospective multicentre double-blind controlled trial included 69 patients matched for age, gender, BMI (MIS n=36, CONV n=33). Assessments at pre-op, 1 week, 3 and 6 months post-op included surgery time, bloodloss, range of motion, Knee Society Score (KSS) and WOMAC, Chair rise test and quadriceps strength. Radiographic analysis included radiographs for lucencies and CAT scans for alignment,. Four patients were lost to follow-up. The MIS group had significantly more prolonged surgery time and blood loss at 24 hours p<0.05. At 6 months mean flexion values for MIS (106,7°±12,91) and CONV 105,92 ±11,58) with no significant differences in flexion ROM between both groups at any time point. KSS scores showed a significant improvement (p<0,01) over time in both groups but no statistical significance between groups. WOMAC score also improved significantly (p<0,01) over time in both groups without reaching statistical significance. A significant decrease of anterior knee pain score was observed over time with no significant difference between both groups.
