The proportion of arthroplasties performed in the ambulatory setting has increased substantially. However, concerns remain regarding whether same-day discharge may increase the risk of complications. The purpose of this study was to compare 90-day outcomes between inpatients and patients having surgery at an ambulatory surgery center (ASC). Among a single-surgeon cohort of 721 patients who underwent arthroplasty at a free-standing ASC, 611 (84.7%) were matched one-to-one to inpatients based on age, gender, American Society of Anesthesiologists (ASA) score, and Body Mass Index (110 patients could not be adequately matched). The cohort included 208 total hip arthroplasties (34.0%), 196 total knee arthroplasties (32.1%), 178 unicompartmental knee arthroplasties (29.1%), 25 hip resurfacings (4.1%), two revision hip arthroplasties (0.3%) and two revision knee arthroplasties (0.3%). Post-operative outcomes including readmissions, reoperations, unplanned clinic visits, emergency department visits, and complications were compared. Complications were classified as either major (i.e. death, periprosthetic joint infection, pulmonary embolism) or as minor (i.e. delayed wound healing, rashes, urinary retention).Introduction
Methods
The purpose of this study was to evaluate the clinical and radiographic outcomes of the rotating-platform, posterior-stabilized PFC Sigma at fifteen-year follow-up. Between January 2000 and November 2001, two hundred consecutive patients underwent TKA with a rotating-platform, posterior stabilized total knee arthroplasty with cement. All patients have been followed prospectively and all patients with minimum 12 year follow up were included in this analysis. Forty-nine TKAs were available for our final analysis with a mean follow up of 16.0 years.Background
Methods
Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) Patients with a history of ACL or MLK reconstruction who underwent TKA between 2007 and 2017 were identified in a single-institution registry. There were 223 patients who met inclusion criteria (188 ACL reconstruction patients, 35 MLK reconstruction patients). A matched cohort, also of 223 patients, was identified based on patient age, body mass index (BMI), sex, and year of surgery. There were 144 male patients and 79 female patients in both cohorts. Mean age at the time of TKA was 57.2 years (31 to 88). Mean BMI was 29.7 kg/m2 (19.5 to 55.7).Aims
Patients and Methods
Mesenchymal stem cells (MSCs) have several properties that may support their use as an early treatment option for osteoarthritis (OA). This study investigated the role of multiple injections of allogeneic bone marrow-derived stem cells (BMSCs) to alleviate the progression of osteoarthritic changes in the various structures of the mature rabbit knee in an anterior cruciate ligament (ACL)-deficient OA model. Two months after bilateral section of the ACL of Japanese white rabbits aged nine months or more, either phosphate buffered saline (PBS) or 1 x 106 MSCs were injected into the knee joint in single or three consecutive doses. After two months, the articular cartilage and meniscus were assessed macroscopically, histologically, and immunohistochemically using collagen I and II.Aim
Materials and Methods
Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There is limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) to a matched cohort of patients undergoing TKA with no history of PKLR. All patients with history of ACL or MLK reconstruction who underwent TKA between 2007–2018 were identified in a single institution registry. A matched cohort was identified based on patient age, body mass index (BMI), sex, and year of surgery. The primary outcome measure was utilization of constrained implants. Secondary outcomes included rates of deep vein thrombosis (DVT), pulmonary embolism (PE), infection, postoperative transfusion, postoperative knee range of motion (ROM), revision surgery, and patient reported outcomes (Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR).Introduction
Methods
In a randomised controlled pragmatic trial we
investigated whether local infiltration analgesia would result in earlier
readiness for discharge from hospital after total knee replacement
(TKR) than patient-controlled epidural analgesia (PCEA) plus femoral
nerve block. A total of 45 patients with a mean age of 65 years
(49 to 81) received a local infiltration with a peri-articular injection
of bupivacaine, morphine and methylprednisolone, as well as adjuvant
analgesics. In 45 PCEA+femoral nerve blockade patients with a mean
age of 67 years (50 to 84), analgesia included a bupivacaine nerve
block, bupivacaine/hydromorphone PCEA, and adjuvant analgesics.
The mean time until ready for discharge was 3.2 days (1 to 14) in
the local infiltration group and 3.2 days (1.8 to 7.0) in the PCEA+femoral
nerve blockade group. The mean pain scores for patients receiving
local infiltration were higher when walking (p = 0.0084), but there
were no statistically significant differences at rest. The mean
opioid consumption was higher in those receiving local infiltration. The choice between these two analgesic pathways should not be
made on the basis of time to discharge after surgery. Most secondary
outcomes were similar, but PCEA+femoral nerve blockade patients
had lower pain scores when walking and during continuous passive
movement. If PCEA+femoral nerve blockade is not readily available, local
infiltration provides similar length of stay and similar pain scores
at rest following TKR. Cite this article:
There has been a recent increase in interest
for non-cemented fixation in total knee arthroplasty (TKA), however
the superiority of cement fixation is an ongoing debate. Whereas the results based on Level III and IV evidence show similar
survivorship rates between the two types of fixation, Level I and
II evidence strongly support cemented fixation. United Kingdom,
Australia, Sweden, and New Zealand registry data show lower failure
rates and greater usage of cemented than non-cemented fixation.
Case series studies have also indicated greater functional outcomes
and lower revision rates among cemented TKAs. Non-cemented fixation
involves more patellofemoral complications, including increased
susceptibility to wear due to a thinner polyethylene bearing on
the cementless metal-backed component. The combination of results
from registry data, prospective randomised studies, and meta-analyses
support the current superiority of cemented fixation in TKAs.
The aim of this study was to compare the outcome between the first and second knee replacement in patients undergoing staged bilateral total knee arthroplasty. A prospective database of outcomes of knee replacements performed at Broadgreen Hospital was commenced in 2003. Data is collected pre operatively, 3 and 12 months post operatively and every two years thereafter. We identified 64 patients (26 male, 38 female) who had bilateral knee replacements and had at least one year post operative outcome studies. Data on pain scores, walking ability (score 1-6), use of walking aids (score 1-6), range of movement, instability, muscle strength, WOMAC scores, SF-12 scores, the Knee Society Radiological Score and length of hospital stay were identified. We compared data between the first and second knee operation.Introduction
Methods
We retrospectively studied the major complications occurring after one- and two-stage bilateral unicompartmental knee replacements (UKR). Between 1999 and 2008, 911 patients underwent 1150 UKRs through a minimally invasive approach in our unit. Of these, 159 patients (318 UKRs) had one-stage and 80 patients (160 UKRs) had two-stage bilateral UKRs. The bilateral UKR groups were comparable in age and American Society of Anaesthesiology grade, but more women were in the two-stage group (p = 0.019). Mechanical thromboprophylaxis was used in all cases. Major complications were recorded as death, pulmonary embolus, proximal deep-vein thrombosis and adverse cardiac events within 30 days of surgery. No statistical differences between the groups were found regarding the operating surgeon, the tourniquet time or minor complications except for distal deep-vein thrombosis. The anaesthetic times were longer for the two-stage group (p = 0.0001). Major complications were seen in 13 patients (8.2%) with one-stage operations but none were encountered in the two-stage group (p = 0.005). Distal deep-vein thrombosis was more frequent in the two-stage group (p = 0.036). Because of the significantly higher risk of major complications associated with one-stage bilateral UKR we advocate caution before undertaking such a procedure.
