Cryocompression therapy is a non-invasive and non-pharmacological modality used in managing acute post-operative inflammation and pain. A prospective, randomised controlled trial (RCT) was undertaken to evaluate the effectiveness of a post-operative cryocompression protocol using the Game Ready™ (GR) device versus usual care on recovery following total knee arthroplasty (TKA). A single centre RCT was conducted with 70 TKAs (68 patients) randomised to a 2-week intervention period consisting of treatment with GR cryocompression (n=33, 33.3% males) or a usual care protocol of ice with static compression using tubigrip (n=35, 54.3% males). Knee range of movement (ROM) (flexion and extension), a visual analogue pain score (VAS) and limb circumference were documented at day 1, 2 and 14, as well as 6 and 12 weeks post-surgery. ROM was also recorded at day 90, while medication use and length of hospital stay were documented. Patient reported outcome measures (PROMs) including the KOOS and patient satisfaction questionnaire were employed. The GR group demonstrated 2.3° more (p=0.05) knee extension ROM overall, as well as 2. 8° more at day 1 (p=0.048), 3.8° at day 14 (p=0.007) and 5.4° at 3 months (p=0.017). There were no group differences (p>0.05) observed in pain (VAS), flexion ROM, limb circumference, opioid use or other PROMs. Across the full cohort, higher pain levels resulted in increased opioid intake (p=0.002), older patients used significantly less opioids (p<0.001) and males reported significantly less pain (VAS) than females (p=0.048). Using GR following TKA is a safe, non-invasive tool that can be used to aid in the post-operative recovery period. Patients using the GR cryocompression device gained significantly more extension ROM compared to the conventional ice with compression group, despite no other group differences.
Femoral component malrotation is a common cause for persisting symptoms and revision following total knee arthroplasty (TKA). There is ongoing debate about the most appropriate use of femoral landmarks to determine rotation. The Sulcus Line (SL, See Figure 1) is a three-dimensional curve produced from multiple points along the trochlear groove. Whiteside's Line, also known as the anteroposterior axis (APA), is derived from single anterior and posterior points. The purposes of the three studies presented are to i) assess the SL in a large clinical series, ii) demonstrate the effect of parallax error on rotational landmarks, and iii) assess the accuracy of a device which transfers a geometrically corrected SL onto the distal cut surface of the femur. The first study assessed the SL using a large, single surgeon series of consecutive patients (n=200) undergoing primary TKA. The postoperative CT scans of patients were examined to determine the final rotational alignment of the femoral component. In the second study measurements were taken in a series of 3DCT reconstructions of osteoarthritic knees (n=44) comparing the rotational landmarks measured along either the mechanical axis or the coronal axis of the trochlear groove. The third study assessed the accuracy of a novel trochlear alignment guide (TAG) using cadavers (n=10)Purpose
Methods
Overlap between the distal tibia and fibula has always been quoted
to be positive. If the value is not positive then an injury to the
syndesmosis is thought to exist. Our null hypothesis is that it
is a normal variant in the adult population. We looked at axial CT scans of the ankle in 325 patients for
the presence of overlap between the distal tibia and fibula. Where
we thought this was possible we reconstructed the images to represent
a plain film radiograph which we were able to rotate and view in
multiple planes to confirm the assessment. Objectives
Methods
