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1.
Aaron J. Casp James A. Browne Nicole E. Durig Brian C. Werner 《The Journal of arthroplasty》2019,34(1):36-39
Background
Pigmented villonodular synovitis (PVNS) is a locally destructive histiocytic proliferation most commonly occurring in the knee. Extensive local joint destruction can indicate the need for a total knee arthroplasty (TKA). The objective of this study is to evaluate PVNS of the knee as a risk factor for complication after TKA.Methods
Patients who underwent TKA with a diagnosis of PVNS of the knee from 2007 to 2016 were identified in a national private payer insurance database. Complication rates for emergency room visits, readmission, revision, stiffness, infection, and death were calculated and compared to a control population of patients who received TKA for osteoarthritis (OA).Results
Four hundred fifty-three patients were diagnosed with PVNS of the knee and underwent TKA during the time period and compared with a matched control cohort of 1812 patients who underwent TKA for OA. The rate of revision TKA at 2 years, emergency room visits, readmission, and death did not differ between the PVNS group and the control cohort. The PVNS group had stiffness at 1 year compared to the OA group (6.84% vs 4.69%, odds ratio 1.48, P = .023). The infection rate at 2 years was 3.31% in the PVNS group and 1.55% in the OA group (odds ratio 1.73, P = .011).Conclusion
The complication rates for TKA in patients with a diagnosis of PVNS of the knee have not been previously demonstrated. These patients have a higher rate of stiffness and infection when compared to a control cohort, so they may have a more complicated postoperative course. 相似文献2.
Background
Our study determined the long-term clinical, radiographic, and computed tomography scanning results of high-flexion mobile-bearing and fixed-bearing total knee arthroplasties (TKAs) in the same younger patients. In addition, the survivorship and complication rates of both groups were evaluated.Methods
Bilateral simultaneous sequential TKAs were performed in 164 patients (328 knees). There were 142 women and 22 men with a mean age of 63 ± 9 years (range 41-65), who received a high-flexion mobile-bearing prosthesis in one knee and a high-flexion fixed-bearing prosthesis in the other. The mean follow-up was 16.9 years (range 15-18).Results
At the latest follow-up, the mean Knee Society knee scores (94 ± 8 vs 95 ± 9 points, P = .7), Western Ontario and McMaster Universities Osteoarthritis Index (20 ± 11 vs 20 ± 11 points, P = 1.0), range of knee motion (125° ± 10° vs 127° ± 9°, P = .8), and University of California, Los Angeles activity scores (7.8 vs 7.8 points, P = 1.0) were below the level of clinical significance between the 2 groups. Survival rate of high-flexion mobile-bearing TKA was 98.2% and that of high-flexion fixed-bearing TKA was 97% at 16 years. No osteolysis was identified in either group.Conclusion
After a minimum duration of follow-up of 13 years, we found no significant difference between these 2 groups with regard to functional outcome, knee motion, prevalence of osteolysis, or survivorship. This study does not clearly direct the surgeon toward either arm of treatment. Longer term follow-up is needed to prove the superiority of one type of implant over the other one. 相似文献3.
Amir Khoshbin Alexandra Stavrakis Achal Sharma Pauline Woo Amit Atrey Yuo-Yu Lily Lee Amethia Joseph Douglas E. Padgett 《The Journal of arthroplasty》2019,34(5):872-876.e1
Background
The objective of the study was to compare the patient-reported outcome measures (PROM) of patients with post-traumatic arthritis (PTA) versus patients with osteoarthritis (OA) undergoing total knee arthroplasty (TKA) and compare the rates of revision among these two groups.Methods
Using a prospectively held institutional registry, we retrospectively reviewed patients ≥60 years of age who underwent unilateral TKA between May 2007 and February 2012. Patients with previous or concomitant diagnosis of inflammatory arthropathy or an initial open fracture were excluded. PTA patients were matched 1:5 with OA patients undergoing TKA. Validated PROMs were recorded at baseline before index TKA and the last follow-up. Reason and time to revision surgery was reported, and survivorship was compared using Kaplan-Meier curves.Results
Seventy-five PTA patients were matched to 375 OA patients. There was no difference between these groups with respect to age (67.7 ± 5.6 vs 67.8 ± 5.5 years; P = .876), body mass index (28.6 ± 5.4 vs 28.7 ± 5.3 kg/m2; P = .948), sex (65.3% vs 65.3% females; P = .999), Charlson Comorbidity Index (21.3% vs 21.3% Index 1-2, P = .999), and time to follow-up (93.0 ± 13.4 vs 88.2 ± 13.7 months; P = .999). No statistically significant difference was found in PROMs at baseline and the last follow-up (P > .05), the rate or time to revision surgery between the two groups (P-value = .635; log-rank test).Conclusion
Unlike previous studies, TKA for PTA does not pose lower PROMs or higher revision rates when compared to TKA for OA. These results could help provide surgeons with a frame of reference in terms of expectations for patients with PTA undergoing TKA. 相似文献4.
David H. Ge Afshin A. Anoushiravani Benjamin S. Kester Jonathan M. Vigdorchik Ran Schwarzkopf 《The Journal of arthroplasty》2018,33(1):124-129.e1
Background
Compared to total knee arthroplasty (TKA) for primary osteoarthritis, conversion TKAs in the post-traumatic setting are associated with increased operative times, infection rates, and readmissions. We aim at determining how post-traumatic osteoarthritis and previous knee surgery influence postoperative outcomes in conversion TKA.Methods
Seventy-two conversion TKA procedures with prior knee trauma at a single institution between April 2012 and 2016 were examined. Twenty-seven (37.5%) cases had a preoperative site-specific diagnosis such as fracture of the proximal tibia, distal femur, or patella whereas 45 (62.5%) cases had a preoperative diagnosis of significant soft-tissue trauma. These 2 groups were compared in terms of total implant cost, length of stay, complications, and readmission and reoperation rates. A subanalysis was conducted to evaluate the effects of previous knee surgery on surgical outcomes.Results
The postfracture TKA cohort suffered significantly higher early surgical site complications (22% vs 4.4%, P = .02) and 90-day readmissions (14.8% vs 2.2%, P = .042) compared to the soft-tissue trauma cohort. Operative time, total implant costs, length of stay, medical complications, 30-day readmissions, and 90-day reoperation rates did not significantly differ. It was also found that patients with multiple prior knee surgeries compared to one prior knee surgery are younger (53.0 vs 63.1, P = .003), healthier, and receive significantly more expensive implants (1.72 vs 1.07, P = .026). In addition, patients with previous open reduction internal fixations experience more surgical site complications than patients with previous arthroscopies (31% vs 3.3%, P = .042).Conclusion
Patients with previous site-specific fracture are more likely to experience surgical site complications and 90-day readmissions after conversion TKA than patients with previous soft-tissue knee trauma. Multiple previous knee surgeries appear to serve as an independent factor in the selection of costlier implants irrespective of preoperative diagnosis. 相似文献5.
Brent J. Sinicrope Anthony W. Feher Samrath J. Bhimani Langan S. Smith Steven F. Harwin Madhusudhan R. Yakkanti Arthur L. Malkani 《The Journal of arthroplasty》2019,34(2):309-314
Background
Total knee arthroplasty (TKA) in the morbidly obese patients can be challenging with an increased risk of complications. Studies have shown increased aseptic failures with well-aligned cemented TKAs in the obese patient. The purpose of this study is to determine if TKA in the morbidly obese (body mass index [BMI] ≥ 40) using cementless implants would demonstrate improved results and survivorship compared to cemented TKA at a minimum 5-year follow-up.Methods
This is a retrospective study comparing clinical results of cemented vs cementless primary TKA with a posterior stabilized design TKA in morbidly obese (BMI ≥ 40) patients with minimal 5-year follow-up. There were 108 patients in the cementless group with a mean BMI of 45.6. In the cemented cohort, there were 85 cemented TKAs with a mean BMI of 45.0. Demographic, clinical, surgical, and radiographic data along with complications were extracted for all study patients.Results
There were 5 failures requiring revision in the cementless group, including 1 for aseptic tibial loosening (0.9%). In the cemented group, there were 22 failures requiring revision, including 16 implants for aseptic loosening (18.8%; P = .0001). Survivorship with aseptic loosening as the endpoint was 99.1% in the cementless group vs 88.2% in the cemented cohort at 8 years (P = .02).Conclusion
Morbidly obese patients (BMI ≥ 40) have a higher failure due to aseptic loosening with cemented TKA with decreasing survivorship over time. The use of cementless TKA in morbidly obese patients with the potential of durable long-term biologic fixation and increased survivorship appears to be a promising alternative to mechanical cement fixation. 相似文献6.
Joshua R. Labott Cody C. Wyles Matthew T. Houdek Megha M. Tollefson David J. Driscoll William J. Shaughnessy Rafael J. Sierra 《The Journal of arthroplasty》2019,34(4):682-685
Background
Klippel-Trénaunay syndrome (KTS) is a severe vascular malformation that can lead to hypertrophic osteoarthritis. Total knee arthroplasty (TKA) performed in extremities affected with KTS is challenging given the high-risk vascular considerations and occasionally poor bone quality.Methods
We identified 12 patients with KTS who underwent TKA between 1998 and 2017. There were 7 men, mean age 42 years, and mean follow-up was 7 years. Before arthroplasty, 2 patients (17%) had preoperative sclerotherapy. Preoperative vascular studies were done for 9 patients (75%) and included magnetic resonance imaging (n = 7), magnetic resonance angiography (n = 1), and computed tomography angiography (n = 1). A preoperative blood conservation protocol was used for all operations and included the use of tranexamic acid (TXA) in later years. Posterior-stabilized TKA was used in 10 cases and cruciate-retaining TKA was used in 2 cases.Results
At final follow-up, 2 patients (17%) had undergone revision surgery: 1 for infection and 1 for tibial loosening with subsequent arthrofibrosis. Knee Society Scores (36-83, P < .0001) and functional scores (48-84, P = .0007) significantly increased between the preoperative and postoperative period. Likewise at last follow-up, the mean knee range of motion significantly increased (82°-104°, P = .04). Median blood loss for patients who received TXA was 200 mL compared to 275 mL in patients who did not receive TXA (P = .66). Likewise there was no difference (P = .5) in the proportion of patients who required a transfusion between those who received TXA (2/6, 33%) and those who did not (3/6, 50%).Conclusion
In this small series, TKA can lead to significant clinical improvement for patients with KTS. Modern blood management techniques and a careful multidisciplinary care approach render TKA a reasonable option for select patients with KTS.Level of Evidence
Level IV case series, therapeutic. 相似文献7.
Cody C. Wyles William A. Robinson Hilal Maradit-Kremers Matthew T. Houdek Robert T. Trousdale Tad M. Mabry 《The Journal of arthroplasty》2019,34(4):671-675
Background
Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a 2-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA.Methods
All primary TKAs performed from 2007 to 2017 by the 2 participating surgeons for each of the 3 groups of interest were identified: team SA (N = 42 patients; 84 knees), single-surgeon SA (N = 146 patients; 292 knees), single-surgeon TA (N = 242 patients; 484 knees). No patients were lost to follow-up.Results
Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (P < .001 overall; P = .0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4% for team SA, 11.0% for single-surgeon SA, and 8.3% for single-surgeon TA (P = .2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31%, single-surgeon SA 53%, and single-surgeon TA after the second operation 34% (P < .001).Conclusion
This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient operating room utilization may further enhance the financial benefits. 相似文献8.
Background
There is none, to our knowledge, about comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties (TKAs) in the same patients. The purpose of this study was to determine whether clinical results; radiographic and computed tomographic scan results; and the survival rate of a high-flexion mobile-bearing TKA is better than that of a high-flexion fixed-bearing TKA.Methods
The present study consisted of 92 patients (184 knees) who underwent same-day bilateral TKA. Of those, 17 were men and 75 were women. The mean age at the time of index arthroplasty was 61.5 ± 8.3 years (range 52-65 years). The mean body mass index was 26.2 ± 3.3 kg/m2 (range 23-34 kg/m2). The mean follow-up was 11.2 years (range 10-12 years).Results
The Knee Society knee scores (93 vs 92 points; P = .531) and function scores (80 vs 80 points; P = 1.000), WOMAC scores (14 vs 15 points; P = .972), and UCLA activity scores (6 vs 6 points; P = 1.000) were not different between the 2 groups at 12 years follow-up. There were no differences in any radiographic and CT scan parameters between the 2 groups. Kaplan-Meier survivorship of the TKA component was 98% (95% confidence interval, 93-100) in the high-flexion fixed-bearing TKA group and 99% (95% confidence interval, 94-100) in the high-flexion mobile-bearing TKA group 12 years after the operation.Conclusion
We found no benefit to mobile-bearing TKA in terms of pain, function, radiographic and CT scan results, and survivorship. Longer-term follow-up is necessary to prove the benefit of the high-flexion mobile-bearing TKA over the high-flexion fixed-bearing TKA. 相似文献9.
Benjamin M. Stronach Jeremy C. Adams LaRita C. Jones Sean M. Farrell Josie M. Hydrick 《The Journal of arthroplasty》2019,34(2):286-289
Background
There is continued debate regarding retention versus sacrificing of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA). We sought to determine if there was a difference in range of motion (ROM) after TKA between patients with PCL sacrifice versus PCL retention when using a highly congruent polyethylene insert.Methods
We conducted an Institutional Review Board approved retrospective study of consecutive patients receiving TKA using the same implant with a highly congruent polyethylene component implanted by one surgeon from November 2013 to January 2016. Patients were placed in 2 groups based on whether the PCL was intact or released at the time of surgery. Patient charts were reviewed for age, body mass index, PCL status at surgery (incompetent, kept intact, or released), and preoperative/postoperative knee ROM.Results
Both groups were similar in average age (60.5 vs 60.6, respectively) and body mass index (33.3 vs 32.6, respectively). Postoperative tibial slope (5.5° PCL release, 6.6° PCL retained, P = .028) was the only alignment variable reaching significance; all other alignment and motion variables were similar.Conclusion
Results indicate that the PCL can be successfully retained with the use of a congruent bearing design, with no evident limitation in postoperative ROM or loss of stability due to the bearing in comparison to patients who undergo PCL release. 相似文献10.
Artit Laoruengthana Piti Rattanaprichavej Supachok Rasamimongkol Monton Galassi Santi Weerakul Krit Pongpirul 《The Journal of arthroplasty》2019,34(5):877-881
Background
Tranexamic acid (TXA) has been widely used in total knee arthroplasty (TKA) for blood loss reduction. Given limited evidence on potential relationship between the TXA and improvement of pain control and functional outcome after TKA, this study aimed at comparing the blood loss, pain scores, morphine consumption, and knee flexion across the TXA administration routes.Methods
The 228 primary TKA were randomized into no TXA use (No-TXA), intra-articular TXA (15 mg/kg) use (IA-TXA), and intravenous TXA (10 mg/kg) use (IV-TXA). A multivariate regression analysis was used for comparing perioperative blood loss (PBL), drain output, average number of units of blood transfused (ANUBT), visual analogue scales (VAS) for pain, amount of morphine consumption, and knee flexion angle.Results
The IA-TXA and IV-TXA group had 193.26 (P < .01) and 160.30 mL (P < .01) less PBL than No-TXA, respectively. No-TXA significantly required higher ANUBT than IA-TXA and IV-TXA (P = .03). The IA-TXA group had lower VAS at 6 (P = .04), 12 (P = .03), and 24 hours (P = .02) postoperative when compared to No-TXA, while IV-TXA had no effect. The IA-TXA required 18.26 mg less total morphine at 48 hours than No-TXA (P = .02), whereas IV-TXA used insignificantly (5.31 mg; P = .31) less total morphine at 48 hours than No-TXA. Both TXA routes tended to improve knee flexion, but not statistically significant.Conclusion
Both IA-TXA and IV-TXA could significantly reduce PBL and ANUBT. The IA-TXA could significantly mitigate VAS and morphine use after TKA. Hence, IA-TXA could minimize blood loss and may be considered as an adjunct to pain control following TKA. 相似文献11.
Jie J. Yao Mario Hevesi Megan M. O’Byrne Daniel J. Berry David G. Lewallen Hilal Maradit Kremers 《The Journal of arthroplasty》2019,34(3):542-548
Background
Long-term mortality following primary total knee arthroplasty (TKA) is lower than the general population. However, it is unknown whether this is true in the setting of revision TKA. We examined long-term mortality trends following revision TKA.Methods
This retrospective study included 4907 patients who underwent 1 or more revision TKA between 1985 and 2015. Patients were grouped by surgical indications and followed until death or October 2017. The observed number of deaths was compared to the expected number of deaths using standardized mortality ratios (SMR) and Poisson regression models.Results
Compared to the general population, patients who underwent revision TKA for infection (SMR, 1.45; 95% confidence interval [CI], 1.33-1.57; P < .0001) and fracture (SMR, 1.16; 95% CI, 1.00-1.34; P = .04) experienced a significantly higher mortality risk. Patients who underwent revision TKA for infection and fracture experienced excess mortality soon after surgery which became more pronounced over time. In contrast, the mortality risk among patients who underwent revision TKA for loosening and/or bearing wear was similar to the general population (SMR, 0.95; 95% CI, 0.89-1.02; P = .16). Aseptic loosening and/or wear and instability patients had improved mortality initially; however, there was a shift to excess mortality beyond 5 years among instability patients, and beyond 10 years among aseptic loosening and/or wear patients.Conclusion
Mortality is elevated soon after revision TKA for infection and fracture. Mortality is lower than the general population after revision TKA for loosening and/or bearing wear but gets worse than the general population beyond the first postoperative decade. 相似文献12.
Adam Tucker Seamus O’Brien Emer Doran Nicola Gallagher David E. Beverland 《The Journal of arthroplasty》2019,34(1):40-46.e1
Background
Valgus knee deformity accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. This study provides a 10-year follow-up on a previously reported series of severe valgus knees performed using an unconstrained mobile-bearing TKA with a modified technique to validate this technique.Methods
A consecutive series of 275 predominantly cementless TKAs in 262 patients were performed for severe valgus (≥10°) deformity and prospectively followed to 10 years. Patient-reported outcome measures included the Oxford Knee Score, American Knee Society Score, Bartlett Patellar Score, and the Short Form 12 questionnaire.Results
Average valgus deformity was reduced from 15.6° to 3.8° (P < .001). At a mean follow-up of 10.4 years (range, 9.5-14.1), 90 (34.4%) patients had died. Of the reviewed survivors, the mean Oxford Knee Score was 27.8 ± 9.8, with an American Knee Society clinical score of 85.6 ± 17.0 and a functional score of 65.1 ± 20.4, with 78% of patients reporting good to excellent results. To date, there has been 1 (0.36%) revision and 13 (4.73%) reoperations. Kaplan-Meier implant survival was 99.6% at 10 years.Conclusion
Despite its challenging nature, the valgus knee is associated with excellent survivorship and satisfactory long-term results using this modified technique.Level of Evidence
Level IV. 相似文献13.
Kyle N. Kunze Faisal Akram Brian C. Fuller Luke Zabawa Scott M. Sporer Brett R. Levine 《The Journal of arthroplasty》2019,34(4):663-670
Background
As the number of total knee arthroplasty (TKA) procedures continues to rise in the context of bundled payment models, patients dissatisfied postoperatively that require additional care will impose additional cost to the healthcare system. The purpose of this study is to internally validate a predictive model for postoperative patient satisfaction after TKA.Methods
In total, 484 consecutive primary TKA patients between January 2014 and January 2016 were included. Patients were stratified into 4 risk tiers based on scores of a retrospectively applied, 11-component novel knee survey for postoperative satisfaction: low risk (>96.5), mild risk (75-96.4), moderate risk (60-74.9), and high risk (<60). Binary logistic and multivariate linear regression models were constructed to determine whether the survey was predictive of satisfaction. A receiver operator curve was constructed to determine a threshold score below which patients were likely to experience postoperative dissatisfaction.Results
The mean (±standard deviation) age was 66.3 ± 9.2 years (range 31.7-100.1) and mean body mass index was 34.2 ± 8.2 kg/m2 (range 16.2-68.4). A knee survey score of 96.5 conferred a 97.5% sensitivity and 95.7% negative predictive value for satisfaction. Patients with higher knee survey scores had greater odds (odds ratio 1.03, 95% confidence interval 1.01-1.06, P = .003) of postoperative satisfaction. Increasing risk tier was significantly associated with decreased satisfaction (low risk 95.7%, mild risk 93.8%, moderate risk 86.4%, and high risk 80.4%; P = .007). The knee survey was not significantly correlated with complications (r = ?0.43, P = .32).Conclusion
This novel knee survey conferred a 97.5% sensitivity and 95.7% negative predictive value in identifying at-risk patients for postoperative dissatisfaction after primary TKA. 相似文献14.
Chloe E.H. Scott Matilda F.R. Powell-Bowns Deborah J. MacDonald Philip M. Simpson Frazer A. Wade 《The Journal of arthroplasty》2018,33(7):2203-2209
Background
The aim of this study is to investigate differences in implant requirement, outcomes, and re-revision when total knee arthroplasty (TKA) was performed following unicompartmental knee arthroplasties (UKAs) with metal-backed (MB) compared to all-polyethylene (AP) tibial components.Methods
Retrospective study of 60 UKAs converted to 60 TKAs at mean 7.3 years (0.1 to 17) after implantation in 55 patients (mean age, 64 [49-83]; 44% male): 44 MB and 16 AP. TKA implant requirement was investigated in addition to mode of failure, Oxford Knee Score, and TKA survival at mean 5.4 years (0.5 to 17).Results
Progression of osteoarthritis was the commonest mode of failure in MB UKAs (P = .03) and unexplained pain in AP (P = .011) where revisions were performed earlier (4.8 ± 3.2 vs 8.2 ± 4.5, P = .012). In 56 of 60 (93%) cases, unconstrained TKA implants were used. The use of standard cruciate-retaining TKAs without augments or stems was less likely following MB UKA compared to AP (12 of 38 [32%] vs 10/14 [71%], P = .013). Specifically MB UKA implants were associated with more tibial stem use (P = .04) and more use of cruciate-substituting polyethylene (P = .05). There was no difference in the use of constrained implants. Multivariate analysis showed tibial resection depth to predict stem requirement. Seven were re-revised giving 7-year TKA survival: from MB UKA 70.3 (95% CI, 47.0 to 93.6) and from AP UKA 87.5 (95% CI, 64.6 to 100; P = .191).Conclusion
MB UKA implants increase the chances of a complex revision requiring tibial stems and cruciate substitution but reduce the chances of early revision compared to AP UKA which often fail early with pain. 相似文献15.
Meagan E. Tibbo Cody C. Wyles Matthew T. Houdek Benjamin K. Wilke 《The Journal of arthroplasty》2019,34(2):315-318
Background
Ehlers-Danlos syndromes (EDS) are connective tissue disorders that cause defects in collagen synthesis or processing, resulting in joint hypermobility. Following total knee arthroplasty (TKA), concern exists that hypermobility will affect the outcome as prosthesis relies on soft tissues for stability. The purpose of this study is to investigate the outcome of TKA in the setting of EDS compared to patients undergoing TKA for osteoarthritis (OA).Methods
We identified 16 patients (20 knees) with EDS who underwent a TKA between 2001 and 2016. Patients were matched 1:2 (n = 40) on age, gender, body mass index, and surgical date to patients undergoing TKA for OA.Results
We found no difference in age, body mass index, or follow-up between the cohorts (P > .05). EDS patients had significantly more surgical interventions prior to TKA (P = .03) and were more likely to require constrained components (x2 = 0.002). Following TKA, 4 patients in the EDS group and 9 patients in the matched cohort underwent a reoperation for any reason including 1 revision in the EDS cohort and 3 in the OA cohort. We found no significant difference in reoperation or revision rates between the cohorts (P > .05). There was no difference in Knee Society Scores between groups at last follow-up (P = .63) or radiographic evidence of loosening.Conclusion
Although patients with EDS were more likely to require a constrained component, they are not at increased risk of revision or reoperation following TKA in the intermediate term. 相似文献16.
M. Chad Mahan Toufic R. Jildeh Troy N. Tenbrunsel Jason J. Davis 《The Journal of arthroplasty》2018,33(6):1699-1704
Background
Mepivacaine as a spinal anesthetic for rapid recovery in total knee arthroplasty (TKA) has not been assessed. The purpose of this study is to compare spinal mepivacaine vs bupivacaine for postoperative measures in patients undergoing primary TKA.Methods
Retrospective review of a prospectively collected single-institution database was performed on 156 consecutive patients who underwent primary TKA. Fifty-three patients were administered mepivacaine and 103 patients were administered bupivacaine. Primary outcomes were urinary retention, length of stay, pain control, opioid consumption, and distance associated with physical therapy. Statistical analysis with univariate logistic regression was performed to evaluate the effect of anesthetic with primary outcomes.Results
Patients undergoing TKA with mepivacaine had a shorter length of stay (28.1 ± 11.2 vs 33.6 ± 14.4 hours, P = .002) and fewer episodes of straight catheterization (3.8% vs 16.5%, P = .021) compared to bupivacaine. Patients administered mepivacaine exhibited slightly higher VAS pain scores and morphine consumption in the postanesthesia care unit (1.3 ± 1.9 vs 0.5 ± 1.3, P = .002; 2.2 ± 3.3 vs 0.8 ± 2.1 equivalents/h, P = .002), but otherwise exhibited no difference in VAS scores or morphine consumption afterwards. There was no need to convert to general anesthesia or transient neurologic symptom complication in either group.Conclusion
Mepivacaine for spinal anesthesia with TKA had adequate duration to complete the surgery and facilitated a more rapid recovery with less urinary complications and a shorter length of stay. Patients administered mepivacaine did not display worse pain control or transient neurologic symptoms afterwards. 相似文献17.
Romain Gaillard Christopher Bankhead Nicolaas Budhiparama Cécile Batailler Elvire Servien Sébastien Lustig 《The Journal of arthroplasty》2019,34(3):469-477
Background
The aim of this study is to assess clinical results of total knee arthroplasty (TKA) with pre-operative patella alta or patella baja, compared to TKA with pre-operative normal patellar height.Methods
Patella height was measured using the Blackburne-Peel (BP) method in an initial, prospective cohort of 4103 TKAs performed at a single center. Three groups were defined: normal patella height (0.54 < BP index ≤ 1.06), patella alta (BP index >1.06), and patella baja (BP index ≤0.54). Pre-operative and post-operative clinical and radiological characteristics were collected and compared. All prostheses used a system of posterior stabilization by a third condyle. The primary outcome measure was the post-operative Knee Society Score. Statistical analysis was performed using Student’s t-test and chi-squared test, with P < .05.Results
Two hundred twenty-three TKAs with pre-operative patella alta, 307 TKAs with pre-operative patella baja, and 2248 with pre-operative normal patella height, mean follow-up 39.3 months (range 24-239), were ultimately included. Post-operatively, there was no difference between the 3 groups in terms of Knee Society Score (knee and function scores). Patella baja statistically decreased the maximal flexion (118.2° vs 115.5°, P = .002) and increased the rate of patellar fracture (0.9% vs 2%, P = .05). Finally, survival rates were similar in the 3 groups with each above 91% (±2%) at 10 years.Conclusion
Clinical and radiological results for TKAs with pre-operative patella alta and patella baja were comparable to TKAs with a normal pre-operative patellar height. Risk of post-operative patellar fracture increased for patients with pre-operative patella baja. 相似文献18.
Jodie A. McClelland Julian A. Feller Kate E. Webster 《The Journal of arthroplasty》2018,33(3):897-902
Background
Before total knee arthroplasty (TKA), males walk with biomechanics that are distinct from females. It is not known whether these sex-specific profiles are maintained after TKA and whether any differences reflect those typical of unimpaired males and females. The aim of this study was to compare knee biomechanics of males and females with TKA with unimpaired controls during walking.Methods
Eighty-five participants (44 females and 41 males) who were at least 12 months after unilateral TKA and 39 matched control participants (21 females and 18 males) were included in this observational cohort study. All participants were assessed with 3-dimensional motion analysis during comfortable speed walking.Results
All key biomechanics parameters during walking were significantly different between males with TKA and male controls (P < .01). There were no differences in the same parameters between females with TKA and female controls.Conclusion
Sex-specific biomechanics profiles are maintained after TKA. Biomechanics of females with TKA were closer to normal than males, suggesting that previous studies that investigate a mixed-sex cohort may have underestimated biomechanics outcome from TKA for females. Future studies should consider evaluating outcome from TKA independently for males and females. 相似文献19.
Reza M. Tabatabaee Mohammad R. Rasouli Mitchell G. Maltenfort Robert Fuino Camilo Restrepo Ali Oliashirazi 《The Journal of arthroplasty》2018,33(4):1076-1081
Background
Image-based and imageless computer-assisted total knee arthroplasty (CATKA) has become increasingly popular. This study aims to compare outcomes, including perioperative complications and transfusion rate, between CATKA and conventional total knee arthroplasty (TKA), as well as between image-based and imageless CATKA.Methods
Using the 9th revision of the International Classification of Diseases codes, we queried the Nationwide Inpatient Sample database from 2005 to 2011 to identify unilateral conventional TKA, image-based, and imageless CATKAs as well as in-hospital complications and transfusion rates.Results
A total of 787,809 conventional TKAs and 13,246 CATKAs (1055 image-based and 12,191 imageless) were identified. The rate of CATKA increased 23.13% per year from 2005 to 2011. Transfusion rates in conventional TKA and CATKA cases were 11.73% and 8.20% respectively (P < .001) and 6.92% in image-based vs 8.27% in imageless (P = .023). Perioperative complications occurred in 4.50%, 3.47%, and 3.41% of cases after conventional, imageless, and imaged-based CATKAs, respectively. Using multivariate analysis, perioperative complications were significantly higher in conventional TKA compared to CATKA (odds ratio = 1.17, 95% confidence interval 1.03-1.33, P = .01). There was no significant difference between imageless and image-based CATKA (P = .34). Length of hospital stay and hospital charges were not significantly different between groups (P > .05).Conclusion
CATKA has low complication rates and may improve patient outcomes after TKA. CATKA, especially the image-based technique, may reduce in-hospital complications and transfusion without increasing hospital charges and length of hospital stay significantly. Large prospective studies with long follow-up are required to verify potential benefits of CATKA. 相似文献20.
Mohamad J. Halawi Nicholas Caminiti Mark P. Cote Adam D. Lindsay Vincent J. Williams 《The Journal of arthroplasty》2019,34(1):136-139