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21.
Background:The purpose of this meta-analysis was to assess whether a urinary catheter is necessary for all patients in primary total knee arthroplasty (TKA).Methods:PubMed, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs). All RCTs were compared with receive either an indwelling urinary catheter or no urinary catheter in TKA. Primary outcomes were urinary retention and urinary tract infection. Secondary outcomes were the length of stay, duration of the surgery, and the first urination time.Results:A total of 6 RCTs involving 1334 patients were included in the meta-analysis. No significant difference between the 2 groups was found in urinary retention (P = .52), length of stay (P = .38), duration of the surgery (P = .55). However, patients with an indwelling catheter were associated with a higher risk of urinary tract infections and longer time for the first urination than patients without indwelling catheters (P = .009 and P = .004).Conclusion:The available evidence indicates that patients without using the indwelling catheters could reduce urinary tract infections and the time for the first urination, without increase in the incidence of urinary retention in primary TKA.Level of Evidence:Level I, therapeutic study. 相似文献
22.
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23.
24.
《The Journal of arthroplasty》2019,34(9):1938-1945
BackgroundLife expectancy and higher complication rates have made the routine use of total knee arthroplasty (TKA) in elderly patients disputed by some authors. The purpose of this study was to assess patient and implant survivorship, complication and revision rates, and patient-reported outcomes (PROMS) in a cohort of patients aged above 80 years undergoing TKA. A comparison with a propensity matched cohort of patients of average age within our database for TKA was performed.MethodsA retrospective review of prospectively collected data identified 644 patients over the age of 80 years undergoing a TKA within a 14-year period. After calculating the average age of all TKA patients within the reviewed database, a cohort deemed average age was created within 1 standard deviation of the average age and matched using the following criteria: gender, surgeon, diagnosis, procedure type, and year. The primary outcomes were survivorship of the implant and the patient. The secondary outcomes were complications, transfusion rates, discharge destination, and PROMS.ResultsThe revision rate was low for both groups (P = .051). Implant survivorship at 10 years was similar (P = .07). Mortality rate was higher in the elderly (P < .001). General complication rate was higher in the elderly (P = .031). Surgical complications rates were similar (P = .702). The PROMS at final follow-up were 4% lower in the elderly (P < .001).ConclusionTKA in the elderly is a safe procedure. With measures minimizing the perioperative complications and blood loss, the outcome can be expected to be similar to patients of average age. The projected implant and patient survivorship in the elderly cohort is long enough to suggest that TKA in the elderly could have a high impact on remaining quality of life.Level III retrospective study. 相似文献
25.
《The Foot》2019
BackgroundHaving had a previous experience of 4 open F2 osteotomies to correct interphalangeal hallux valgus, the aim of this study was to test the efficacy of a percutaneous approach for this correction.Methods3 open and 12 percutaneous F2 osteotomies in 15 cadaver feet were performed. Interphalangeal (IPH), F2 asymmetry (AF2) and joint deviation (JD) angles were measured on radiographs. The operated great toes were anatomically analyzed looking for possible lesions to surrounding tissues.ResultsMean IPH decreased from 10.7° to 2.9°, AF2 from 7.8° to 1°, and JD from 1.4° to 0.5°. Damage to the hallux extensor tendon was detected in 1 foot and a nail bed lesion was detected in 1 case, both operated percutaneously.ConclusionsF2 Valgus deformity can be corrected using open or percutaneous osteotomy. The authors consider the open correction worthwhile because percutaneous techniques may damage surrounding tissues and the incision length difference is minor.Level of clinical evidence: 3. 相似文献
26.
《Orthopaedics and Trauma》2019,33(3):166-174
Infection is one of the most feared complications following knee arthroplasty and soft tissue arthroscopic procedures. This article summarizes the current understanding on the management of this rare but devastating problem. The healthcare and economic burden of periprosthetic joint infection (PJI) is highlighted, together with how the classification of infection and host staging can aid decision-making. Surgical treatment options will be described. These consist of ‘debridement, antibiotics and implant retention’ (DAIR), revision arthroplasty (single- or two-stage), as well as salvage procedures (arthrodesis, permanent resection, and amputation). In selected cases, chronic antibiotic suppression may be the only viable option. All implant-related orthopaedic infections must be managed using a multidisciplinary team (MDT) approach, ideally within dedicated bone infection units, in order to optimize clinical outcomes. 相似文献
27.
Background
Total knee arthroplasty is a treatment option for debilitating arthritis. In the postoperative period, patients experience moderate to severe pain affecting the rehabilitation, hospital stay, and patient satisfaction. This study aims at utilizing current best evidence to determine whether adductor canal block (ACB) or periarticular injection (PAI) is a better modality for managing short-term postoperative pain and opioid consumption.Methods
Embase, MEDLINE, HealthStar, Emcare, and PubMed were searched for randomized controlled trials from 1946 to August 2018, for literature addressing the comparison of ACB and PAI for pain management in the setting of total knee arthroplasty. A systematic review and meta-analysis were performed.Results
Six studies were included in our meta-analysis. When examining the combined visual analog scale (VAS) pain values for each group, analysis demonstrated greater reduction in scores for the PAI group, and the difference was statistically significant (P = .001). When comparing the VAS scores of subgroups analyzed at specific periods in time, there was a trend toward lower VAS scores in subgroups analyzed at 24 hours and 48 hours postoperatively (at rest and at movement) in the PAI group. Overall opioid consumption was lower in the PAI group, with demonstrated statistical significance (P = .03). When comparing the postoperative subgroups, there was a trend toward decreased opioid use in the PAI group, with 13.25% less opioid use at 48 hours and 9.5% less opioid use at 24 hours.Conclusion
PAI could significantly improve postoperative pain and opioid consumption when compared with ACB. Additional, high-quality studies are required to further address this topic. 相似文献28.
Eytan M. Debbi Benjamin Bernfeld Amir Herman Moshe Salai Yocheved Laufer Alon Wolf 《The Journal of arthroplasty》2019,34(1):47-55
Background
Biomechanics after total knee arthroplasty (TKA) often remain abnormal and may lead to prolonged postoperative recovery. The purpose of this study is to assess a biomechanical therapy after TKA.Methods
This is a randomized controlled trial of 50 patients after unilateral TKA. One group underwent a biomechanical therapy in which participants followed a walking protocol while wearing a foot-worn biomechanical device that modifies knee biomechanics and the control group followed a similar walking protocol while wearing a foot-worn sham device. All patients had standard physical therapy postoperatively as well. Patients were evaluated throughout the first postoperative year with clinical measures and gait analysis.Results
Improved outcomes were seen in the biomechanical therapy group compared to the control group in pain scores (88% vs 38%, P = .011), function (86% vs 21%, P = .001), knee scores (83% vs 38%, P = .001), and walking distance (109% vs 47%, P = .001) at 1 year. The therapy group showed healthier biomechanical gait patterns in both the sagittal and coronal planes at 1 year.Conclusion
A postoperative biomechanical therapy improves outcomes following TKA and should be considered as an additional therapy postoperatively. 相似文献29.
Sophia A. Traven Russell A. Reeves Molly G. Sekar Harris S. Slone Zeke J. Walton 《The Journal of arthroplasty》2019,34(1):140-144
Background
While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty.Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.Results
One hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001).Conclusions
The mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes.Level of Evidence
III. 相似文献30.
Eric So Bryan Van Dyke Maria R. McGann Roberto Brandao David Larson Christopher F. Hyer 《The Journal of foot and ankle surgery》2019,58(1):62-65
The Lapidus bunionectomy is performed to treat hallux valgus. Recurrence of the deformity remains a concern. A transverse intermetatarsal screw spanning the base of the first metatarsal to the base of the second can increase stability. The neurovascular bundle is located within the proximity of this screw. In this study, we assessed the structures at risks with the use of this technique. In 10 specimens, a guide wire was placed, and a 4.0-mm cannulated screw was inserted. The neurovascular bundle was dissected and inspected for direct trauma to the neurovascular bundle, and the proximity of the screw was measured using a digital caliper. Ten cadaveric specimens were used. The dorsalis pedis artery and deep peroneal nerve were free from injury in 9 of 10 specimens. In those 9 specimens, the neurovascular bundle was located dorsal in relation to the screw. The mean distance of the screw to the neurovascular bundle was 7.1 ± 3.3 mm. The mean distance from the screw to the first tarsometatarsal joint (TMTJ) was 14.7 ± 4.3 mm. The mean distance from the screw as it entered the second metatarsal to the second TMTJ was 18.0 ± 7.2 mm. In 1 specimen, the screw was found to be traversing through the neurovascular bundle. The distance from the screw to the first TMTJ was 15.0 mm. The distance of the screw from where it entered the second metatarsal to the second TMTJ was 24.0 mm. Although the intermetatarsal screw avoided the neurovascular cases in most instances, there is some anatomic risk to the neurovascular bundle. Further study is warranted to evaluate clinical results using the intermetatarsal screw for the modified Lapidus procedure. 相似文献