共查询到20条相似文献，搜索用时 15 毫秒
1.
Jason M. Hurst Riccardo Ranieri Keith R. Berend Michael J. Morris Joanne B. Adams Adolph V. Lombardi 《The Journal of arthroplasty》2018,33(10):3268-3272
Background
Persistent pain after medial unicompartmental knee arthroplasty (UKA) is a prevailing reason for revision to total knee arthroplasty (TKA). Many of these pathologies can be addressed arthroscopically. The purpose of this study is to examine the outcomes of patients who undergo an arthroscopy for any reason after medial UKA.Methods
A query of our practice registry revealed 58 patients who had undergone medial UKA between October 2003 and June 2015 with subsequent arthroscopy. Mean interval from medial UKA to arthroscopy was 22 months (range 1-101 months). Indications for arthroscopy were acute anterior cruciate ligament tear (1), arthrofibrosis (7), synovitis (12), recurrent hemarthrosis (2), lateral compartment degeneration including isolated lateral meniscus tears (11), and loose cement fragments (25).Results
Mean follow-up after arthroscopy was 49 months (range 1-143 months). Twelve patients have been revised from UKA to TKA. Relative risk of revision after arthroscopy for lateral compartment degeneration was 4.27 (6 of 11; 55%; P = .002) and for retrieval of loose cement fragments was 0.05 (0 of 25; 0%; P = .03). Relative risk for revision after arthroscopy for anterior cruciate ligament tear, arthrofibrosis, synovitis, or recurrent hemarthrosis did not meet clinical significance secondary to the low number of patients in these categories.Conclusion
The results of this study suggest that arthroscopic retrieval of cement fragments does not compromise UKA longevity. However, arthroscopy for lateral compartment degradation after UKA, while not the cause of revision, appears to be an ineffective treatment and predicts a high risk of revision to TKA regardless of its relative radiographic insignificance. 相似文献2.
Background
No previous studies have investigated the risk of infection following intra-articular corticosteroid injection (IACI) into a pre-existing total knee arthroplasty (TKA). The aim of this study is to determine the risk of acute infection following IACI into a pre-existing TKA.Methods
A retrospective chart review identified all patients at a single institution between October 2009 and May 2015 that had an ipsilateral knee injection subsequent to a TKA. The risk of acute infection, as defined by development of an infection within 3 months of IACI, was determined via review of clinic notes, operative reports, laboratory records, and telephone interviews.Results
A total of 1845 injections in 736 patients met the inclusion criteria. In total, 101 (4.8%) patients were lost to follow-up. Three infections in 3 patients occurred within 3 months of IACI, yielding an infection rate of 0.16% per injection, or 1 infection in every 625 IACIs following TKA.Conclusion
This study is the first to investigate the risk of acute infection following injection of corticosteroid into a pre-existing TKA. Given the dire consequences of infection following TKA, the routine use of IACI into a pre-existing TKA should be avoided, and a thorough workup should be performed in any patient with a painful TKA prior to consideration of IACI. 相似文献3.
Rajitha Gunaratne Dylan N. Pratt Joseph Banda Daniel P. Fick Riaz J.K. Khan Brett W. Robertson 《The Journal of arthroplasty》2017,32(12):3854-3860
Background
Dissatisfaction following total knee arthroplasty (TKA) is common. Approximately 20% of patients report dissatisfaction following primary TKA. This systematic literature review explores key factors affecting patient dissatisfaction following TKA.Methods
Six literature databases published between 2005 and 1 January 2016 were searched using 3 key search phrases. Papers were included if the study investigated patient dissatisfaction in primary unilateral or bilateral TKA. Information from each article was categorized to the domains of socioeconomic, preoperative, intraoperative, and postoperative factors affecting patient dissatisfaction.Results
This review found that patient dissatisfaction pertains to several key factors. Patient expectations prior to surgery, the degree of improvement in knee function, and pain relief following surgery were commonly cited in the literature. Fewer associations were found in the socioeconomic and surgical domains.Conclusion
Identifying who may be dissatisfied after their TKA is mystifying; however, we note several strategies that target factors whereby an association exists. Further research is needed to better quantify dissatisfaction, so that the causal links underpinning dissatisfaction can be more fully appreciated and strategies employed to target them. 相似文献4.
Cameron K. Ledford Brian P. Chalmers Joseph M. Statz Kevin I. Perry Tad M. Mabry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(1):101-105
Background
Clinical outcomes remain largely unknown beyond perioperative and short-term follow-up of solid organ transplant (SOT) patients undergoing total knee arthroplasty (TKA).Methods
Patient mortality, implant survivorship, and complications of 96 TKAs (76 patients) after SOT were retrospectively reviewed through an internal joint registry. Mean age at index arthroplasty was 66 years, and mean follow-up was 4 years.Results
Overall mortality rates at 1 year, 2 years, and 5 years from TKA were 2.6%, 7.9%, and 13.2%, respectively, and combined SOT patient survivorship was 92% at 2 years and 82% at 5 years. Implant survivorship free of any component revision or implant removal was 98% at 2 years and 93% at 5 years. There was a high rate of perioperative complications (12.5%), including periprosthetic fractures (5.2%) and deep periprosthetic infection (3.2%).Conclusion
TKA does not appear to have any effect on SOT patient survivorship following the procedure. However, SOT patients may have a higher risk of perioperative complications and a lower implant survivorship than the general population of TKA patients at midterm follow-up. 相似文献5.
6.
Chris A. Anthony Ryan A. Peterson Daniel K. Sewell Linnea A. Polgreen Jacob E. Simmering John J. Callaghan Philip M. Polgreen 《The Journal of arthroplasty》2018,33(2):510-514.e1
Background
Surgical site infections (SSIs) after total knee (TKA) and total hip (THA) arthroplasty are devastating to patients and costly to healthcare systems. The purpose of this study is to investigate the seasonality of TKA and THA SSIs at a national level.Methods
All data were extracted from the National Readmission Database for 2013 and 2014. Patients were included if they had undergone TKA or THA. We modeled the odds of having a primary diagnosis of SSI as a function of discharge date by month, payer status, hospital size, and various patient co-morbidities. SSI status was defined as patients who were readmitted to the hospital with a primary diagnosis of SSI within 30 days of their arthroplasty procedure.Results
There were 760,283 procedures (TKA 424,104, THA 336,179) in our sample. Our models indicate that SSI risk was highest for patients discharged from their surgery in June and lowest for December discharges. For TKA, the odds of a 30-day readmission for SSI were 30.5% higher at the peak compared to the nadir time (95% confidence interval [CI] 20-42). For THA, the seasonal increase in SSI was 19% (95% CI 9-30). Compared to Medicare, patients with Medicaid as the primary payer had a 49% higher odds of 30-day SSI after TKA (95% CI 32-68).Conclusion
SSIs following TKA and THA are seasonal peaking in summer months. Payer status was also a significant risk factor for SSIs. Future studies should investigate potential factors that could relate to the associations demonstrated in this study. 相似文献7.
Gwo-Chin Lee Kevin Ong Doruk Baykal Edmund Lau Arthur L. Malkani 《The Journal of arthroplasty》2018,33(7):2070-2074.e1
Background
The purpose of this study is to evaluate the impact of prior bariatric surgery on survivorship, outcome, and complications following primary total hip arthroplasty (THA)/total knee arthroplasty (TKA).Methods
Using the Medicare 5% part B data from 1999 to 2012, we analyzed patients who underwent primary THA (n = 47,895) and primary TKA (n = 86,609). Patients with prior bariatric surgery before arthroplasty were compared to patients with other common metabolic conditions. Kaplan-Meier risk of revision THA/TKA for those with and without bariatric surgery and each of the metabolic bone conditions was calculated. The risk for infection was also evaluated. Regression analysis was used to determine the relative risk of revision at various time intervals for those with and without each of the metabolic conditions. Analysis was also adjusted for the metabolic conditions, age, gender, socioeconomic status, and Charlson comorbidity index.Results
The prevalence of patients with prior bariatric surgery within 24 months of primary THA/TKA was 0.1%. Benchmarked against other common chronic metabolic conditions, bariatric surgery prior to THA was not associated with an increased risk for revision surgery at all measured intervals but positively correlated with increased risk for developing infections. Conversely, patients undergoing primary TKA following bariatric surgery were at increased risk for revision compared to controls but not at increased risk for infection.Conclusion
The impact of bariatric surgery prior to elective THA/TKA remains unclear. These patients remain at increased risk for infections following THA and revisions following TKA. 相似文献8.
Background
Considerable blood loss which requires transfusion is frequently reported after total hip and knee arthroplasties (THA and TKA). The purpose of this study is to review the transfusion rates in contemporary THA and TKA with optimized perioperative protocols including minimized surgical trauma and optimal perioperative patient care.Methods
This retrospective study included 1442 consecutive patients receiving either a primary THA or a TKA from the same high-volume surgeon between January 2008 and December 2015. Demographics and surgical data were collected from patients' journals. Estimated blood loss, decline in hemoglobin, and use of transfusion were registered.Results
One (0.0013%) THA and 3 (0.0044%) TKAs required blood transfusion postoperatively. Average measured bleeding was 253 mL ± 142 and 207 mL ± 169 in THA and TKA, respectively. Average decline in hemoglobin was 23.5 g/L ± 11.4 and 22.9 g/L ± 11.6 for THA and TKA, respectively.Conclusion
In contemporary THA and TKA, perioperative protocols and patient optimization can decrease the rate of blood transfusion to near zero. 相似文献9.
Kelvin Y. Kim Afshin A. Anoushiravani Kevin K. Chen Mackenzie Roof William J. Long Ran Schwarzkopf 《The Journal of arthroplasty》2018,33(1):107-112
Background
Chronic opioid users pose a unique challenge for orthopedic surgeons, as they often report suboptimal outcomes following total knee arthroplasty (TKA). We aim at identifying risk factors associated with patients who were preoperative chronic opioid users and continued to use 6 months following TKA.Methods
All preoperative chronic opioid users among 338 consecutive TKA cases performed at our institution between February and June 2016 were identified and divided into 2 cohorts: patients who (1) persistently used opioids and (2) discontinued use by the 6-month time point following surgery. Baseline characteristics were compared between cohorts in order to determine risk factors for persistent opioid use following TKA.Results
Of the 338 patients, 53 (15.7%) were identified as preoperative chronic opioid users. Of these, 23 (43.4%) continued chronic opioid use 6 months following surgery, whereas 14 (4.9%) previously nonchronic users were identified as new chronic users at 6 months. Characteristics that were predictive of persistent opioid use included male gender, prior injury or surgery to the ipsilateral knee, current tobacco smoking status, and a history of psychiatric disorder. Opioid dose consumption of ≥12 mg/d morphine-equivalents over the 3 months leading up to surgery had an increased risk of persistent chronic opioid use by a factor of 6.Conclusion
TKA candidates who have complicated medical, social, and surgical histories are at an increased risk of chronic opioid abuse postoperatively. By better understanding the risk factors associated with persistent chronic opioid use, targeted opioid reduction programs may be appropriately implemented to manage this high-risk population. 相似文献10.
Alex Gu Adam J. Michalak Jordan S. Cohen Neil D. Almeida Alexander S. McLawhorn Peter K. Sculco 《The Journal of arthroplasty》2018,33(5):1598-1605
Background
Knee stiffness following primary total knee arthroplasty can lead to unsatisfactory patient outcomes secondary to persistent pain and loss of function. Manipulation under anesthesia (MUA) remains a viable option for treatment of post-operative stiffness. However, the optimal timing and clinical efficacy of manipulation of anesthesia remains unknown.Methods
A systematic review of the literature was performed to identify studies that reported clinical outcomes for patients who underwent MUA for post-operative stiffness treatment. Repeat MUA procedures were included in the study but were analyzed separately.Results
Twenty-two studies (1488 patients) reported on range of motion (ROM) after MUA, and 4 studies (81 patients) reported ROM after repeat MUA. All studies reported pre-MUA motion of less than 90°, while mean ROM at last follow-up exceeded 90° in all studies except 2. For studies reporting ROM improvement following repeat MUA, the mean pre-manipulation ROM was 80° and the mean post-manipulation ROM was 100.6°.Conclusion
MUA remains an efficacious, minimally invasive treatment option for post-operative stiffness following TKA. MUA provides clinically significant improvement in ROM for most patients, with the best outcomes occurring in patients treated within 12 weeks post-operatively.Prospero Registration Number
CRD42016052215. 相似文献11.
Shay I. Warren Taylor S. Murtaugh Akshay Lakra Luke A. Reda Roshan P. Shah Jeffrey A. Geller H. John Cooper 《The Journal of arthroplasty》2018,33(10):3263-3267
Background
Soft-tissue deficiency is a potentially devastating complication of the infected total knee arthroplasty (TKA). Rotational muscle flaps are commonly used to address these defects. However, reported success rates vary widely.Methods
We reviewed 26 consecutive patients who underwent rotational muscle flap surgery for full-thickness anterior soft-tissue defect during treatment of an infected TKA. Twenty-four cases used a medial gastrocnemius rotational flap, 1 used a lateral gastrocnemius flap, and 1 used a rectus femoris-vastus intermedius flap. Implant survival, recurrence of infection, and limb survival were reported. Patient and procedural characteristics were tested for association with failure using χ2 and Student t-test. Kaplan-Meier analysis was used to estimate the failure-free survival function.Results
Mean follow-up time was 3.3 years. Eighteen of 26 patients (69.2%) experienced recurrent infection requiring an average of 5.3 additional operations (range, 1-20). Five (19.2%) required arthrodesis while 6 (23.1%) eventually underwent above-the-knee amputation. Two patients (7.7%) died due to complications of revision surgery or persistent infection. Eleven patients (42.3%) were infection free with a retained prosthesis after treatment at a mean follow-up of 5.3 years (range, 0.7-18.0 years).Conclusion
Rotational muscle flap coverage of soft-tissue defects in the setting of the infected TKA remains a viable salvage option. However, despite adequate tissue coverage, many patients experience recurrent infection requiring additional surgical treatment. Patients and surgeons should be aware of the potential high failure rates observed when treating these complex problems. 相似文献12.
Christopher J. White Antony J.R. Palmer E. Carlos Rodriguez-Merchan 《The Journal of arthroplasty》2018,33(4):1288-1295
Background
The aim of this study is to compare intramedullary nailing with external fixation for knee arthrodesis after failed infected total knee arthroplasty (TKA). Primary outcome is radiographic union. Secondary outcomes include recurrent deep infection, revision arthrodesis, and amputation.Methods
Systematic review and meta-analysis of studies comparing outcomes from intramedullary nailing and external fixation in patients with infected TKA undergoing arthrodesis procedures was performed. Randomized controlled trials and cohort studies were included.Results
Intramedullary nailing achieves a significantly higher rate of radiographic union compared with external fixation (odds ratio [OR] 5.17, 95% confidence interval [CI] 2.74-9.75, P < .00001) at a mean follow-up of 44.22 months. There is no significant difference in the rate of recurrent deep infection (OR 0.91, 95% CI 0.38-2.15, P = .83) or amputation (OR 0.94, 95% CI 0.23-3.84, P = .93). The rate of revision arthrodesis procedures is significantly lower for intramedullary nailing compared with external fixation (OR 0.28, 95% CI 0.08-0.93, P = .04).Conclusion
Intramedullary nailing is more effective than external fixation with respect to several clinically important outcomes. Therefore, we recommend intramedullary nailing for achieving knee arthrodesis as a salvage procedure for infected TKA in the absence of specific indications for external fixation. 相似文献13.
Masahiro Hasegawa Shinichi Miyazaki Toshio Yamaguchi Hiroki Wakabayashi Akihiro Sudo 《The Journal of arthroplasty》2017,32(1):43-46
Background
Minimally invasive surgery (MIS) has perceived advantages in the early postoperative stage for total knee arthroplasty (TKA). It is not clear whether the improved radiographic alignment achieved by computer-assisted navigation surgery (CAS) improves midterm clinical outcomes. The aim of this study was to compare patient outcomes of MIS TKA performed with and without CAS after a minimum follow-up of 7 years.Methods
Between 2007 and 2009, 50 patients underwent CAS and MIS TKA, and 50 patients underwent jig-based MIS TKA in this prospective study. Ninety-six patients were evaluated after a mean follow-up of 7.7 years, and clinical and radiological evaluations were performed.Results
Midterm results demonstrated that the Knee Society knee score, function score, and range of motion were comparable in the 2 groups. The percentage of patients with the mechanical axis within ±3° of neutral was significantly higher in the CAS group than in the jig-based group (94% vs 79%, respectively; P = .038). No knees had loosening after TKA. However, 1 patient in the CAS group demonstrated late infection 4 years postoperatively.Conclusion
CAS did not improve midterm outcomes after MIS TKA compared with jig-based surgery, although CAS reduced outliers in coronal alignment. 相似文献14.
15.
Hidenori Tanikawa Mitsunori Tada Kengo Harato Kazunari Okuma Takeo Nagura 《The Journal of arthroplasty》2017,32(1):280-285
Background
Patellofemoral complications are one of the main problems after total knee arthroplasty (TKA). The design of the TKA component may affect the patellar biomechanics, which may be associated with this postoperative complication. The purpose of this study was to assess the influence of TKA and prosthesis designs on the patellar kinematics and patellofemoral pressure.Methods
Using fresh-frozen cadavers, we measured the patellofemoral pressure, patella offset, and patella tilt in the following 4 conditions: normal knee (patella replacement only), cruciate-retaining TKA, condylar-stabilizing TKA, and posterior-stabilized TKA.Results
The patellofemoral pressure increased significantly after the cruciate-retaining TKA and condylar-stabilizing TKA compared with the normal knee. The patella offset in the normal knee decreased with increasing knee flexion angles, while the patella offset in the TKA knees did not change significantly through the full range of motion. The amount of lateral patella tilt in the normal knee was significantly larger than the TKA knees in the full range of motion.Conclusion
Although the femoral components are designed to reproduce an anatomical patellar tracking, the physiological patellar kinematics were not observed. Relatively high patellofemoral pressure and kinematic change after TKA may be associated with postoperative complications such as the anterior knee pain. 相似文献16.
Teng Lijia Zeng Rui-Xi Gong Long Chen Lei Liu Yujie He Jin-Yun Wang Zhen-Hu 《Journal of orthopaedic science》2017,22(5):880-885
Background
The interaction between patients is rather important source of information about surgery and recovery. Patients always prefer particularly to compare themselves with others of relatively similar ability, opinion and situation. Exploration of patients' dyads, however, is rare and needs further elaboration as to the significance of fellow patients. This study was designed to determine in whether and how preoperative assignment affects TKA's results.Methods
We assessed early post-operative outcomes in a cohort of 520 TKA patients. Preoperative, and postoperative outcome measures at 6-months following TKA were analyzed and compared between patients who were hospitalized with a roommate whose surgical status was either similar (preoperative) or dissimilar (postoperative) and whose type of surgery was either similar (TKA) or dissimilar (THA). Mean scores, and postoperative change in scores were calculated. Outcome measures evaluated included WOMAC, SF-36, patient affiliation, preoperative anxiety, expectation and analgesic consumption, length of hospital stay.Results
patients were more willing to have serious conversations with roommates whose surgical status was dissimilar (postoperative) and whose type of surgery was similar (TKA). And their SF-36 and WOMAC scores to be significantly improved better. Besides, they were released from hospital more quickly and showed significantly less preoperative anxiety.Conclusions
We recommend implementation of an assignment policy that patients prior to TKA should be assigned into a postoperative roommate undergoing TKA as well. 相似文献17.
Mohamed Shaher Hasanain Dragos Apostu Attaallh Alrefaee Samih Tarabichi 《The Journal of arthroplasty》2018,33(7):2119-2124
Background
Total knee arthroplasty (TKA) is a commonly performed procedure worldwide for the treatment of knee joint disease. Tourniquet is frequently used during the entire procedure to reduce blood loss and increase surgical comfort. On the other hand, tourniquet-related complications exist, and there are still controversies whether benefits outweigh the risks.Methods
Patients undergoing simultaneous TKAs had one knee assigned to group A (use of tourniquet during the entire procedure) and the other knee assigned to group B (use of tourniquet only during cementation). Blood loss, intraoperative complications, implant alignment, soft tissue swelling, pain score, and range of motion were analyzed.Results
Fifty-four patients undergoing 108 TKAs were included in the study. Total blood loss was almost 2 times higher in group B knees compared with group A. No difference was observed between groups in implant alignment, soft tissue swelling, pain, range of motion, or other early postoperative complications.Conclusion
Tourniquet use in TKAs during the entire surgical procedure reduces total blood loss, without an increase in early postoperative complications. 相似文献18.
Jeffrey Hartman Patrick Thornley Stephan Oreskovich Anthony Adili Asheesh Bedi Moin Khan 《The Journal of arthroplasty》2018,33(1):284-290.e1
Background
Currently, no guidelines exist to assist surgeons in providing recommendations to patients undergoing total knee arthroplasty (TKA) on when it is safe to return to driving. The purpose of this systematic review is to analyze the best available literature to assist surgeons in providing evidence-based recommendations on when it is safe to return to driving after TKA.Methods
Following established methodology for the conduct of systematic reviews, a literature search was performed for prospective studies on driving after TKA. Two reviewers screened citations for inclusion, assessed methodological quality, and extracted data.Results
Nine studies with 330 subjects met the inclusion criteria. Normalization of brake response time, movement time, and reaction time to preoperative baseline was assessed by pooling data across studies between 0 and 4 weeks and >4 weeks after TKA. Patients who underwent left TKA and right TKA showed normalization by 2 and 4 weeks, respectively. The limited studies that evaluated brake response time, movement time, and reaction time prior to 2 weeks postoperatively also showed normalization to preoperative levels.Conclusion
Patients with right TKA have normalization of braking time by 4 weeks, and normalization is as early as 2 weeks following left TKA. Surgeons must consider these recommendations and other patient factors that determine fitness to drive prior to deeming a patient safe to return to driving. 相似文献19.
Anders El-Galaly Poul T. Nielsen Steen L. Jensen Andreas Kappel 《The Journal of arthroplasty》2018,33(7):2131-2135.e1
Background
High tibial osteotomy (HTO) is a joint preserving treatment of unicompartmental osteoarthritis in the knee. In cases with insufficient or deteriorating clinical results patients may undergo a total knee arthroplasty (TKA). The influence of prior HTO on TKA survival is debated.Methods
We conducted a population-based registry study comparing 1044 primary TKAs in patients with prior HTO to 63,763 de novo TKAs inserted from 1997 to 2015. Implant survival was estimated by Kaplan-Meier analysis with revision of any kind as endpoint. Patient and surgery characteristics, including choice of implant design, were compared and their influence on TKA survival was estimated by Cox regression. Finally, indications of revision were compared between the groups.Results
TKA following HTO had an inferior survival with a 10-year estimated survival of 91% compared to 94% for de novo TKA, corresponding to a crude hazard ratio (HR) of 1.73 (P < .001). However, after adjustment for differences in gender and age this risk diminished (HR 1.19, P = .09). The choice of implant constraint was similar between the groups and in both groups posterior stabilized TKA was associated with inferior survival with an adjusted HR of 1.46 (P = .03) in post-HTO TKA when compared to cruciate-retaining TKA.Conclusion
TKA following HTO had a crude inferior survival when compared to TKA without prior surgery of any kind. The inferior survival was explainable by patient characteristics, defined by male gender and lower age, rather than the prior HTO. However, when the prior HTO resulted in the use of posterior stabilized TKA the survival decreased. 相似文献20.
Paolo Adravanti Andrea Tecame Laura de Girolamo Aldo Ampollini Rocco Papalia 《The Journal of arthroplasty》2018,33(3):696-699