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1.
Vikas Kulshrestha Barun Datta Santhosh Kumar Gaurav Mittal 《The Journal of arthroplasty》2017,32(5):1460-1469
Background
With increasing number of patients with early osteoarthritis of knee opting for total knee arthroplasty (TKA), there has been increase in patients dissatisfied with surgical outcomes. It is being presumed that offering unicondylar knee arthroplasty (UKA) to them would improve outcomes.Methods
Primary objective of our study was to look for any difference in patient-reported outcome and function at 2-year follow-up in patients undergoing UKA as compared to TKA. Our study was a randomized study with parallel assignment conducted at a high-volume specialized arthroplasty center. Eighty patients with bilateral isolated medial compartment knee arthritis were randomized into simultaneous 2-team bilateral TKA (n = 40) and UKA (n = 40) group. We finally analyzed 36 patients in each group. Main outcome measure was improvement in Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and High Activity Arthroplasty Score (HAAS) obtained at 2-year follow-up.Results
Improvement in KOS-ADLS and HAAS at 2 years was similar (P = .2143 and .2010) in both groups. Performance as assessed with Delaware index was also similar. Length of hospital stay was less in UKA group (6.6 days as against 5.4 days). Complications and readmission rates were more in TKA group (nil in UKA group; 08 in TKA group).Conclusion
At 2-year follow-up, UKA provides similar improvement in patient-reported outcomes, function, and performance as compared to TKA when performed in patients with early arthritis. However, UKA patients have shorter hospital stay and fewer complications. 相似文献2.
Man S. Kim In J. Koh Young J. Choi Jong Y. Lee Yong In 《The Journal of arthroplasty》2017,32(5):1453-1459
Background
The purpose of this study was to compare the patient-reported outcomes regarding joint awareness, function, and satisfaction after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).Methods
We identified all patients who underwent a UKA or TKA at our institution between September 2011 and March 2014, with a minimum follow-up of 2 years. Propensity score matching was performed for age, gender, body mass index, operation side, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. One hundred UKAs to 100 TKAs were matched. Each knee was evaluated according to the WOMAC score, Forgotten Joint Score (FJS), High Flexion Knee Score (HFKS) and patient's satisfaction at postoperative 2 years.Results
There was no significant difference in WOMAC score at postoperative 2 years between UKA and TKA groups. However, the FJS of the UKA group was significantly higher than that of the TKA group (67.3 ± 19.8 and 60.6 ± 16.6, respectively; P = .011). The HFKS was also significantly higher in the UKA group compared with the TKA group (34.4 ± 6.4 and 31.3 ± 5.2, respectively; P < .001). Eighty-six percent of all patients who underwent UKA were satisfied compared with 71% of those who underwent TKA (P = .027).Conclusion
Patients who underwent UKA had higher FJS, HFKS, and satisfaction rate when compared with patients who underwent TKA, indicating that UKA facilitated less knee awareness and better function and satisfaction than TKA. 相似文献3.
Alexander J. Adams Gregory S. Kazarian Jess H. Lonner 《The Journal of arthroplasty》2017,32(6):1786-1791
Background
Patellofemoral chondromalacia (PFCM) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA), but there is limited data assessing PFCM's impact on the results of fixed-bearing UKA. Our objective was to assess the impact of medial patellar and/or medial trochlear PFCM on overall and patellofemoral-specific 2-year outcomes after fixed-bearing medial UKA.Methods
Intraoperative notes defined the presence and location of PFCM during fixed bearing medial UKA. Outcome measures included the New Knee Society Score (NKSS), Kneeling Ability Score (KAS) and Forgotten Joint Score (FJS-12). Thirty-one knees with PFCM (PFCM group), and 52 knees without PFCM (N-PFCM group) were included for analysis. Mann-Whitney U tests assessed the statistical significance of observed differences, and a Bonferroni correction was applied, adjusting threshold for significance to P = .005.Results
At minimum follow-up of 2 years, no statistical differences were detected between the N-PFCM and PFCM groups in the postoperative NKSS (159 vs 157, P = .731), preoperative to postoperative NKSS change (P = .447), FJS-12 (70.5 vs 67.6, P = .471), or KAS (71% vs 65%, P = .217). Patients with isolated patellar chondromalacia (n = 13) demonstrated trends toward worse outcomes according to NKSS (147, P = .198), FJS-12 (58, P = .094), and KAS (46%, P = .018), but were statistically insignificant. No failures occurred in either group.Conclusion
Functional outcomes of fixed-bearing medial UKA are not adversely impacted by the presence of PFCM involving the medial patellar facet and/or medial or central trochlea. Further follow-up is needed to determine longer-term implications of fixed-bearing medial UKA in patients with PFCM. 相似文献4.
Homayoun Siman Atul F. Kamath Nazly Carrillo William S. Harmsen Mark W. Pagnano Rafael J. Sierra 《The Journal of arthroplasty》2017,32(6):1792-1797
Background
Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up.Methods
A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritis considered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship.Results
UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates.Conclusion
Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA. 相似文献5.
Jennie M. Scarvell Diana M. Perriman Paul N. Smith David G. Campbell Warwick J.M. Bruce Bo Nivbrant 《The Journal of arthroplasty》2017,32(11):3356-3363.e1
Background
The bicruciate-stabilized (BCS) knee arthroplasty was developed to replicate normal knee kinematics. We examined the hypothesis that patients with osteoarthritis requiring total knee arthroplasty (TKA) will have better functional outcome and satisfaction with the BCS implant compared with an established posterior cruciate-stabilized implant.Methods
This multicenter, randomized, controlled trial compared the clinical outcomes of a BCS implant against an established posterior cruciate-stabilized implant with 2-year follow-up. Of the patients awaiting primary knee arthroplasty for osteoarthritis, 228 were randomized to receive either a posterior-stabilized or BCS implant. Primary outcomes were knee flexion and Oxford Knee Score. Secondary outcomes were rate of complications and adverse events (AEs). Tertiary outcomes included Knee Society Score, University of California, Los Angeles, activity score, Patella scores, EQ-5D, 6-minute walk time, and patient satisfaction.Results
Complete data were recorded for 98 posterior-stabilized implants and 97 BCS implants. Twelve patients had bilateral knee implants. There was no difference between the groups for any of the measures at either 1 or 2 years. At 2 years, knee flexion was 119 ± 0.16 and 120 ± 1.21 degrees for the posterior-stabilized and BCS implants, respectively, (mean, standard error, P = .538) and Oxford Knee Scores were 40.4 ± 0.69 and 40.0 ± 0.67 (P = .828), respectively. There were similar device-related AEs and revisions in each group (AEs 18 vs 22; P = .732; revisions 3 vs 4; P = .618).Conclusion
There was no evidence of clinical superiority of one implant over the other at 2 years. 相似文献6.
Estrella Borrego Paredes Pablo Barrena Sánchez David Serrano Toledano Andrés I. Puente González Salvador Fornell Pérez Gabriel Domecq Fernández de Bobadilla 《The Journal of arthroplasty》2017,32(1):193-196
Background
The loss of anatomic references and bone stock turns unicompartmental knee arthroplasty (UKA) revision surgery difficult, and according to some authors, it is technically as challenging as a total knee arthroplasty (TKA) revision surgery.Methods
A retrospective review of 559 Oxford medial UKA was performed between 2007 and 2013. Nineteen knees were revised to TKA for reasons other than infection, most commonly for osteoarthritis progression.Results
The most frequent cause of failure in our series was osteoarthritis progression (10 cases, 52.63%). In 15 patients (78.95%), tibial stems were needed, and in 10 (55.5%), metallic blocks for augmentation of tibial plateau were used. Postoperative radiographic studies showed a correct implant alignment, preserving adequate joint line (24.8 mm), and patellar (1.1 mm) height (according to Insall-Salvati). After a mean follow-up of 21 months (range 6-51) mean values of 78.8 (standard deviation [SD] = 16.8) and 62.3 (SD = 19.6) were obtained for the physical and mental scores of the Knee Society Score test. In the SF-36 tests mean values of 45.2 (SD = 7.6) and 53 (SD = 5.2) were obtained for the physical and mental scores respectively. In one case, a varus/valgus instability occurred intraoperatively and it required revision with a prosthesis with higher constriction. No thromboembolic or infectious events were observed during postoperative follow-up.Conclusion
Following a standardized technique, UKA revision surgery can be achieved with TKA in almost every case despite bone stock loss and lack of anatomic landmarks. 相似文献7.
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8.
Jason B. O&#x;Neal Andrew A. Freiberg Marc D. Yelle Yandong Jiang Chengwei Zhang Yin Gu Xiangyi Kong Wenling Jian Wesley T. O&#x;Neal Jingping Wang 《The Journal of arthroplasty》2017,32(10):3029-3033
Background
The efficacy of intravenous (IV) acetaminophen compared with its oral formulation for postoperative analgesia is unknown. We hypothesized that the addition of acetaminophen to a multimodal analgesia regimen would provide improved pain management in patients after total knee arthroplasty (TKA) and that the effect of acetaminophen would be variable based on the route of delivery.Methods
The study was a single-center, randomized, double-blinded, placebo-controlled clinical trial on the efficacy of IV vs oral acetaminophen in patients undergoing unilateral TKA. One hundred seventy-four subjects were randomized to one of the 3 groups: IV acetaminophen group (IV group, n = 57) received 1 g IV acetaminophen and oral placebo before postanesthesia care unit (PACU) admission; oral acetaminophen group (PO group, n = 58) received 1 g oral acetaminophen and volume-matched IV normal saline; placebo group (Placebo group, n = 59) received oral placebo and volume-matched IV normal saline. Pain scores were obtained every 15 minutes during PACU stay. Average pain scores, maximum pain score, and pain scores before physical therapy were compared among the 3 groups. Secondary outcomes included total opiate consumption, time to PACU discharge, time to rescue analgesia, and time to breakthrough pain.Results
The average PACU pain score was similar in the IV group (0.56 ± 0.99 [mean ± standard deviation]) compared with the PO group (0.67 ± 1.20; P = .84) and Placebo group (0.58 ± 0.99; P = .71). Total opiate consumption at 6 hours (0.47 mg hydromorphone equivalents ± 0.56 vs 0.54 ± 0.53 vs 0.54 ± 0.61; P = .69) and at 24 hours (1.25 ± 1.30 vs 1.49 ± 1.34 vs 1.36 ± 1.31; P = .46) were also similar between the IV, PO, and Placebo groups. No significant differences were found between all groups for any other outcome.Conclusion
Neither IV nor oral acetaminophen provides additional analgesia in the immediate postoperative period when administered as an adjunct to multimodal analgesia in patients undergoing TKA in the setting of a spinal anesthetic. 相似文献9.
Maria A. Martínez-Huedo Rodrigo Jiménez-García Isabel Jiménez-Trujillo Valentín Hernández-Barrera Benito del Rio Lopez Ana López-de-Andrés 《The Journal of arthroplasty》2017,32(12):3729-3734.e2
Background
We aimed to compare in-hospital postoperative complications (IHPC) and in-hospital mortality between patients with and without type 2 diabetes mellitus (T2DM) undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).Methods
We analyzed data from the Spanish National Hospital Discharge Database, 2010-2014. We selected patients who had undergone THA (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 81.51) and TKA (code 81.54). Diabetic patients with THA and TKA were matched by year, age, sex, and the comorbidities included in the modified Elixhauser Comorbidity Index with a nondiabetic patient.Results
We identified 115,234 THA patients and 195,355 TKA patients, 12.4% and 15.6% with T2DM, respectively. We matched 10,777 and 26,640 pairs of diabetic and nondiabetic patients. In T2DM patients who had undergone THA, the incidence of urinary tract infection was higher than in nondiabetic patients (1.50% vs 1.09%, P = .007), as was that of “any IHPC” (9.68% vs 8.98%, P = .038). In patients who had undergone TKA, the incidence of postoperative anemia was significantly higher in diabetic patients (4.90% vs 4.53, P = .040), as was that of urinary tract infection (0.80% vs 0.53%, P = .025) and “any IHPC” (7.30% vs 6.76%, P = .014). In both procedures, mean length of hospital stay was significantly higher in diabetic patients; for TKA, in-hospital mortality was higher in diabetic patients (0.09% vs 0.02%, P = .002). Previous comorbidities, age, and obesity predict a higher incidence of IHPC among diabetic patients.Conclusions
This study confirms the higher risk of IHPC among T2DM patients after joint arthroplasty. IHPC may result in a higher risk of mortality in patients undergoing TKA. 相似文献10.
Brent A. Kokubun Gregory C. Manista P. Maxwell Courtney Sean M. Kearns Brett R. Levine 《The Journal of arthroplasty》2017,32(6):1798-1802
Background
The relationship between intra-articular injections and complication rates after total knee arthroplasty (TKA) remains controversial. This study's purpose was to determine the relationship between the number and timing of intra-articular injections with complications and outcomes after TKA from a single surgeon's database.Methods
We retrospectively reviewed a series of 442 patients who underwent primary TKA from 2008-2015. Patient demographics, comorbidities, number and timing of ipsilateral intra-articular injections, and preoperative and postoperative functional outcome scores were recorded. Complications and infection rates at a minimum of 12-month follow-up were compared between patients who received 3 or less preoperative injections and those who received 4 or greater before TKA. Multivariate logistic regression analysis was performed to identify independent risk factors for complications and poor short-term outcomes after TKA.Results
Of the 442 patients enrolled in the study, 390 patients (90%) received an ipsilateral injection before TKA. Patients receiving 4 or more injections (175 patients, 40%) did not have a difference in complication rate (14% vs 17%, P = .346), poor functional outcomes (6% vs 9%, P = .299), or infection rate (2% vs 4%, P = .286). When controlling for confounding variables, intra-articular corticosteroid, viscosupplementation, and any injection within 90 days were not associated with an increase in complications, infection, or poor functional outcomes after TKA (all P > .05).Conclusion
Our data suggest that there is no relationship between timing and number of intra-articular injections with complication rate, infection, or poor short-term functional outcomes. Further larger studies are needed to confirm these findings. 相似文献11.
Man S. Kim In J. Koh Young J. Choi Yong D. Kim Yong In 《The Journal of arthroplasty》2017,32(5):1488-1495
Background
Extensive medial soft tissue release may be necessary to correct severe varus deformity during total knee arthroplasty (TKA). However, this procedure may result in instability. Here, we describe a novel soft tissue balancing technique, which can minimize medial release in severe varus deformity during TKA.Methods
Fifty knees (40 patients) with hip-knee-ankle angle of more than 20° of varus were corrected using this technique (group 1). After achieving flexion gap balancing by needle puncturing and spreading of the superficial medial collateral ligament, extension gap balancing was obtained by gradual extension with the trial components in place. After group 1 was set, a one-to-one patient-matched control group who had mild varus deformity was selected by propensity score matching (50 knees, 48 patients, group 2). At postoperative 1 year, mediolateral laxity was compared between the 2 groups using the stress radiographs. Clinical outcomes were also compared using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score.Results
There were no differences in mean medial and lateral laxities between groups 1 and 2 at 1 year after the operation (medial laxity: 2.3° ± 1.4° and 2.7° ± 1.3°, respectively, P = .310) (lateral laxity: 3.6° ± 1.7° and 3.2° ± 2.0°, respectively, P = .459). There were no significant differences in postoperative clinical scores and knee alignment.Conclusion
Our technique of obtaining extension gap balancing using trial components led to safe and effective balancing by avoiding unnecessary extensive release in severe varus deformity during TKA. 相似文献12.
Alfonso E. Ayala Kevin A. Lawson Angelika C. Gruessner Michael P. Dohm 《The Journal of arthroplasty》2017,32(2):386-389
Background
Advantages of unicondylar knee arthroplasty (UKA) over total knee arthroplasty include rapid recovery and shorter lengths of stay following surgery. Patients requiring extended postoperative care fail to recognize these benefits. Patient-reported outcome measures have proved useful in predicting outcomes following joint arthroplasty. The purpose of this study was to identify and report preoperative patient-reported outcome measures and clinical variables that predict discharge to skilled nursing facilities following UKA.Methods
A prospective cohort of 174 patients was used to collect 36-Item Short Form scores and objective clinical data. Univariate and multivariate analysis with backward elimination were conducted to find a predictive risk model.Results
The predictive model reported (78.7% concordance, receiver operating characteristic curve c-statistic 0.719, P = .0016) demonstrates that risk factors for discharge to skilled nursing facilities are: older age (odds ratio 4.18; 95% confidence interval [CI] 1.256-13.911, P = .019), bilateral UKA procedures (odds ratio 1.887; 95% CI 1.054-3.378, P = .0326) and lower patient-reported preoperative 36-Item Short Form physical function scores (odds ratio 0.968; CI 0.938-1, P = .0488).Conclusion
The information presented here regarding possible patient disposition following UKA could aid informed decision-making regarding patients' short-term needs following surgery and help streamline preoperative planning. 相似文献13.
Omar A. Behery Sean M. Kearns Justin M. Rabinowitz Brett R. Levine 《The Journal of arthroplasty》2017,32(5):1510-1515
Background
The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.Methods
A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.Results
Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.Conclusion
It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components. 相似文献14.
Christian Skovgaard Nielsen Kirill Gromov Øivind Jans Anders Troelsen Henrik Husted 《The Journal of arthroplasty》2017,32(1):177-182
Background
Postoperative anemia is frequent after revision of total knee arthroplasty (TKA) with reported transfusion rates up to 83%. Despite increased efforts of reducing blood loss and enhancing fast recovery within the fast-track setup, a considerable transfusion rate is still evident. The aim of this study was therefore to evaluate the effect of a bipolar sealer on blood loss and transfusion in revision TKA.Methods
In this single-center prospective cohort study with retrospective controls, 51 patients were enrolled in a fast-track setup for revision TKA without the use of a tourniquet. Twenty-five prospectively enrolled patients received treatment with both a bipolar sealer and electrocautery, whereas 26 patients had received treatment with a conventional electrocautery only in the retrospective group.Results
No significant differences were found neither for calculated blood loss, with 1397 (standard deviation, ± 452) mL in the bipolar sealer group vs 1452 (SD, ± 530) mL in the control group (P = .66), nor for blood transfusion rates of 53% and 46% (P = .89), respectively. Four controls were readmitted within 90 days follow-up.Conclusion
The use of a bipolar sealer in a TKA revision setting without the use of a tourniquet did not reduce blood loss or blood transfusion rates. 相似文献15.
Majid Chowdhry Raghbir S. Khakha Mark Norris Amin Kheiran Sandeep K. Chauhan 《The Journal of arthroplasty》2017,32(4):1132-1136
Background
Unicompartmental knee arthroplasty (UKA) is an underutilized implant for medial tibiofemoral arthritis despite proven benefits in performance and reduced complications. This is likely related to registry recorded higher revision rates compared with total knee arthroplasty. It is our feeling that better component alignment resulting from the usage of computer-assisted surgery should improve longer-term functional results and survival of UKAs.Methods
Between August 2003 and June 2007, 265 medial UKAs were performed in 264 consecutive patients using navigation.Results
Eighty-eight women and 176 men with an average age of 51.7 (±4.63) years were assessed for function and survival over a follow-up period of 92.6 (63-120) months (7.7 years). The final survival rate over 5 years for this cohort was 97.6% at 5 years.Conclusion
We conclude that computer-assisted UKA, to treat medial tibiofemoral joint arthritis, produces 5-year survival rates that are comparable with total knee arthroplasty. 相似文献16.
Minako Murata-Ooiwa Sachiyuki Tsukada Motohiro Wakui 《The Journal of arthroplasty》2017,32(10):3024-3028
Background
Although multimodal pain management including periarticular multidrug injection can provide excellent pain relief in the early postoperative period after total knee arthroplasty (TKA), rebounding pain remains an important challenge. A randomized, double-blind, placebo-controlled trial was performed to investigate the efficacy of adding intravenous acetaminophen to multimodal pain management for TKA.Methods
We enrolled 67 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals or normal saline at the same intervals. All patients were treated with intraoperative periarticular multidrug injection and intravenous and oral nonsteroidal anti-inflammatory drugs. The primary outcome was the postoperative 100-mm visual analog pain scale at the time of administration of study drugs.Results
In the intention-to-treat analysis, the pain score was significantly better in the intravenous acetaminophen group than the placebo group at 17:00 one day after TKA (15.3 ± 17.0 mm vs 26.8 ± 19.0 mm; P = .013). There were no significant differences in terms of the rate of complications between groups.Conclusion
Even in the setting of multimodal pain management including periarticular multidrug injection, intravenous acetaminophen provided better pain relief for patients undergoing unilateral TKA. 相似文献17.
Alice Bonnefoy-Mazure Stéphane Armand Yoshisama Sagawa Domizio Suvà Hermes Miozzari Katia Turcot 《The Journal of arthroplasty》2017,32(3):793-800
Background
The aim of this study was to describe the evolution of kinematic and clinical outcomes of a large patient cohort with knee osteoarthritis from before surgery (V1) to 3 months (V2) and 1 year (V3) after a total knee arthroplasty (TKA).Methods
The patients were evaluated at each visit (118 patients at V1, 93 patients at V2, and 79 patients at V3) during a clinical gait analysis and were compared with a matched control group of healthy adults (CG). The kinematic parameters, the Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Gait velocity and knee range of motion (ROM) as well as clinical parameters were compared at each visit with CG was based on the unpaired samples t-test. To determine changes in the data at baseline, 3 months, and 1 year after surgery in the patient groups, repeated-measure analysis of variance was conducted (P < .05). Pearson correlation was used to examine relationships between clinical and biomechanical outcomes.Results
One year after TKA (V3) compared to V1 and V2, the ROM of the operated knee during gait was significantly improved (V1: 44.2 ± 8.8° vs V3: 47.5 ± 7.1°, P < .001, and V2: 42.2 ± 9.3° vs V3: 47.5 ± 7.1°, P = .001), as was the gait velocity (V1: 1.0 ± 0.2 and V2: 1.1 ± 0.2 m/s vs V3: 1.3 ± 0.2 m/s, P < .001). The WOMAC and knee pain were significantly better 1 year after TKA. No strong relationships have been found between clinical parameters and knee kinematics.Conclusion
This study showed that 1 year after TKA, patients exhibited improved gait velocity and ROM and experienced a significant decrease in the level of pain and an increased clinical score (although different from CG). 相似文献18.
Denis Nam Judith E. Kopinski Zachary Meyer Richard D. Rames Ryan M. Nunley Robert L. Barrack 《The Journal of arthroplasty》2017,32(7):2151-2155
Background
Cementless total knee arthroplasty (TKA) designs that incorporate a highly porous, titanium surface have the potential to achieve biologic fixation and improve component survivorship. This study's purpose was to compare perioperative and early postoperative outcomes of a cemented vs cementless TKA of the same design.Methods
This was a retrospective review of a consecutive series of TKAs performed at a single institution using a cemented or cementless TKA of the same design (Triathlon, Stryker Inc, Mahwah, NJ). All patients with a minimum of 1-year clinical and radiographic follow-up were reviewed, with 1:1 matching performed for age, gender, body mass index, and preoperative Oxford Knee Score. Chi-square or independent student t tests were used for statistical analyses.Results
Overall, 62 cemented and 66 cementless TKAs were reviewed, with secondary analyses performed after 1:1 matching of 38 patients in each cohort. In both overall and secondary 1:1 matching analyses, there was no difference in baseline demographics (P = .6-.9). Total operative times were decreased in the cementless cohort (P = .03), but there was no difference in the estimated blood loss or change in hemoglobin levels (P = .2-.7). At a mean of 1.4 ± .5 years postoperatively, patients in both cohorts demonstrated similar improvements in Oxford Knee Scores and satisfaction scores (P = .2-.8), with no patients requiring a revision surgical procedure.Conclusion
A recently introduced cementless TKA design demonstrates excellent perioperative and early postoperative results without failures. Continued surveillance is necessary to elucidate the survivorship and potential long-term benefits of this cementless design. 相似文献19.
Ing H. Moo Jerry Y.Q. Chen Eric H. Pagkaliwaga See W. Tan Kein B. Poon 《The Journal of arthroplasty》2017,32(5):1483-1487
Background
Total knee arthroplasty (TKA) is associated with major blood loss and blood transfusion is often required. This study aimed to evaluate the efficacy of bone wax in reducing blood loss and transfusion rates after TKA.Methods
A prospective randomized controlled study that included 100 patients undergoing primary unilateral TKA with cement was conducted in a tertiary center between March 2014 and June 2014. The bone wax group received 2.5 g of bone wax, applied onto the uncovered bone around the prostheses and the nail holes before the tourniquet was released, whereas the control group had hemostasis achieved using electrocautery only. Total blood loss was calculated using the hemoglobin balance method.Results
There were no demographic differences between the 2 groups. The preoperative serum hemoglobin levels were comparable between the 2 groups. The drop in serum hemoglobin levels at 24 h post-TKA was 1.6 ± 0.9 and 2.1 ± 1.1 g/dL in the bone wax and control groups respectively (P = .021), while the drop in serum hemoglobin levels at 72 h post-TKA was 2.7 ± 1.1 and 3.6 ± 1.2 g/dL respectively (P = .013). Total blood loss at 72 h post-TKA was 987.9 and 1183.5 mL for the bone wax and control groups respectively (P = .017). There was no adverse event associated with the use of bone wax at the 3-month follow-up.Conclusion
The application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels. 相似文献20.
R. Michael Meneghini Evan R. Deckard Marshall K. Ishmael Mary Ziemba-Davis 《The Journal of arthroplasty》2017,32(10):3009-3015