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1.
Aims
To determine the temporal changes in patient dissatisfaction following primary knee arthroplasty surgery (TKA).Patients and methods
Three hundred and ninety patients that had previously indicated they were either dissatisfied or unsure with their TKA at one-year post-surgery in our region were mailed a simple questionnaire in addition to the Oxford Knee Score and EQ-5D.Results
A 55% response rate was achieved. The mean follow-up time period was 9.1 years. Of the 120 patients who were initially dissatisfied, 46.7% remained so. Of the 96 patients who were initially unsure, 20.8% remained so, 21.9% and 57.3% became dissatisfied and satisfied, respectively. The primary reason for continued dissatisfaction was persistent pain. Of the 19.4% of patients who had revision surgery, 47.6% remained dissatisfied. 54.2% of patients stated that they would be happy to have a primary TKA again and 55.6% indicated that they would recommend one to a friend. Patients who had concurrent hip pain were six times more likely to remain unsure or dissatisfied over time (OR 6.7, p-value 0.0000). Patients who had back pain or contralateral knee pain were two or three times as likely to remain unsure or dissatisfied.Conclusion
In time half of the patients who stated that they were not satisfied with their arthroplasty, at one year, go on to be satisfied with their knee. 相似文献2.
Olivia Unwin Mohammed Hassaballa James Murray William Harries Andrew Porteous 《The Knee》2017,24(2):454-459
Background
MIS TKA has been shown to offer a reduced in-patient stay, but no clinical difference at two years. Whilst there may be a benefit from earlier discharge, we need to ensure that there are no detrimental effects in the medium and long-term following MIS-TKA. To report the mid-term result from a prospective randomised controlled trial (RCT) comparing MIS-TKA with standard approach for TKA.Methods
Using knee score questionnaires, we collected patient reported outcome measures (PROMs) regarding pain and function. Sixty-six patients (from an eligible cohort of 83 patients) completed the mid-term postal follow-up.Results
There was no significant difference between groups for change in score from pre-operative to final follow-up in all three PROMs. Mean MIS and standard group improvement was: AKSS 53 and 51 (p = 0.7644), OKS 15 and 16 (p = 0.2341) or WOMAC 15 and 15 (p = 0.9900) respectively. Both groups showed improvement in pain and function with no significant difference between groups. There was no difference between groups for revision due to malalignment at a mean six year follow-up.Conclusions
In addition to the early benefits regarding hospital stay and complications, we have found that at a mean of six years there was no increase in malalignment, pain or function with MIS techniques. 相似文献3.
Background
Total knee arthroplasty (TKA) has been successful for many younger patients, but some experience residual symptoms or dissatisfaction. We performed this study to assess the relationship between radiographic disease severity and patient demographic features on patient reported TKA outcome scores.Methods
We compared 100 TKAs performed for 82 patients ≤ 55 years old with 100 gender-matched TKAs performed for 85 patients between 65 and 75 years old. These study cases represented 25% and 21%, respectively, of TKAs performed between January 2006 and June 2011. Radiographic disease severity was determined from preoperative weight bearing AP and lateral radiographs. Patient reported outcome instruments (SF-12, Knee Society function, and WOMAC) were assessed for all patients within six months before surgery and postoperatively at a mean of 20 months after TKA.Results
Although younger patients had less mean articular cartilage loss (p < 0.01), osteoarthritis severity (p < 0.01), and Kellgren–Lawrence grade (p = 0.05), they reported lower preoperative scores (p < 0.01) exceeding the MCID for SF-12 mental health (8.3 points), WOMAC pain (12.1 points), and WOMAC physical function (6.9 points). While substantial improvement was noted, WOMAC pain scores remained lower than those reported by older TKA patients (11.5 points, p < 0.05).Conclusion
Younger patients with less severe radiographic arthritis experience significant improvement with TKA, but outcome scores do not match those attained by older patients with more severe radiographic disease. 相似文献4.
Background
The purpose of this study was to compare the clinical outcomes and second-look arthroscopic findings of remnant preservation technique with those of conventional anterior cruciate ligament (ACL) reconstruction in single bundle ACL reconstructions.Methods
One hundred sixty two consecutive patients underwent ACL reconstruction by one surgeon, with 93 patients receiving remnant preservation technique (Group A) and 69 patients receiving conventional ACL reconstruction (Group B). The mean follow-up was 15 months. Clinical outcomes were assessed using Lysholm scores and the International Knee Documentation Committee form (IKDC form) evaluation. Post-operative knee stability was evaluated through manual knee laxity evaluation, pivot-shift test, and a Telos device.Results
Differences in post-operative stability (manual knee laxity, pivot shift test and Telos device) were not significant between the groups (p = 0.681, p = 0.610, p = 0.696). And also no significant differences were noted with respect to the IKDC form and the latest Lysholm scores. But in the second-look arthroscopic findings, synovial coverage was confirmed to be excellent in 36% (22/61) of Group A patients and 23% (7/30) of Group B patients.Conclusions
ACL reconstruction with both techniques was found to result in acceptable stability, clinical outcomes and second-look arthroscopic findings. With regard to synovial coverage, the remnant reservation techniques were found to be superior to conventional ACL reconstruction.Level of evidence
Level III, retrospective comparative study. 相似文献5.
Matthew T. Houdek Maurizio Scorianz Cody C. Wyles Robert T. Trousdale Franklin H. Sim Michael J. Taunton 《The Knee》2017,24(4):851-855
Background
Pigmented villonodular synovitis (PVNS) is a rare, benign proliferation of the synovium, commonly affecting the knee. Arthroplasty can successfully manage arthrosis in this population; however, outcome data is limited. The purpose of this study was to investigate the oncologic and functional outcome of patients undergoing total knee arthroplasty (TKA) in the setting of PVNS.Methods
48 patients were identified at our institution with histologically confirmed PVNS that subsequently received TKA. The cohort consisted of 28 females and 20 males with a mean age and body mass index of 61 years and 29.2 kg/m2. 37 patients had “active” disease, defined as diffuse in 40 patients and focal in eight. Mean follow-up was 14 years.Results
The 10-year disease free-survival was 88%. Recurrence occurred in 6 patients and was treated with synovectomy and revision arthroplasty (n = 4), local excision (n = 1) and transfemoral amputation (n = 1). 25 patients sustained at least 1 complication, most commonly decreased knee range of motion. Complications resulted in revision TKA in 10 patients (21%). There was no difference (P = 0.74) between mean pre- and postoperative ROM; however, there was a significant reduction in the number of patients with a flexion contracture > 15° (P = 0.03). The mean Knee Society score and functional score significantly improved following surgery (P < 0.001).Conclusions
This study indicates arthroplasty in the setting of PVNS improves patient function and reduces the presence of flexion contractures. Patients with a history of PVNS should be cautioned when undergoing arthroplasty on the elevated risk of subsequent procedures.Level of evidence
Level III. 相似文献6.
Background
Whether early or delayed surgical intervention in patients with multi-ligament injuries results in better outcomes, is of current and controversial debate.Purpose
The purpose of this study was to perform a meta-analysis comparing early versus late surgical treatment of multi-ligament knee injuries.Methods
We performed a systematic review of Medline, Embase, Scopus, and Google Scholar to identify relevant studies in the English and German literature. Eligibility criteria included studies comparing early or delayed surgical interventions for multi-ligament knee injuries, with a minimum follow-up of two years, reporting the primary clinical outcome using a validated functional scoring system and range of motion. Exclusion criteria were patients treated with multi-trauma, head injury, non-union, lower extremity fractures, or a documented history of previous knee injuries. Publication bias was assessed by funnel plot, and the risk of bias was established using the Cochrane Collaboration's risk of bias tool. Heterogeneity was assessed using χ2 and I2 statistic.Results
Eight studies (n = 260 patients) were included in the analysis. 149 patients were treated early with a mean of 10.6 days; 111 patients were treated late with a mean of 294 days. The pooled estimate for clinical outcome demonstrated that early surgery resulted in significantly higher Lysholm scores (SMD 0.669, 95% CI: 0.379 to 0.959, p = 0.0001, I2 = 0%). Thirty-one per cent of all patients with early surgery had a normal or near normal knee, whereas only 15% of patients with late reconstruction reported the knee to be normal or near normal. The pooled estimates for total ROM did not demonstrate a significant difference between the groups (SMD 0.113, 95% CI: ? 0.271 to 0.498, p = 0.564, I2 = 35.57%).Conclusions
The results of this meta-analysis suggest that early surgical intervention in multi-ligament injuries of the knee produces a significantly superior clinical outcome, compared to late reconstruction. Although an overall trend of improved total range of knee motion was also demonstrated, this was very small and unlikely to be clinically relevant.Level of evidence
Level 4; Systematic review and meta-analysis. 相似文献7.
Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis
Background
To conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of normal and high body mass index (BMI) to provide the predictive diagnosis for clinic.Methods
Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to February.RCTs comparing the benefits and risks of normal BMI with those of high BMI in primary total knee arthroplasty (TKA) were included. Statistical heterogeneity was quantitatively evaluated by X2 test with the significance set P < 0.10 or I2 > 50%.Results
Seven RCTs consisting of 33,778 patients were included. (6065 normal BMI patient; 27,713 high BMI). The results showed that high BMI was related to a greater increase in operative time, post-operative range of motion (ROM), post-operative Knee Society and function scores (KSS), infection rate (P < 0.1). No differences in pulmonary embolism and perioperative mortality rates were found between normal and high body mass index patients with follow-up ≥ 5 years (P > 0.1).Conclusions
Compared with normal BMI patients, high BMI patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between normal and high BMI about TKA. 相似文献8.
Michael Worlicek Benedikt Moser Günther Maderbacher Raphael Zentner Florian Zeman Joachim Grifka Armin Keshmiri 《The Knee》2017,24(4):711-717
Background
Patellofemoral instability may lead to osteoarthritis, anterior knee pain, and patellar luxation. The purpose of this study was to conduct an exploratory investigation into the difference of patellar kinematics of healthy knees during extension/flexion cycles in neutral, varus and valgus alignment.Methods
The three-dimensional patellar kinematics of 10 lower extremities of whole body cadavers were examined during passive motion, in neutral position, and under valgus and varus stress. Kinematics was recorded by means of an optical computer navigation system.Results
The study samples did not significantly differ with regard to mediolateral patellar shift and epicondylar distance. Varus stress led to significantly higher external rotation than valgus stress (P = 0.04) and to a significantly higher lateral patellar tilt than neutral position (P = 0.016) and valgus stress (P = 0.016). No difference was found between valgus stress and neutral position.Conclusion
Analysis of tibiofemoral alignment alone is insufficient for predicting patellar kinematics. 相似文献9.
Hiroyuki Kawashima Akira Ogose Tetsuo Hotta Takashi Ariizumi Tetsuro Yamagishi Naoto Endo 《The Knee》2017,24(3):657-662
Background
Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several surgical procedures are available. The purpose of this study was to determine the outcome of the fibular transposition technique for reconstruction of the extensor mechanism of the knee after proximal tibial resection.Methods
We retrospectively reviewed five consecutive patients who underwent resection of the proximal tibia with prosthetic reconstruction and reconstruction of the extensor using fibular transposition between 1997 and 2011. There were two female and three male patients with a mean age of 50 years (range, 27 to 76 years). A follow-up evaluation included both passive and active range of motion, extensor lag, the MSTS score and complications.Results
Patients were followed up for 93 months (range, 44 to 160 months). The mean extensor lag and active flexion were four degrees (range, 0 to 10°) and 103° (range, 85 to 110°), respectively. The mean MSTS score was 80% (range, 73 to 90%). All patients were able to ambulate without crutches at the latest follow-up.Conclusions
The utilization of the fibular transposition technique is a simple, reliable, and successful procedure for extensor reconstruction after proximal tibial resection. 相似文献10.
Karin Mani William F. Brechue Bernd Friesenbichler Nicola A. Maffiuletti 《The Knee》2017,24(2):237-242
Background
Conventional one-legged hop tests simply evaluate the total hop distance, thus neglecting important temporal and spatial parameters related to the strategy of execution, such as foot contact time.Aim
To examine the validity and reliability of an instrumented one-legged hop test, the “four hops, three contacts” (4H3C) test, in patients with knee injuries.Methods
The 4H3C test consists of four consecutive one-legged hops, of which individual hop distance and foot contact time are recorded by a validated floor-based photocell system. We examined the test–retest reliability, discriminant validity (involved vs. uninvolved side) and convergent validity (relation with maximal voluntary strength) of consecutive hop distance and foot contact time parameters in 50 patients with unilateral knee injuries.Results
Test–retest reliability was very high for hop distance (intraclass correlation coefficients: 0.91 to 0.97) and high for contact time variables (intraclass correlation coefficients: 0.75 to 0.88). The difference between the involved and the uninvolved side was significant for all hop distance and contact time parameters (p < 0.05). Maximal voluntary strength was correlated to both hop distance (r = 0.67; p < 0.001) and contact time (r = ? 0.42; p < 0.01) variables.Conclusion
The 4H3C is a valid and reliable test for the evaluation of single hops in patients with knee injuries and may be useful in sport and clinical settings. The interpretation of foot contact time data requires however some caution. 相似文献11.
Suguru Nakamura Yukihide Minoda Shigeru Nakagawa Yoshinori Kadoya Susumu Takemura Akio Kobayashi Shigekazu Mizokawa Yoichi Ohta Sinji Takahashi Kazumasa Yamamura Hiroaki Nakamura 《The Knee》2017,24(2):434-438
Background
The medial pivot total knee prosthesis with alumina ceramic femoral components was introduced to reproduce physiological knee kinematics and reduce polyethylene wear. The five-year clinical outcomes of alumina medial pivot total knee arthroplasties (TKA) have previously been reported. The purpose of this study was to provide the longer-term clinical results at a minimum follow-up of 10 years.Methods
The clinical results of 70 alumina medial pivot TKA in 51 consecutive patients, with a minimum follow-up period of 10 years, were evaluated.Results
Mean follow-up was 11.8 years (range 10 to 13). Alumina medial pivot TKAs improved the patients' Knee Society knee scores, function scores, and postoperative ranges of motion compared with their pre-operative statuses (P < 0.05 for each). Revision surgery was required in one knee due to a postoperative fracture of the tibial plateau after a fall that occurred two years postoperatively. Osteolysis and femoral component loosening was identified in one case after the initial five-year time point of analysis. The survival rate was 99.1% at 10 years.Conclusions
This study demonstrated excellent clinical results for patients receiving the alumina medial pivot prosthesis at a minimum follow-up period of 10 years. 相似文献12.
Background
The general opinion is that outcomes of open primary repair of the anterior cruciate ligament (ACL) in the historical literature were disappointing. Since good outcomes of primary repair of proximal tears have recently been reported, we aimed to assess the role of tear location on open primary repair outcomes in the historical literature.Methods
All studies reporting outcomes of open primary ACL repair published between the inception of PubMed, Embase and Cochrane and 2000 were identified. Studies were included if tear location was reported. Outcome scores, return to sports, stability examinations, failures and patient satisfaction were collected and reviewed in the total study cohort and in a subgroup of studies treating only proximal tears. Spearman correlation analysis was performed between the percentage of proximal tears in the studies and all outcomes.Results
Twenty-nine studies were included reporting outcomes of open primary in 1457 patients of which 72% had proximal and 23% midsubstance tears. Mean age was 30 years, 65% were males, and mean follow-up was 3.6 years. Good outcomes were noted in the total cohort, and excellent outcomes were noted following repair of proximal tears. Positive correlation was found between the percentage proximal tears in the studies and percentage satisfied patients (p = 0.010).Conclusion
Tear location seems to have played a role on the outcomes of open primary ACL repair. Outcomes of open primary repair in patients with proximal tears were excellent, which confirms there may be a potential role for primary repair as treatment for proximal ACL tears. 相似文献13.
Charles Rivière Matthieu Ollivier Damien Girerd Jean Noël Argenson Sébastien Parratte 《The Knee》2017,24(3):627-633
Background
A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait. Therefore, the aim of our study is to assess the relationship between the standing and the dynamic (gait activity) HKAs.Methods
A prospective study on a cohort of 35 patients treated with a posterior-stabilized TKA for primary osteoarthritis. Three months after surgery each patient had a long-leg radiograph and the limb was classified as neutrally aligned (17 patients), varus aligned (nine patients), or valgus aligned (four patients). Patients then performed a gait analysis for level walking.Results
Standing HKA has a moderate correlation with the peak dynamic varus (r = 0.318, p = 0.001) and the mean and peak adduction moments (r = 0.31 and r = ? 0.352 respectively). No significant correlation between standing HKA and the mean dynamic coronal alignment (r = 0.14, p = 0.449). No differences were found for dynamic frontal parameters (dynamic HKA and adduction moment) between patients defined as neutrally or varus aligned.Conclusions
The standing HKA after TKA was of little value to predict dynamic behaviour of the limb during gait, this may explain why standing coronal alignment after TKA may have limited influence on long-term implant fixation and wear. 相似文献14.
Background
Unplanned hospital readmissions are indicators of the quality and performance of a health care system, but data on early readmission after primary total knee arthroplasty (TKA) in the Asian population are limited. The purpose of this study was to determine the causes, risk factors, and rate of unplanned readmission after primary TKA at a single institution in Korea.Methods
We analyzed all primary TKAs from 2004 to 2013 using the data from our institutional electronic database. A total of 4596 TKAs were performed on 3049 patients. All unplanned readmissions within 30 and 90 days of discharge were identified, categorized into arthroplasty-related, medical, and other orthopedic causes.Results
The overall unplanned readmission rate was 1.9% (n = 59) within 30 days and 3.3% (n = 101) within 90 days, and both the 30 and 90 day readmission rates remained stable over the entire study period. The majority of readmissions involved arthroplasty-related causes; the most common cause being wound problems, accounting for 22% (13/59) within 30 days and 24% (24/101) within 90 days. Age (P = 0.029) and hypertension (P = 0.021) were identified as risk factors for unplanned readmissions after TKA.Conclusion
This study demonstrates that unplanned readmissions after TKA are not infrequent in Korean patients and has identified wound complication as the most frequent cause of unplanned readmissions. Optimized care systems should be established to minimize unplanned readmissions, particularly for patients with high risk factors. 相似文献15.
Christopher J. Maugans Matthew G. Scuderi Frederick W. Werner Stefanos F. Haddad John P. Cannizzaro 《The Knee》2017,24(2):264-270
Purpose
The purpose of this study was to determine whether a modified step-cut tibial tubercle osteotomy (Maquet–Fulkerson hybrid) might produce comparable or better results than a standard oblique anteromedialization tibial tubercle osteotomy (Fulkerson type) and thus warrant the surgical need for additional cuts.Methods
Six pairs of cadaveric knees were evaluated prior to and after tibial tubercle osteotomies. Simulation was done via a shallow knee bend simulator through 20 to 70° of knee flexion for the intact specimens and following the surgical procedures. The variables tested were trochlear contact forces and pressures and patellar motion.Results
Testing showed a decreased force (P = 0.027), peak contact pressure (P = 0.01) and contact area (P = 0.034) on the lateral trochlea of the femur for both types of osteotomies. There was no significant difference in the lateral femoral peak pressure or in the medial femoral peak pressure between the oblique cut and the step-cut. Also, there was no difference in patellar motion after either procedure.Conclusion
We conclude that both osteotomies decrease lateral patellofemoral trochlear pressure. The oblique osteotomy may decrease lateral pressure to a greater extent. Regarding biomechanical testing, there was no demonstrable advantage to performing a step-cut osteotomy. 相似文献16.
Jourdan M. Cancienne Harrison S. Mahon Ian J. Dempsey Mark D. Miller Brian C. Werner 《The Knee》2017,24(3):594-600
Background
To determine patient-related risk factors for infection following knee arthroscopy using two large databases.Methods
A private-payer (PP) and Medicare national insurance database were queried for patients undergoing simple knee arthroscopy procedures from 2005 to 2015. Patients undergoing concomitant open or complex procedures with grafts were excluded. Postoperative infection within 90 days was assessed using ICD-9 and CPT codes. A multivariate logistic regression analysis was utilized to evaluate patient-related risk factors for postoperative infection. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor, with P < 0.05 considered statistically significant.Results
One hundred thousand three hundred ninety nine patients from the PP database and 629,842 patients from the Medicare database met all inclusion and exclusion criteria. In the PP database, there were 250 patients with documented infections (0.25%); the incidence of infection was similar in the Medicare database (1755 patients, 0.28%). There were numerous patient-related comorbidities and demographics independently associated with a significantly increased risk of postoperative infection that were similar across the PP and Medicare patient populations, respectively, including younger age (OR = 1.27, 1.43), morbid obesity (OR = 1.26, 1.74), tobacco use (OR = 1.34, 1.48), inflammatory arthritis (OR = 1.61, 1.60), chronic kidney disease (OR = 1.65, 1.14), hemodialysis (OR = 1.93, 1.36), depression (OR = 2.02, 1.73), and a hypercoagulable disorder (OR = 2.76, 1.58).Conclusion
The present study identified numerous patient-related risk factors independently associated with an increased risk of infection following knee arthroscopy in PP and Medicare-aged patients. 相似文献17.
Background
There are unanswered questions about knee–ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee–ankle alignment after TKA.Methods
The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis.Results
The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (P < 0.05). The pre-operative malalignment of the knee was corrected (P < 0.05), and the ankle tilt angle was accordingly improved in the operative side after TKA (P < 0.05). In addition, TKA had little effect on knee–ankle alignment on the non-operative side (P > 0.05).Conclusion
These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA.Level of evidence
Level III. 相似文献18.
Background
Superficial wound complications occur in up to 10% of total knee arthroplasty (TKA) procedures and have been associated with periprosthetic joint infection. The ideal material for TKA closure should offer: 1) fast intraoperative application, 2) minimal wound complications and 3) removable by patients without assistance. We evaluated a novel, non-invasive, removable skin closure system for TKA to determine its effect on wound complications.Methods
We prospectively evaluated 221 consecutive TKA patients who received skin closure using a non-invasive zipper-like system (‘Zip’; Zip 16 Surgical Skin Closure System; Zipline Medical). All procedures were performed by a single surgeon using the mini-midvastus approach. Patients received two weeks of rivaroxaban postoperatively. Demographics, comorbidities, in-hospital complications and six-week wound evaluation were recorded. Data was compared to a cohort of 1001 patients from the same surgeon who received staples for closure and coumadin for thromboprophylaxis.Results
Zip patients had a significantly higher BMI (p = 0.001), incidence of diabetes (p = 0.035) and smoking (p = 0.005). Zip patients removed dressings themselves and did not report problems with dressing care. Rate of readmission for wound-related complications was significantly lower in the Zip closure group (p = 0.045). Overall readmission rates were similar between groups.Conclusions
In our experience, the Zip 16 Surgical Skin Closure System is easy to apply, avoids home care and has produced fewer wound complications compared to staples. Results have been positive despite the study cohort having a higher number of diabetic patients and using an anticoagulant associated with a higher risk of wound complications. 相似文献19.
20.
Manabu Kawata Yusuke Sasabuchi Hiroshi Inui Shuji Taketomi Hiroki Matsui Kiyohide Fushimi Hirotaka Chikuda Hideo Yasunaga Sakae Tanaka 《The Knee》2017,24(5):1198-1205