Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty

This study investigated the physical and psychosocial consequences of living with osteoarthritis (OA) in daily life and peoples’ views of total knee arthroplasty (TKA) and the role of physiotherapy. In-depth interview data were used from a prospective qualitative study conducted by the senior author (KY). Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto. A modified grounded theory method approach was used to analyze the interview data. The findings showed that experiences for the participants with OA were conceptualized as a “breakpoint.” The breakpoint was centred on the experiences/processes of living with unremitting pain, the limitations of mobility, leisure and social activities, and the resulting consequences to the participant's physical and psychological well-being. In addition to the above experiences, participants also discussed their perceptions of TKA surgery. The findings showed that expectations of TKA were linked to participants’ knowledge of the procedure and its outcomes. The participants listed acquaintances, friends, family members, and doctors as the main sources of knowledge for TKA. On the basis of the above analysis, recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery.     

Effect of the comprehensive rehabilitative treatment on rigidity of knee joint

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Is there a role for sonography in the diagnosis of tears of the knee menisci?

PURPOSE: The aim of this study was to investigate the usefulness of sonography in diagnosing tears of the knee menisci. METHODS: In this retrospective study, we reviewed the sonographic examinations of the knees of 321 patients diagnosed with a torn meniscus on the basis of clinical findings. Of the 321 knees imaged, 216 were also examined using MRI or CT. Arthroscopic meniscectomy was performed on 126 knees. RESULTS: MRI or CT did not confirm 48% (71 cases) of the positive sonographic diagnoses (ie, false positives) and 72% (50 cases) of the negative sonographic diagnoses (ie, false negatives). Thus, the sonographic diagnosis was correct in 95 cases (44%) and incorrect in 121 cases (56%), yielding low rates of sensitivity (60%) and specificity (21%). Among the 126 cases in which arthroscopic meniscectomy was performed, arthroscopy confirmed 100% of the MRI or CT diagnoses of meniscal tears. CONCLUSIONS: Our results indicate that sonography is not accurate enough to be used as the only imaging modality for diagnosing tears of the knee menisci.     

The research of the improved quadricepsplasty combining rehabilitaion training on arthroclisis of knee

Objective:To introduce the improved quadricepsplasty and rehabilitation training in the therapy of arthroclisis of knee,and to evaluate its curative effect in the near future.Methods:21 patients with old arthroclisis of kne resulf trom surrounding bone fracture were treated with improved quadricepsplasty and early rehabilitation training including ROM trainin,myodynamic exercise and physiotherapy for more than half a year.Knee joint functions before and after were compared to summarize the feasibility and effects of the therapy.Results:After above mentioned therapy;the patients‘ knee joint functions were obviously improved.ROM and function scores were significantly increased than that before operation (P&;lt;0.01).Conclusion: compared with the former style,the improved quadricesplasty has some merits such as better wound healing,suitable for early functional exercise and less comlication .Combining it with early rehabilitation training si on effective treatment on arthroclisis of knee.     

Can the method of fixation influence the wear behaviour of ZrN coated unicompartmental mobile knee prostheses?

Background

Modern unicompartmental knee prostheses represent a valid alternative to total knee replacement. It is known that variations in clinical alignment lead to altered biomechanics and abnormal wear. The aim of this study was to assess the influence, on wear behaviour, of two different cementing interfaces of the femoral components tested on a knee joint wear simulator.

Methods

The wear tests were run in a knee wear simulator at a frequency of 1.1 Hz for 3 million cycles in accordance with ISO 14243-3. Twelve commercial mobile GUR 1020 UHMWPE meniscus specimens articulated in between 12 cobalt–chromium–molybdenum alloy femoral and tibial components covered by a multi-layer of chromium nitride and a final layer of zirconium nitride ceramic coating to prevent ion release from the substrate. Two wear tests were performed: in the first test, each femoral component was cemented into a custom made metallic-block shaped to perfectly host it. In the second test, synthetic composite femurs received the femoral components on the basis of guidelines used in current surgery.

Findings

The two cementing interfaces showed a significantly different wear behaviour, quantified as mean weight loss (P < 0.001). Scanning electron microscope examinations of new and tested metallic components showed macro- and micro-pores of few microns on both configurations.

Interpretation

The wear pattern observed at 3 million cycles showed differences between the two methods of fixation for the meniscus femoral components.     

Are the kinematics of the knee joint altered during the loading response phase of gait in individuals with concurrent knee osteoarthritis and complaints of joint instability? A dynamic stereo X-ray study

Background

Joint instability has been suggested as a risk factor for knee osteoarthritis and a cause of significant functional decline in those with symptomatic disease. However, the relationship between altered knee joint mechanics and self-reports of instability in individuals with knee osteoarthritis remains unclear.

Methods

Fourteen subjects with knee osteoarthritis and complaints of joint instability and 12 control volunteers with no history of knee disease were recruited for this study. Dynamic stereo X-ray technology was used to assess the three-dimensional kinematics of the knee joint during the loading response phase of gait.

Findings

Individuals with concurrent knee osteoarthritis and joint instability demonstrated significantly reduced flexion and internal/external rotation knee motion excursions during the loading response phase of gait (P < 0.01), while the total abduction/adduction range of motion was increased (P < 0.05). In addition, the coronal and transverse plane alignment of the knee joint at initial contact was significantly different (P < 0.05) for individuals with concurrent knee osteoarthritis and joint instability. However, the anteroposterior and mediolateral tibiofemoral joint positions at initial contact and the corresponding total joint translations were similar between groups during the loading phase of gait.

Interpretations

The rotational patterns of tibiofemoral joint motion and joint alignments reported for individuals with concurrent knee osteoarthritis and joint instability are consistent with those previously established for individuals with knee osteoarthritis. Furthermore, the findings of similar translatory tibiofemoral motion between groups suggest that self-reports of episodic joint instability in individuals with knee osteoarthritis may not necessarily be associated with adaptive alterations in joint arthrokinematics.     

Which factors affect the duration of inpatient rehabilitation after total knee arthroplasty in the absence of complications?

ObjectiveThe aim of this study was to determine which preoperative factors might predict the duration of inpatient rehabilitation for total knee arthroplasty (TKA) patients in the absence of complications.MethodsWe included 282 patients who had undergone primary TKA for osteoarthritis. The aim of the rehabilitation program was to recover 90 degrees of active knee flexion and good enough functional status to allow direct discharge to the patient's home. Patients presenting complications were excluded. The following preoperative parameters were recorded: demographic factors, comorbidity, previous lower limb arthroplasty, the presence of a home help, the pain level (on a visual analogue scale, VAS) and functional scores. The length of stay in the orthopaedic surgery unit was also taken into consideration. Predictive factors for the duration of inpatient rehabilitation were analyzed using univariate and then multivariate linear regression.ResultsIn a univariate analysis, the length of stay (24.1 ± 8.1 days) depended on female gender, living alone, the presence of a home help and previous arthroplasty (p < 0.25). However, when these factors were introduced into a multivariate predictive model, only 2% of the variation in the length of stay was accounted for.ConclusionThe duration of inpatient rehabilitation for TKA patients in the absence of complications cannot be statistically modelled from the preoperative parameters studied here.     

What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? An observational study with data from the Osteoarthritis Initiative

BackgroundCrepitus is a common clinical feature of knee osteoarthritis. However, the importance of crepitus in the overall clinical presentation of individuals with knee osteoarthritis is unknown.Objective(s)(A) To compare function, pain and quality of life between individuals with knee osteoarthritis with and without crepitus; (B) to compare whether individuals with knee osteoarthritis in both knees, but crepitus in just one, differ in terms of function pain, and knee strength.Methods:Setting: Observational study. Participants: (A) A total of 584 participants with crepitus who had the same Kellgren–Lawrence grade on both knees were matched for gender, body mass index and Kellgren-Lawrence grade to participants without crepitus on both knees. (B) 361 participants with crepitus in only one knee and with the same Kellgren-Lawrence grade classification on both knees were included. Main outcome measure(s): A – Self-reported function, pain, quality of life, 20-m walk test and chair-stand test. B –Knee extensor and flexor strength, self-reported function and pain.ResultsA – Individuals with crepitus had lower self-reported function, quality of life and higher pain compared to those without crepitus (3–11%; small effect = 0.17–0.41, respectively). No difference was found in objective function between groups. B – Self-reported function was lower in the limb with crepitus compared to the limb without crepitus (15%; trivial effect = 0.09). No difference was found in pain and knee strength between-groups.Conclusion(s)Individuals with knee osteoarthritis and knee crepitus have slightly lower self-reported physical function and knee-related quality of life (small or trivial effect). However, the presence of knee crepitus is not associated with objective function or knee strength.     

Impact of postoperative functional exercise on recovery of knee joint followin g knee arthroscopic meniscectomy

INTRODUCTIONItiswellknownthatsemilunarplateiscapableofconductingload，absorbingconcussion，stablilizingkneejoit．Semilunarplatecanconduct４０％－６０％ofload，increasecontactarea，andreducepressureenduredbycartilageofkneejoint．MATERIALSANDMETHODSMaterialsFromJune１９９６toDecember２０００，７８patientswitharthroscopeconfirmedsemilunarplateinjuryandundergonemeniscectomyun－derkneearthroscopeparticipatedourstudy．Thesepatientsincluded３０menand４８womenaged１２－５８years（meanage…     

Wear of contemporary total knee replacements – A knee simulator study of six current designs

Background

Compared to conventional ultra-high molecular weight polyethylene (UHMWPE), crosslinked polyethylene showed significantly reduced wear rate in hip simulation and early prospective-randomized clinical studies. The crosslinking process can reduce the mechanical properties of UHMWPE, particularly the fatigue strength. UHMWPE fatigue occurs more frequently in the knee joint than in the hip joint due to its higher contact stresses and there is therefore an increased concern of mechanical failure. Therefore, the purpose of this study was to determine the wear behaviour and the wear rates of different current knee designs and bearing materials.

Methods

In a knee-joint-simulator four kinds of crosslinked polyethylene (one produced by sequential irradiation and annealing process, three by different remelting processes, including fixed- and mobile-bearing-types) and two UHMWPE- (fixed- and mobile-bearing) inserts were tested with the appropriate femoral and tibial component recommended from the manufacturer.

Findings

All types of crosslinked polyethylene produced statistically significant (P < 0.05) lower wear rates than the conventional UHMWPEs without any traces of fatigue. There were no differences in the wear rates between fixed-and mobile-bearings (crosslinked polyethylenes and UHMWPEs; P > 0.05). The crosslinked polyethylene tibial inserts manufactured by sequential irradiation and annealing (X3™) combined with the Scorpio^®-knee-design had the lowest wear rates (P < 0.05) overall.

Interpretation

Fixed- as well as mobile-bearing crosslinked polyethylene tibial inserts are suitable for total knee arthroplasty and showed reduced wear rates compared with conventional UHMWPE. The combination of the fixed-bearing Scorpio^®-knee-design with a sequential irradiated and annealed crosslinked polyethylene tibial insert (X3™) seems to have an advantage in wear generation compared with other fixed- and mobile-bearing knee designs.     

Knee crepitus is not associated with the occurrence of total knee replacement in knee osteoarthritis – a longitudinal study with data from the Osteoarthritis Initiative

Objective(s)To investigate whether the presence of knee crepitus is associated with the occurrence of total knee replacement (TKR), quality of life and deficits in physical function at long-term.MethodsSetting – This observational study uses longitudinal data (up to 4-year follow-up) from the Osteoarthritis Initiative (OAI). Participants – 4566 participants. Main Outcome Measure(s) – Logistic regression models were used to test if baseline knee crepitus is associated with the occurrence of TKR. Linear mixed models with adjustment for confounding variables (age, gender, BMI and Kellgren–Lawrence grade) were used to test the association between baseline knee crepitus and longitudinal changes in the pain, self-reported physical function, quality of life and performance-based function.ResultsThe presence of knee crepitus at baseline does not predict the occurrence of TKR at 36 months (p = 0.58 and 0.67 for right and left knees, respectively). The crepitus group presented a slightly knee extension strength decline from baseline to 48 months (p = 0.03 for the right and 0.01 for the left knee; between group difference = 2% for both right [95%CI = −0.12; −0.01] and left knees [95%CI = −0.13; −0.02]).ConclusionThe presence of knee crepitus is not associated with the occurrence of TKR in the following three years. Knee crepitus is associated with slightly declines in knee extension strength, but this does not seem to affect physical function and quality of life at long-term.     

Dedicated extremity MR imaging of the knee: how low can you go?

Low-field strength, dedicated extremity MR imaging systems can provide clinically effective MR images at substantially lower costs, compared with high-field strength, whole-body MR imaging machines. Dedicated extremity units also reduce risks of patient safety and claustrophobia. The diagnostic performance of presently existing extremity MR scanners rivals that of high-field strength units. Focusing on the imaging of the knee joint, this article discusses issues of technique, imaging protocol, clinical roles, and economics, and reviews diagnostic efficacy studies.     

Functional training of knee joint after fracture of lower limb

BACKGROUND: In treatment of fracture of lower limb, clinical healing of fracture needs a long time after replace and immobilization. But clinical healing does not represent complete recovery of joint function. Knee ankylosis or stiffness could happen if not treated properly in this term.OBJECTIVE: To discuss the effects of functional training on knee joint function after fracture of lower limb.     

Recovery after functional exercises following arthroscopic debridement of knee joint in elderly persons with osteoarthritis of knee joint

INTRODUCTIONInrecentyears,arthroscopehasbecomeanewapproachfortreatmentofosteoarthritisofkneejoint.Weobtainedfavorableeffectofarthroscopicarticulardebridementinpatientswithbonyarthropathyofkneejoint.MATERIALSANDMETHODSMaterials104elderlypatientswithosteoarthritisofkneejointreceivedarthro-scopicdebridementfromJune1993toJune1998.Thesepatientsin-cluded41menand63women,agingfrom48-82years(meanage:61.3years).47hadlesioninleftknee,55inrightknee,2hadbilaterallesions,total106affectedknees.…