Browsing by Subject "Knee arthroplasty"

Now showing 1 - 4 of 4
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    Musculoskeletal Features in Adults With X-linked Hypophosphatemia: An Analysis of Clinical Trial and Survey Data
    (Endocrine Society, 2022) Javaid, Muhammad Kassim; Ward, Leanne; Pinedo-Villanueva, Rafael; Rylands, Angela J.; Williams, Angela; Insogna, Karl; Imel, Erik A.; Medicine, School of Medicine
    Context: Patients with X-linked hypophosphatemia (XLH) experience multiple musculoskeletal manifestations throughout adulthood. Objective: To describe the burden of musculoskeletal features and associated surgeries across the lifespan of adults with XLH. Methods: Three groups of adults were analyzed: subjects of a clinical trial, participants in an online survey, and a subgroup of the online survey participants considered comparable to the clinical trial subjects (according to Brief Pain Inventory worst pain scores of ≥ 4). In each group, the adults were categorized by age: 18-29, 30-39, 40-49, 50-59, and ≥ 60 years. Rates of 5 prespecified musculoskeletal features and associated surgeries were investigated across these age bands for the 3 groups. Results: Data from 336 adults were analyzed. In all 3 groups, 43% to 47% had a history of fracture, with the proportions increasing with age. The overall prevalence of osteoarthritis was > 50% in all 3 groups, with a rate of 23% to 37% in the 18- to 29-year-old group, and increasing with age. Similar patterns were observed for osteophytes and enthesopathy. Hip and knee arthroplasty was reported even in adults in their 30s. Spinal stenosis was present at a low prevalence, increasing with age. The proportion of adults with ≥ 2 musculoskeletal features was 59.1%, 55.0%, and 61.3% in the clinical trial group, survey group, and survey pain subgroup, respectively. Conclusion: This analysis confirmed high rates of multiple musculoskeletal features beginning as early as age 20 years among adults with XLH and gradually accumulating with age.
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    Osteoarthritic Severity in Unresurfaced Patellae Does Not Adversely Affect Patient-reported Outcomes in Contemporary Primary TKA
    (Wolters Kluwer, 2022-04-06) Schmidt, Gregory J.; Farooq, Hassan; Deckard, Evan R.; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Introduction: The degree of osteoarthritis (OA) acceptable to leave in a native patella during unresurfaced total knee arthroplasty (TKA) remains unknown. This study's purpose was to examine the effect of patellofemoral OA severity on patient-reported outcome measures (PROMs) in primary TKAs performed without patellar resurfacing. Methods: One hundred ninety-three primary TKAs performed without patellar resurfacing were retrospectively reviewed. Preoperative patellofemoral OA severity was graded on severity, marginal osteophytes, joint space narrowing, and chondral damage using accepted grading systems. Patellar tilt and tibiofemoral alignment were measured radiographically. PROMs were evaluated at a minimum of 1-year follow-up. Results: In multivariate regression, preoperative lateral patella Kellgren-Lawrence grade ≥2 was associated with superior change in Knee Society Score pain with level walking, higher absolute change in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (P ≤ 0.029), and knees ‟always feeling normal" (odds ratio [OR] 3.12; P = 0.005). Osteoarthritis Research Society International atlas grades and Outerbridge classification scores did not significantly influence PROMs. Discussion: Worse preoperative OA severity in the lateral patellar facet, graded with the Kellgren-Lawrence system, predicted superior knee-specific PROMs in patients with unresurfaced patellae after contemporary TKA. This observation supports the clinical finding that patients with more severe OA have optimized patient outcomes and highlights the minimal contribution of patella OA to knee function after primary TKA.
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    Resource Reallocation during the COVID-19 Pandemic in a Suburban Hospital System: Implications for Outpatient Hip and Knee Arthroplasty
    (Elsevier, 2020-04-22) Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    The COVID pandemic of 2020 has emerged as a global threat to patients, health care providers, and to the global economy. Owing to this particular novel and highly infectious strain of coronavirus, the rapid community spread and clinical severity of the subsequent respiratory syndrome created a substantial strain on hospitals and health care systems around the world. The rapid surge of patients presenting over a small period for emergent clinical care, admission to the hospital, and intensive care units with many requiring mechanically assisted ventilators for respiratory support demonstrated the potential to overwhelm health care workers, hospitals, and health care systems. The purpose of this article is to describe an effective system for redeployment of health care supplies, resources, and personnel to hospitals within a suburban academic hospital system to optimize the care of COVID patients, while treating orthopedic patients in an equally ideal setting to maximize their surgical and clinical care. This article will provide a particular focus on the current and future role of a specialty hip and knee hospital and its partnering ambulatory surgery center in the context of an outpatient arthroplasty program.
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    Tibiofemoral Contact Forces Influence Intraoperative Kinematic Pivot Pattern Dependent on Posterior Cruciate Ligament Resection in Primary Total Knee Arthroplasty
    (Wolters Kluwer, 2022-04-05) Deckard, Evan R.; Ziemba-Davis, Mary; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Background: Optimizing knee kinematics has the potential to increase patient satisfaction with total knee arthroplasty (TKA); however the ability to enact a particular kinematic pattern is variable and inconsistent. The purpose of this study was to determine whether intraoperative contact forces were predictive and can potentially drive a particular kinematic pivot pattern. Methods: All TKAs used sensor-embedded tibial trials to intraoperatively measure medial and lateral compartment forces, and the associated condylar contact points were used to calculate kinematic pivot patterns between preceding flexion angles. Results: After exclusions, 157 TKAs were analyzed. For posterior cruciate ligament-intact TKAs, no predictors of lateral pivot were identified in early flexion; however, increased medial compartment force and increased lateral compartment force were predictors of medial and lateral pivots for mid and late flexion, respectively (P ≤ 0.037). For posterior cruciate ligament-resected TKAs, increased lateral compartment force was a predictor of lateral pivot in early and midflexion (P ≤ 0.031) but not late flexion. Conclusion: The tibiofemoral compartment with greater contact force exhibited less anteroposterior translation at certain flexion ranges and correlated with kinematic pivot patterns. This information may benefit surgeons who are attempting to facilitate a particular kinematic pattern. Further research is recommended to confirm that intraoperative kinematics correlate with weight-bearing postoperative kinematics and clinical outcomes.