Browsing by Subject "Total knee arthroplasty"

Now showing 1 - 7 of 7
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    Complex regional pain syndrome as a result of total knee arthroplasty: A case report and review of literature
    (Elsevier, 2019-07-24) Royeca, J. Matthew; Cunningham, Conor M.; Pandit, Hemant; King, Samuel W.; Medicine, School of Medicine
    Total knee arthroplasty (TKA) is an effective treatment for patients with end-stage symptomatic knee osteoarthritis. As the aging population grows, the demand for the procedure is projected to increase. While highly successful, TKA has associated risks and complications. Complex regional pain syndrome is one uncommon but debilitating complication that can negatively impact patient satisfaction and quality of life. We present a case of complex regional pain syndrome in the operated leg that resulted in significant functional deficits. Key findings of this case include significant and disproportionate pain in the joint, altered cutaneous sensation around the joint, and decreased range of motion in flexion in the absence of any mechanical issues with the TKA. Because of the debilitating nature of this condition, patients must be fully informed of and realize the risks associated with undergoing a widely appreciated procedure such as TKA.
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    Early failure of sequentially annealed polyethylene in total knee arthroplasty
    (Elsevier, 2020-01-09) Sonn, Kevin A.; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Improvements in the processing of polyethylene have led to a dramatic reduction in wear rates in total hip arthroplasty. This led to the adoption of modern highly cross-linked polyethylene in total knee arthroplasty (TKA). However, the differences in modes of wear and failure between total hip arthroplasty and TKA have tempered expectations regarding similar decreases in polyethylene-related complications in TKA. We present a case of early catastrophic failure of a modern sequentially irradiated and annealed highly cross-linked polyethylene insert only 5 years after contemporary cementless TKA.
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    Effect of Tobacco Use on Radiolucent Lines in Modern Cementless Total Knee Arthroplasty Tibial Components
    (Elsevier, 2023-01-14) Patel, Sohum K.; Dilley, Julian E.; Carlone, Andrew; Deckard, Evan R.; Meneghini, R. Michael; Sonn, Kevin A.; Orthopaedic Surgery, School of Medicine
    Background: The link between tobacco consumption and wound complications following total knee arthroplasty (TKA) is well established. However, the effect of tobacco use on biologic fixation in cementless TKA remains unknown. This study evaluated the influence of tobacco use on the presence of radiolucent lines of tibial components in cementless TKA. Methods: A total of 293 consecutive cementless TKAs of 2 contemporary designs were retrospectively reviewed. Tibial radiolucent lines and component alignment were measured using an established measurement protocol. Patients with any history of tobacco use or active tobacco use (tobacco users) were compared to those with no history of tobacco use (tobacco nonusers). No significant differences which influenced outcomes were detected between the tobacco user and tobacco nonuser groups (P ≥ .071). Results: Radiolucent lines decreased from 1-month to latest follow-up (mean 2.5 years) in all 10 radiographic zones regardless of tobacco use (P ≤ .084). However, evaluating intrapatient change in radiolucent line width, the tobacco nonuser group had more radiolucent lines resolve by the latest follow-up in nearly all radiographic zones, although most differences did not reach statistical significance, except for anteroposterior zone 1 (-31% vs -19%, P = .022). No tibial components were revised for aseptic loosening. Conclusions: Results from this study suggest that any tobacco use prior to cementless TKA has the potential to hinder biologic fixation of tibial components. While no tibial components were revised for aseptic loosening, follow-up was relatively short at 2.5 years and therefore warrants further study to discern the effect of persistent radiolucent lines on long-term fixation.
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    Patients With Previous COVID-19 Infection Can Safely Undergo Primary Total Joint Arthroplasty
    (Elsevier, 2023) Rosas, Samuel; Pollock, David C.; Roche, Martin W.; Najafi, Farideh; Hollingsworth, Neusha; Buller, Leonard T.; Krueger, Chad A.; Orthopaedic Surgery, School of Medicine
    Background: The COVID-19 virus is believed to increase the risk of diffusing intravascular coagulation. Total joint arthroplasty (TJA) is one of the most common elective surgeries and is also associated with a temporarily increased risk of venous thromboembolism (VTE). However, the influence of a history of COVID-19 infection on perioperative outcomes following TJA remains unknown. Therefore, this study sought to determine what effect a history of COVID-19 infection had on outcomes following primary TJA. Methods: A retrospective case-control study using the national database was performed to identify all patients who had a history of COVID-19 and had undergone TJA, between 2019 and 2020. Patients who had a history of both were 1:1 matched to those who did not have a history of COVID-19, and 90-day outcomes were compared. A total of 661 TKA and 635 THA patients who had a history of COVID-19 were 1:1 matched to controls. There were no differences in demographics and comorbidities between the propensity-matched pairs in both TKAs and THAs studied. Previous COVID-19 diagnosis was noted in 28.3% of patients 5 days within TJA and in 78.6%, 90 days before TJA. Results: Patients who had a previous diagnosis of COVID-19 had a higher risk of pneumonia during the postoperative period for both THA and TKA (6.9% versus 3.5%, P < .001 and 2.27% versus 1.21%, P = .04, respectively). Mean lengths of stay were also greater for those with a previous COVID-19 infection in both cohorts (TKA: 3.12 versus 2.57, P = .027, THA: 4.52 versus 3.62, P < .001). Other postoperative outcomes were similar between the 2 groups. Conclusion: COVID-19 infection history does not appear to increase the risk of VTE following primary TJA, but appears to increase the risk of pneumonia in addition to lengths of stay postoperatively. Individual risk factors should be discussed with patients, to set reasonable expectations regarding perioperative outcomes.
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    Satisfaction and Functional Outcomes in Unicompartmental Compared with Total Knee Arthroplasty: Radiographically Matched Cohort Analysis
    (Wolters Kluwer, 2020-09-28) Jansen, Kirsten; Beckert, Mitchell; Deckard, Evan R.; Ziemba-Davis, Mary; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Unicompartmental and total knee arthroplasty (UKA and TKA) have demonstrated excellent mid- and long-term outcomes and have been compared in clinical series for decades; however, to our knowledge, no study has sufficiently matched UKA and TKA cohorts on preoperative osteoarthritis severity. The purpose of this study was to evaluate patient-reported outcomes of radiographically and demographically matched UKA and TKA cohorts. Methods: One hundred and thirty-five UKAs and 135 TKAs were matched by patient age, sex, body mass index, and American Society of Anesthesiologists Physical Status (ASA-PS) classification as well as preoperative osteoarthritis severity in medial and lateral tibiofemoral and patellofemoral compartments (Kellgren-Lawrence grading system). Patient-reported outcome measures for pain, function, activity level, and satisfaction were evaluated at minimum 1-year follow-up via components of the modern Knee Society Score, the University of California Los Angeles (UCLA) activity-level score, and a Likert satisfaction scale. Results: The patients in the UKA group reported significantly less pain, a higher activity level, and greater satisfaction while performing several functional activities and could walk for a longer amount of time before stopping due to knee discomfort compared with those in the TKA group (p ≤ 0.038). In addition, a greater proportion of patients in the UKA than in the TKA group were "satisfied or very satisfied" with their knee replacement surgery at minimum 1-year follow-up (90% versus 81%; p = 0.043). Conclusions: With minimum 1-year follow-up, patients who underwent UKA reported significantly higher function, less pain, and a greater level of patient satisfaction than a radiographically and demographically matched TKA cohort.
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    Techniques and Strategies to Optimize Efficiencies in the Office and Operating Room: Getting Through the Patient Backlog and Preserving Hospital Resources
    (Elsevier, 2021) Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    The effects of the coronavirus disease 2019 pandemic are pervasive and have decreased the volume of hip and knee arthroplasty procedures since the mandated cessation of elective surgical procedures at the height of the pandemic in early 2020. Therefore, a backlog of patients in need of these elective procedures is a probable consequence and increased productivity and efficiency in patient care delivery is essential now and into the future. This article outlines multiple strategies and techniques to develop and optimize efficiency in the hip and knee arthroplasty practice. Techniques for increasing surgical efficiency are detailed, along with perioperative strategies in the hospital, ambulatory surgery center, and office settings are outlined and discussed.
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    Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
    (Elsevier, 2021-10-04) Madden, Joseph A.; Arnold, Payton K.; Buller, Leonard T.; Deckard, Evan R.; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Background: In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing TKA remains unknown. This study sought to determine whether these modifiable, surgical-technique-dependent variables meaningfully impact patient-reported outcome measures. Methods: A total of 759 primary TKAs of the same dual-pivot design performed using a consistent surgical technique between January 2016 and April 2019 were retrospectively reviewed. PCL status was recorded, and anteroposterior (AP) tibial baseplate position and posterior tibial slope were measured by two independent blinded raters. Patient-reported outcomes related to pain, function, satisfaction, and activity level were analyzed in relationship to PCL status, posterior tibial slope, and AP tibial baseplate position, in addition to other pertinent covariates. Results: Median age and body mass index of the cohort were 68.3 years and 33.4 kg/m2, respectively, with 73% being female. In multivariate analysis, partial or full release of the PCL was predictive of a knee "always" feeling normal (odds ratio 1.42, P = .041). Furthermore, tibial baseplate position closer to the middle of the tibia was associated with greater improvements in pain with level walking, pain while climbing stairs, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores (P ≤ .079). Conclusion: In congruent dual-pivot bearing TKA, partially or fully releasing the PCL and AP tibial baseplate position closer to the middle of the tibia may provide greater improvement in pain and function scores at minimum 1-year follow-up.