Radiolucent lines and component stability in knee arthroplasty. Standard versus fluoroscopically-assisted radiographs.
(1/937)
The radiolucent lines and the stability of the components of 66 knee arthroplasties were assessed by six orthopaedic surgeons on conventional anteroposterior and lateral radiographs and on fluoroscopic views which had been taken on the same day. The examiners were blinded as to the patients and clinical results. The interpretation of the radiographs was repeated after five months. On fluoroscopically-assisted radiographs four of the six examiners identified significantly more radiolucent lines for the femoral component (p < 0.05) and one significantly more for the tibial implant. Five examiners rated more femoral components as radiologically loose on fluoroscopically-assisted radiographs (p = 0.0008 to 0.0154), but none did so for the tibial components. The mean intra- and interobserver kappa values were higher for fluoroscopically-assisted radiographs for both components. We have shown that fluoroscopically-assisted radiographs allow more reproducible, and therefore reliable, detection of radiolucent lines in total knee arthroplasty. Assessment of the stability of the components is significantly influenced by the radiological technique used. Conventional radiographs are not adequate for evaluation of the stability of total knee arthroplasty and should be replaced by fluoroscopically-assisted films. (+info)
Manipulation of total knee replacements. Is the flexion gained retained?
(2/937)
As part of a prospective study of 476 total knee replacements (TKR), we evaluated the use of manipulation under anaesthesia in 47 knees. Manipulation was considered when intensive physiotherapy failed to increase flexion to more than 80 degrees. The mean time from arthroplasty to manipulation was 11.3 weeks (median 9, range 2 to 41). The mean active flexion before manipulation was 62 degrees (35 to 80). One year later the mean gain was 33 degrees (Wilcoxon signed-rank test, range -5 to 70, 95% CI 28.5 to 38.5). Definite sustained gains in flexion were achieved even when manipulation was performed four or more months after arthroplasty (paired t-test, p < 0.01, CI 8.4 to 31.4). A further 21 patients who met our criteria for manipulation declined the procedure. Despite continued physiotherapy, there was no significant increase in flexion in their knees. Six weeks to one year after TKR, the mean change was 3.1 degrees (paired t-test, p = 0.23, CI -8.1 to +2). (+info)
The tourniquet in total knee arthroplasty. A prospective, randomised study.
(3/937)
We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis. We conclude that the use of a tourniquet is safe and that current practice can be continued. (+info)
Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority.
(4/937)
OBJECTIVES: To develop, from simple clinical factors, criteria to identify appropriate patients for referral to a surgeon for consideration for arthroplasty, and to rank them in the queue once surgery is agreed. DESIGN: Delphi process, with a panel including orthopaedic surgeons, rheumatologists, general practitioners, epidemiologists, and physiotherapists, who rated 120 case scenarios for appropriateness and 42 for waiting list priority. Scenarios incorporated combinations of relevant clinical factors. It was assumed that queues should be organised not simply by chronology but by clinical and social impact of delayed surgery. The panel focused on information obtained from clinical histories, to ensure the utility of the guidelines in practice. Relevant high quality research evidence was limited. SETTING: Ontario, Canada. MAIN MEASURES: Appropriateness ratings on a 7-point scale, and urgency rankings on a 4-point scale keyed to specific waiting times. RESULTS: Despite incomplete evidence panellists agreed on ratings in 92.5% of appropriateness and 73.8% of urgency scenarios versus 15% and 18% agreement expected by chance, respectively. Statistically validated algorithms in decision tree form, which should permit rapid estimation of urgency or appropriateness in practice, were compiled by recursive partitioning. Rating patterns and algorithms were also used to make brief written guidelines on how clinical factors affect appropriateness and urgency of surgery. A summary score was provided for each case scenario; scenarios could then be matched to chart audit results, with scoring for quality management. CONCLUSIONS: These algorithms and criteria can be used by managers or practitioners to assess appropriateness of referral for hip or knee replacement and relative rankings of patients in the queue for surgery. (+info)
Limb salvage surgery in bone tumour with modular endoprosthesis.
(5/937)
Thirty-three patients with bone tumours were treated by resection of the growth and reconstruction with a Kotz modular endoprosthesis. The average follow-up was for 50 months, ranging from 14 to 79 months. At the last review, 12 patients (36%) had died due to the tumour and 9 others (27%) had metastases. All 4 patients with proximal tibial reconstruction had poor functional results, due to an extension lag or to knee stiffness. Four of the six tumours of the proximal femur were complicated by local recurrence or dislocation of the hip, and had poor or fair functional results. Of the patients with distal femoral reconstruction, 17 out of 22 had excellent or good functional results. Reconstruction with a modular prosthesis after resection of a tumour gives excellent or good functional results in more than three-fourths of the cases of distal femur reconstruction, but it should be used with caution in the proximal tibia and proximal femur. (+info)
Soft tissue cover for the exposed knee prosthesis.
(6/937)
This study assess the use of muscle flaps to cover exposed knee prostheses and emphasises the need for early plastic surgery consultation. In five of the six patients studied the wound was successfully covered and the knee prosthesis salvaged with a reasonable functional outcome. (+info)
Survivorship analysis of the "Performance" total knee replacement--7-year follow-up.
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We present the results of a prospective study in which 32 "Performance" total knee replacements were implanted with a mean follow-up period of 6.5 years. Survival analysis showed 89% survival at 7 years. Of those knees that survived to follow-up 80% were pain free or had mild pain when climbing stairs and only 1 knee was unable to flex beyond 100 degrees. Eighty-six percent of patients were able to walk unlimited distances and all knees had a statistically significant improvement in the knee evaluation scores at follow-up. There was no evidence of loosening or migration in the surviving knees. (+info)
The results at ten years of the Insall-Burstein II total knee replacement. Clinical, radiological and survivorship studies.
(8/937)
We reviewed the outcome of 146 Insall-Burstein II total knee replacements carried out in 121 patients over a period of nearly four years in a general orthopaedic unit. At a mean follow-up of ten years, 94 knees in 78 patients were available for review. Six patients (7 knees) were lost to follow-up and 37 (45 knees) had died. The clinical outcome using the scoring system of the Hospital for Special Surgery (HSS) was excellent or good in 79% of patients, fair in 14% and poor in 7%. The mean preoperative HSS score was 31, improving to 79 at the latest review. Using the newer rating system of the Knee Society, the mean score at ten years was 87 and the mean functional score 56. The arc of flexion improved from a mean preoperative value of 88 degrees to 100 degrees. The 18 patients who had had a previous high tibial osteotomy were analysed separately and were found to have benefited equally from the operation. Nine prostheses were revised, giving a cumulative survival rate of 92.3% at ten years. Radiological evaluation of 104 radiographs showed radiolucent lines around ten tibial components, none of which required revision. Anterior knee pain was a significant problem. (+info)