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Knee Exam

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361. Intra-Articular Corticosteroids and the Risk of Knee Osteoarthritis Progression: Results from the Osteoarthritis Initiative. Full Text available with Trip Pro

Intra-Articular Corticosteroids and the Risk of Knee Osteoarthritis Progression: Results from the Osteoarthritis Initiative. A recent randomized clinical trial reported that repeated intra-articular corticosteroids (IACs) were associated with a greater cartilage loss. This study aimed to examine the relation of IACs to knee radiographic osteoarthritis (ROA) progression in a real-world setting.A cohort that initiated IACs and a comparison cohort without IACs from participants with mild (...) to moderate knee ROA in the Osteoarthritis Initiative (OAI) were assembled (from 0-month to 48-month). Two measures of knee ROA progression were assessed during the follow-up period: (1) an increase in Kellgren and Lawrence (KL) grade by ≥1 grade or having a knee replacement (i.e., KL grade worsening); and (2) a decrease in joint space width (JSW) by ≥0.7 mm or having a knee replacement (i.e., JSW worsening). The associations of IACs initiation using a propensity-score matched cohort study and continuous

2019 Osteoarthritis and Cartilage

362. The effect of preoperative oral antibiotic use on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up. Full Text available with Trip Pro

The effect of preoperative oral antibiotic use on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up. Antibiotics are used for various reasons before elective joint replacement surgery. The aim of this study was to investigate patients' use of oral antibiotics before joint replacement surgery and how this affects the risk for periprosthetic joint infection (PJI).Patients having a primary hip or knee replacement (...) in a tertiary care hospital between September 2002 and December 2013 were identified (n = 23 171). Information on oral antibiotic courses purchased 90 days preoperatively and patients' chronic diseases was gathered. Patients with a PJI in a 1-year follow-up period were identified. The association between antibiotic use and PJI was examined using a multivariable logistic regression model and propensity score matching.One hundred and fifty-eight (0.68%) cases of PJI were identified. In total, 4106 (18%) joint

2019 Clinical Microbiology and Infection

363. Can Machine Learning Methods Produce Accurate and Easy-to-use Prediction Models of 30-day Complications and Mortality After Knee or Hip Arthroplasty? Full Text available with Trip Pro

Can Machine Learning Methods Produce Accurate and Easy-to-use Prediction Models of 30-day Complications and Mortality After Knee or Hip Arthroplasty? Existing universal and procedure-specific surgical risk prediction models of death and major complications after elective total joint arthroplasty (TJA) have limitations including poor transparency, poor to modest accuracy, and insufficient validation to establish performance across diverse settings. Thus, the need remains for accurate (...) development. Tenfold validation was used to produce C-statistics, a measure of how well models discriminate patients who experience an outcome from those who do not. External validation, which evaluates the generalizability of the models to new data sources and patient groups, was accomplished using data from the Veterans Affairs Surgical Quality Improvement Program (VASQIP). Models previously developed from VASQIP data were also externally validated using NSQIP data to examine the generalizability

2019 Clinical Orthopaedics and Related Research

364. Factors Associated With Opioid Use in Pre-surgical Knee, Hip and Spine Osteoarthritis Patients. Full Text available with Trip Pro

Factors Associated With Opioid Use in Pre-surgical Knee, Hip and Spine Osteoarthritis Patients. To evaluate rates of prescription opioid use among pre-surgical knee, hip and spine osteoarthritis (OA) patients, and associations between use and socio-demographic and health status characteristics.Participants were pre-surgical patients with end-stage knee (N=577), hip (N=459) and spine (N=168) OA. Data were collected on current use of opioid and other pain medications, as well as measures of socio (...) -demographics and health status, depression and pain (0-10 numeric rating scale). Rates of opioid use were calculated by sex, age and surgical site. Multivariable logistic regression was used to examine associations between opioid use (outcome: sometimes/daily vs. never) and other study variables.Participants were of mean age 65.6 years; 55.5% were women. 15% of patients reported 'sometimes' using opioids and 15% reported 'daily' use. Use of opioids was highest among spine OA patients (40%) and similar

2019 Arthritis care & research

365. A rare primary Candida parapsilosis infection of the knee joint in a patient without predisposing factors: A case report. Full Text available with Trip Pro

-up visits and was very satisfied with the therapeutic effect.If there were suspected symptoms of primary Candida infection cases, imaging and microscopic examinations, tissue cultures, and pathological examination of the puncture knee joint fluid were required. (...) A rare primary Candida parapsilosis infection of the knee joint in a patient without predisposing factors: A case report. Knee joint infection caused by isolated primary Candida is extremely rare, with only a few cases reported. It occurs most often in patients with predisposing factors (e.g., immunosuppression, malignancy, drug abuse) or fungal invasion during traumatic procedures, including surgery. We report an unusual case of Candida parapsilosis infection in the knee joint

2019 Medicine

366. Distribution of Bone Ongrowth in Metaphyseal Sleeves for Revision Total Knee Arthroplasty: A Retrieval Analysis. (Abstract)

Distribution of Bone Ongrowth in Metaphyseal Sleeves for Revision Total Knee Arthroplasty: A Retrieval Analysis. The metaphyseal region of the bone has been recognized by its importance to the overall stability of a revision construct. Porous titanium metaphyseal sleeves to enhance biologic fixation can be used to manage bone loss encountered during revision total knee arthroplasty. While clinical results for metaphyseal sleeves are encouraging, there is little information on the extent (...) to which biologic fixation is achievable with metaphyseal sleeves. We examined retrieved metaphyseal sleeves to determine the amount of bone ongrowth.We studied 14 tibial and 11 femoral retrieved metaphyseal sleeves from 16 typical arthroplasty patients. Prerevision radiographs were reviewed for the presence of biologic fixation to the sleeves and the stem canal fill ratio. Bone ongrowth was assessed regionally in the anterior, posterior, medial, and lateral areas of the retrieved implants.Bone

2019 Journal of Arthroplasty

367. Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee. Full Text available with Trip Pro

Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee. To determine whether needle arthroscopy (NA) compared with magnetic resonance imaging (MRI) in the diagnosis and treatment of meniscal tears is cost-effective when evaluated over a 2-year period via patient-reported outcomes. The hypothesis is that improved diagnostic accuracy with NA would lead to less costly care and similar outcomes.A Markov model (...) /decision tree analysis was performed using TreeAge Pro 2017 software. Patients were evaluated for degenerative and traumatic damage to the lateral/medial meniscus. Assumed sensitivities and specificities were derived from the medical literature. The direct costs for care were derived from the 2017 Medicare fee schedule and from private payer reimbursement rates. Costs for care included procedures performed for false-positive findings and for care for false-negative findings. Effectiveness was examined

2019 Arthroscopy

368. Association between severity of depressive symptoms and chronic knee pain in Korean adults aged over 50 years: a cross-sectional study using nationally representative data. Full Text available with Trip Pro

Association between severity of depressive symptoms and chronic knee pain in Korean adults aged over 50 years: a cross-sectional study using nationally representative data. To identify the association between the presence and severity of depressive symptoms and those of chronic knee pain.A retrospective cross-sectional study.We used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2) performed in 2014. Overall, 7550 patients were included in the KNHANES VI (...) -2.Participants were asked whether they had chronic knee pain, and each answer was either 'yes' or 'no'. Patient Health Questionnaire-9 (PHQ-9) was used as a screening tool for depressive symptoms, and PHQ-9 scores of 10 or higher was classified as the depressed group. In total, 527 patients reported that they had pain in their knee, of whom 91 also had depressive symptoms.The prevalence of chronic knee pain in the Korean population aged over 50 years was 19.8%. Multiple logistic regression

2019 BMJ open

369. Subacute polyarticular arthralgias · swelling of the ankles and right knee · recent travel to the Dominican Republic · Dx? (Abstract)

developed generalized joint pain and a fever that lasted 1 to 2 weeks and subsequently resolved with the lingering polyarthralgias. She denied any rash, constitutional symptoms, photosensitivity, headaches, photophobia, or history of tick bite. Physical examination revealed normal vital signs, notable warmth and swelling of the bilateral ankles that was worse on the right side, and swelling of the right knee with effusion-but no tenderness-to palpation. (...) Subacute polyarticular arthralgias · swelling of the ankles and right knee · recent travel to the Dominican Republic · Dx? A 78-year-old woman with a history of anxiety and hypertension presented to our family medicine residency practice in Massachusetts with subacute polyarticular arthralgias that had been present for 2 months. She complained of pain and swelling of both ankles and the right knee. She noted that her symptoms had started on a recent trip to the Dominican Republic, where she

2019 Journal of Family Practice

370. Despite Improved Survivorship of Uncemented Fixation in Total Knee Arthroplasty for Osteoarthritis, Cemented Fixation Remains the Gold Standard: An Analysis of a National Joint Registry. (Abstract)

Despite Improved Survivorship of Uncemented Fixation in Total Knee Arthroplasty for Osteoarthritis, Cemented Fixation Remains the Gold Standard: An Analysis of a National Joint Registry. Total knee arthroplasty (TKA) numbers are increasing worldwide. While cement fixation for both femoral and tibial components is commonly used, alternatives include hybrid and uncemented TKAs. This study aimed to evaluate survivorship, revision rates, and patient-reported outcomes for cemented, hybrid (...) , and uncemented TKAs using New Zealand Joint Registry (NZJR) data.NZJR data relating to all TKAs performed during the 19 years up to the end of December 2017 were analyzed. Outcomes were assessed using prosthesis survivorship data (including reasons for revision) and Oxford scores at 6 months, 5 years, and 10 years postoperatively.A total 96,519 primary TKAs were performed during the period examined. Most (91.5%) were fully cemented with 4.8% hybrid and 3.7% uncemented. Mean Oxford scores at 6 months were

2019 Journal of Arthroplasty

371. Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Full Text available with Trip Pro

Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Medial collateral ligament (MCL) injury is the single most common traumatic knee injury in football. The purpose of this study was to study the epidemiology and mechanisms of MCL injury in men's professional football and to evaluate the diagnostic and treatment methods used.Fifty-one teams were followed prospectively between (...) one and three full seasons (2013/2014-2015/2016). Individual player exposure and time-loss injuries were recorded by the teams' medical staffs. Moreover, details on clinical grading, imaging findings and specific treatments were recorded for all injuries with MCL injury of the knee as the main diagnosis. Agreement between magnetic resonance imaging (MRI) and clinical grading (grades I-III) was described by weighted kappa.One hundred and thirty of 4364 registered injuries (3%) were MCL injuries

2019 Knee Surgery, Sports Traumatology, Arthroscopy

372. Single-stage revision anterior cruciate ligament reconstruction using bone grafting for posterior or widening tibial tunnels restores stability of the knee and improves clinical outcomes. (Abstract)

Single-stage revision anterior cruciate ligament reconstruction using bone grafting for posterior or widening tibial tunnels restores stability of the knee and improves clinical outcomes. Revision ACL surgery may be complicated by tunnel malposition and/or tunnel widening and often requires a staged treatment approach that includes bone grafting, a period of several months to allow bone graft incorporation and then definitive revision ACL reconstruction. The purpose of this study (...) was to evaluate the results of a single-staged ACL revision reconstruction technique using a cylindrical dowel bone graft for patients who have existing posteriorly placed and/or widened tibial tunnels in the tibia at a minimum of 2 years follow-up.Between 2010 and 2014, patients undergoing single-stage revision ACL reconstruction with the described technique were prospectively enrolled and evaluated. At a minimum of 24 months, patients were evaluated by physical examination, multiple clinical outcome

2019 Knee Surgery, Sports Traumatology, Arthroscopy

373. Iatrogenic Medial Collateral Ligament Injury by Valgus Stress During Arthroscopic Surgery of the Knee. (Abstract)

surgery of the knee. All patients were treated conservatively without an immobilizer or brace. The mean follow-up period was 24 months (range, 18-51 months). Evaluations included magnetic resonance imaging immediately postoperatively, as well as physical examinations and valgus stress radiographs (at 0° and 30° of knee flexion) 6 weeks after surgery and at final follow-up.Postoperative magnetic resonance imaging in all patients showed increased signal intensity, swelling, and partial loss (...) of continuity at the meniscofemoral portion of the MCL. Physical examination showed mild tenderness in only 1 patient after 6 weeks and none at final follow-up. Valgus stress tests and valgus stress radiographs showed no significant differences between the injured and uninjured knees at 6 weeks postoperatively and at final follow-up (P > .05).Iatrogenic MCL injuries during arthroscopic knee surgery could be treated successfully without a splint or brace.Level IV, prognostic case series.Copyright © 2019

2019 Arthroscopy

374. BLOOD CHROMIUM-COBALT LEVELS IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY AND THEIR EFFECT ON THE RETINAL NERVE FIBER LAYER AND MACULAR GANGLION CELL COMPLEX. (Abstract)

BLOOD CHROMIUM-COBALT LEVELS IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY AND THEIR EFFECT ON THE RETINAL NERVE FIBER LAYER AND MACULAR GANGLION CELL COMPLEX. To study blood cobalt (Co) and chromium (Cr) levels in patients who have undergone total knee arthroplasty and their effect on the retinal nerve fiber layer and macular ganglion cell complex.One hundred patients who had undergone total knee arthroplasty and 50 healthy individuals who had no implants were included in the study. The patients (...) were separated into two groups based on how long ago the prosthesis had been implanted (Group 1: 1 to 5 years; Group 2: 5 to 10 years). After a complete ophthalmological examination, retinal nerve fiber layer and macular ganglion cell complex of the patients were evaluated with optical coherence tomography, performed on dilated pupils. To assess the metal ion levels of the patients, venous blood samples were drawn from each patient.The mean age of the patients was 64.72 ± 6.26 years in Group 1

2019 Retina

375. Marker-based versus model-based radiostereometric analysis of total knee arthroplasty migration: a reanalysis with comparable mean outcomes despite distinct types of measurement error. Full Text available with Trip Pro

Marker-based versus model-based radiostereometric analysis of total knee arthroplasty migration: a reanalysis with comparable mean outcomes despite distinct types of measurement error. Background and purpose - Pooling data of studies evaluating total knee arthroplasty migration using radiostereometric analysis (RSA) may be compromised when the RSA method used would influence estimated differences between groups. We therefore reanalyzed a marker-based RSA study with model-based RSA to assess (...) possible limitations of each RSA method, including insert micromotions in modular TKA and their effect on estimated group differences. Patients and methods - All patients had received a cemented Triathlon implant (Stryker, Mahwah, NJ, USA) with either an all-polyethylene (n = 29) or a metal-backed (n = 28) tibial component. The latter group was reanalyzed with model-based RSA. Precision of each RSA method was calculated using double examinations. Bland-Altman plots were constructed to determine

2019 Acta Orthopaedica

376. Do Clinical Correlates of Knee Osteoarthritis Predict Outcome to Intra-Articular Steroid Injections? Full Text available with Trip Pro

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome to Intra-Articular Steroid Injections? To determine if clinical correlates of knee osteoarthritis(OA) affect likelihood of outcome to intra-articular steroid injections(IASI) in symptomatic knee OA.Men and women aged≥40 years with painful knee OA who participated in an open label trial of IASI completed questionnaires and clinical examination. OMERACT-OARSI criteria were used to assess response to therapy in the short-term(within 2 (...) -weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline KOOS-pain score at 6-months were characterised as longer-term responders. Log binomial regression was used to examine factors associated with outcome.199 participants were included, of whom 146(73.4%) were short-term and 40(20.1%) longer-term responders. Compared to short-term non-responders, participants with medial joint-line tenderness(RR=1.42;1.10-1.82), medial & lateral joint-line

2019 Journal of Rheumatology

377. The Timing of Corticosteroid Injections Following Simple Knee Arthroscopy Is Associated With Infection Risk. (Abstract)

The Timing of Corticosteroid Injections Following Simple Knee Arthroscopy Is Associated With Infection Risk. To examine any association between the timing of ipsilateral postoperative corticosteroid injection following simple knee arthroscopy and infection.Private payer (PP) and Medicare (MC) national insurance databases were queried for patients who underwent simple arthroscopic knee procedures. Patients undergoing concomitant open or more complex procedures with grafts were excluded. Patients (...)  = .009; MC: OR 7.80, P = .001) groups. There was no difference in infection rates between the 2- and 4-week groups in either dataset (PP: P = .278; MC: P = .861).There is a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both MC and PP patients after knee arthroscopy compared with patients with steroid injections more than 4 weeks postoperatively and matched controls who did not receive

2019 Arthroscopy

378. Validation of Simendo Knee Arthroscopy Virtual Reality Simulator. (Abstract)

Validation of Simendo Knee Arthroscopy Virtual Reality Simulator. To determine the face and construct validity as well as educational value and user-friendliness of the Simendo knee arthroscopy virtual reality simulator.Sixty participants were recruited and equally divided into novices (0 arthroscopic procedures), intermediates (1-59 arthroscopic procedures), and experts (60 or more arthroscopic procedures). Participants were excluded if they had previously trained with the studied simulator (...) . Construct validity, that is, the ability to discriminate between different levels of expertise, was examined by a navigation task. All participants were asked to perform 5 navigation trials within 10 minutes. Face validity, educational value, and user-friendliness were examined by questionnaires before and after the navigation trials. Face validity is the subjective impression of how closely the simulation replicates the real environment.The novices were significantly slower than the intermediates

2019 Arthroscopy

379. Radiographic-based measurement of tibiofemoral joint space width and magnetic resonance imaging derived articular cartilage thickness are not related in subjects at risk for post traumatic arthritis of the knee. Full Text available with Trip Pro

cruciate ligament reconstruction (ACLR) who were at increased risk for the onset and early progression of post-traumatic OA, and in uninjured subjects with normal knees (Control). In both ACLR and Control groups, there were large measurement biases, wide limits of agreement, and poor correlation between the two measurement techniques. Clinical significance: The finding from this study suggest that the two methods of examining changes associated with the onset and early progression of PTOA either (...) Radiographic-based measurement of tibiofemoral joint space width and magnetic resonance imaging derived articular cartilage thickness are not related in subjects at risk for post traumatic arthritis of the knee. Joint space width (JSW), measured as the distance between the femoral and tibial subchondral bone margins on two-dimensional weight-bearing radiographs, is the initial imaging modality used in clinical settings to diagnose and evaluate the progression of osteoarthritis (OA). While, JSW

2019 Journal of Orthopaedic Research

380. General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ? (Abstract)

General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ? The incidence of both primary total knee arthroplasty (TKA) and revision TKA is increasing. Data from primary arthroplasty patients suggest a risk reduction with the use of spinal anesthesia when compared with general anesthesia. However, the same relationship has not been examined in the revision knee arthroplasty patient.This is a retrospective cohort study using the American College of Surgeons

2019 Journal of Arthroplasty

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