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Knee Exam

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361. Gender and Preoperative Function Predict Physical Activity Levels After Revision Total Knee Arthroplasty. (Abstract)

Gender and Preoperative Function Predict Physical Activity Levels After Revision Total Knee Arthroplasty. The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative function will be increasingly important to help counsel patients. The primary aim of this study was to examine factors influencing return to physical (...) activity following revision TKA.Patients who had undergone tibiofemoral revision between 2003 and 2013 at a single UK teaching hospital were retrospectively identified from a prospectively collected arthroplasty database. Preoperative activity level (University of California, Los Angeles [UCLA] score), patient demographics, indication, implant used, and Oxford Knee Scores (OKSs) were recorded in the database. At a mean follow-up of 3.9 years (standard deviation, 2.2), UCLA score, OKS, EuroQol-5

2019 Journal of Arthroplasty

362. Blueberries Improve Pain, Gait Performance, and Inflammation in Individuals with Symptomatic Knee Osteoarthritis. Full Text available with Trip Pro

is one of the major drives of the progression of OA. Dietary polyphenols have been studied for their anti-inflammatory properties and potential anabolic effects on the cartilage cells. Blueberries are widely consumed and are high in dietary polyphenols, therefore regular consumption of blueberries may help improve OA. The purpose of the present study was to examine the effect of freeze dried whole blueberries on pain, gait performance, and inflammation in individuals with symptomatic knee OA (...) Blueberries Improve Pain, Gait Performance, and Inflammation in Individuals with Symptomatic Knee Osteoarthritis. Osteoarthritis (OA) is the most common joint disorder in the world and is the most frequent cause of walking related disability among older adults in the US, which brings a significant economic burden and reduces quality of life. The initiation and development of OA typically involves degeneration or progressive loss of the structure and function of articular cartilage. Inflammation

2019 Nutrients Controlled trial quality: predicted high

363. Protocol for a randomised trial evaluating the comparative effectiveness of strategies to promote shared decision making for hip and knee osteoarthritis (DECIDE-OA study). (Abstract)

Protocol for a randomised trial evaluating the comparative effectiveness of strategies to promote shared decision making for hip and knee osteoarthritis (DECIDE-OA study). There are several different interventions available to promote shared decision making (SDM); however, little is known about the comparative effectiveness of different approaches.To examine the impact of patient-directed and physician-directed decision support strategies on the quality of treatment decisions for hip and knee (...) osteoarthritis (OA).A 2×2 factorial randomised controlled trial.One academic medical centre, one community hospital and one orthopaedic specialty hospital.The enrolment targets were 8 surgeons and 1120 patients diagnosed with hip or knee OA. Patients were randomly assigned to receive one of two different decision aids (DAs) stratified by site. The DAs varied in length, content and the level of detail regarding treatment options. Both DAs were available by paper or online.Surgeons were randomly assigned

2019 BMJ open Controlled trial quality: predicted high

364. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. Full Text available with Trip Pro

The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. Comprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting

2019 BMC Musculoskeletal Disorders

365. To what extent do education and physical work load factors explain occupational differences in disability retirement due to knee OA? A nationwide register-based study in Finland. Full Text available with Trip Pro

To what extent do education and physical work load factors explain occupational differences in disability retirement due to knee OA? A nationwide register-based study in Finland. To examine the association of education and physical work load factors on the occupational differences in disability retirement due to knee osteoarthritis (OA).Longitudinal study.Linkage of several nationwide registers and a job exposure matrix in Finland.A total of 1 135 654 Finns aged 30-60 years in gainful (...) employment were followed from 2005 to 2013 for full disability retirement due to knee OA.We calculated age-adjusted incidence rates and examined the association of occupation, education and physical work load factors with disability retirement using competing risk regression model. Disability retirement due to other causes than knee OA, old-age retirement and death were treated as competing risk.A total of 6117 persons had disability retirement due to knee OA. Women had a higher age-adjusted incidence

2019 BMJ open

366. Joint unloading inhibits articular cartilage degeneration in knee joints of a monosodium iodoacetate-induced rat model of osteoarthritis. Full Text available with Trip Pro

Joint unloading inhibits articular cartilage degeneration in knee joints of a monosodium iodoacetate-induced rat model of osteoarthritis. The aim of the study was to examine how mechanical unloading affects articular cartilage degeneration in the patellofemoral (PF) and tibiofemoral (TF) joints of a monosodium iodoacetate (MIA)-induced rat model of osteoarthritis (OA).The study involved 60 male rats. OA was induced by intra-articular injecting MIA into both knee joints. All animals were equally

2019 Osteoarthritis and Cartilage

367. Revisiting the International Normalized Ratio (INR) Threshold for Complications in Primary Total Knee Arthroplasty: An Analysis of 21,239 Cases. (Abstract)

Revisiting the International Normalized Ratio (INR) Threshold for Complications in Primary Total Knee Arthroplasty: An Analysis of 21,239 Cases. Consensus guidelines recommend use of the international normalized ratio (INR) to predict the risk of perioperative bleeding in orthopaedic surgery. However, current recommendations for targeting an INR of <1.5 are based on studies across all surgical disciplines. This study examined the impact of the INR on perioperative bleeding, mortality (...) , postoperative infections, length of hospital stay (LOS), and readmissions following primary total knee arthroplasty (TKA).We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for adult patients who underwent primary TKA from 2010 to 2016. Patients for whom an INR had been recorded within 1 day before the surgery were stratified and analyzed for perioperative bleeding, mortality within 30 days, deep wound and superficial infections, LOS

2019 The Journal of Bone and Joint Surgery. American Volume

368. Is a Combination of Exercise and Dry Needling Effective for Knee OA? (Abstract)

 = 31).Participants received six sessions of either DN or sham DN over the leg muscles related to knee pain from osteoarthritis plus a supervised exercise program. We evaluated between-group differences in terms of the numerical pain rating scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. We used the EuroQol Group 5-Dimension Self-Report Questionnaire, Barthel Index, Timed Up & Go Test, and Global Rating of Change Scale to examine between-group (...) Is a Combination of Exercise and Dry Needling Effective for Knee OA? To assess the effectiveness of adding dry needling (DN) to an exercise program on pain intensity and disability in patients with knee osteoarthritis.Double-blind randomized clinical trial with one-year follow-up.Older adults in a multicenter study.Sixty-two patients with knee osteoarthritis were randomly allocated into one of two groups: exercise plus DN (exercise + DN; N = 31) or exercise plus sham DN (exercise + sham DN; N

2019 Pain Medicine Controlled trial quality: predicted high

369. Restrictive Opioid Prescribing Protocols Following Total Hip Arthroplasty and Total Knee Arthroplasty Are Safe and Effective. Full Text available with Trip Pro

Restrictive Opioid Prescribing Protocols Following Total Hip Arthroplasty and Total Knee Arthroplasty Are Safe and Effective. Orthopedic surgeons may overprescribe opioids postoperatively. Literature examining opioid prescribing guidelines following total joint arthroplasty (TJA) is limited.Retrospective review was conducted of primary TJAs from June 2017 to February 2018, with 3-month follow-up. Patients were divided into those who underwent surgery before (historical cohort) and after

2019 Journal of Arthroplasty

370. Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis. Full Text available with Trip Pro

Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis. Exercise-induced pain flares represent a significant barrier for individuals with knee osteoarthritis to meet physical activity recommendations. There is a need to understand factors that contribute to pain flares and the potential for the motor system to adapt and reduce joint loading should a flare occur. The study aim was to examine the impact of a bout of exercise on self-reported pain, walking mechanics (...) and muscle co-contraction for participants with knee osteoarthritis.Thirty-six adults (17 healthy older and 19 knee osteoarthritis) participated in this study. Self-reported pain, joint mechanics and muscle co-activation during gait at two self-selected speeds were collected before and after a 20-min preferred pace treadmill walk (20MTW).Eight of nineteen osteoarthritis participants had a clinically significant pain flare response to the 20MTW. At baseline the participants that did not experience a pain

2019 BMC Musculoskeletal Disorders

371. Effect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis. Full Text available with Trip Pro

Effect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis. Data from a recent clinical trial of vitamin D therapy in knee OA suggests that, compared to placebo, vitamin D therapy may be associated with a reduction in effusion-synovitis. Our aim was, using contrast-enhanced (CE) magnetic resonance imaging (MRI), to examine the effect of vitamin D therapy on synovial tissue volume (STV) and also subchondral bone (...) marrow lesion (BML) volume in men and women with symptomatic knee OA.Data was acquired from participants who took part in a randomised placebo-controlled trial (UK VIDEO) investigating the effect of vitamin D therapy (800 IU cholecalciferol daily) on radiographic joint space narrowing. A subsample had serial CE MRI scans acquired during the trial. Subjects with serial images were assessed (N = 50) for STV and subchondral BML volume. The difference in the mean change from baseline in these structural

2019 BMC Musculoskeletal Disorders Controlled trial quality: predicted high

372. A Surgeon Scorecard Is Associated with Improved Value in Elective Primary Hip and Knee Arthroplasty. (Abstract)

A Surgeon Scorecard Is Associated with Improved Value in Elective Primary Hip and Knee Arthroplasty. Despite increasing interest in total joint arthroplasty registries, evidence of the impact of physician-level performance on the value of care provided to patients undergoing hip and knee arthroplasty is lacking. The purpose of this study was to examine the effectiveness of an unblinded orthopaedic surgeon-specific value scorecard in improving patient outcomes and reducing hospital costs.We

2019 The Journal of Bone and Joint Surgery. American Volume

373. Marked and Rapid Change of Bone Shape In Acutely Acl Injured Knees - An Exploratory Analysis Of The Kanon Trial. Full Text available with Trip Pro

reference cohort of 176 individuals was selected from the Osteoarthritis Initiative (OAI). Primary endpoint was change in bone area of the medial femoral condyle; exploratory analyses compared results by treatment and examined other knee regions. Comparisons were made using repeated measures mixed model ANOVA with adjustment for age, sex and body mass index (BMI).Mean medial femur bone area increased 3.2% (78.0 [95% CI 70.2 to 86.4] mm2) over 5 years after ACL injury and most prominently in knees (...) Marked and Rapid Change of Bone Shape In Acutely Acl Injured Knees - An Exploratory Analysis Of The Kanon Trial. To investigate changes in knee 3D bone shape over the first 5 years after acute anterior cruciate ligament (ACL) injury in participants of the randomized controlled KANON-trial.Serial MR images over 5 years from 121 young (32 women, mean age 26.1 years) adults with an acute ACL tear in a previously un-injured knee were analyzed using statistical shape models for bone. A matched

2019 Osteoarthritis and Cartilage Controlled trial quality: uncertain

374. Relationship between alignment and cartilage thickness in patients with non-traumatic and post-traumatic knee osteoarthritis. (Abstract)

regression analyses examined the relationship between cartilage thickness and knee OA group after controlling for disease severity, meniscal status, and alignment.In participants with predominantly medial compartment knee OA, compared to healthy controls, those with non-traumatic knee OA had diminished cartilage thickness in the medial plateau (p = 0.035) and those with post-traumatic knee OA had greater cartilage thickness in the lateral condyle (p = 0.044). In the lateral condyle, data revealed (...) Relationship between alignment and cartilage thickness in patients with non-traumatic and post-traumatic knee osteoarthritis. To compare cartilage thickness between patients with non-traumatic and post-traumatic knee osteoarthritis (OA) and healthy controls and to determine if disease severity and alignment impact these differences.Participants with non-traumatic (n = 22) and post-traumatic (n = 19) knee OA, and healthy controls (n = 22) were recruited for this cross-sectional study

2019 Osteoarthritis and Cartilage

375. 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

376. Factors Associated With Opioid Use in Pre-surgical Knee, Hip and Spine Osteoarthritis Patients. (Abstract)

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

377. 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

378. Anterolateral Ligament of the Knee: Diagnosis, Indications, Technique, Outcomes. (Abstract)

and with increasing knee flexion angles (>35). Clinically, when a patient presents with an anterior cruciate ligament (ACL) injury, clinical examination (pivot shift test), radiography (Segond fracture), ultrasound, and 3-dimensional magnetic resonance imaging are useful to assess a combined ALL injury. The following indications for ALL reconstruction are now well established: ACL revision, high-grade pivot shift test, chronic ACL rupture, young patients, pivoting activities, and patients undergoing medial (...) Anterolateral Ligament of the Knee: Diagnosis, Indications, Technique, Outcomes. In the context of anterior cruciate ligament reconstruction surgery, anterolateral ligament reconstruction is now recognized as a reliable option to control rotatory instability and should be considered in the knee surgeon's modern armamentarium. By highlighting its daily practical application, this infographic presents the indications for this specific additional lateral augmentation, the anatomic

2019 Arthroscopy

379. 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

380. 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

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