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Knee Exam

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401. Statin Use and Knee Osteoarthritis Outcome Measures according to the Presence of Heberden Nodes: Results from the Osteoarthritis Initiative. Full Text available with Trip Pro

Statin Use and Knee Osteoarthritis Outcome Measures according to the Presence of Heberden Nodes: Results from the Osteoarthritis Initiative. Background The exact contribution of statins to knee osteoarthritis (OA) radiographic outcomes and the characteristics of patients with OA as potential responders to statins remain unclear. Purpose To evaluate the effect of statin use on the incidence of radiographic knee OA (development of Kellgren-Lawrence grade ≥2) and progression of joint space (...) were classified as having HN-positive or HN-negative findings according to the presence of HNs at baseline physical examination. In each cohort, per-protocol and new-user design were used to match statin initiators (participants who reported ≤1 year of statin use before enrollment) and nonusers (participants who reported no statin use before enrollment) for variables that potentially contributed to confounding by indication bias. Participants were followed up annually over 8 years. Any associations

2019 Radiology

402. Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks. Full Text available with Trip Pro

Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks. With the rising utilization of total joint arthroplasty, the role of simultaneous-bilateral surgery will have an expanding impact. The purpose of this study is to examine the risks of perioperative complications with this approach in total knee arthroplasty (TKA), to inform shared decision-making.We reviewed national hospital discharge data from 2005 to 2014 to compare outcomes between (...) simultaneous-bilateral TKAs (sim-BTKAs) and staged-bilateral TKAs (staged-BTKAs). Hierarchical logistic regression analyses were used to adjust for confounders. Outcomes analyzed included mortality, various medical complications, knee infection, and mechanical complications.This study analyzed 27,301 sim-BTKAs and 45,419 staged-BTKAs. Patients who underwent simultaneous surgery had a statistically significant higher adjusted odds of mortality, cardiac events, thromboembolic events, and complications

2019 Journal of Arthroplasty

403. Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach? (Abstract)

with a ROM above 60°. The TTO approach was applied to patients with knee flexion limited to 0°-30°. We clinically assessed knee ROM, Knee Society scores, and Hospital for Special Surgery scores at the time of the last follow-up. We radiographically measured femorotibial alignment and patellar height. We also examined the complication rates. The average length of the TTO was 1.0 × 2.5 cm × 10 cm. We used 3 or more 3.5-mm half-threaded screws.The mean postoperative ROM of the knee joint at the time (...) Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach? As the frequency of total knee arthroplasty (TKA) is increasing, long-term follow-up of patients has become essential, and the frequency of revision total knee arthroplasty (R-TKA) due to the occurrence of various complications has also increased. There is controversy regarding which approach has minimal complications and an adequate

2019 Journal of Arthroplasty

404. Reasons for Revision, Oxidation, and Damage Mechanisms of Retrieved Vitamin E-Stabilized Highly Crosslinked Polyethylene in Total Knee Arthroplasty. Full Text available with Trip Pro

-stabilized highly crosslinked polyethylene (HXLPE) for total knee arthroplasty.We examined 103 retrieved knee inserts fabricated from vitamin E (VE)-stabilized HXLPE and 67 fabricated from remelted HXLPE as a control. The implantation times were 1.2 ± 1.3 and 1.5 ± 1.3 years for the VE and control cohorts, respectively. The inserts were evaluated for 7 surface damage mechanisms using a semiquantitative scoring method and analyzed for oxidation using Fourier-transform infrared spectroscopy. Reasons (...) Reasons for Revision, Oxidation, and Damage Mechanisms of Retrieved Vitamin E-Stabilized Highly Crosslinked Polyethylene in Total Knee Arthroplasty. In order to improve oxidation resistance, antioxidants such as vitamin-E are added to polyethylene used in the bearing surfaces of orthopedic components. Currently, little is known about the efficacy of this treatment in vivo. This study therefore reports on the reasons for revision, surface damage mechanisms, and oxidation of retrieved vitamin E

2019 Journal of Arthroplasty

405. Influence of Hip Geometry Reconstruction on Frontal Plane Hip and Knee Joint Moments During Walking Following Primary Total Hip Replacement. Full Text available with Trip Pro

Influence of Hip Geometry Reconstruction on Frontal Plane Hip and Knee Joint Moments During Walking Following Primary Total Hip Replacement. Following total hip replacement (THR), hip geometry reconstruction parameters such as the femoral offset (FO) correlate with hip stability and wear. The purpose of this study is to determine the relationship between hip geometry parameters and knee and hip joint loading during walking.Forty-one patients were examined before and a minimum of 1 year after (...) primary THR. Pearson correlation coefficient (r) was performed to identify relationships between radiographic parameters and gait data. In addition, we divided patients into 2 groups according to the restoration of the FO (within ±5 mm vs more than 5 mm increment).The FO and global offset (GO) showed a positive correlation with the first (r = 0.469, P = .002; r = 0.542, P < .001) and second (r = 0.365, P = .019; r = 0.484, P = .001) knee adduction moment (KAM). The neck-shaft angle revealed a negative

2019 Journal of Arthroplasty

406. Should the Pareto Principle Be Applied as a Cost Savings Method in Hip and Knee Arthroplasty? Full Text available with Trip Pro

Should the Pareto Principle Be Applied as a Cost Savings Method in Hip and Knee Arthroplasty? Understanding the most significant contributions to the cost of completing total hip arthroplasty (THA) and total knee arthroplasty (TKA) is essential to optimize costs and meet funding standards. The objectives of this study are to determine whether cost distribution of THA and TKA follows the Pareto Principle (80/20 rule) and factors predictive of costs that could be modified.All inpatient, primary (...) , elective, and unilateral THA and TKA patients from April 2008 to September 2017 were retrospectively reviewed. The Pareto Principle was tested by dividing patients into top 5% cost increments and calculating patient cost category ratio. Relationship between patient-related factors and acute care costs and relationship between cost categories and length of stay (LOS) were examined using multiple regression.The Pareto Principle does not apply for THA or TKA patients, with the top 20% of costly patients

2019 Journal of Arthroplasty

407. Vancomycin-Gentamicin Prefabricated Spacers in 2-Stage Revision Arthroplasty for Chronic Hip and Knee Periprosthetic Joint Infection: Insights Into Reimplantation Microbiology and Outcomes. Full Text available with Trip Pro

. The associations of second-stage positive cultures with treatment failures and patient-associated factors were analyzed.We conducted a retrospective cohort study, examining patients managed with 2-stage revision arthroplasty due to knee or hip chronic periprosthetic joint infection between 2010 and 2017. Prefabricated vancomycin-gentamicin cement spacers were used during the spacer stage. Intraoperative microbiological culture results after the first and second stages were evaluated. The primary end point (...) Vancomycin-Gentamicin Prefabricated Spacers in 2-Stage Revision Arthroplasty for Chronic Hip and Knee Periprosthetic Joint Infection: Insights Into Reimplantation Microbiology and Outcomes. Second-stage positive cultures in 2-stage revision arthroplasty are a matter of concern, as their influence in outcomes is not clearly defined. We sought to study reimplantation microbiology when using vancomycin-gentamicin prefabricated cement spacers in hip and knee periprosthetic joint infection

2019 Journal of Arthroplasty

408. Midterm Effect of Mental Factors on Pain, Function, and Patient Satisfaction 5 Years After Uncomplicated Total Knee Arthroplasty. Full Text available with Trip Pro

Midterm Effect of Mental Factors on Pain, Function, and Patient Satisfaction 5 Years After Uncomplicated Total Knee Arthroplasty. The effects of psychological factors on the short-term outcome after uncomplicated total knee arthroplasty (TKA) have been described in several studies. However, the effects of mental factors on the midterm (5-year) outcome have not been described in the literature. This study was performed to examine the influence of pain catastrophizing, anxiety, depression (...) the Knee Injury and Osteoarthritis Outcome Score and patient satisfaction. Intergroup differences were tested using an independent t-test. Odds ratios were calculated to determine the probability of an unsatisfactory outcome.At the 5-year follow-up, only depressive symptoms and somatization dysfunction had a significant effect on postoperative pain (numerical rating scale score). This significant effect was also observed for the different Knee Injury and Osteoarthritis Outcome Score subscales

2019 Journal of Arthroplasty

409. Impact of Resilience on Outcomes of Total Knee Arthroplasty. (Abstract)

Impact of Resilience on Outcomes of Total Knee Arthroplasty. Resilience, defined as the ability to bounce back from stress, has been suggested as a predictor of surgical outcomes. The purpose of this study is to examine the relationship between resilience and patient-reported outcomes following primary elective total knee arthroplasty (TKA). We hypothesized that patients exhibiting greater preoperative resilience would report better outcome scores.A prospective cohort of 153 patients (74 male (...) , 79 female) undergoing primary elective TKA completed questionnaires preoperatively and at 3 and 12 months following their index procedure. The validated Brief Resilience Scale was used to evaluate resilience. Hierarchical multiple linear regression was used to analyze the effect of resilience on KOOS-JR (Knee Injury and Osteoarthritis Outcome Score JR) and PROMIS-10 (Patient-Reported Outcomes Measurement Information System) outcome scores.At 12 months, the change in the coefficient

2019 Journal of Arthroplasty

410. Activity Impairment and Work Productivity Loss After Total Knee Arthroplasty: A Prospective Study. (Abstract)

Activity Impairment and Work Productivity Loss After Total Knee Arthroplasty: A Prospective Study. Total knee arthroplasty (TKA) is increasingly performed among working-aged individuals, highlighting the importance of work-related outcomes. Therefore, the aim is to examine the extent of both activity impairment outside work and work productivity (absenteeism, presenteeism, at-work productivity loss) at 6 and 24 months post-TKA surgery. Additionally, associated risk factors with these outcomes (...) age, gender, education, pain catastrophizing, pain, function, psychological distress, and knee-related and health-related quality of life. Linear and logistic regression was used to assess associations between covariates and Work Productivity and Activity Impairment scores at follow-up.At 6 months, the mean activity impairment was 22.8% (standard deviation [SD] 23.5) dropping to 17.1% (23.1) by 24 months. Among workers, presenteeism was 18.4% (24.6) and at-work productivity loss was 20.8% (26.1

2019 Journal of Arthroplasty

411. Surgeon Mean Operative Times in Total Knee Arthroplasty in a Variety of Settings in a Health System. (Abstract)

Surgeon Mean Operative Times in Total Knee Arthroplasty in a Variety of Settings in a Health System. High-quality care is essential in total joint arthroplasty. Multiple initiatives such as centers of excellence, patient optimization, and alternative payment models have demonstrated improved outcomes and decreased cost. Many studies have shown that longer operative times (OTs) are associated with increased frequency of postoperative complications. These findings often come from large data sets (...) and may not accurately represent the average OT of individual surgeons. The purpose of this study was to determine the hospital and patient-related factors that influence OT.This retrospective study reviewed OT of 6003 total knee arthroplasty cases performed by 41 surgeons at 4 hospitals in a single health-care system. Mean OT was calculated for each surgeon. The effect of surgeon, hospital-, and patient-related factors on OT was assessed.Among the 41 surgeons, the mean OT was 105 ± 25 minutes. Two

2019 Journal of Arthroplasty

412. Learning knee arthrocentesis using YouTube videos. (Abstract)

Learning knee arthrocentesis using YouTube videos. This study aims to compare medical students' educational outcomes in performing knee arthrocentesis through searching and using YouTube videos versus traditional supervisor-led sessions.Seventy-one medical students were randomly assigned to three groups. Group A had a traditional supervisor-led clinical session, where the supervisor demonstrated the procedure. Students in group B were provided with links to YouTube videos of knee arthrocentesis (...) that were deemed to be of high educational quality, whereas group C searched and learned from any YouTube video that they found themselves based on the learning objectives provided. Student performance was first examined following the learning sessions, and then again after receiving feedback on the performance.Prior to feedback, statistically significant higher mean scores were noted for group A in the identification of an appropriate puncture site (p = 0.015), puncture site sterilization (p = 0.046

2019 The clinical teacher Controlled trial quality: uncertain

413. The Influence of Preoperative Radiographic Patellofemoral Degenerative Changes and Malalignment on Patellofemoral-Specific Outcome Scores Following Fixed-Bearing Medial Unicompartmental Knee Arthroplasty. (Abstract)

The Influence of Preoperative Radiographic Patellofemoral Degenerative Changes and Malalignment on Patellofemoral-Specific Outcome Scores Following Fixed-Bearing Medial Unicompartmental Knee Arthroplasty. There is controversy as to whether the presence of degenerative changes and malalignment of the patellofemoral joint is a contraindication to medial unicompartmental knee arthroplasty. Therefore, the aim of the present study was to examine the influence of preoperative radiographic (...) patellofemoral joint osteoarthritis and alignment on intermediate-term knee and patellofemoral joint-specific patient-reported outcomes following fixed-bearing medial unicompartmental knee arthroplasty.We performed a retrospective review of the records on a consecutive series of patients who had undergone robotic arm-assisted fixed-bearing onlay medial unicompartmental knee arthroplasty and had a minimum duration of follow-up of 2 years. All records were collected from a single surgeon's arthroplasty

2019 The Journal of Bone and Joint Surgery. American Volume

414. Role of the PERK-eIF2<i>α</i>-CHOP Signaling Pathway in the Effect of Needle Knife Therapy on Knee Joint Chondrocyte Apoptosis. Full Text available with Trip Pro

knee joint chondrocyte apoptosis. Apoptosis and ultrastructural changes in the articular cartilage were examined by pathological study and transmission electron microscopy, and PERK, eIF2α, and CHOP mRNA and protein levels were detected by qRT-PCR and western blot, respectively. PERK, eIF2α, and CHOP protein levels were significantly higher in the model group than in the normal group (P < 0.01) and were considerably downregulated in the needle knife and the medicine groups compared to the model (...) Role of the PERK-eIF2α-CHOP Signaling Pathway in the Effect of Needle Knife Therapy on Knee Joint Chondrocyte Apoptosis. Needle knife therapy, a form of acupuncture and moxibustion, has been widely used in the clinical treatment of knee osteoarthritis (KOA). However, the mechanism is not clear. Therefore, we studied the mechanisms of action of needle knife intervention on KOA in rabbits, with the PERK-eIF2α-CHOP pathway as a starting point, in order to determine the mechanism underlying

2019 Evidence-based Complementary and Alternative Medicine (eCAM)

415. A Double-Blind, Randomized Controlled 12-Week Follow-Up Trial to Evaluate the Efficacy and Safety of Polycan in Combination with Glucosamine for the Treatment of Knee Osteoarthritis. Full Text available with Trip Pro

A Double-Blind, Randomized Controlled 12-Week Follow-Up Trial to Evaluate the Efficacy and Safety of Polycan in Combination with Glucosamine for the Treatment of Knee Osteoarthritis. The aim of the present study was to examine the efficacy and safety of Polycan, a β-glucan produced from the black yeast Aureobasidium pullulans SM-2001, in combination with glucosamine in reducing knee osteoarthritis-associated symptoms.This was a double-blind, randomized controlled trial of a formulated product

2019 Evidence-based Complementary and Alternative Medicine (eCAM) Controlled trial quality: predicted high

416. Calcaneal insufficiency fractures following total knee arthroplasty: Classification and clinical findings. (Abstract)

Calcaneal insufficiency fractures following total knee arthroplasty: Classification and clinical findings. Calcaneal insufficiency fracture (IF) following total knee arthroplasty (TKA) is a rare disorder. This study aimed to examine the prevalence and clinical findings of calcaneal IF following TKA.We retrospectively reviewed 3,585 consecutive patients undergoing primary TKA between 2012 and 2017 in four hospitals. Calcaneal IF following TKA was diagnosed by plain radiography or magnetic

2019 Injury

417. A case of Ehlers-Danlos syndrome presenting with widened atrophic scars of forehead, elbow, knee, and pretibial area: A case report. Full Text available with Trip Pro

on forehead, elbows, knees and pretibial area that had developed since childhood.With the skin hyperextensibility, joint hypermobility, papyraceous scar revealed by physical examination, and the heterozygous pathogenic variant c1997G > A (p.P659P) in COL5A2 gene revealed by whole exome sequencing, the diagnosis of the classical Ehlers-Danlos syndrome was made.The patient underwent facial scar resection and sutured in minimizing tension and perfect apposition to avoid the post-surgery scar formation.Follow (...) A case of Ehlers-Danlos syndrome presenting with widened atrophic scars of forehead, elbow, knee, and pretibial area: A case report. Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disorder. Currently, the genotype-phenotype correlations of classical EDS (cEDS) are still controversial. Hence, this study reported a case of cEDS with both clinical manifestations and COL5A2 gene mutation.A 30-year-old female presented to the plastic-surgery clinic with widen atrophic scars

2019 Medicine

418. Modifiable factors associated with symptomatic knee osteoarthritis: The Murakami cohort study. (Abstract)

, information on sociodemographic characteristics, body size, lifestyle, and living condition was obtained using a self-administered questionnaire.Incident symptomatic knee OA observed at hospitals and orthopaedic clinics in the five years to 2016. Clinical grades of knee OA were based on the Kellgren-Lawrence scale. P for trend was assessed to examine linear associations between predictors and the outcome in multiple logistic regression analysis.The mean age of participants was 58.1 (SD 9.3) years (...) Modifiable factors associated with symptomatic knee osteoarthritis: The Murakami cohort study. Modifiable risk factors for knee osteoarthritis (OA) have not been studied in detail. This study aimed to determine lifestyle-related modifiable factors of symptomatic knee osteoarthritis in an East Asian population.This 5-year cohort study involved 11,091 individuals (age range 40-72 years) living in the Murakami region of Niigata, Japan, who did not have a history of knee OA. At baseline

2019 Maturitas

419. Arthroscopic gel-type autologous chondrocyte implantation presents histologic evidence of regenerating hyaline-like cartilage in the knee with articular cartilage defect. (Abstract)

Arthroscopic gel-type autologous chondrocyte implantation presents histologic evidence of regenerating hyaline-like cartilage in the knee with articular cartilage defect. To investigate the clinical, radiological, and histological results of arthroscopic gel-type autologous chondrocyte implantation (GACI) in treating chondral defects of the knee.This study prospectively examined five males and five females with a mean age of 40.3 ± 10.3 years who underwent arthroscopic GACI between March 2012 (...) and February 2013. The gel comprised a mixture of 1 ml of fibrinogen plus 0.1-0.2 ml of thrombin. The mean size of chondral defect was 2.9 ± 1.2 cm2 (range 1.2-5.4 cm2). International knee documentation committee (IKDC) subjective score, knee injury and osteoarthritis outcome score (KOOS), knee society score, and visual analog scale (VAS) for pain were assessed preoperatively and during regular follow-up examinations performed for up to 5 years postoperatively. Serial magnetic resonance imaging

2019 Knee Surgery, Sports Traumatology, Arthroscopy

420. Bone SPECT/CT has excellent sensitivity and specificity for diagnosis of loosening and patellofemoral problems after total knee arthroplasty. (Abstract)

and the specificity of SPECT/CT for different pathologies such as loosening and patellofemoral overloading.A retrospective analysis was carried out on 214 knees in 202 consecutive patients (mean age 69 ± 11 years) with persistent or recurrent knee pain after TKA. All patients underwent clinical examination, standardised radiographs, and 99mTc-hydroxymethane diphosphonate (HDP) SPECT/CT as part of a routine diagnostic algorithm. The diagnoses before and after SPECT/CT and final treatment were recorded. TKA (...) Bone SPECT/CT has excellent sensitivity and specificity for diagnosis of loosening and patellofemoral problems after total knee arthroplasty. The primary purpose of this retrospective study with prospectively collected data was to evaluate the clinical value of SPECT/CT, in particular its impact on clinical diagnosis and patient management, in patients with pain, stiffness, or swelling after primary total knee arthroplasty (TKA). The secondary purpose was to determine the sensitivity

2019 Knee Surgery, Sports Traumatology, Arthroscopy

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