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knee rehabilitation

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5741. Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. (Abstract)

design (88) TKAs were reviewed. Surgeon, surgical approach, and a hyperflexion postoperative rehabilitation protocol were the same. Results showed significant improvement in knee flexion, ROM, Knee Score, and Function Score within each group. Postoperative mean total ROM was slightly higher with the posterior stabilized design. The 2 groups were the same postoperatively in the improvement in ROM, Knee Score, Function Score, satisfaction level, among other activity metrics. There was no clear evidence (...) Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. The study compared postoperative range of motion (ROM) and functional outcome of total knee arthroplasty (TKA) with a posterior cruciate ligament (PCL)-substituting knee prosthesis compared with an ultracongruent PCL-sacrificing design. Two hundred nine patients underwent primary TKA. Posterior stabilized design (121) and highly conforming, PCL-sacrificing, ultracongruent

2006 Journal of Arthroplasty

5742. Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. (Abstract)

Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. Two important questions remain in simultaneous bilateral total knee arthroplasty (TKA). Is bilateral TKA significantly more painful and is physical recovery significantly more difficult compared with unilateral TKA? A retrospective matched-pair analysis compared 59 bilateral and 59 unilateral TKA patients based on age, sex, diagnosis, surgeon, and surgery date. Analog (...) pain scores, narcotic use, ambulatory distances, and rehabilitative milestones were recorded. Bilateral patients' pain scores were 1 point higher during day 1 with subsequent equal scores. Narcotic use was 20% higher for the first 48 hours but equalized after that period. Ambulatory milestones lagged behind by 36 hours. Patients wishing to pursue bilateral TKA can proceed without pain, use of narcotics, and walking distance significantly different than unilateral TKA.

2006 Journal of Arthroplasty

5743. Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty: a new surgical technique. (Abstract)

Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty: a new surgical technique. Extensor mechanism disruption is an uncommon but devastating complication of total knee arthroplasty. A new technique of extensor mechanism reconstruction for patellar tendon loss, after total knee arthroplasty, with the help of extensor mechanism composite allograft is described. Four patients with chronic extensor mechanism-deficient total knee arthroplasty (...) were undertaken for revision surgery along with reconstruction of extensor mechanism with an innovative technique using an extensor mechanism composite allograft consisting of a patella-patellar tendon-tibial tubercle. On final follow-up, none of the patients had extensor lag but for 10 degrees of extensor lag in 1 patient only. Providing an environment for bone-to-bone healing both proximally as well as distally and supervised postoperative rehabilitation led to encouraging results

2008 Journal of Arthroplasty

5744. Tibial forces measured in vivo after total knee arthroplasty. (Abstract)

Tibial forces measured in vivo after total knee arthroplasty. An instrumented tibial prosthesis was developed to measure forces in vivo after total tibial arthroplasty. This prosthesis was implanted in a 67-kg, 80-year-old man. The prosthesis measured forces at the 4 quadrants of the tibial tray. Tibial forces were measured postoperatively during rehabilitation, rising from a chair, standing, walking, and climbing stairs. By the sixth postoperative week, the peak tibial forces during walking (...) averaged 2.2 times body weight (BW). Stair climbing increased from 1.9 times BW on day 6 to 2.5 times BW at 6 weeks. This represents the first direct in vivo measurement of tibial forces, which should lead to refined surgical techniques and enhanced prosthetic designs. Technical design improvements will enhance function, quality of life, and longevity of total knee arthroplasty.

2006 Journal of Arthroplasty

5745. Postoperative management after total hip and knee arthroplasty. (Abstract)

Postoperative management after total hip and knee arthroplasty. Despite major advances in the field of total joint arthroplasty, a standardized postoperative management protocol currently does not exist following total hip arthroplasty (THA) and total knee arthroplasty (TKA). A survey was mailed to the active members of the American Association of Hip and Knee Surgeons to investigate issues such as postoperative rehabilitation and activity restriction. The information derived from this survey

2005 Journal of Arthroplasty

5746. The stiff total knee arthroplasty: causality and solution. (Abstract)

The stiff total knee arthroplasty: causality and solution. A stiff total knee arthroplasty is a disabling condition, which can be caused by technical errors, patient factors, and postoperative complications. The results of treatment are dependent on the cause of stiffness. The best treatment is prevention by providing preoperative patient education, aggressive postoperative rehabilitation, and avoidance of technical errors. Early manipulation may improve motion with a well-aligned component

2005 Journal of Arthroplasty

5747. Mini-subvastus approach for total knee arthroplasty. (Abstract)

raise the day after surgery. Hospital length of stay was decreased in the MIS group, 3.4 days, vs the traditional group, 4.1 days (P = .00013). Fewer MIS patients required skilled nursing or rehabilitation center admission. Increased knee flexion was seen for the MIS patients throughout the first 2 years of follow-up. Mean knee flexion at 1 year was 127 degrees for the MIS patients vs 114 degrees in the traditional TKA patients (P < .0001). Comparison between the MIS and traditional techniques (...) Mini-subvastus approach for total knee arthroplasty. The mini-subvastus surgical technique avoids both quadriceps arthrotomy and patella eversion. Since March 2003, this quad-sparing minimally invasive surgical (MIS) technique has been applied to more than 98% of our primary total knee arthroplasty (TKA) patients. This study compares our first 150 MIS TKA patients to our previous 150 traditional TKA patients. Quadriceps recovery was rapid in the MIS group with 83% able to do a straight leg

2008 Journal of Arthroplasty

5748. Management of flexion contracture in total knee arthroplasty. (Abstract)

Management of flexion contracture in total knee arthroplasty. Flexion contracture is a common deformity encountered during total knee arthroplasty. Most deformities are mild and can be passively corrected at the time of surgery. Severe fixed deformities require surgical correction with release of the contracted soft tissues and appropriate management of the femoral bone resection. The goal of surgery is to correct the contracture and bring the knee to full extension. After surgery, attention (...) must be given to maintaining full extension during the rehabilitation phase. Residual or recurrent flexion contractures are not tolerated well by the patient and pose a functional disability.

2007 Journal of Arthroplasty

5749. Through-knee amputation in patients with peripheral arterial disease: a review of 50 cases. (Full text)

Through-knee amputation in patients with peripheral arterial disease: a review of 50 cases. For good rehabilitation candidates, the biomechanical advantages of the end weight-bearing through-knee amputation (TKAmp) compared with the above knee amputation (AKA) are well established. However, the TKAmp has been abandoned by vascular surgeons because of poor wound healing rates related to long tissue flaps and challenges to prosthetic fitting related to the femoral condyles. Since 1998, we have (...) performed the modified "Mazet" technique TKAmp procedure that creates shorter flaps to close the wound and greatly facilitates prosthesis fitting. The purpose of this study is to review our results with TKAmp in patients with peripheral vascular disease who were not candidates for below-knee amputation.The records of all patients who underwent through-knee amputation between 1998 and 2006 were retrospectively reviewed. Mean follow-up was 33 months (range, 38 days to 99 months). Amputations for trauma

2008 Journal of Vascular Surgery PubMed abstract

5750. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. (Abstract)

Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. We sought to evaluate the functional and radiographic outcome of osteochondral lesions involving the femoral condyle that were arthroscopically repaired via a bioabsorbable fixation device made of self-reinforced poly-L-lactic acid.A retrospective clinical and radiographic evaluation of 9 patients (8 male and 1 female) with a mean age of 18 years at the time of surgery was carried out. Of these patients, 8 were (...) , and repeated MRI with specific cartilage pulse sequencing.At surgery, the mean size of the fragment was 2 x 2 cm. A mean of 4 nails was used in each case (range, 2 to 10). All patients were treated with a postoperative rehabilitation protocol of non-weight-bearing for a minimum of 6 weeks. The mean postoperative Lysholm score was 94 (range, 78 to 100). The outcomes were excellent in 7 patients, good in 1, and fair in 1. After surgery, MRI evaluation of the osteochondral lesion and overlying cartilage

2008 Arthroscopy

5751. Outcome of isolated tibial polyethylene insert exchange after uncemented total knee arthroplasty: 27 patients followed for 8-71 months. (Full text)

an ITPIE was similar to that of a total knee revision with exchange of all components. Since the ITPIE is a much smaller operation with fast rehabilitation, we recommend it in elderly patients with a well-fixed and wellaligned prosthesis without surface damage of the components. (...) Outcome of isolated tibial polyethylene insert exchange after uncemented total knee arthroplasty: 27 patients followed for 8-71 months. The outcome of performing isolated tibial polyethylene insert exchange (ITPIE) after total knee arthroplasty (TKA) is under debate. We evaluated the survival probability of ITPE after uncemented TKA.27 patients (27 knees) with an ITPIE performed mean 9 (0.9-17) years after the initial TKA were included in the study (22 patients also had the patellar component

2006 Acta Orthopaedica PubMed abstract

5752. Minimally invasive versus standard approach in total knee arthroplasty. (Abstract)

to radiographically poor results, more operative time, and increased complications. The extensor and flexor torque, visual analog scale, pace of rehabilitation, Knee Society scores, radiographic findings, operative time, and complications of each group were examined. The minimally invasive group showed higher extensor torque values, higher ratios of postoperative to preoperative extensor torque, and lower average visual analog scale scores at 1 and 2 weeks. The patients in this group achieved straight leg raising (...) Minimally invasive versus standard approach in total knee arthroplasty. We compared a group of 20 patients who had 24 minimally invasive total knee arthroplasties with a similar group of 21 patients who had 25 standard medial parapatellar approach total knee arthroplasties. We wanted to clarify whether the minimally invasive group had an advantage over the standard group in muscle strength, pain level, postoperative recovery, and clinical results and whether the patients were prone

2007 Clinical Orthopaedics and Related Research

5753. Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee OA. (Abstract)

in meniscectomised subjects compared with reference subjects. Rehabilitative efforts may be warranted in middle-aged meniscectomised patients, especially in women and those who have developed radiographic knee OA, who are at greater risk of worsening. (...) Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee OA. In the present work, we describe the clinical course and predictors of change in self-reported outcomes and objectively assessed physical function over time in middle-aged subjects at high risk of, or with knee osteoarthritis (OA).We examined 259 subjects (mean (SD) age 52.6 (10.4)) at mean 18 and 25 years after previous meniscectomy and 50 population-based age

2007 Annals of the Rheumatic Diseases

5754. Role of muscle in the genesis and management of knee osteoarthritis. (Abstract)

and whether improvements in muscle function lead to improved symptoms and joint structure. It concludes with a discussion of exercise prescription for muscle rehabilitation in knee OA. (...) Role of muscle in the genesis and management of knee osteoarthritis. The muscles of the lower limb play an important role in the genesis and management of knee osteoarthritis (OA). This article outlines the influence of muscle activity on knee joint loading, the deficits in muscle function observed in people who have knee OA, and available evidence pertaining to the role of muscle in the development and progression of knee OA. It also discusses whether muscle deficits can be modified in knee OA

2008 Rheumatic Diseases Clinics of North America

5755. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. (Full text)

Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction after total hip and knee replacement surgery.Between September 2003 and December 2005, 712 (...) consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit. Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction.92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking aids, pre

2008 Acta Orthopaedica PubMed abstract

5756. Spontaneous locking of the knee after anterior cruciate ligament reconstruction as a result of a broken tibial fixation device. (Abstract)

Spontaneous locking of the knee after anterior cruciate ligament reconstruction as a result of a broken tibial fixation device. The Intrafix device (DePuy Mitek, Raynham, MA) is one of a number of recently developed products whose aim is to improve fixation of quadrupled hamstring grafts when used for anterior cruciate ligament reconstruction. We present a case of failure and intra-articular migration of the sleeve of an Intrafix device causing locking of the knee 10 weeks after anterior (...) cruciate ligament reconstruction. We were unable to identify the cause of the failure or migration of the device. Rehabilitation had been progressing normally and without incident. The broken fragments were removed arthroscopically, and the reconstruction was found to be intact and healing well. Presumably, the device retained enough mechanical function to allow healing to progress, despite failure of the sleeve. This is, to our knowledge, the first reported case of such an event occurring with the new

2008 Arthroscopy

5757. Conversion of bilateral hip and knee ankylosis to total joint replacements. (Full text)

Conversion of bilateral hip and knee ankylosis to total joint replacements. We present a 25-year-old patient with juvenile rheumatoid arthritis and ankylosis of both hips and both knees treated by staged bilateral hip and knee arthroplasty. She was followed up for 18 months. We discuss the pre-operative planning, surgical details and post-operative rehabilitation.

2008 The Journal of Bone and Joint Surgery British Volume PubMed abstract

5758. Postoperative analgesia after knee surgery: a comparison of three different concentrations of ropivacaine for continuous femoral nerve blockade. (Abstract)

receiving a combined femoral and sciatic nerve block. Secondary aims were to evaluate side effects such as motor blockade, rehabilitation indices, and ropivacaine plasma concentrations.One hundred twenty-two patients undergoing total knee arthroplasty under combined general and regional anesthesia received femoral infusions of ropivacaine 0.1, 0.2, or 0.3%. Infusions were started after initial loading doses of 30 mL ropivacaine 0.5% into the femoral catheter and a sciatic catheter and were targeted (...) Postoperative analgesia after knee surgery: a comparison of three different concentrations of ropivacaine for continuous femoral nerve blockade. The most effective ropivacaine concentration for femoral infusion after total knee arthroplasty is currently ill defined. We designed the present study to compare ropivacaine in three different concentrations (0.1, 0.2, and 0.3%) to evaluate analgesic quality, when administered as a continuous infusion with frequent infusion adjustments in patients

2007 Anesthesia and Analgesia

5759. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis

Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis Medical Advisory Secretariat Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA (...) database. Citation Medical Advisory Secretariat. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis. Toronto: Medical Advisory Secretariat (MAS). Volume 5(8). 2005 Authors' objectives The purpose of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement

2005 Health Technology Assessment (HTA) Database.

5760. A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. (Abstract)

A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. To evaluate the efficacy of continuous passive motion (CPM) in the postoperative management of patients undergoing total knee arthroplasty.A randomized controlled single-blind trial of CPM plus standardized rehabilitation vs standard rehabilitation alone.A referral hospital for arthritis and musculoskeletal care.Consecutive patients with end-stage osteoarthritis or rheumatoid arthritis (...) undergoing primary total knee arthroplasty who had at least 90 degrees of passive knee flexion. One hundred fifty-four patients were eligible and 102 patients agreed to participate and were randomized. Ninety-three patients completed the study protocol.Continuous passive motion machines programmed for rate and specified arc of motion within 24 hours of surgery with range increased daily as tolerated with standardized rehabilitation program compared with standardized rehabilitation program alone.Primary

1992 JAMA Controlled trial quality: uncertain

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