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Latest & greatest articles for knee replacement
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Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or kneereplacement or hip fracture repair. The optimal duration of thromboprophylaxis after total hip or kneereplacement, or hip fracture repair remains controversial. It is common practice to administer prophylaxis using low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) until discharge from hospital, usually seven to 14 days after surgery. International guidelines recommend (...) undergoing elective hip or kneereplacement surgery, or hip fracture repair.The Cochrane Vascular Information Specialist searched the Specialised Register (last searched May 2015) and CENTRAL (2015, Issue 4). Clinical trials databases were searched for ongoing or unpublished studies.Randomised controlled trials assessing extended-duration thromboprophylaxis (five to seven weeks) using accepted prophylactic doses of LMWH, UFH, vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) compared
Outcome of total kneereplacement following explantation and cemented spacer therapy Infection after total kneereplacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two (...) -setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation.A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient's group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging
A Randomized, Controlled Trial of Total KneeReplacement. More than 670,000 total kneereplacements are performed annually in the United States; however, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking.In this randomized, controlled trial, we enrolled 100 patients with moderate-to-severe knee osteoarthritis who were eligible for unilateral total kneereplacement. Patients were randomly assigned to undergo total knee (...) replacement followed by 12 weeks of nonsurgical treatment (total-knee-replacement group) or to receive only the 12 weeks of nonsurgical treatment (nonsurgical-treatment group), which was delivered by physiotherapists and dietitians and consisted of exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the change from baseline to 12 months in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, activities
Prophylactic Tranexamic Acid Administration for Patients Undergoing Hip and KneeReplacement Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid (...) Administration for Patients Undergoing Hip and KneeReplacement: Clinical Effectiveness, Cost-Effectiveness, and Guidelines DATE: 16 June 2015 RESEARCH QUESTIONS 1. What is the clinical effectiveness of the administration of tranexamic acid for blood conservation in patients who are undergoing hip or kneereplacement surgery? 2. What is the cost-effectiveness of the administration of tranexamic acid for blood conservation in patients who are undergoing hip or kneereplacement surgery? 3. What
interest are provided in the appendix. OVERALL SUMMARY OF FINDINGS Five non-randomized studies 1-5 were identified regarding Smith & Nephew Journey total kneereplacement systems in patients requiring total kneereplacement. One study 1 reported high complication rates (e.g., 1.65 complications requiring major revision surgery per 100 component years) with the Journey bicruciate substituting total kneereplacement. Two studies 2,3 comparing Journey Bicruciate Stabilised kneereplacement systems (...) KneeReplacement System 3 REFERENCES SUMMARIZED Health Technology Assessments No literature identified. Systematic Reviews and Meta-analyses No literature identified. Randomized Controlled Trials No literature identified. Non-Randomized Studies 1. Christen B, Neukamp M, Aghayev E. Consecutive series of 226 journey bicruciate substituting total kneereplacements: early complication and revision rates. BMC Musculoskelet Disord [Internet]. 2014 [cited 2015 Mar 17];15:395. Available from: http
Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: A systematic review To systematically review the effect of early mobilization after hip or knee joint replacement surgery on length of stay in an acute hospital.Randomized controlled trials were selected from electronic databases based on inclusion criterion requiring an experimental group mobilizing (sitting out of bed/walking) earlier than a comparison group post joint replacement (...) 48 hours post operatively. Individual trials reported benefits in range of motion, muscle strength and health-related quality of life in favor of the experimental group. There were no differences in discharge destinations, incidence of negative outcomes or adverse events attributable to early mobilization when compared to the comparison groups.Early mobilization post hip or knee joint replacement surgery can result in a reduced length of stay of about 1.8 days. Trials that reported these positive
Comparison of highly cross-linked and conventional polyethylene in posterior cruciate-substituting total knee arthroplasty in the same patients We are not aware of any information on in vivo clinical results at a minimum of five years after posterior cruciate-substituting total knee arthroplasties performed with a highly cross-linked polyethylene insert. The purpose of the study was to evaluate whether the clinical and radiographic results of posterior cruciate-substituting total knee (...) prostheses, including the prevalences of fracture of the polyethylene post, failure of the locking mechanism of the tibial polyethylene insert, and osteolysis, would be similar between patients treated with conventional polyethylene and those treated with highly cross-linked polyethylene.Three hundred and eight patients with a mean age of 60.3 years (range, twenty-two to sixty-five years) received a posterior cruciate-substituting total knee prosthesis with a conventional polyethylene tibial insert
Appraisal of evidence base for introduction of new implants in hip and kneereplacement: a systematic review of five widely used device technologies. To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare.Systematic review of clinical trials, comparative observational studies (...) ) and two in total kneereplacement (high flexion kneereplacement and gender specific kneereplacement). All clinical studies of primary total hip or kneereplacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors
Adverse outcomes after total and unicompartmental kneereplacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales. Total kneereplacement (TKR) or unicompartmental kneereplacement (UKR) are options for end-stage osteoarthritis. However, comparisons between the two procedures are confounded by differences in baseline characteristics of patients undergoing either procedure and by insufficient reporting of endpoints other than revision. We
45-day mortality after 467 779 kneereplacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Understanding the risk factors for early death after kneereplacement could help to reduce the risk of mortality after this procedure. We assessed secular trends in death within 45 days of kneereplacement for osteoarthritis in England and Wales, with the aim of investigating whether any change that we recorded could be explained by alterations (...) in modifiable perioperative factors.We took data for kneereplacements done for osteoarthritis in England and Wales between April 1, 2003, and Dec 31, 2011, from the National Joint Registry for England and Wales. Patient identifiers were used to link these data to the national mortality database and the Hospital Episode Statistics database to obtain details of death, sociodemographics, and comorbidity. We assessed mortality within 45 days by Kaplan-Meier analysis and assessed the role of patient
Aspirin for VTE prophylaxis in hip and kneereplacement surgery Aspirin for VTE prophylaxis in hip and kneereplacement surgery Aspirin for VTE prophylaxis in hip and kneereplacement surgery Mitchell MD, Williams K Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mitchell MD, Williams K. Aspirin for VTE prophylaxis in hip and kneereplacement surgery (...) . Philadelphia: Center for Evidence-based Practice (CEP). 2014 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Aspirins; Venous Thromboembolism Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market St. Suite 50, Philadelphia PA 19104
Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement Update on physiotherapy rehabilitation after total knee or hip replacement Update on physiotherapy rehabilitation after total knee or hip replacement Ontario Health Technology Advisory Committee 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 Ontario Health (...) Technology Advisory Committee. Update on physiotherapy rehabilitation after total knee or hip replacement. Toronto: Health Quality Ontario (HQO). OHTAC Recommendation. 2014 Authors' conclusions OHTAC recommends the health system support the move towards community-based physiotherapy after primary total knee or hip replacement and discharge from acute care. In regards to location of physiotherapy within the community, the health system should allow for flexibility, depending on the local care context
Functional outcome and alignment in computer-assisted and conventionally operated total kneereplacements: a multicentre parallel-group randomised controlled trial We performed a randomised controlled trial comparing computer-assisted surgery (CAS) with conventional surgery (CONV) in total kneereplacement (TKR). Between 2009 and 2011 a total of 192 patients with a mean age of 68 years (55 to 85) with osteoarthritis or arthritic disease of the knee were recruited from four Norwegian hospitals (...) . At three months follow-up, functional results were marginally better for the CAS group. Mean differences (MD) in favour of CAS were found for the Knee Society function score (MD: 5.9, 95% confidence interval (CI) 0.3 to 11.4, p = 0.039), the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for 'pain' (MD: 7.7, 95% CI 1.7 to 13.6, p = 0.012), 'sports' (MD: 13.5, 95% CI 5.6 to 21.4, p = 0.001) and 'quality of life' (MD: 7.2, 95% CI 0.1 to 14.3, p = 0.046). At one-year follow-up, differences
Preoperative education for hip or kneereplacement. Hip or kneereplacement is a major surgical procedure that can be physically and psychologically stressful for patients. It is hypothesised that education before surgery reduces anxiety and enhances clinically important postoperative outcomes.To determine whether preoperative education in people undergoing total hip replacement or total kneereplacement improves postoperative outcomes with respect to pain, function, health-related quality (...) trials of preoperative education (verbal, written or audiovisual) delivered by a health professional within six weeks of surgery to people undergoing hip or kneereplacement compared with usual care.Two review authors independently assessed trial quality and extracted data. We analysed dichotomous outcomes using risk ratios. We combined continuous outcomes using mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). Where possible, we pooled data using
Femoral nerve blocks for acute postoperative pain after kneereplacement surgery. Total kneereplacement (TKR) is a common and often painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia.To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web (...) , number needed to treat for an additional harmful outcome (NNTH) four, high-quality evidence), greater knee flexion (11 RCTs, 596 participants, MD 6.48 degrees, 95% CI 4.27 to 8.69 degrees, moderate-quality evidence) and greater patient satisfaction (four RCTs, 180 participants, SMD 1.06, 95% CI 0.74 to 1.38, low-quality evidence) compared with PCA.We could not demonstrate a difference in pain between FNB (any type) and epidural analgesia in the first 72 hours post operation, including pain at 24
Increased risk of revision for high flexion total kneereplacement with thicker tibial liners The outcome of total kneereplacement (TKR) using components designed to increase the range of flexion is not fully understood. The short- to mid-term risk of aseptic revision in high flexion TKR was evaluated. The endpoint of the study was aseptic revision and the following variables were investigated: implant design (high flexion vs non-high flexion), the thickness of the tibial insert (≤ 14 mm vs (...) > 14 mm), cruciate ligament (posterior stabilised (PS) vs cruciate retaining), mobility (fixed vs rotating), and the manufacturer (Zimmer, Smith & Nephew and DePuy). Covariates included patient, implant, surgeon and hospital factors. Marginal Cox proportional hazard models were used. In a cohort of 64 000 TKRs, high flexion components were used in 8035 (12.5%). The high flexion knees with tibial liners of thickness > 14 mm had a density of revision of 1.45/100 years of observation, compared
Computer assisted surgery for unicondylar and total kneereplacement Computer assisted surgery for unicondylar and total kneereplacement Computer assisted surgery for unicondylar and total kneereplacement Malaysian Health Technology Assessment (MaHTAS) 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 Malaysian Health Technology (...) Assessment (MaHTAS). Computer assisted surgery for unicondylar and total kneereplacement. Putrajaya: Malaysian Health Technology Assessment (MaHTAS). 2014 Authors' objectives To review evidence on the effectiveness, safety and costeffectiveness of computer assisted surgery for unicondylar and total kneereplacement in patients with osteoarthritis. Authors' conclusions Computer assisted surgery or computer image-based navigation or robotic-assisted procedure has the potential to be used as alternative
Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement: OHTAC Recommendation. March 2014; pp. 1–9 Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement: OHTAC Recommendation Ontario Health Technology Advisory Committee March 2014 Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement: OHTAC Recommendation. March 2014; pp. 1–9 Suggested Citation This report (...) should be cited as follows: Ontario Health Technology Advisory Committee (OHTAC). Update on physiotherapy rehabilitation after total knee or hip replacement: OHTAC recommendation [Internet]. Toronto: Queen's Printer for Ontario; 2014 March. 9 p. Available from: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/ontario-health- technology-assessment-series/physiotherapy-rehabilitation-after-total-knee-or-hip-replacement. Permission Requests All inquiries regarding permission
A systematic review and meta-regression of mobile-bearing versus fixed-bearing total kneereplacement in 41 studies Mobile-bearing (MB) total kneereplacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical advantages of mobile- over fixed-bearing (FB) TKR have been found. In this study we evaluated whether mobile bearings have an advantage over fixed bearings with regard to revision rates and clinical outcome scores (...) . Furthermore, we determined which modifying variables affected the outcome. A systematic search of the literature was conducted to collect clinical trials comparing MB and FB in primary TKR. The primary outcomes were revision rates for any reason, aseptic loosening and wear. Secondary outcomes included range of movement, Knee Society score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score and radiological parameters. Meta-regression techniques were used to explore factors modifying the observed