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Latest & greatest articles for knee replacement
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on knee replacement or other clinical topics then use Trip today.
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Improved fixation in cementless unicompartmental kneereplacement: five-year results of a randomized controlled trial When used for appropriate indications, unicompartmental kneereplacement is associated with fewer complications, faster recovery, and better function than total kneereplacement. However, joint registries demonstrate a higher revision rate for unicompartmental kneereplacement. Currently, most unicompartmental kneereplacements are cemented; common reasons for revision include (...) aseptic loosening and pain. These problems could potentially be addressed by using cementless implants, with coatings designed to improve fixation. The objectives of this study were to compare the quality of fixation as well as clinical outcomes of cemented and cementless unicompartmental kneereplacements at five years of follow-up.A randomized controlled trial was established with sixty-three knees (sixty-two patients) receiving either cemented (thirty-two patients) or cementless Oxford
Do modern total kneereplacements offer better value for money? A health economic analysis Do modern total kneereplacements offer better value for money? A health economic analysis Do modern total kneereplacements offer better value for money? A health economic analysis Hamilton DF, Clement ND, Burnett R, Patton JT, Moran M, Howie CR, Simpson AH, Gaston P Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract (...) replacements offer better value for money? A health economic analysis. International Orthopaedics 2013; 37(11): 2147-2152 PubMedID DOI Indexing Status Subject indexing assigned by NLM MeSH Aged; Arthroplasty, Replacement, Knee /economics /instrumentation /methods; Cost-Benefit Analysis; Disability Evaluation; Female; Health Care Costs /statistics & Humans; Knee Joint /physiology /surgery; Knee Prosthesis /economics; Life Expectancy; Male; Middle Aged; Osteoarthritis, Knee /surgery; Quality of Life; Quality
Analgesia after total kneereplacement: local infiltration versus epidural combined with a femoral nerve blockade: a prospective, randomised pragmatic trial In a randomised controlled pragmatic trial we investigated whether local infiltration analgesia would result in earlier readiness for discharge from hospital after total kneereplacement (TKR) than patient-controlled epidural analgesia (PCEA) plus femoral nerve block. A total of 45 patients with a mean age of 65 years (49 to 81) received
Five-year results of a randomised controlled trial comparing mobile and fixed bearings in total kneereplacement There is conflicting evidence about the merits of mobile bearings in total kneereplacement, partly because most randomised controlled trials (RCTs) have not been adequately powered. We report the results of a multicentre RCT of mobile versus fixed bearings. This was part of the knee arthroplasty trial (KAT), where 539 patients were randomly allocated to mobile or fixed bearings (...) difference between trial groups in OKS at five years (-1.12 (95% confidence interval -2.77 to 0.52) or any of the other outcome measures. Furthermore, there was no significant difference in the proportion of patients with knee-related re-operations or in total costs. In this appropriately powered RCT, over the first five years after total kneereplacement functional outcomes, re-operation rates and healthcare costs appear to be the same irrespective of whether a mobile or fixed bearing is used.
Steroid modulation of cytokine release and desmosine levels in bilateral total kneereplacement: a prospective, double-blind, randomized controlled trial The perioperative inflammatory response as measured by elevated levels of interleukin-6 (IL-6) has been linked to acute respiratory distress syndrome, postoperative confusion, and fever. Because of the extent of surgery,patients undergoing bilateral total knee arthroplasty may be at high risk of complications. We had found a significant (...) decrease in IL-6 in patients having bilateral total kneereplacement who received two doses of 100 mg of hydrocortisone eight hours apart; however, by twenty-four hours, IL-6 levels were equal to those in the group that received a placebo. In the present study, we investigated whether the administration of three doses would reduce IL-6 levels at twenty-four hours and affect other outcomes such as desmosine level, a marker of lung injury.After institutional review board approval, a total of thirty-four
Cryotherapy Machines versus Ice Packs for the Post-Operative Management of Anterior Cruciate Ligament Replacement Surgery or Total Knee Arthroplasty: Clinical Evidence and Guidelines 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 (...) by the owners’ own terms and conditions. TITLE: Cryotherapy Machines versus Ice Packs for the Post-Operative Management of Anterior Cruciate Ligament Replacement Surgery or Total Knee Arthroplasty: Clinical Evidence and Guidelines DATE: 28 November 2012 RESEARCH QUESTIONS 1. What is the clinical evidence for the use of cyrotherapy machines versus ice packs for the post-operative management of anterior cruciate ligament replacement surgery or total knee arthroplasty? 2. What are the evidence-based guidelines
Does Exercise Reduce Pain and Improve Physical Function Before Hip or KneeReplacement Surgery? A Systematic Review and Meta-Analysis of Randomized Controlled Trials To investigate the preoperative effects of exercise-based interventions on pain and physical function for people awaiting joint replacement surgery of the hip or knee.Four computer databases (CINAHL, MEDLINE, Embase, and Cochrane Library) were searched until July 4, 2012. Search terms included knee, hip, joint replacement (...) , arthroplasty, physiotherapy, physical therapy, exercise, hydrotherapy, rehabilitation, and preoperative. Reference lists of retrieved articles were also screened.Randomized or quasi-randomized studies comparing an exercise-based intervention with a no-intervention group for people awaiting hip or knee joint replacement surgery were included. Outcomes were pain and physical function including self-reported function, walking speed, and muscle strength. One of 2 reviewers determined that 18 studies met
Cancellation of Hip and KneeReplacement Surgeries: Guidelines 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 responses should be considered along (...) . It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions. TITLE: Cancellation of Hip and KneeReplacement Surgeries: Guidelines
Does a mobile-bearing, high-flexion design increase knee flexion after total kneereplacement? This prospective randomised controlled double-blind trial compared two types of PFC Sigma total kneereplacement (TKR), differing in three design features aimed at improving flexion. The outcome of a standard fixed-bearing posterior cruciate ligament-preserving design (FB-S) was compared with that of a high-flexion rotating-platform posterior-stabilised design (RP-F) at one year after TKR. The study (...) group of 77 patients with osteoarthritis of the knee comprised 37 men and 40 women, with a mean age of 69 years (44.9 to 84.9). The patients were randomly allocated either to the FB-S or the RP-F group and assessed pre-operatively and at one year post-operatively. The mean post-operative non-weight-bearing flexion was 107° (95% confidence interval (CI) 104° to 110°)) for the FB-S group and 113° (95% CI 109° to 117°) for the RP-F group, and this difference was statistically significant (p = 0.032
Rationing of total kneereplacement: a cost-effectiveness analysis on a large trial data set Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
The blood-saving effect of tranexamic acid in minimally invasive total kneereplacement: Is an additional pre-operative injection effective? Tranexamic acid (TEA), an inhibitor of fibrinolysis, reduces blood loss after routine total kneereplacement (TKR). However, controversy persists regarding the dosage and timing of administration of this drug during surgery. We performed a prospective randomised controlled study to examine the optimum blood-saving effect of TEA in minimally invasive TKR
Review: Factor Xa inhibitors reduce DVT more than LMWH in total knee or hip replacement. 22910959 2012 10 19 2012 08 22 1539-3704 157 4 2012 Aug 21 Annals of internal medicine Ann. Intern. Med. ACP Journal Club: review: factor Xa inhibitors reduce DVT more than LMWH in total knee or hip replacement. JC2-5 10.7326/0003-4819-157-4-201208210-02005 Bona Robert R Frank H. Netter School of Medicine at Quinnipiac University Hamden, Connecticut, USA. eng Comment Journal Article United States Ann Intern
Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic review, meta-analysis, and indirect treatment comparisons Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic review, meta-analysis, and indirect treatment comparisons Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or kneereplacement: systematic (...) review, meta-analysis, and indirect treatment comparisons Gomez-Outes A, Terleira-Fernandez AI, Suarez-Gea L, Vargas-Castrillon E CRD summary This generally well-conducted review concluded that higher efficacy in prevention of symptomatic venous thromboembolism in new anticoagulants following total knee or hip replacement was associated with a higher risk of bleeding. This conclusion accurately reflects the evidence and is likely to be reliable. Authors' objectives To assess clinical outcomes
Apixaban versus enoxaparin for thromboprophylaxis after hip or kneereplacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials In order to compare the effect of oral apixaban (a factor Xa inhibitor) with subcutaneous enoxaparin on major venous thromboembolism and major and non-major clinically relevant bleeding after total knee and hip replacement, we conducted a pooled analysis of two previously reported double-blind (...) randomised studies involving 8464 patients. One group received apixaban 2.5 mg twice daily (plus placebo injection) starting 12 to 24 hours after operation, and the other received enoxaparin subcutaneously once daily (and placebo tablets) starting 12 hours (± 3) pre-operatively. Each regimen was continued for 12 days (± 2) after knee and 35 days (± 3) after hip arthroplasty. All outcomes were centrally adjudicated. Major venous thromboembolism occurred in 23 of 3394 (0.7%) evaluable apixaban patients
Do we need a gender-specific total kneereplacement? A randomised controlled trial comparing a high-flex and a gender-specific posterior design The purpose of this study was to investigate whether a gender-specific high-flexion posterior-stabilised (PS) total kneereplacement (TKR) would offer advantages over a high-flex PS TKR regarding range of movement (ROM), 'feel' of the knee, pain and satisfaction, as well as during activity. A total of 24 female patients with bilateral osteoarthritis (...) entered this prospective, blind randomised trial in which they received a high-flex PS TKR in one knee and a gender-specific high-flexion PS TKR in the other knee. At follow-up, patients were assessed clinically measuring ROM, and questioned about pain, satisfaction and daily 'feel' of each knee. Patients underwent gait analysis pre-operatively and at one year, which yielded kinematic, kinetic and temporospatial parameters indicative of knee function during gait. At final follow-up we found
Long-Term Comparison of Fixed-Bearing and Mobile-Bearing Total KneeReplacements in Patients Younger Than Fifty-one Years of Age with Osteoarthritis There is limited information comparing the results of fixed-bearing total kneereplacement and mobile-bearing total kneereplacement in patients with osteoarthritis who are younger than fifty-one years and who have a fixed-bearing implant in one knee and a mobile-bearing implant in the other. The purpose of this study was to compare our long-term (...) clinical and radiographic results of fixed-bearing total kneereplacement and mobile-bearing total kneereplacement in a group of patients from this population.We prospectively compared the results of 108 patients with osteoarthritis who were younger than fifty-one years (mean age, forty-five years) who had received a fixed-bearing prosthesis in one knee and a rotating platform mobile-bearing prosthesis in the other. The mean follow-up was 16.8 years (range, fifteen to eighteen years). The patients
Oral direct factor Xa inhibitors versus low-molecular-weight heparin to prevent venous thromboembolism in patients undergoing total hip or kneereplacement: a systematic review and meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Oral Direct Factor Xa Inhibitors Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Patients Undergoing Total Hip or KneeReplacement: A Systematic Review and Meta-analysis. Thromboembolic disease is the most frequent medical complication of arthroplasty.To evaluate the benefits and harms of oral direct factor Xa inhibitors versus low-molecular-weight heparin (LMWH) in patients undergoing total hip or knee replacement.MEDLINE (1966 to December 2011), EMBASE (1980 (...) to December 2011), and the Cochrane Central Register of Controlled Trials (up to December 2011), without language restrictions. References of reviews and abstracts of conferences were hand-searched.Randomized trials in patients undergoing hip or kneereplacement that evaluated factor Xa inhibitors versus LMWH.Two reviewers independently evaluated eligibility, abstracted the data, and assessed risk for bias.In 22 trials, high-quality evidence indicated that the absolute effect of factor Xa inhibitors