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Asian Journal of Surgery Oct 2021Progressive resistance training (PRT) is one of the most commonly used exercise methods after joint replacement, while its effectiveness and safety are still... (Meta-Analysis)
Meta-Analysis Review
Progressive resistance training (PRT) is one of the most commonly used exercise methods after joint replacement, while its effectiveness and safety are still controversial. Therefore, it's vital to investigate the effect of PRT on muscle strength and functional capacity early postoperative total hip arthroplasty (THA) or total knee arthroplasty (TKA). Relevant studies were identified via a search of Medline, Web of science and Cochrane Library from 2002 to 12 May 2020. Fifteen of 704 studies which comprised 6 THAs and 8 TKAs, involving 1021 adult patients were eligible for inclusion in the meta-analysis. There were no significant differences between the two groups after TKA in the 6-min walk test (6-WMT) within 1 month (95% CI = -0.41, 1.53), within 3 months (95% CI = -0.27, 0.76), within 12 months (95% CI = -0.29, 0.66); climb performance in seconds (s) (SCP), leg extension power, timed up and go test in seconds (s) (TUG) within 1 month (95% CI = -1.75, 0.77), within 3 months (95% CI = -0.48, 0.33), within 12 months (95% CI = -0.44, 0.35), sit to stand, number of repetitions in 30s (ST). There was no difference in the incidence of adverse events (95% CI = -0.01, 0.10). Similarly, two groups were also no obvious distinction after THA in the 6-WMT, SCP, Leg extension power, ST. PRT early after THA or TKA did not differ significantly from SR in terms of functional capacity, muscle strength recovery and incidence of adverse events. PRT is one of the options for rapid rehabilitation after joint replacement.
Topics: Adult; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Postural Balance; Resistance Training; Time and Motion Studies
PubMed: 33715964
DOI: 10.1016/j.asjsur.2021.02.007 -
BMC Musculoskeletal Disorders Jul 2022Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge... (Observational Study)
Observational Study
BACKGROUND
Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA.
METHODS
Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥ 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).
RESULTS
In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥ 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥ 12 weeks of postoperative PT (range Odds Ratios 0.97-0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01-1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations.
CONCLUSION
Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients' needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities.
TRIAL REGISTRATION
Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197 .
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Physical Therapy Modalities; Recovery of Function; Treatment Outcome
PubMed: 35831841
DOI: 10.1186/s12891-022-05429-z -
Orthopaedics & Traumatology, Surgery &... Feb 2022The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population,... (Review)
Review
The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population, whose life expectancy is lengthening. Thus, fractures of the femur between proximal and distal implants, although rare, are becoming more frequent. Women over the age of 70, with fragile bones and whose ends of the two implants are close to each other ("kissing implants") are particularly vulnerable to them. Reliable and reproducible fracture classifications exist when it comes to 2 prostheses, but they are less well established in the presence of one, or even two, non-prosthetic implants. Their treatment is difficult and must consider the possibility of fracture consolidation while ensuring or restoring the stability and role of the implants. Whether it is the main element of treatment or a complement to prosthesis revision, locked plating forms the basis of the treatment but it must be rigorous, considering that failures are mainly the result of technical errors. Other more invasive treatments (total femoral arthroplasty, cortical sleeves) are offered more rarely if consolidation appears compromised.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bone Plates; Female; Femoral Fractures; Fracture Fixation, Internal; Humans; Periprosthetic Fractures; Reoperation; Treatment Outcome
PubMed: 34666198
DOI: 10.1016/j.otsr.2021.103117 -
Osteoarthritis and Cartilage Aug 2022To provide an evidence-based overview of the different surgical procedures in osteoarthritis (OA). (Review)
Review
OBJECTIVE
To provide an evidence-based overview of the different surgical procedures in osteoarthritis (OA).
DESIGN
This narrative review reports on surgical therapies (1) for severe, end stage OA and (2) of surgical options aiming to possibly reduce OA development earlier in the course of the disease.
RESULTS
Surgical practice guidelines provide evidence-based recommendations to assist in the clinical decision-making. Total joint arthroplasty represents the only valuable, established surgical option for severe, end stage OA. For hip and knee OA, it is by far the most common surgical procedure and provides considerable pain relief, functional restoration, and improved quality of life. Surgical therapy aiming to postpone OA essentially addresses extra- or intraarticular pre-osteoarthritic deformities, defined as congenital or acquired disturbances of the joint structure that adversely affect its function. Approaches in this category include osteotomies and different cartilage repair procedures such as osteochondral autograft and allograft transfer, marrow stimulation techniques, and autologous chondrocyte implantation. However, they are not only less commonly performed than arthroplasty, but the scientific clinical evidence in favour of this type of surgery to reduce the long-term risk of developing OA is considerably reduced.
CONCLUSION
Total knee and hip arthroplasty are two of the most successful procedures in all of medicine. As the progression of this insidious disease is often asymptomatic and slow, it is imperative to judge reparative procedures at their potential to reduce OA development at long-term, besides their primary clinical outcomes. Evidence-based guidelines provide a valuable tool for high-quality surgical decision making in OA.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Osteotomy; Quality of Life
PubMed: 35183776
DOI: 10.1016/j.joca.2022.01.012 -
Orthopaedics & Traumatology, Surgery &... Feb 2023The concept of stemless shoulder arthroplasty was born in 2005. It is now a valid option in the context of either anatomical or reverse shoulder replacement. Several... (Review)
Review
The concept of stemless shoulder arthroplasty was born in 2005. It is now a valid option in the context of either anatomical or reverse shoulder replacement. Several questions have come up over our 15 years of using this system: How was the stemless shoulder arthroplasty concept born? It was motivated by a desire to have epiphyso-metaphyseal fixation using a corolla-shaped impacted anchor design. What are the features of commercially available stemless shoulder arthroplasty implants? The stemless anatomical implants now available have either a cage or central peg that is impacted or a system that is screwed into the epiphysometaphyseal bone. Several companies have introduced stemless reverse implants, some of which have an onlay configuration. How do the results of stemless implants compare to those of traditional stemmed implants? At a mean follow-up of 10 years, the outcomes of stemless TSA can be superimposed with those of traditional stemmed TSA. What are the advantages of stemless shoulder implants? The advantages are their simple implantation, ability to adapt to patient morphology and any malunions, various orientation angles, no stress-shielding, reduced risk of infection and bleeding and less complex revision surgery (if needed). What are the limitations or drawbacks of using stemless implants? The two main limitations are insufficient metaphyseal bone stock and poor bone quality, especially for reverse configurations. What does the future hold for stemless shoulder arthroplasty? Like with traditional stemmed implants, the longevity of stemless shoulder arthroplasty depends on its tribology, which can still be improved. In the future, a stemless implant will need to be convertible like stemmed humeral implants, and if possible, provide an inlay reverse configuration.
Topics: Humans; Adolescent; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Prosthesis Design; Shoulder Prosthesis; Arthroplasty
PubMed: 36942793
DOI: 10.1016/j.otsr.2022.103460 -
Canadian Journal of Surgery. Journal... 2020The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time.
METHODS
A prospective, randomized, multicentre clinical study was conducted between February 2011 and July 2013, with an average follow-up of 55 months. Patients undergoing the direct anterior or posterior approach for THA were enrolled. Hospital length of stay, surgical time and complications were documented. The Harris Hip Score and visual analogue scale were used to monitor functional outcome and pain until 5 years postoperatively. Radiologic analysis was used to assess implant position.
RESULTS
Fifty-five patients (28 undergoing the direct anterior approach, 27 undergoing the posterior approach) were enrolled in this study. Length of stay, functional outcome, pain, implant position and complications were similar for the 2 approaches. There was a trend toward a better functional outcome for patients who underwent the direct anterior approach in the first 3 months postoperatively, with a peak at 4 weeks (Harris Hip Score 76.7 v. 68.7; = 0.08). Average surgical time for the direct anterior approach was significantly longer (69.9 v. 45.7 min; = 0.002).
CONCLUSION
The direct anterior approach for THA appears to be a safe and effective option. However, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov, no. NCT03673514.
Topics: Aged; Arthroplasty, Replacement, Hip; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Operative Time; Postoperative Complications; Prospective Studies; Recovery of Function; Time Factors; Treatment Outcome
PubMed: 33009898
DOI: 10.1503/cjs.012019 -
Brazilian Journal of Anesthesiology... 2021The role of the anesthesiologist in the perioperative management of hemostasis has attracted increasing attention. The fibrinolytic system participates in hemostasis,... (Review)
Review
INTRODUCTION AND OBJECTIVES
The role of the anesthesiologist in the perioperative management of hemostasis has attracted increasing attention. The fibrinolytic system participates in hemostasis, removing clots after repair of the vascular injury. Over the past two decades, several studies have assessed the efficacy and safety of antifibrinolytic agents in reducing perioperative bleeding and transfusion requirements. Some of the conditions that seem to benefit from antifibrinolytic drugs involve trauma, postpartum hemorrhage, cardiac surgery, spine surgery, knee or hip arthroplasty, urological and gynecological surgery, among others. However, there are currently few publications focusing on the perioperative features of fibrinolytic system, which will be the subject of the present review.
CONTENT AND CONCLUSIONS
Fibrinolytic physiology, its relationship with the clot structure and its perioperative behavior are described. Pathophysiological mechanisms related to anesthesiology clinical practice and their possible perioperative scenarios are addressed according to a suggested classification. This article aims to provide anesthesiologists with a broader understanding of the normal functioning of fibrinolysis, the mechanisms of possible deviations from normality in the perioperative period, the pathophysiological rationale supporting the current indications of antifibrinolytics, and some recent outcomes obtained with their use.
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Coagulation Disorders; Fibrinolysis; Humans
PubMed: 33712256
DOI: 10.1016/j.bjane.2020.12.007 -
The Knee Jan 2022Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of... (Observational Study)
Observational Study
BACKGROUND
Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of LOS > 5 days and readmission ≤ 90 days after revision knee arthroplasty in centers with a well-established fast-track protocol in both primary and revision surgery.
METHODS
An observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Knee Arthroplasty Register. We included elective aseptic major component revision knee arthroplasties consecutively from 6 dedicated fast-track centers from 2010 to 2018.
RESULTS
1439 revision knee arthroplasties were analyzed, including 900 total revisions, 171 large partial revisions (revision of either femoral or tibia component) and 368 revisions of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). Mean age was 65 years (SD 10.9) and 66% were females. Mean LOS was 3.7 days (SD 3.9) in the study period, but decreased to 2.4 days (SD 1.3) in 2018. Risk factors for LOS > 5 days was ≥ 1 previous revision, use of walking aid, BMI > 35, ages < 50, 70-79 and ≥ 80 years, whereas revision of UKA to TKA and large partial revision were negatively associated. The 90-day readmission and mortality risk was 9.1% and 0.5%. Cardiac disease and use of walking aid were associated with increased risk of readmission ≤ 90 days.
CONCLUSION
Elective aseptic major component revision knee arthroplasty using similar fast-track protocols as in primary TKA is safe with short and decreasing LOS.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cohort Studies; Elective Surgical Procedures; Female; Humans; Length of Stay; Reoperation
PubMed: 34894588
DOI: 10.1016/j.knee.2021.09.001 -
The Journal of Arthroplasty Nov 2022Joint arthroplasties are among the most commonly performed elective surgeries in the United States. Surgical outcomes are known to improve with volume but it is unclear...
BACKGROUND
Joint arthroplasties are among the most commonly performed elective surgeries in the United States. Surgical outcomes are known to improve with volume but it is unclear whether this has led to consolidation among elective surgeries. We examined trends in volumes per surgeon and hospital to assess whether the known volume-outcome relationship has led to consolidation in elective joint arthroplasty and to determine if there exist volume thresholds above which outcomes do not change.
METHODS
Among Medicare beneficiaries who underwent either total knee or total hip arthroplasty from 2009 through 2015, we described volume trends and used mixed-effect models to relate annual surgeon and hospital volumes with 30-day complications or mortality. We tested for optimal volume cut points at both the hospital and surgeon level.
RESULTS
Adjusted annual complication rates were inversely associated with volume for both procedures at both the surgeon level and hospital level, but there was minimal consolidation between 2009 and 2015. Complications no longer declined after volumes of each case exceeded 260 per year. The vast majority of cases (around 93% of hip and 88% of knee arthroplasties) were performed by surgeons operating at suboptimal volumes.
CONCLUSION
More than 2 decades after the volume-outcome relationship was established for joint arthroplasty, many cases continue to be performed by low-volume surgeons, with far more cases performed by surgeons operating at suboptimal volumes. Further improvement could be expected through consolidation at both the hospital and surgeon level, with a target of at least 260 cases per surgeon annually for each operation. Payers seem best-equipped to drive consolidation.
Topics: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Hospitals; Humans; Medicare; Postoperative Complications; United States
PubMed: 35568138
DOI: 10.1016/j.arth.2022.05.011 -
Acta Orthopaedica Jul 2022
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Postoperative Period
PubMed: 35848732
DOI: 10.2340/17453674.2022.3977