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PubMed1994

Heterotopic ossification after primary cemented and noncemented total hip arthroplasty in patients with osteoarthritis and rheumatoid arthritis.

OBJECTIVE: To compare the frequency and severity of heterotopic ossification (HO) in patients with osteoarthritis or rheumatoid arthritis who undergo cemented or noncemented total hip arthroplasty. DESIGN: A prospective case study. SETTING: A university referral centre. PATIENTS: One hundred and sixty one patients underwent 184 total hip arthroplasties. The 184 hips were categorized as follows: cemented total hip arthroplasty--60 osteoarthritis hips, 26 hips affected by rheumatoid arthritis; noncemented total hip arthroplasty--67 osteoarthritic hips, 31 hips affected by rheumatoid arthritis. INTERVENTIONS: Total hip arthroplasty. A standard approach was used to implant either a cemented or noncemented prosthesis. Radiographs were obtained of each hip preoperatively, immediately postoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. MAIN OUTCOME MEASURES: Radiographs were graded in blind fashion for HO, according to the criteria of Brooker. Modified Harris hip scores were calculated at 1 and 2 years postoperatively. RESULTS: HO (incidence of Brooker grades 2, 3 and 4) was greater after cemented (22%) than noncemented (9%) total hip arthroplasty in osteoarthritic hips (p < 0.05), but there was no significant difference between the two types of prosthesis in hips affected by rheumatoid arthritis. When both types of prosthesis were considered together there was no significant difference in the incidence of HO between osteoarthritic hips (15%) and hips affected by rheumatoid arthritis (12%). With respect to Harris hip score, the presence of grade 4 HO was associated with a significantly (p < 0.05) lower score (50.6) than grade 3 (89.4) and grade 2 (91) HO. CONCLUSIONS: Cemented total hip arthroplasty increases the frequency of HO only in osteoarthritic hips. Compared with Brooker's grades 2 and 3 HO, grade 4 HO significantly lowers the Harris hip score after total hip arthroplasty.

Adult↗
PubMed1996

Transfusion needs in hip and knee arthroplasty.

A 12 months retrospective study of cross-match and transfusion practice in hip and knee arthroplasty in a general orthopaedic unit was carried out aiming to assess the transfusion needs for these procedures prior to enrolling future patients in a pre-donation program for autologous transfusion. The study revealed acceptable transfusion practice in the unit. For both procedures, over 75% of all transfusions were carried out in the peri-operative period. Eighty-nine percent of patients undergoing hip arthroplasty required transfusion with a maximum of three units, while a maximum of only two units were needed to meet the transfusion requirements of 86% of patients undergoing knee arthroplasty. In hip arthroplasty, the overall transfusion index (Ti), was 2.05, and this value did not vary significantly according to preoperative haemoglobin values. This was in contrast to knee arthroplasty, where the Ti was 2.9 in patients with preoperative haemoglobin value less than 11 g/dL compared to only 0.6 for haemoglobin value greater than 13 g/dL. In conclusion, in an autologous transfusion program, the availability of three units would satisfy the transfusion needs in 89% of hip arthroplasties, while the availability of two units would satisfy the needs in 86% of knee arthroplasties. Preoperative donation for knee arthroplasty with a haemoglobin level over 13 g/dL may prove wasteful as in our current practice, the transfusion index in this group of patients was only 0.6.

Aged↗
PubMed1998

Outcomes for patients undergoing one or more total hip and knee arthroplasties.

Either total hip arthroplasty (THA), total knee arthroplasty (TKA) or both were performed in 105 patients from 1981 to 1994. These patients were experiencing severe joint destruction in the lower extremities due to rheumatoid arthritis (RA). These patients were followed for more than 2 years after their last operation. Eighty-six patients were alive and 19 patients had died at the time of follow-up. The 86 living patients were divided into four groups based on the number of replaced joints. Their pre- and postoperative conditions, including such factors as pain, mobility and disability for the quality of life (QOL), were compared. All of the four groups showed some reduction in pain and disability, and an improvement in ambulation after the operations. The 19 deceased patients were classified into two groups, one including those with multiple (three or four) arthroplasties and the other, those with only a small number (one or two). The mean age at death was lower (55.7+/-6.2 years) in patients with multiple arthroplasties than that (69.1+/-7.5 years) in patients with only a small number of arthroplasties. Secondary diseases from RA, such as amyloidosis, spinal injury and pulmonary fibrosis, were found to be the primary cause of death in patients with multiple arthroplasties. The most important finding in this study is that although RA patients with multiple arthroplasties in the lower extremities improved their QOL, they were still afflicted with secondary diseases derived from RA and experienced complications that could shorten their lifespan.

Adult↗
PubMedDate not supplied

Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study.

Shoulder arthroplasty outcomes have been reported in many case series. Typically, these series have followed either a single prosthesis used to treat a variety of arthritic disorders of the shoulder or experience in a single institution. In contrast, this report of a prospective study summarizes the experience of several surgeons with a single prosthetic design for treatment of primary osteoarthritis of the shoulder. A prospective, multicenter clinical outcome study evaluated 176 shoulders in 160 patients with primary osteoarthritis. This study evaluated a single prosthetic design (Global Shoulder) used by 19 contributing surgeons. Enrollment included 133 total shoulder replacements and 43 humeral head replacements (hemiarthroplasty) in 98 men and 62 women. Neither age nor sex affected whether hemiarthroplasty or total shoulder arthroplasty was performed. Patients with full-thickness cuff tears preferentially had hemiarthroplasty. The decision to perform total shoulder arthroplasty or hemiarthroplasty was based on the surgeon's preference. There were significant improvements (P <.001) in all evaluated and self-assessed outcome parameters from the preoperative baseline for both total shoulder arthroplasty and hemiarthroplasty. The results confirm that prosthetic arthroplasty leads to dramatic improvement in pain, function, and patient satisfaction. Intraoperative complications occurred in 5.4% of cases, and postoperative complications occurred in 7.8%. The most common intraoperative complications were intraoperative fractures, occurring in 9 cases. The most common postoperative complications were glenoid component loosening and humeral head subluxation. Almost all cases of humeral head instability were associated with rotator cuff tears or glenoid component loosening (or both). Seven shoulders underwent 9 additional surgeries during the 5-year study period. Thirteen shoulders in 11 patients were lost as a result of death unrelated to the procedure; 2 shoulders in 1 patient were lost within 3 days/3 months after the bilateral replacements as a result of death from pulmonary embolism. Nine percent of the shoulders (16/176) had full-thickness rotator cuff tears. Eight of the 16 shoulders with full-thickness supraspinatus cuff tears had hemiarthroplasty. All of these tears were isolated to the supraspinatus tendon, and all were repairable. There were no differences in postoperative pain, function, American Shoulder and Elbow Surgeons scores, or range of motion. There were no differences between total shoulder arthroplasty and hemiarthroplasty in those patients with a reparable rotator cuff tear. Total shoulder arthroplasty and hemiarthroplasty for treatment of primary osteoarthritis result in good or excellent pain relief, improvement in function, and patient satisfaction in 95% of cases. Avoiding intraoperative humeral shaft fractures through use of an uncemented, canal-filling prosthetic stem requires careful attention to reaming and component sizing. Postoperative humeral head subluxation is often associated with other factors including rotator cuff tears or glenoid component loosening.

Aged↗
PubMed2007

Success of clinical pathways for total joint arthroplasty in a community hospital.

Clinical pathways for total joint arthroplasty have been implemented successfully during the past decade. We report the results of pathway use for primary elective total hip and total knee arthroplasty in a community teaching hospital. We evaluated pathway efficacy using patient data forms and the hospital's financial database. Before instituting the pathway, the average length of stay was 4.41 days for patients having total hip arthroplasty and 3.92 days for patients having total knee arthroplasty. The average length of stay for patients having total hip arthroplasty decreased to 3.24 days and to 2.98 days for patients having total knee arthroplasty. Press Ganey Survey results showed high patient satisfaction rates before and after pathway initiation. Pathway implementation did not lead to increased complication rates or readmissions. Despite higher expected increases in the overall healthcare cost during the time of implementation (3 years), direct cost increases were limited to 3.48%. The key elements contributing to pathway success included preoperative patient education, standardized orders derived from evidence-based medicine, and a nurse practitioner who championed the pathway and ensured compliance. We recommend clinical pathways for patients having total joint arthroplasties to reduce length of stay, facilitate effective resource use, and preserve quality of care without compromising patient satisfaction or safety.

Aged↗
PubMed2006

Cancer after total joint arthroplasty: a meta-analysis.

BACKGROUND: Some epidemiologic and laboratory studies have suggested that total joint arthroplasty could increase the risk of cancer. In this meta-analysis, we attempt to clarify the association of joint arthroplasty with subsequent cancer incidence. METHODS: We identified population-based studies reporting standardized incidence ratios (SIR) for cancer following large joint arthroplasty. After summing the observed and expected numbers of cases across all qualifying studies, we calculated SIRs for all cancers, and for those at 28 anatomic sites. Latency analysis involving 175,166 patients characterized short-term and long-term cancer associations. RESULTS: The analyses included 1,435,356 person-years of follow-up and 20,045 cases of cancer. Overall cancer risk among patients with arthroplasty was equal to that for the general population. The relative risk of lung cancer, reduced in the first 5 years after arthroplasty, increased significantly over time to approach that of the general population. Risks for all sites in the luminal gastrointestinal tract were significantly reduced by 10% to 20%; with relative risks that were generally stable over time. Increased risks were seen for cancer of the prostate (SIR, 1.12; 95% confidence interval, 1.08-1.16); similar relative risks were seen in each time period after the procedure. For melanoma, relative risks increased with follow-up to a SIR of 1.43 (95% confidence interval, 1.13-1.79) for 10 or more years after arthroplasty. There was a similar delayed emergence of increased risks for cancers of the urinary tract and oropharynx. The relative risk for bone cancer decreased with time after the procedure. CONCLUSIONS: There does not seem to be an overall increased risk of cancer following total joint arthroplasty. Although the risks of prostate cancer and melanoma seem to be elevated, there is no obvious mechanism for these associations. Reductions in risk for some malignancies may not be causal.

Aged↗
PubMed2005

Blood salvage in total hip and knee arthroplasty in a community hospital: a retrospective study.

PURPOSES: To assess the results of postoperative and intra-operative blood salvage in patients undergoing total knee and hip arthroplasty, respectively, and to determine if both methods of blood salvage reduce allogeneic transfusion. METHODS: Of 229 patients who attempted blood salvage, 114 of 152 patients who underwent total knee arthroplasty received the salvaged blood postoperatively, 35 of 77 patients who underwent total hip arthroplasty received the salvaged blood intra-operatively. Various data were collected to assess whether certain factors resulted in autologous and/or allogeneic blood transfusions. RESULTS: Patients that received postoperative salvaged blood after total knee arthroplasty generally had higher postoperative levels of haemoglobin and haematocrit compared to those who did not. Patients with autologous blood transfusion following cemented knee surgery were less likely to require allogeneic blood transfusion. For hip arthroplasty patients, postoperative levels of haemoglobin and haematocrit were similar in both groups who received and did not receive salvaged blood. Lower preoperative haemoglobin and haematocrit levels correlated with a greater likelihood of autologous and/or allogeneic blood transfusion for both knee and hip arthroplasty patients. CONCLUSIONS: Although total knee arthroplasty patients who received salvaged blood had higher haemoglobin levels on the first postoperative day, the receipt of salvaged blood did not significantly reduce the incidence of allogeneic blood transfusion, because salvaged blood was a kind of blood loss. However, reinfusion of salvaged blood may reduce the number of units of allogeneic blood used. Given the short supply of allogeneic blood and its risks of transmitting disease, intra-operative and postoperative blood salvage carries clear advantages.

Aged↗
PubMed2006

Sports activity after total hip and knee arthroplasty : specific recommendations concerning tennis.

Lower extremity total joint arthroplasties are among the most successful operations in orthopaedics. Presently, it appears that some patients wish to not only have general functions restored, but also desire the opportunity to return or continue on a high level of activity. This review summarises the literature concerning athletic activity, and tennis in particular, in relation to lower extremity total joint arthroplasties. Orthopaedic surgeons frequently recommend participation in low-impact sports such as swimming, walking, bicycling, bowling and golf. The patient's return to these recreational activities appears to be without problems. In contrast, there has been a general consensus from surgeons to avoid high-impact sports such as tennis and jogging after total joint arthroplasty, but there have been numerous studies that reported functional results being compatible with these activity levels. Conflicts emerge with some studies that describe lower survival rates for hip and knee arthroplasty in patients participating in high-impact sports. Most of these studies report that participation in sporting activities following total joint arthroplasty refers to increased polyethylene wear and debris, which could eventually result in implant failure. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. Various studies assessing the association between clinical outcome and participation in tennis did not demonstrate a harmful effect on implant survival rates. Although the majority of these studies do not reflect a true representation of the average patient undergoing total joint arthroplasty, more surgeons are confronted with the patients' desire to continue with sports activity. To optimise results, patients who demand higher levels of activity must be carefully selected, and must have the motivation and drive to optimise their results. In general, all patients should be encouraged to remain physically active to improve general health, maintain good bone quality, and improve implant fixation. There is still a need for prospective, randomised controlled studies concerning high activity and its impact on total joint arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2026

Anti-inflammatory agents after hip and shoulder arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Postoperative inflammation after arthroplasty contributes to pain, delayed mobilization and prolonged hospitalization. Recent randomized trials have evaluated pharmacological anti-inflammatory strategies within contemporary enhanced recovery pathways, but evidence after hip and shoulder arthroplasty remains scattered across different drug classes and perioperative regimens. OBJECTIVES: To synthesize recent randomized controlled trial (RCT) evidence on perioperative anti-inflammatory agents after hip and shoulder arthroplasty. METHODS: PubMed, Embase, Cochrane Library and Web of Science were searched for English-language RCTs published from January 2020 to March 2026. The 2020-2026 window was selected to update evidence generated under modern arthroplasty, anesthesia, multimodal analgesia and enhanced recovery after surgery (ERAS) pathways. Eligible trials included adults undergoing hip or shoulder arthroplasty and compared corticosteroids, cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal anti-inflammatory drug (NSAID)-based/local anti-inflammatory regimens, or related anti-inflammatory interventions with placebo, saline, no treatment, or the same regimen without the target component. Weighted mean differences (WMDs) were pooled using random-effects models. RESULTS: Nine RCTs involving 800 patients were included. Anti-inflammatory interventions significantly reduced postoperative C-reactive protein (CRP) [WMD=-32.18, 95% confidence interval (CI) (-41.16, -23.21), P<0.001], interleukin-6 (IL-6) [WMD=-31.25, 95% CI (-41.79, -20.77), P<0.001], rest pain [WMD=-0.41, 95% CI (-0.58, -0.23), P<0.001], activity pain [WMD=-0.56, 95% CI (-0.83, -0.29), P<0.001] and hospital stay [WMD=-0.54, 95% CI (-0.92, -0.15), P=0.006]. CONCLUSION: Recent RCT evidence suggests that perioperative anti-inflammatory interventions can attenuate early inflammatory responses and improve short-term pain and recovery after hip and shoulder arthroplasty. Because data were limited and clinically heterogeneous, the findings should not be interpreted as evidence favoring a specific drug class, dose, route, or timing.

Humans↗
PubMed2005

A biomechanical comparison between the single-axis and multi-axis total knee arthroplasty systems for the stand-to-sit movement.

BACKGROUND: Compared to the design of a traditional multi-axis total knee arthroplasty, the single-axis arthroplasty studied has a fixed flexion/extension center of rotation in the femoral component. The influence of this characteristic on functional daily activity, i.e., stand-to-sit, is not well understood. The purpose of this study was to investigate the effect of different arthroplasty designs on knee kinematic and lower limb muscular activation for the stand-to-sit movement. METHODS: Sixteen unilateral, posterior-stabilized knee arthroplasty participants (8 single-axis and 8 multi-axis) with excellent Knee Society scores performed 4 trials of the stand-to-sit test. Three-dimensional video analysis of whole body and joint kinematics and electromyography analysis of quadriceps and hamstrings were conducted. One-way ANOVAs were used for statistical analyses (alpha=0.05). FINDINGS: The multi-axis group showed some functional adaptations while sitting down. The single-axis group exhibited less arthroplasty limb quadriceps electromyography and hamstring co-activation electromyography than the multi-axis group. For the arthroplasty limb, single-axis demonstrated less abduction angular displacement and reached peak abduction earlier than the multi-axis arthroplasty limb. The estimated effect size for this study was 0.196. INTERPRETATION: The single-axis design requires less eccentric knee extensor muscle activation and exhibits greater medio-lateral stability than the multi-axis designs. Findings from this study could provide useful information to orthopedic knee surgeons and rehabilitative specialists.

Adaptation, Physiological↗
PubMed2006

[Results of reimplantation for infected total knee arthroplasty: 107 cases].

PURPOSE OF THE STUDY: The purpose of this study was to assess the results of reimplantations of total knee arthroplasties complicated by infection. Outcome was assessed in terms of eradicated infection and function. MATERIAL AND METHODS: This retrospective multicentric study included 107 cases of infected total knee arthroplasties treated by changing the implants. Seventy-seven patients had a two-stage revision and thirty had a one-stage procedure. Patients were reviewed with a minimal 2-year and an average 52-month follow-up. RESULTS: Revision arthroplasty (one- or two-stage) eradicated infection in two out of three patients. With a two-year follow-up, revision arthroplasty was successful in 77% of patients without any sepsis risk factor, in 65% of patients with one risk factor and in 33% of patients with at least two risk factors. After reimplantation for total knee arthroplasty infection, overall function outcome was good (KS knee score: 74.8 after two-stage revision and 75.5 after one-stage revision, NS). After two-stage procedures, the knee outcome was excellent in one-third of patients, good in another third and fair or poor in the final third. After one-stage reimplantation, 40% of the knees had an excellent outcome, 30% a good outcome and 30% a fair or poor outcome. Regarding functional outcome, overall results were fair (KS function score 62.5 for one-stage and two-stage revisions). Functional outcome was fair or poor in 42% of patients with a two-stage procedure and in 55% of patients with a one-stage revision (NS). DISCUSSION: Our study was unable to disclose any difference between one-stage and two-stage revision for eradicating infection. Unfavorable systemic and local conditions decreased the rate of success after revision total knee arthroplasty for infection. Length of infection before reimplantation, number of surgical procedures and bacterial virulence or resistance were not, in our series, predicting factors for failure of septic revision total knee arthroplasty. No difference was found for the clinical and functional results between one-stage and two-stage procedures. Functional outcome was fair or poor for half of the patients after septic revision total knee arthroplsty. The use of an external device between the two procedures for two-stage revision significantly decreased the functional outcome compared with the use of a spacer. Articulated spacers did not offered any advantage compared with a static spacer for functional outcome.

Adolescent↗
PubMed1986

Surgical management of the rheumatoid wrist--fusion or arthroplasty.

Forty-eight patients with 33 wrist fusions and 37 silicone wrist arthroplasties were reviewed and compared. Of those who had arthrodesis 97% showed a good or excellent result. Follow-up time averaged 82 months. All patients had a decrease in pain. Most patients had stronger wrists but complained of decreased dexterity. There were no pseudarthroses. The complication rate was 18%. Of patients in the arthroplasty group, 78% had a good or excellent result. Follow-up time averaged 51 months. Most patients in the arthroplasty group had improved dexterity and adequate wrist strength. Average flexion/extension was 32 degrees/29 degrees. The complication rate was 25%, which included four revisions. Of patients who had arthroplasties, 14% had bone resorption about the stem, and 11% of the patients with arthroplasties had x-ray evidence of settling. Factors that did not influence the result of the arthroplasty were patient age, duration of disease before surgery, finger extensor tendon rupture, preoperative motion, and hand dominance. Factors that were associated with failure and/or a fair result in arthroplasty patients were the use of ambulatory aids, the older and narrower prosthetic design, dislocated wrist preoperatively, and the chronic use of steroids.

Adult↗
PubMed2002

Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review.

There are few published results in the literature on patello-femoral arthroplasty. The aim of this study was to help to define the place of patello-femoral arthroplasty in the treatment of isolated patello-femoral arthritis. All patients who underwent patello-femoral arthroplasty using the Lubinus prosthesis for patello-femoral arthritis between 1992 and 1998 in two neighbouring district general hospitals were studied. There were 34 patients who underwent 45 arthroplasties. The modified Hungerford and Kenna scoring system and the Insall and Crosby scoring system were used to clinically evaluate the patients. Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change. Twenty-three knees (64%) had a good or excellent result, six (17%) had an unsatisfactory result and seven (19%) were revised to either a total knee arthroplasty (5 knees) or patellofemoral arthroplasty (2 knees). Although the results do not compare favourably with those of total knee replacement for generalised arthritis of the knee; we believe that with careful patient selection coupled with careful surgical technique, patello-femoral arthroplasty can be successfully used to treat isolated patello-femoral osteoarthritis.

Adult↗
PubMed2001

Arthroplasty-associated malignant fibrous histiocytoma: two case reports.

AIMS: Sarcoma localized to the site of an arthroplasty procedure is a rare occurrence, and detailed histological depictions and descriptions are limited. We report the clinicopathological findings in two cases of arthroplasty-associated malignant fibrous histiocytoma (MFH) and review the literature. METHODS AND RESULTS: The patients were an elderly man and woman. Medical histories, radiographs and slides were reviewed. Immunohistochemistry, electron microscopy, cytogenetics, and electron dispersion spectroscopy were performed in one case. Both were destructive femoral bone tumours that appeared 2 and 8 years post-total hip arthroplasty, and pursued aggressive clinical courses. The histology was similar in both tumours, consisting of high-grade, pleomorphic sarcoma with numerous osteoclastic giant cells, prominent phagocytic activity, and entrapped particles of bone cement. Literature review disclosed 14 previous reports of arthroplasty-associated MFH, representing the most common phenotype. A number of materials and factors related to arthroplasty procedure, such as metal corrosion, wear debris, osteonecrosis, and chronic inflammation, have been implicated as causative agents. CONCLUSIONS: Arthroplasty-associated MFH is a rare and aggressive tumour. Although the aetiology remains unclear, the small number of arthroplasty-associated sarcomas compared with the large number of joint replacement operations performed over the past four decades suggests a coincidental as opposed to a causal relation.

Aged↗
PubMed2001

Acute colonic pseudo-obstruction after elective total joint arthroplasty.

A retrospective review of 31 patients who developed acute colonic pseudo-obstruction (ACPO) after total joint arthroplasty was undertaken to determine predisposing factors related to, and outcomes following, therapeutic intervention. Comparison with all patients who underwent total joint arthroplasty revealed an overall 1.2% incidence of ACPO. There was a higher incidence of ACPO in patients undergoing sequential bilateral total knee arthroplasty (3.4%) compared with unilateral total knee arthroplasty (0.3%) and a higher incidence in patients undergoing revision total hip arthroplasty (5.6%) compared with primary total hip arthroplasty (1.4%). Additional risk factors for developing ACPO included slow postoperative mobilization and male gender. No association was found with respect to body mass index, age, comorbidity, anesthetic type, international normalized ratio level, or postoperative analgesia. There were no deaths, and 2 patients required operative intervention. The remaining cases of ACPO resolved with nonsurgical treatment. In all cases, there was a prolonged length of hospitalization (mean, 13.2 days) compared with all other arthroplasties performed at our institution (mean, 7.5 days).

Acute Disease↗
PubMed2003

Fate of failed Meuli total wrist arthroplasty.

Sixteen Meuli wrist arthroplasties in 13 patients suffering mainly from rheumatoid arthritis were revised for failure. Causes for failure were mechanical problems with the implant in three wrists, soft tissue problems in two wrists and a combination of mechanical failure and soft tissue problems in 11 wrists. Management included 11 revision arthroplasties in ten wrists, four arthrodeses and two primary soft tissue reconstructions. Twenty-six additional soft tissue procedures were required in association with the revision arthroplasties or arthrodeses. Five of the 11 revision arthroplasties had to be converted to arthrodeses after an average of 5 (range 3-8) years. After removal of a failed wrist implant union of the salvage arthrodesis was difficult to achieve in two of the nine instances. This series demonstrates that revision arthroplasty may be a useful alternative to arthrodesis for the salvage of primary wrist arthroplasties in rheumatoid patients. However, complications and reoperations may occur after both revision arthroplasty and arthrodesis.

Adult↗
PubMedDate not supplied

Proprioceptive function in knees with and without total knee arthroplasty.

The goal of this study was to evaluate the differences in angle reproduction capability after nonconstrained posterior cruciate ligament retaining total knee arthroplasty after a follow-up time of 63.9 months compared with the healthy contralateral leg and a control group. In 28 total knee arthroplasty patients (mean age, 65.7 yr) and 25 control subjects (mean age, 55.7 yr), 16 measurements were made between 0 degrees and 90 degrees in 30 degree steps. The leg was positioned by the examiner and then relaxed; afterward, the subject was asked to reproduce the original position. Each measurement was made with the patient or control being blindfolded and not blindfolded to assess the influence of visual control. We found significant differences in total knee arthroplasty patients in contrast to healthy subjects. Without visual control, the mean deviation of the total knee arthroplasty group starting with a 0 degree angle was 7.7+/-5.9 degrees and 4.6+/-4.7 degrees for the healthy subjects. With visual control, the mean deviation in the patient group was 11+/-7.5 degrees, and in the control group, it was 7.2+/-5.0 degrees. Total knee arthroplasty patients did not show significant differences between the operated on and the contralateral knee. Also, in the total knee arthroplasty group, significant differences could not be found comparing reproduction with and without visual control and comparing both starting positions. In the control group, significant differences could be found comparing visual and nonvisual control in the 60 degree angle. The comparison between the 30 and 60 degree repositioning from both 0 and 90 degree starting positions showed a significant difference in the 60 degree angle. In summary, reduced proprioceptive capabilities are present after knee arthroplasty in both the operated on and the contralateral leg in our study group. Postoperative complaints can perhaps be explained by a loss of proprioceptive capabilities, especially at the 60 degree angle. The operative technique should involve special care of ligaments and muscles to preserve stability and receptors as well. Rehabilitation should pay more attention to the remaining receptors.

Aged↗
PubMed2000

Osteolytic indicators found in total knee arthroplasty synovial fluid aspirates.

Interleukin-1beta and tartrate resistant acid phosphatase concentrations in synovial fluid aspirates were examined to determine if they could be used as indicators of increased synovial inflammation and an osteolytic reaction in patients having total knee arthroplasty. Synovial aspirates were obtained from seven patients with severely osteoarthritic knees that were scheduled for primary total knee arthroplasty and from 20 patients with knees scheduled for total knee arthroplasty revision. Eleven of the revision cases involved titanium alloy prostheses and nine involved cobalt chrome alloy prostheses. The interleukin-1beta and tartrate resistant acid phosphatase concentrations were obtained and compared between the group having primary total knee arthroplasty and the group having revision total knee arthroplasty. The knees having revision surgery had higher concentrations of interleukin-1beta and tartrate resistant acid phosphatase than did the knees having primary total knee arthroplasty. These results indicate a greater inflammatory and osteolytic response in knees having revision surgery. Although the osteoarthritic knees and the knees needing revision surgery in this study are considered to have an inflammatory state, it was only after total knee arthroplasty when particulate wear debris would be present that appreciable concentrations of interleukin-1beta and tartrate resistant acid phosphatase were produced.

Acid Phosphatase↗