NICE Joint Replacement Guidelines: Partial vs Total Knee Replacement and Patellar Resurfacing

OrthoMedia ◽  
2021 ◽  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Patellar Resurfacing ◽  
Total Knee

Achieving Consensus on Total Joint Replacement Trial Outcome Reporting Using the OMERACT Filter: Endorsement of the Final Core Domain Set for Total Hip and Total Knee Replacement Trials for Endstage Arthritis

2017 ◽  
Vol 44 (11) ◽  
pp. 1723-1726 ◽  
Author(s):  
Jasvinder A. Singh ◽  
Michelle M. Dowsey ◽  
Michael Dohm ◽  
Susan M. Goodman ◽  
Amye L. Leong ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Working Group ◽  
Total Joint Replacement ◽  
Core Domain ◽  
Total Knee ◽  
Core Domain Set

Objective.Discussion and endorsement of the OMERACT total joint replacement (TJR) core domain set for total hip replacement (THR) and total knee replacement (TKR) for endstage arthritis; and next steps for selection of instruments.Methods.The OMERACT TJR working group met at the 2016 meeting at Whistler, British Columbia, Canada. We summarized the previous systematic reviews, the preliminary OMERACT TJR core domain set and results from previous surveys. We discussed preliminary core domains for TJR clinical trials, made modifications, and identified challenges with domain measurement.Results.Working group participants (n = 26) reviewed, clarified, and endorsed each of the inner and middle circle domains and added a range of motion domain to the research agenda. TJR were limited to THR and TKR but included all endstage hip and knee arthritis refractory to medical treatment. Participants overwhelmingly endorsed identification and evaluation of top instruments mapping to the core domains (100%) and use of subscales of validated multidimensional instruments to measure core domains for the TJR clinical trial core measurement set (92%).Conclusion.An OMERACT core domain set for hip/knee TJR trials has been defined and we are selecting instruments to develop the TJR clinical trial core measurement set to serve as a common foundation for harmonizing measures in TJR clinical trials.

The Effect of Micro Grooving on Goat Total Knee Replacement: A Finite Element Study

2020 ◽  
Author(s):  
Morshed Khandaker ◽  
Onur Can Kalay ◽  
Fatih Karpat ◽  
Amgad Haleem ◽  
Wendy Williams ◽  
...  
Keyword(s):  
Finite Element ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Mechanical Performance ◽  
The United States ◽  
Cement Interface ◽  
Bonding Failure ◽  
Total Knee ◽  
Joint Prostheses

Abstract A method to improve the mechanical fixation of a total knee replacement (TKR) implant is clinically important and is the purpose of this study. More than one million joint replacement procedures are performed in people each year in the United States, and experts predict the number to increase six-fold by the year 2030. Whether cemented or uncemented, joint prostheses may destabilize over time and necessitate revision. Approximately 40,000 hip arthroplasty surgeries have to be revised each year and the rate is expected to increase by approximately 140% (and by 600% for total knee replacement) over the next 25 years. In veterinary surgery, joint replacement has a long history and the phenomenon of surgical revision is also well recognized. For the betterment of both people and animals, improving the longevity of arthroplasty devices is of the utmost clinical importance, and towards that end, several strategies are under investigation. One approach that we explore in the present research is to improve the biomechanical performance of cemented implant systems by altering the implant surface architecture in a way that facilitates its cement bonding capacity. Beginning with the Charnley system, early femoral stems were polished smooth, but a number of subsequent designs have featured a roughened surface — created with bead or grit blasting — to improve cement bonding. Failure at the implant-cement interface remains an issue with these newer designs, leading us to explore in this present research an alternate, novel approach to surface alteration — specifically, laser microgrooving. This study used various microgrooves architectures that is feasible using a laser micromachining process on a tibia tray (TT) for the goat TKR. Developing the laser microgrooving (LM) procedure, we hypothesized feasibility in producing parallel microgrooves of precise dimensions and spacing on both flat and round metallic surfaces. We further hypothesized that laser microgrooving would increase surface area and roughness of the cement interface of test metallic implants and that such would translate into an improved acute mechanical performance as assessed in vitro under both static and cyclic loads. The objective was to develop a computational model to determine the effect of LIM on the tibial tray to the mechanical stimuli distributions from implant to bone using the finite element method. This study designed goat TT 3D solid model from a computer topography (CT) images, out of which three different laser microgrooves were engraved on TT sample by varying depth, height and space between two adjacent grooves. The simulation test results concluded that microgrooves acchitecures positively influence microstrain behavior around the implant/bone interfaces. There is a higher amount of strain observed for microgroove implant/bone samples compared to non-groove implant/bone samples. Thus, the laser-induced microgrooves have the potential to be used clinically in TKR components.

The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement

2019 ◽  
Vol 101 (14) ◽  
pp. 1261-1270 ◽  
Author(s):  
Christopher J. Vertullo ◽  
Stephen E. Graves ◽  
Alana R. Cuthbert ◽  
Peter L. Lewis
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Patellar Resurfacing ◽  
Total Knee ◽  
Revision Risk

scholarly journals RETROSPECTIVE ANALYSIS OF FUNCTIONAL OUTCOME OF TOTAL KNEE REPLACEMENT IN RURAL TEACHING SETUP

2021 ◽  
Vol 9 (12) ◽  
pp. 222-226
Author(s):  
Ketas Mahajan ◽  
Keyword(s):  
Knee Joint ◽  
Total Knee Replacement ◽  
Retrospective Analysis ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Observation Data ◽  
Knee Joint Replacement ◽  
Total Knee ◽  
Set Up ◽  
Rural Teaching

Background:Indian population is mainly residing in two areas- urban and rural. The literature has shown consistent results following knee joint replacement surgeries, however these studies have been done in highly efficient and equipped hospitals in urban areas. Aim: The aim of this study was to compare outcome at a rural set-up with those at a high-end teaching or corporate hospital in urban set-up from published literature. Materials and Methods: This study was an observational and retrospective analysis. Observation data was collected from January, 2020 and April, 2021. This study included follow-up of 60 total knee joint replacements. Results: In our study of total knee joint replacement surgeries in rural teaching set- up, we achieved 95.39% results (excellent) while the remaining 4.61% results were good. Conclusion: This study confirmed that results of total knee replacement are comparable to any other highly well equipped urban center, if all basic surgical principles including aseptic precautions are stringently followed-up. Further the clinical outcomes in our cases was more surgeon dependent rather than technology dependent as all surgeries were performed by one single surgeon.

scholarly journals The Effect on Long Term Survivorship of Surgeon Preference for Posterior Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63416 Cases from the AOANJRR

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Christopher Vertullo ◽  
Peter Lewis ◽  
Michelle Lorimer ◽  
Stephen Graves
Keyword(s):  
Total Knee Replacement ◽  
Selection Bias ◽  
Knee Replacement ◽  
High Volume ◽  
Patellar Resurfacing ◽  
Posterior Stabilized ◽  
Observational Series ◽  
Total Knee ◽  
Optimum Management

Introduction & Aims: Controversy still exists as to the optimum management of the PCL in TKR, with registry data suggesting Posterior Stabilised TKR have a higher Cumulative Percent Revision (CPR) compared to Minimally Stabilised TKR. Proponents of PS TKR suggest this difference is due to selection bias as result of preferential use of PS TKR in complex or more severe cases. To remove this selection bias, we aimed to compare CPR based on surgeon TKR stability preference to treat with PS or MS TKR rather than actual prosthesis type received. Method: Observational series. An analysis of AOANJRR data from 1999 – 2014 was utilized to identify two cohorts of high volume surgeons who preferred to use routinely either MS or PS TKR. Only fixed tibial inserts and patellar resurfacing TKR were included. A MS preferring surgeon used MS TKR at least 90% of the time and a PS preferring surgeon used PS TKR at least 90% of the time. Consequently, each patient cohort included both PS and MS TKR in differing proportions. Results: Procedures undertaken by PS preferring surgeons had a significantly higher risk of revision (CPR (Hazard Ratio = 1.45 (95% CI 1.30, 1.63), p< 0.001). There was a higher rate of revision for loosening and infection in the PS group. Of the 39 941 TKR with cemented fixation of both femur and tibia, the PS preferring surgeons had a higher CPR than the MS preferring cohort (HR = 1.55 (1.33, 1.80), p< 0.001). Regardless of whether the polyethylene was crosslinked or non-crosslinked, the MS preferring surgeons had a lower CPR compared to the PS preferring surgeons. Conclusions: In this analysis, procedures undertaken by surgeons who mainly preferred to use PS TKR had a higher rate of revision than those that mainly used MS TKR. This finding was irrespective of patient age and was also evident when fixation and the type of polyethylene used was taken into account.

Rasch Analysis for the Knee Injury and Osteoarthritis Outcome Score Joint Replacement Version in Individuals Awaiting Total Knee Replacement Surgery

2020 ◽  
Author(s):  
Saurabh P. Mehta ◽  
Joshua Jobes ◽  
Chloe Parsemain ◽  
Steve Lu ◽  
Kristie Kelley ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Lower Extremity ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Rasch Analysis ◽  
Knee Injury ◽  
Measurement Properties ◽  
Latent Construct ◽  
Outcome Score ◽  
Total Knee

AbstractThe aim of this study was to verify the single-factor structure of the joint replacement version of the Knee Injury and Osteoarthritis Outcome Score (KOOS-JR) and examine its measurement properties in the context of Rasch analysis in patients with end-stage osteoarthritis of the knee (KOA) awaiting total knee replacement (TKR). The study design was retrieval of prospectively collected clinical data. The data were extracted from the presurgery visit for individuals with KOA who were scheduled for primary TKR at a tertiary care hospital. Those who were scheduled for revision of TKR had any other lower extremity injury or surgery during 6 months prior to the presurgery visit, or those who had reported pre-existing neurological impairments affecting the lower extremity functions were excluded during data extraction. The assumptions of Rasch analysis that were examined included the test of fit, fit of residuals, ordering of item thresholds, Pearson separation index, differential item functioning (DIF), dependency, and unidimensionality. The main outcome measure was KOOS-JR. Data were extracted for 283 patients, including 112 men and 160 women, from clinical charts. The KOOS-JR demonstrated good overall fit to the Rasch model. However, it failed to meet the assumption of unidimensionality. None of the items demonstrated DIF or concerns with response thresholds. Person–item threshold distribution indicated that the score for KOOS-JR overestimated person traits with floor and ceiling effects. Reliability statistics were equal to 0.9, suggesting that seven items within the KOOS-JR were internally consistent and reliable. The hypothetical unidimensional KOOS-JR could not be reproduced in our sample in that KOOS-JR had a latent construct. Future research should perform exploratory factor analysis to examine this latent construct.

scholarly journals Do Knee Pain Phenotypes Have Different Risks of Total Knee Replacement?

2020 ◽  
Vol 9 (3) ◽  
pp. 632 ◽  
Author(s):  
Feng Pan ◽  
Jing Tian ◽  
Ishanka P. Munugoda ◽  
Stephen Graves ◽  
Michelle Lorimer ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Structural Damage ◽  
Latent Class ◽  
Emotional Problems ◽  
High Prevalence ◽  
Class 1 ◽  
Total Knee ◽  
Low Prevalence

Pain is the main impetus for osteoarthritis (OA) patients to seek healthcare including joint replacement. The pain experience in OA is heterogeneous and affected by factors across multiple domains—peripheral, psychological, and neurological. This indicates the existence of homogenous subgroups/phenotypes within OA patients with pain. We recently identified three pain phenotypes using a wide spectrum of pain-related factors, including structural damage on magnetic resonance imaging (MRI), emotional problems, number of painful sites, sex, body mass index, education level and comorbidities (i.e., Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%); Class 2: low prevalence of emotional problems and high prevalence of structural damage (20%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%)). This study was to examine whether the total knee replacement (TKR) risk over 12 years was different among these three pain phenotypes. Data on 963 participants (mean age 62.8 ± 7.4 years) from a population-based cohort study were utilised. Data on socio-demographic, psychological and comorbidities were collected. MRI of the right knee structural pathology was performed. TKR history was ascertained by linking to the Australian Orthopedic Association National Joint Replacement Registry. Latent class analysis and the Cox proportional hazards model were applied for the analysis. During the follow-up period, 41 right and 44 left TKRs in 67 participants were identified. In multivariable analyses, participants in Class 1 and 2 had a higher risk of having a TKR (Class 1 vs. Class 3, HR (hazard ratio) 4.81, 95%CI (confidence interval) 2.33–9.93; Class 2 vs. Class 3, HR 9.23, 95%CI 4.66–18.30). These associations were stronger in the imaged right knee but were also significant in the left knee. Participants within distinct pain phenotypes have different risks of TKR, suggesting that the identified phenotypes reflect distinct clinical subgroups with different prognoses. The risk for TKR was higher in Class 1 than that in Class 3, suggesting that pain/emotional status is a stronger driver for TKR than structural damage, and that selecting patients for TKR needs to be optimized in clinical practice.

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