scholarly journals Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update

2018 ◽  
Vol 9 (4) ◽  
Author(s):  
Vishesh Khanna ◽  
Senthil N. Sambandam ◽  
Munis Ashraf ◽  
Varatharaj Mounasamy
Keyword(s):  
Soft Tissues ◽  
English Literature ◽  
Published Data ◽  
Congenital Disorders ◽  
Evidence Based ◽  
Thought Process ◽  
Radiological Assessment ◽  
Ambulatory Status ◽  
Total Knee ◽  
Anatomical Alignment

Critical to the success of a total knee arthroplasty (TKA) is the anatomical alignment. This may appear as a challenge in an extra-articular deformity (EAD) that may be inherent in certain people or result from fracture malunion, congenital disorders, nutritional, metabolic and infective causes. This appraisal aimed at providing the reader with an up-todate overview of the research carried out on, and existent evidence of EAD correction while planning a TKA. We reviewed the current English literature on TKA in extra-articular knee deformities. Among the published data, a common initial approach of mandatory clinical and radiological assessment emerges as an obligatory step while handling cases with EAD. While several methods of managing the deformity and arthritis have been described, a broad division into intra-articular and extra-articular means can be deciphered. The relatively old-school, yet reliable thought process of extra-articular correction allows an all-inclusive restoration of alignment with the inherent complications related to the necessary osteotomy. A cohort of younger and more venturesome surgeons seem inclined towards performing navigated, intra-articular correction for mild to moderate and sometimes, severe deformities. The crux of the matter lies is obtaining a well-balanced knee without violating the all-important cruciates. Restoring the patient’s ambulatory status seems sooner with the intra-articular methods which are also more precise in determining the axes and while removing minimum bone. Greatest satisfaction is accomplished in those with less grotesque, rotationallyaligned knees while meticulously balancing soft-tissues and encouraging earlier weightbearing.

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

scholarly journals Diagnostic algorithm in septic total knee arthroplasty failure – What is evidence-based?

2021 ◽  
Vol 23 ◽  
pp. 208-215
Author(s):  
Christian Suren ◽  
Igor Lazic ◽  
Maximilian Stephan ◽  
Florian Walter Lenze ◽  
Florian Pohlig ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Diagnostic Algorithm ◽  
Evidence Based ◽  
Total Knee ◽  
Arthroplasty Failure

scholarly journals Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

2011 ◽  
Vol 57 (6) ◽  
pp. e1-e47 ◽  
Author(s):  
David B Sacks ◽  
Mark Arnold ◽  
George L Bakris ◽  
David E Bruns ◽  
Andrea Rita Horvath ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Laboratory Analysis ◽  
Published Data ◽  
Expert Committee ◽  
Evidence Based ◽  
Hb A1c ◽  
Written Comments ◽  
Patients With Diabetes ◽  
Practice Committee

BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (Hb A1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.

scholarly journals Wound Issues after Total Knee Arthroplasty

2015 ◽  
Vol 5 (1) ◽  
pp. 10-13
Author(s):  
Douglas A Dennis
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Wound Complications ◽  
Operative Techniques ◽  
Proper Selection ◽  
Wound Healing Problems ◽  
Total Knee ◽  
Selection Of

ABSTRACT Wound healing problems following total knee arthroplasty (TKA) are infrequent, but if present may lead to devastating results. Occurrence may be minimized by modifying patient risk factors, proper selection of skin incisions, and using operative techniques that protect soft tissues. When wound complications arise, prompt management is imperative to assure the best outcome after TKA. Jennings JM, Dennis DA. Wound Issues after Total Knee Arthroplasty. The Duke Orthop J 2015;5(1):10-13.

A Bibliometric Analysis of COVID-19 Across Economics and Business Research Landscape

2021 ◽  
Vol 9 (3) ◽  
Author(s):  
Nida Nida ◽  
Ashish Chandra ◽  
Ruchi Shukla
Keyword(s):  
Quantitative Assessment ◽  
Research Study ◽  
Published Data ◽  
Evidence Based ◽  
Port City ◽  
Business Research ◽  
Precise Knowledge ◽  
Global Issue ◽  
Extensive Introduction ◽  
Data Source

The Coronavirus disease which generated the unique virus appeared first in Port city of Hubei, China at the close of 2019, which significantly changed the whole humankind around the globe. Because of it’s rapid outspread, it taken into consideration as a global issue such as health, wellness, social and economic, eventually it ended up being a significant global health as a result of its pathogenicity. In spite of an expanding rate, modest  is investigated about the present state, The lack of understanding on this has motivated academic element for detailed check out, This bibliometric examined the peer scientific literary works to figure out the procedure of noesis on COVID-19, The research study is based upon bibliometric researches on Coronavirus, published data were collected from Scopus data source, quantitative assessment was carried out to evaluate the features of the present learning and generate visualizations for understanding, 668 documents were preserved. Web of writers, as well as nations were picturized in maps. However, COVID-19 search discloses special archeozoic use knowledge, spot a spaciotemporal as well as extensive introduction continues to be untended.. The precise knowledge on n-Cov is helpful for evidence-based policymakers in direction to avert and also resolve the pandemic.

Monophasic Synovial Sarcoma Arising in the Vulva: A Case Report and Review of the Literature

2008 ◽  
Vol 132 (4) ◽  
pp. 698-702
Author(s):  
Beverly E. White ◽  
Alan Kaplan ◽  
Dolores H. Lopez-Terrada ◽  
Jae Y. Ro ◽  
Robert S. Benjamin ◽  
...  
Keyword(s):  
Synovial Sarcoma ◽  
Soft Tissues ◽  
English Literature ◽  
Review Of The Literature ◽  
First Case ◽  
Additional Surgery ◽  
Synovial Sarcomas ◽  
The Right ◽  
Disease Free ◽  
Vulvar Mass

Abstract Synovial sarcomas most commonly arise in the soft tissue of the extremities. Less commonly, these tumors present in the head and neck, abdominal wall, and other sites. However, synovial sarcoma occurring in the vulvar area is extremely rare. Only 2 previous cases of biphasic synovial sarcoma of the vulva have been reported, but no case of vulvar monophasic synovial sarcoma has been described in the English literature. We report the third case of synovial sarcoma and apparently the first case of monophasic synovial sarcoma arising in soft tissues of the vulva. The patient was a 33-year-old woman who presented for evaluation of a painless vulvar mass. The tumor was located in the deep fibroadipose tissue of the right vulva (6.5 × 4.2 × 3.5 cm). The histology of the lesion was that of a monophasic synovial sarcoma with a hemangiopericytic vascular pattern. A subsequent molecular analysis revealed SYT-SSX2 gene fusion, which confirmed the diagnosis of synovial sarcoma. After an initial wide local excision, the patient developed a recurrence in the right groin and received chemotherapy and additional surgery. The patient is currently disease free, on adjuvant chemotherapy, and being followed up closely.

Tourniquet Use in Total Knee Arthroplasty

2019 ◽  
Vol 32 (08) ◽  
pp. 719-729 ◽  
Author(s):  
Jaymeson R. Arthur ◽  
Mark J. Spangehl
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Complications ◽  
Evidence Based ◽  
Increased Risk ◽  
Negative Effect ◽  
Total Knee ◽  
Controversial Topic ◽  
Antibiotic Delivery

AbstractTourniquet use in total knee arthroplasty has become a controversial topic. There are several benefits of its use including improved visualization, decreased blood loss, shorter operative times, and improved antibiotic delivery. Conversely, there are several significant downsides associated with tourniquet use including postoperative pain, neuromuscular injuries, wound complications, reperfusion injury, increased risk of thrombosis, patellar tracking issues, delayed rehabilitation including decreased postoperative range of motion, and its negative effect on patients with vascular disease. However, objectively, the literature does not definitively push us toward or away from the use of a tourniquet. Furthermore, several alternatives have been developed to help mitigate some of the adverse effects associated with its use. This article summarizes the evidence for and against tourniquet use and provides an evidence-based approach to help guide surgeons in their own practice.

scholarly journals Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

2019 ◽  
Vol 8 (10) ◽  
pp. 495-501 ◽  
Author(s):  
Emily L. Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew E. Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Soft Tissue Damage ◽  
Anatomical Structures ◽  
Cruciate Retaining ◽  
Robotic Assisted ◽  
Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

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