Search

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

With the spread of enhanced recovery protocols, the management of the perioperative pathway of patients undergoing major orthopaedic surgery has been harmonised to these international standards. A natural evolution of the enhanced recovery framework is to integrate personalised pathways of care for those with unique needs, thus addressing inter-individual differences. Personalised nutrition is the practice of attributing a personal imprint to the perioperative nutritional support and has the potential to ensure more effective and equitable care for those patients who may require more than standard support. The authors of this opinion article review each important element of personalisation with respect to their coverage of what is important in the perioperative care of major orthopaedic procedures such as hip and knee replacement. [ABSTRACT FROM AUTHOR]

The study compares the body mass index (BMI), 10-m walk test results, and self-rated health-related quality of life (HRQoL) of patients awaiting total knee or hip arthroplasty with age and sex-matched controls. Additionally, we investigated relationships between these variables to better understand how mobility impairments and HRQoL contribute to the need for surgical intervention. Forty-three patients (age: 66.7 ± 8.7 years) awaiting total knee arthroplasty (n = 23) or total hip arthroplasty (n = 20) and 54 healthy control individuals (age: 65.6 ± 1.5 years) participated in this study. Weight and height were measured, the BMI was calculated, the 10 m walk test was performed, and HRQoL was assessed using the EQ-5D-5L questionnaire. Patients had a significantly higher BMI than controls (p = 0.037), with the majority of both groups classified as overweight or obese (patients, 86%; controls, 73%). Patients also walked significantly more slowly than controls (p < 0.001). HRQoL was significantly lower in patients across all dimensions (p < 0.001), with the greatest impairments observed in mobility, usual activities, and pain. Significant but weak correlations (p = 0.001–0.042, rs = 0.31–0.48) were found between the HRQoL, BMI, and 10 m walk test results. These findings confirm that patients awaiting total knee or hip arthroplasty exhibit an increased BMI, reduced locomotor function, and impaired HRQoL, highlighting the extent of functional limitations in individuals with end-stage osteoarthritis. The strong association between mobility impairments and HRQoL further underscores the impact of osteoarthritis on daily life and the increasing need for surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: To explore the factors that affect the efficacy of knee replacement surgery in hemophiliacs. Methods: A retrospective analysis was conducted on 87 patients with hemophilia (PWH) (117knees) who underwent knee arthroplasty in our hospital from January 2012 to December 2020 (mean follow-up 70.8 ± 22 months). General information, hemophilia information, surgical information, follow-up information and psychological assessment information were collected. The knee joint efficacy was evaluated using the Hospital for Special Surgery (HSS) knee score, the American Knee Society's Clinical (KSC) and Functional (KSF) scores, flexion contracture degree (FC), range of motion (ROM), and wound healing. The excellent and poor groups were divided based on these factors. Logistic regression analysis was used to analyze factors that may affect the knee joint efficacy of patients. Results: Seventy-four cases of excellent knee joints and 43 cases of poor knee joints were included. Single factor analysis: The pre-ROM, SF-12MCS, HSS, KSF, and KSC of the excellent group were significantly higher than those of the poor group (P < 0.05); the Hamilton Depression Scale (HAMD), Preoperative Visual Analogue Scale(Pre-VAS), pre-FC degree of the excellent group were significantly lower than those of the poor group (P < 0.05). The proportion of patients undergoing Simultaneous bilateral knee replacement, severe hemophilia, and quadricepsplasty during surgery in the excellent group was significantly lower than that in the poor group (P < 0.05). Logistic regression: Pre-ROM and Simultaneous bilateral knee replacement are independent risk factors affecting knee joint efficacy. Pre-ROM is positively correlated with knee joint efficacy, while Simultaneous bilateral knee replacement is negatively correlated. Conclusion: In PWH, the efficacy of knee replacement surgery is related to preoperative ROM and Simultaneous bilateral knee replacement. Better preoperative knee joint mobility is associated with improved outcomes, whereas Simultaneous bilateral knee replacement negatively impacts surgical efficacy. [ABSTRACT FROM AUTHOR]

Population-based studies have been inconsistent in terms of the relationship between bone mineral density (BMD) and the progression of osteoarthritis. This study aimed to evaluate the causal relationship between BMD and the risk of joint replacement in patients with osteoarthritis. We performed a two-sample Mendelian randomization (MR) analysis to determine the association of BMD of the total body, femoral neck, and lumbar spine with the risk of hip and knee replacements. Inverse variance weighting (IVW) was used as the main analysis method. Heterogeneity and horizontal pleiotropy were checked. Multivariable MR analysis was performed by adjusting for hip/knee pain, body mass index (BMI), estrogen levels, BMI-based sex hormone-binding globulin (SHBG) levels, and physical activity. BMD of the total body and the lumbar spine were significantly associated with higher risks of both knee (IVW odds ratios (ORs) = 1.08–1.10, p = 4.62E-03) and hip replacements (IVW ORs = 1.19–1.37, P = 3.23E-09). Femoral neck BMD was significantly associated with the risk of hip but not knee replacement (IVW OR = 1.27, 95% confidence interval 1.13 to 1.43, p = 9.15E-05). Multivariable MR analyses produced similar results compared to the univariable analyses. No evidence of heterogeneity and horizontal pleiotropy were found, except that there was heterogeneity in the association between total body BMD and the risk of knee replacement. BMD is significantly associated with an increased risk of both knee and hip replacement, and the association is stronger for hip replacement. These findings suggest a causal relationship between BMD and the progression of osteoarthritis. Key Points • BMD is associated with an increased risk of hip and knee joint replacement. • BMD was more strongly associated with hip replacement risk. [ABSTRACT FROM AUTHOR]

Background: In the landscape of knee-related health issues there has been a notable shift in treatment protocols. Nowadays, there is a growing trend toward primary total knee arthroplasty (TKA) in the event of periarticular knee fractures. A review of the literature on TKA in acute knee fractures has been done in order to provide scientific evidence to the four statements submitted for voting to the members of the European Knee Society (EKS). Materials and Methods: A literature review has been performed around four topics of TKA in acute knee fractures, specifically: 1) The indications for TKA in acute knee fractures are undoubtful and clear; 2) Pre-existing osteoarthritis is not mandatory for the indication of TKA in acute fractures, while age, co-morbidities and type of fracture are; 3) A series of established criteria with scores to give indication for TKA (approved algorithm) is needed; and 4) This (complex) surgery must be performed in referral centers with all technical options and specific peri-operative management and post-operative care. Results: The panel of experts therefore believes that the indications cannot be considered undoubtful and clear. According to the literature up to the time of the consensus vote, there was no objective method for deciding on the treatment to offer the patient (Agree: 34.1%, Disagree: 61%, Abstain: 4.9%). It emerges that there are no mandatory conditions for the treatment of acute knee fractures with TKA (Agree: 32.3%, Disagree: 51.6%, Abstain: 16.1%). However, there are several characteristics to consider for a multifactorial evaluation rather than being limited to a single condition. While the consensus has highlighted a need for a scoring system to guide surgical decisions in periarticular knee fractures (Agree: 88.24%, Disagree: 8.82%, Abstain: 2.94%), research in the literature has confirmed that, to date, no validated algorithm exists. After the vote, a score was proposed, which requires validation. Although the panel of experts does not deem it necessary for this surgery to be reserved for reference centers (Agree: 32.35%, Disagree: 50%, Abstain: 17.65%), literature suggests that it is crucial that before undertaking knee arthroplasty in the setting of an acute fracture around the knee, the orthopedic surgeon is confident with all the necessary skills for a complex intervention that requires advanced knowledge and practical competence in osteosynthesis and revision TKA. Conclusion: This discussion on the questions voted by the panel of experts has allowed for an in-depth exploration of a topic of interest, assessing indications, contraindications, types of possible treatment, and the critical aspects to consider when treating an acute fracture around the knee with a prosthesis. It is important to consider that the choice must be carefully weighed, evaluating the risks and benefits, with an increasingly need for a scoring system for selecting the most appropriate treatment. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsthe aim of this systematic review was to evaluate the efficacy of electro-analgesia after knee arthroplasty surgery.the literature search involved multiple databases. All randomized controlled trials (RCTs) were included and pain assessment or analgesic consumption were considered as outcomes. Risk of Bias analysis, me-ta-analysis and GRADE method was applied.11 articles were selected for quantitative data analysis. In the meta-analyses for VAS on first and third day after surgery, the mean difference was lower in the intervention group by 0.5 (CI: −1.03; 0.03) and 0.66 (CI: −1.2; −0.11) points with a significance equal to 0.07 and 0.02 respectively but with high heterogeneity. On the fifth day the difference disappeared (mean difference: −0.02; CI: −0.75, 0.71; p = 0.96).There is no evidence to support the effectiveness of electro-analgesia treatment following knee replacement surgery. A low certainty of evidence showed a limited effect of this treatment modality. [ABSTRACT FROM AUTHOR]

Introduction: Unicompartmental knee arthroplasty (UKA) treats osteoarthritis in one knee compartment, while total knee arthroplasty (TKA) addresses all compartments. The debate focuses on UKA's advantages of quicker recovery and fewer complications versus TKA's lower long-term revision rates, emphasizing the need for thorough outcome evaluations. The aim of the present study is to describe and compare the pain, functional and psychological trajectories during a 6-month postoperative rehabilitation period between total and unicompartmental knee arthroplasties. Materials and Methods: 115 participants who had undergone either TKA or UKA were recruited. Outcome measurements were performed at 1, 4, 12 and 24 weeks post-surgery. Measurements included pain intensity (Visual Analog Scale), range of motion, walking speed (4 m walking test), physical performance (30-s chair stand test), health functioning (Western Ontario and McMaster Universities Osteoarthritis Index), pain catastrophizing (pain catastrophizing scale), fear of movement (Tampa Scale of Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale). A mixed-effects model was used to estimate the influence of type of surgery (either unicompartmental or total knee arthroplasty) to pain, function, and psychological trajectories. Results: Both TKA and UKA groups showed significant improvements across the six-month rehabilitation period except for anxiety symptoms in the TKA group, and fear of movement and depression in the UKA group. Between group analysis revealed that in the acute phase UKA patients showed improved range of motion and TKA patients displayed faster walking speed but higher fear of movement. Overall, the type of surgery does not significantly influence the overall rehabilitation pain, functional and psychological trajectories. Conclusions: Despite differences in the acute phase, there are no differences in pain, functional and psychological trajectories throughout the six-month rehabilitation period. These results should be acknowledged to better inform patients and to improve patient education during the perioperative period. Trial registration number: NCT03378440 (2017-12-18), retrospectively registered. Level of evidence: Level II. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL)-deficient knees are no longer considered a contra-indication for unicompartment knee arthroplasty (UKA). The purpose of this study was to determine if patients who had an ACL-deficient knee who underwent lateral UKA had similar mean 10-year outcomes compared to patients who had an ACL-intact knee and lateral UKA. Patients who underwent a lateral UKA with ACL deficiency by a single surgeon between 2004 and 2016 were identified. Preoperative magnetic resonance images were utilized to identify a torn or absent ACL in all knees. The absence of an ACL was confirmed during arthroscopy prior to UKA. Patients were matched 1:2 based on age and sex with patients who underwent lateral UKA with an ACL intact knee. The primary patient-reported outcome variable was survival without conversion to total knee arthroplasty. Secondary outcomes included Veterans Rand-12, the Lysholm score, the Knee Osteoarthritis Outcome Score activities of daily living subscale, and Sport subscale. A power analysis showed that 14 patients were needed to identify differences of 10 points on the Knee Osteoarthritis Outcome Score with a power of 80% (P =.05). The cohort of patients who had an ACL-deficient lateral UKA included 4 men and 12 women (43 to 82 years of age). The matched control group included 32 patients. The mean age of both groups was 67 years (range, 43 to 85). There were 2 patients in the ACL-deficient group who failed. At 10 years, survivorship in the ACL-deficient group was 85%, while survival in the ACL-intact group was 100% (P =.035). At an average follow-up of 11 years (range, 4 to 19.6), there was no difference in outcome scores between ACL-deficient and ACL-intact patients. Fixed-bearing lateral UKA in the ACL-deficient knee resulted in lower survival than patients who had an intact ACL. Patient-reported outcomes were similar in both groups. The ACL-deficient patient who wishes to undergo lateral UKA should be counseled on the lower survival. Level III. Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Aims: Around the world, the emergence of robotic technology has improved surgical precision and accuracy in total knee arthroplasty (TKA). This territory-wide study compares the results of various robotic TKA (R-TKA) systems with those of conventional TKA (C-TKA) and computer-navigated TKA (N-TKA). Methods: This is a retrospective study utilizing territory-wide data from the Clinical Data Analysis and Reporting System (CDARS). All patients who underwent primary TKA in all 47 public hospitals in Hong Kong between January 2021 and December 2023 were analyzed. Primary outcomes were the percentage use of various robotic and navigation platforms. Secondary outcomes were: 1) mean length of stay (LOS); 2) 30-day emergency department (ED) attendance rate; 3) 90-day ED attendance rate; 4) 90-day reoperation rate; 5) 90-day mortality rate; and 6) surgical time. Results: A total of 8,492 knees from 7,746 patients were included in the study. Overall robotic use had risen to 20.4% (2023 Q3 to Q4: 355/1,738) by the end of 2023, with Mako being the most popular at 10.3% (179/1,738). R-TKA had the shortest mean LOS compared with N-TKA and C-TKA (5.5 vs 6.3 and 7.1 days, respectively; p < 0.001). Only Mako (9.7%) demonstrated reduced 90-day ED attendance compared to C-TKA (13.1%; p = 0.009), Cori/Navio (15.0%; p = 0.005), and Rosa (16.4%; p < 0.001). No differences in 90-day reoperation rate and mortality were observed between all groups. Mean surgical times were longer in R-TKA groups by 20.6 minutes (p < 0.001). Conclusion: R-TKA use has increased in recent years, and has been shown to reduce hospital stay despite having a slightly longer surgical time, proving a promising candidate to alleviate the burden on healthcare systems. Individual differences between R-TKA systems contributed to variable clinical outcomes. Cite this article: Bone Jt Open 2024;6(1):12–20.

Abstract Patients undergoing knee replacement, which is mainly indicated in severe osteoarthritis, are frequently co-affected by osteoporosis and osteopenia. With a prevalence standing at around 20% in patients receiving knee arthroplasty, osteoporosis could lead to poor outcomes postoperatively. Some of these complications include periprosthetic fractures and an increased revision rate. Antiresorptive medications have been shown to be beneficial postoperatively. However, no studies have been conducted on whether they had any benefits if given preoperatively. Surgical management may also be beneficial, but this area remains full of controversy.

Background: There is considerable diversity in arthroplasty follow‐up pathways. This qualitative study aimed to understand healthcare professionals' practice and attitude to follow‐up, their motivation for change and what evidence they considered before implementing new pathways. Methods: The main UKSAFE study enroled 38 centres providing revision procedures across the United Kingdom. A purposive sample of professional leads and service managers was identified from site contacts. Individual interviews were conducted by telephone, transcribed verbatim and analysed using a theoretical framework derived from current evidence and the data collected in our previous studies. Results: We found that there had been a shift away from bringing patients back into the clinic for repeat follow‐up assessments, but that this was not universal, and some centres had long‐established care pathways that involved long‐term follow‐up. The way in which those services were provided might be different or have common features, but centres were likely to face common problems including large patient numbers and funding restraints. Conclusion: The reliability of newer prosthetics and surgical skill has influenced some changes by increasing confidence in a pathway which does not routinely provide long‐term follow‐up. Service commissioners also have a role to play in how follow‐up care pathways are configured, but scrutiny of the ratio of new to follow‐up appointments can put pressure on clinical staff to follow‐up only patients with identified clinical need. Virtual clinics can provide a service to patients and use scarce resources efficiently, but NHS IT systems that would be needed to support more remote working, for example, telemedicine and plans to collect PROMS data online from patients to assist with monitoring were not advanced. [ABSTRACT FROM AUTHOR]

Background: As one of the main goals of hip and knee replacements is to improve patients' health-related quality of life, a meaningful evaluation can be achieved by calculating minimal important changes (MICs) for improvements in patient-reported outcome measures (PROMs). This study aims at providing MICs adjusted for patient characteristics for EQ-5D-3L index score improvements after hip and knee replacements. It adds to existing literature by relying on a large national sample and precise clustering algorithms, and by employing a state-of-the-art methodology for the calculation of improved adjusted MICs. Methodology: A retrospective observational study was conducted using the publicly available National Health Service (NHS) PROMs dataset for primary hip and knee replacements. We used information on 252,331 hip replacements and 279,668 knee replacements from all NHS-funded providers in England between 2013 and 2020. Clusters of patients were created based on pre-operative EQ-VAS, depression status, and sex. Unstratified and stratified estimates for meaningful EQ-5D-3L improvements were obtained through anchor-based predictive MICs corrected for the proportion of improved patients and the reliability of transition ratings. Results: Stratifying patients showed that MICs varied across subgroups based on pre-operative EQ-VAS, depression status, and sex. MICs were larger for patients with worse pre-operative EQ-VAS scores, while patients with better pre-operative scores required smaller MICs to achieve a meaningful change. We show how after stratification the percentage of patients achieving their stratified MIC was better in line with the actual share of improved patients. Larger MICs were found for patients with depression and for female patients. MICs calculated for knee replacements were consistently lower than those for hip replacements. Conclusions: Our findings show the importance of adjusting MICs for patients' characteristics and should be considered for quality-related choices and policy initiatives. [ABSTRACT FROM AUTHOR]

This study analyses waiting times for elective surgeries and potential determinants, including supplementary private health insurance, visits in the operating physician's private practice and informal payments for faster treatment. Retrospective patient questionnaire survey. The survey was conducted in eleven Austrian rehabilitation centres in 2019. Data was analysed based on bivariate tests (n = 400) and a multivariate negative-binomial regression model (n = 310) with institution- and patient-related characteristics as independent variables. Median waiting times were 8.9 weeks (IQR: 4.5–18.0) for hip replacement and 8.4 weeks (IQR: 5.0–20.0) for knee replacement surgery. 10.9% of the patients reported having received an offer to shorten their waiting time through a visit in the operating physician's private practice before the surgery or through an informal payment directly to the operating physician. Surgery in private for-profit hospitals, supplementary private health insurance and severe pain were associated with shorter waiting times. While waiting times for elective surgeries in Austria are below international levels, shorter waits for patients with private health insurance and offers to reduce waiting times through informal payments point to equitable access concerns in a public healthcare system. [ABSTRACT FROM AUTHOR]

Purpose: The potential influence of surgical sequence of elective hip-and-knee reconstructive surgery in relation to an infection-related procedure on postoperative infection rates is not clearly understood. Therefore, we aimed to examine the impact of surgical sequence on the incidence of postoperative infections within one-year and the longest available follow-up period in patients undergoing hip-and-knee reconstructive surgery. Methods: A case-control study with propensity matching was utilized to examine elective surgeries conducted at Sunnybrook Holland Orthopaedic & Arthritic centre, Toronto, Canada between 2015 and 2018. We determined and categorized them based on their operating room (OR) sequence in relation to an infected case; the cases were those performed right after (post-infection cohort), and the controls were those performed before an infection-related procedure in the same OR (pre-infection cohort). We employed survival analysis to compare the infection incidence within one year and at the longest available follow-up among the propensity-matched cohort. Results: A total of 13,651 cases were identified during the four year period. We successfully matched 153 cases (21 post-infection and 132 pre-infection) using propensity scores. Demographic and clinical characteristics were balanced through matching. Kaplan-Meier survival analysis showed no significant difference in infection-free survival within one year and at a median follow-up of 2.2 years [interquartile range 0.9-5.0] between surgeries conducted before and after infected cases (both log-rank p-values = 0.4). The hazard ratios for infection within one year and the longest follow-up period were both 0.37 [95%Confidence Interval 0.03–4.09, p = 0.418], as no more events occurred after one year. Conclusion: The sequence of surgical procedures, whether or not an elective arthroplasty or lower limb reconstructive procedure occurs before or after an infection-related case in the same OR, does not significantly affect postoperative infection rates. This finding supports the efficacy of the current infection control measures and suggests a reconsideration of surgical scheduling standards. Take home message: The sequence of surgical procedures, whether performed after an infected case or not, might not affect the rate of postoperative infections within the first year and until the median follow-up time of 2.2 years after surgery. [ABSTRACT FROM AUTHOR]

Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system. Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments. Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001). Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals. [ABSTRACT FROM AUTHOR]

This article discusses the controversy surrounding pre-operative opioid tapering and its potential to advance personalized, patient-centered pain medicine. The use of opioids for chronic non-cancer pain management is common, but it is associated with negative outcomes in the peri-operative period, such as respiratory failure and surgical site infections. The article presents the findings of a pilot study that assessed the feasibility of a pharmacist-led opioid tapering program before elective hip or knee arthroplasty. The study found high adherence to the program and positive outcomes in terms of physical functioning and quality of life. However, the study has limitations, and further research is needed to determine the effectiveness of pre-operative opioid tapering in a broader patient population. [Extracted from the article]

Patients undergoing knee replacement, which is mainly indicated in severe osteoarthritis, are frequently co-affected by osteoporosis and osteopenia. With a prevalence standing at around 20% in patients receiving knee arthroplasty, osteoporosis could lead to poor outcomes postoperatively. Some of these complications include periprosthetic fractures and an increased revision rate. Antiresorptive medications have been shown to be beneficial postoperatively. However, no studies have been conducted on whether they had any benefits if given preoperatively. Surgical management may also be beneficial, but this area remains full of controversy. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is the most effective method of pain relief and increased functional status for end-stage knee arthritis. We aimed to assess in patients undergoing unilateral, primary TKA whether the temperature of the operated limb, compared to the nonoperative limb, remains elevated up to 1 year postoperatively. Using a prospective, longitudinal, observational study design, 1,094 patients were enrolled, and 889 patients completed a minimum of 4 out of 5 follow-up appointments. There were 864 patients who had a normal postoperative course, while 25 patients were deemed to have a superficial or deep infection. Skin temperatures were measured using an infrared thermometer on the operated and nonoperated knees preoperatively, at 2, 6, 12 weeks, and 1 year postoperatively. A subgroup analysis was performed on the 25 patients deemed to have a superficial or deep infection. There was a statistically significant increase in skin temperature in the operated versus nonoperated knee at every follow-up, with a P <.001. However, the effect size was small at the 1-year follow-up, with a mean difference in skin temperature of 0.3 °C. In the infected subgroup, there was a statistically significant difference in skin temperature at 2, 6, and 12 weeks, with a greater difference in skin temperature between the operated and nonoperated knees (4.05 versus 3.78 °C in the noninfected). However, there was little clinical difference (0.27 °C) at 2 weeks between infected and noninfected patients. This study could improve postoperative interactions between patients and surgeons. It is normal for skin temperature post-TKA to increase initially and improve over time, but it can take up to 1 year before there is little clinical difference. Because of the small difference in the rise of skin temperature between infected and noninfected patients, there is little indication that skin temperature is a reliable indicator of infection. [ABSTRACT FROM AUTHOR]

Introduction: Prosthetic infection is a serious complication that can develop after knee and hip arthroplasty and remains a common reason for revision surgery. Guidelines recommend various measures to prevent infection, howewer some professional associat ions argue that there is insufficient evidence for single-dose antibiotic prophylaxis. Our study compares the outcomes of patients receiving short - and long-term antibiotic prophylaxis in arthroplasty surgery. Materials and Methods: In this retrospective study of 424 patients undergoing knee or hip arthroplasty, two prophylaxis protocols were compared. Group 1 (190 patients, 44.8%) received cefazolin pre- and postoperatively on day 1, while group 2 (234 patients, 55.2%) received extended cefazolin (5 days postoperatively) and oral amoxicillin clavulanic acid (5 days). Early postoperative infection rates wer e evaluated. Results: In this study, 83.4% of 424 patients who underwent total knee and hip arthroplasty were female. Knee and hip operations were performed in 86.8% and 13.2% of the patients, respectively. The mean age did not show a statistically significant difference. There was no significant difference between the groups in terms of periprosthetic infection rates (p=0.828). Posto perative wound complications were seen in 34 (18%) patients in group 1 and 44 (19%) patients in group 2, but this difference was not statistically significant (p=0.704). No significant difference in wound complications and prosthesis infection rates was found between group 1 and group 2 patients with risk factors (p>0.05). Conclusion: In primary joint arthroplasty, extended oral antibiotic prophylaxis did not provide additional protection against single -day antibiotic prophylaxis. The results were similar in both risk and non-risk groups. Considering antibiotic resistance, side effects and costs, it is concluded that extended prophylaxis is unnecessary. However, further large -scale studies on this subject are required. [ABSTRACT FROM AUTHOR]

Abstract Background With advancements in perioperative care, joint replacement (JR) surgery is undergoing a transition from opacified in-patient institutions to nimble out-patient Ambulatory Surgical Centers (ASC). The goal of JR in ASC setting is safe patient discharge with subsequent rehabilitation without readmission. Multi-modal preoperative rehabilitation (MMPR) is a novel field of perioperative care, encompassing comprehensive parameters to ensure smooth transition from fitness for surgery to JR in outpatient setting. At present, there are no open-access schemes for selecting patients qualified for JR in the ASC setting. In this article, we propose an evidence-based, 10-point systematic evaluation of patients with target endpoints for MMPR to qualify patients for JR as an outpatient procedure. This checklist is a non-proprietary scheme serving as an initial framework for surgeons exploring surgery in the ASC setting. Body We introduce factors for a prehabilitation scheme, called Checklist Outpatient-Joint Replacement (CO-JR) to qualify patients for outpatient JR surgery. These factors have been developed based on an extensive literature review and the significant experience of authors to incorporate variables that drive a successful outpatient JR procedure. The factors include patient education, psychiatric & cognitive ability, medical fitness, musculoskeletal capability, financial ability, transportation access, patient motivation, information technology (IT) capabilities, along with ability to recover independently at home postoperatively. The CO-JR scheme is under the process of validation at multiple institutions. We introduce this as a starting point for collaborative development of an open-access scheme for all surgeons to learn and adapt as needed for their respective global region. Conclusion We established a non-proprietary 10-point CO-JR scheme, serving as a framework for surgeons to successfully select patients for JR surgery in the ASC setting. We encourage concomitant validation of this scheme globally. Our goal is to reach an international consensus on an open-access scheme, available for all surgeons to enrol patients for JR in the ASC setting, but modifiable to accommodate regional needs.

Objective: This study aims to investigate the effect of video-assisted patient education (VPE) on knee functions, quality of life (QoL) and decrease complications in total knee replacement (TKR) patients.Methods: This study is designed as a prospective, parallel, two-arm, randomized clinical trial. It included 44 patients who underwent elective TKR at an orthopedics and traumatology clinic. The VPE group received VPE including early postoperative care for TKR, activities of daily living, and gradual exercise program in addition to the existing routine care at the clinic. The control group received only routine care. The results were collected with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) scores measured at baseline, 1st and 3rd months after TKR. Results: The mean scores of the VPE group on the pain, stiffness, and physical function of the WOMAC were significantly lower in 3rd month after TKR than the control group. The VPE group had significantly higher scores than the control group on SF-36 of all subcategories except pain, emotional role, and mental health in 3rd month after TKR.Conclusion: The VPE can improve knee function and QoL in TKR patients. Nurses can use the VPE method in patients to improve knee functions and QoL after TKR.

Umberto Restelli,1 Jacopo Vitale,2 Edoardo Croce,3 Susan Bernareggi,3 Stefania Guida,3 Sofia Silvola,1,4 Giuseppe Banfi,3,5 Luigi Zagra3 1LIUC University, Castellanza, Italy; 2Schulthess Klinik, Zürich, Switzerland; 3IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 4Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Science, University of Pretoria, Pretoria, South Africa; 5Vita-Salute San Raffaele University, Milan, ItalyCorrespondence: Umberto Restelli, Email urestelli@liuc.itObjective: The objective of the analysis presented is to assess the efficacy of a fast-track pathway for elective hip and knee arthroplasty, compared to the traditional approach, adopted within a research hospital located in Milan (Italy), in terms of length of stay reduction and related direct medical costs.Methods: A monocentric observational retrospective study was implemented considering adult subjects who underwent elective primary total hip or knee replacement, with a diagnosis of primary or secondary osteoarthritis. Exclusion criteria were subjects admitted via emergency department, subjects undergoing knee or hip replacement because of fractures or prosthesis revision. The analysis compared the length of stay and the direct medical costs, assuming the hospital perspective, of subjects admitted in the pre-fast-track period (years 2016/2017) and during the fast-track period (years 2018/2019).Results: Knee replacement mean costs are 5,599 € (± 1,158.3 €) in the pre-fast-track period and 4,487 € (± 978.4 €) in the fast-track period (− 1,112 €; − 19.9%). Hip replacement mean costs in the pre-fast-track period are 5,364 € (± 1,037.2 €) and 4,450 € (± 843.7 €) in the fast-track period (− 914 €; − 17.0%). The adoption of fast-track pathway led to a statistically significant decrease of days of hospitalization of − 2.8 (− 37.6%) in knee replacement and of − 2.9 (− 39.2%) in hip replacement.Conclusion: The fast-track pathway adopted proved to be effective, reducing patients’ length of stay, and sustainable and efficient, reducing direct medical costs, for both elective hip and knee replacement surgeries.Keywords: health economics, direct medical costs, observational, hip replacement, knee replacement

Abstract The application of Artificial intelligence (AI) and machine learning (ML) tools in total (TKA) and unicompartmental knee arthroplasty (UKA) emerges with the potential to improve patient-centered decision-making and outcome prediction in orthopedics, as ML algorithms can generate patient-specific risk models. This review aims to evaluate the potential of the application of AI/ML models in the prediction of TKA outcomes and the identification of populations at risk. An extensive search in the following databases: MEDLINE, Scopus, Cinahl, Google Scholar, and EMBASE was conducted using the PIOS approach to formulate the research question. The PRISMA guideline was used for reporting the evidence of the data extracted. A modified eight-item MINORS checklist was employed for the quality assessment. The databases were screened from the inception to June 2022. Forty-four out of the 542 initially selected articles were eligible for the data analysis; 5 further articles were identified and added to the review from the PUBMED database, for a total of 49 articles included. A total of 2,595,780 patients were identified, with an overall average age of the patients of 70.2 years ± 7.9 years old. The five most common AI/ML models identified in the selected articles were: RF, in 38.77% of studies; GBM, in 36.73% of studies; ANN in 34.7% of articles; LR, in 32.65%; SVM in 26.53% of articles. This systematic review evaluated the possible uses of AI/ML models in TKA, highlighting their potential to lead to more accurate predictions, less time-consuming data processing, and improved decision-making, all while minimizing user input bias to provide risk-based patient-specific care.

Abstract Background To identify physical activity (PA) trajectories in adults with or at risk of knee osteoarthritis and to evaluate the association of PA trajectories with incident knee replacement (KR). Methods This study used data from the Osteoarthritis Initiative. The Physical Activity Scale for the Elderly and the KR were assessed annually from baseline to 9 years. Individuals were included if they did not undergo KR surgery at baseline and had data on PA at ≥ 1 visit before KR. Latent class growth mixture Modeling was used to identify the optimal trajectories of PA before KR. Log-binomial regression models were used to assess the association between PA trajectories and the risk of KR. Data analyses were conducted in all individuals and those with radiographic osteoarthritis (ROA) and significant knee pain (Western Ontario and McMaster Osteoarthritis Index pain score of ≥ 5 on a 0–20 scale) at baseline, respectively. Results Of 4731 participants (mean age 61.1 years, 58.5% female), four distinct and slightly declined PA trajectories were identified. Compared to individuals with a “Low” PA trajectory, those with “Medium-low”, “Medium-high”, or “High” PA trajectories were not significantly associated with the risk of KR (risk ratios: 0.97–1.19, all p > 0.05). Similar PA trajectories and associations with the risk of KR were observed in the subgroups of individuals with radiographic osteoarthritis and those with significant knee pain at baseline, respectively. Conclusion In participants with or at risk of knee osteoarthritis, PA slightly declines over time and may play no role in the risk of KR.

Aims: To assess the cost-effectiveness of a two-layer compression bandage versus a standard wool and crepe bandage following total knee arthroplasty, using patient-level data from the Knee Replacement Bandage Study (KReBS). Methods: A cost-utility analysis was undertaken alongside KReBS, a pragmatic, two-arm, open label, parallel-group, randomized controlled trial, in terms of the cost per quality-adjusted life year (QALY). Overall, 2,330 participants scheduled for total knee arthroplasty (TKA) were randomized to either a two-layer compression bandage or a standard wool and crepe bandage. Costs were estimated over a 12-month period from the UK NHS perspective, and health outcomes were reported as QALYs based on participants’ EuroQol five-dimesion five-level questionnaire responses. Multiple imputation was used to deal with missing data and sensitivity analyses included a complete case analysis and testing of costing assumptions, with a secondary analysis exploring the inclusion of productivity losses. Results: The base case analysis found participants in the compression bandage group accrued marginally fewer QALYs, on average, compared with those in the standard bandage group (reduction of 0.0050 QALYs (95% confidence interval (CI) -0.0051 to -0.0049)), and accumulated additional mean costs (incremental cost of £52.68 per participant (95% CI 50.56 to 54.80)). Findings remained robust to assumptions tested in sensitivity analyses, although considerable uncertainty surrounded the outcome estimates. Conclusion: Use of a two-layer compression bandage is marginally less effective in terms of health-related quality of life, and more expensive when compared with a standard bandage following TKA, so therefore is unlikely to provide a cost-effective option. Cite this article: Bone Jt Open 2024;5(7):550–559.

Coccidioidomycosis is a fungal infection endemic to certain regions of the Americas. In some cases, the organism may infect the musculoskeletal system, resulting in a prosthetic joint infection (PJI). Due to its difficulty in diagnosis, treatment of coccidioidomycosis in PJI is often delayed. Furthermore, with limited number of case reports, a standard of care in treatment has yet to be established. We present 2 cases of coccidioidomycosis PJI, the extensive evaluation that led to the diagnosis, and the treatment provided. This report highlights the natural progression of coccidioidomycosis in a prosthetic joint, the diagnostic features including histology, advanced imaging, and final treatment administered.

Background: With advancements in perioperative care, joint replacement (JR) surgery is undergoing a transition from opacified in-patient institutions to nimble out-patient Ambulatory Surgical Centers (ASC). The goal of JR in ASC setting is safe patient discharge with subsequent rehabilitation without readmission. Multi-modal preoperative rehabilitation (MMPR) is a novel field of perioperative care, encompassing comprehensive parameters to ensure smooth transition from fitness for surgery to JR in outpatient setting. At present, there are no open-access schemes for selecting patients qualified for JR in the ASC setting. In this article, we propose an evidence-based, 10-point systematic evaluation of patients with target endpoints for MMPR to qualify patients for JR as an outpatient procedure. This checklist is a non-proprietary scheme serving as an initial framework for surgeons exploring surgery in the ASC setting. Body: We introduce factors for a prehabilitation scheme, called Checklist Outpatient-Joint Replacement (CO-JR) to qualify patients for outpatient JR surgery. These factors have been developed based on an extensive literature review and the significant experience of authors to incorporate variables that drive a successful outpatient JR procedure. The factors include patient education, psychiatric & cognitive ability, medical fitness, musculoskeletal capability, financial ability, transportation access, patient motivation, information technology (IT) capabilities, along with ability to recover independently at home postoperatively. The CO-JR scheme is under the process of validation at multiple institutions. We introduce this as a starting point for collaborative development of an open-access scheme for all surgeons to learn and adapt as needed for their respective global region. Conclusion: We established a non-proprietary 10-point CO-JR scheme, serving as a framework for surgeons to successfully select patients for JR surgery in the ASC setting. We encourage concomitant validation of this scheme globally. Our goal is to reach an international consensus on an open-access scheme, available for all surgeons to enrol patients for JR in the ASC setting, but modifiable to accommodate regional needs. [ABSTRACT FROM AUTHOR]

Background: Persistent high levels of knee pain after a total knee replacement have been estimated to affect 5%–10% of people and this is related to dissatisfaction with surgery, reduced function and reduced quality of life. This systematic review aims to evaluate the effectiveness of rehabilitation programs or strategies to reduce persistent pain and improve function and quality of life in people following a total knee replacement. Methods: The systematic review was conducted following PRISMA guidelines with a search of relevant online databases up to 17 July 2024. The search criteria included English language randomised controlled trials of rehabilitation programs or strategies in any setting to treat people with persistent knee pain more than 3 months after a total knee replacement. Rehabilitation could include exercise, education, cognitive strategies and self‐management programs and excluded medication trials, procedural techniques and complementary therapies. Results: After removal of duplicates, there were 468 abstracts screened for eligibility with 23 remaining for full‐text screening and finally, one study meeting the eligibility criteria. This study's interventions were pain neuroscience education alone and pain neuroscience education plus neuromuscular exercise. There were no statistically significant between‐group differences for pain reduction or functional improvement. Conclusion: The evidence examining the value of rehabilitation programs or strategies for pain reduction and functional improvement in people with persistent pain following total knee replacement is deficient. Given the high number of people affected annually, further research concerning both prevention and management of persistent pain after knee replacement is warranted. [ABSTRACT FROM AUTHOR]

Background: Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised. Objective: The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA). Methods: PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full‐texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised. Results: A total of 1485 records were retrieved. Sixty‐four articles were included for screening full‐texts, and four articles were ultimately included. Core exercises were administered for three to 6 weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p < 0.05). Conclusions: Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted. Trial Registration: PROSPERO Registration Number: CRD42024542992 [ABSTRACT FROM AUTHOR]

Background: Functional tests such as the 6‐minute walk test (6MWT) are used in many areas of medicine to monitor disease progression and outcomes of treatment. They are particularly helpful in Orthopaedic surgery as the outcomes have been shown to be responsive to recovery over time. The 6MWT is typically performed in a controlled supervised environment which may limit its widespread use (Terwee et al., Rheumatology (Oxford), 2006, 45, 890–902). The primary aim is to investigate if a patient measured 6MWT is comparable to a 6MWT performed under formal testing conditions (Täger et al., Int. J. Cardiol. 2014, 176, 94–98). Methods: A total of 55 patients undergoing elective primary hip or knee replacement were instructed to use a smart watch to record a 6MWT in their home community environment (C‐6MWT). These measurements were compared to a formally tested 6MWT (F‐6MWT) at 2 separate time periods—6 and 12 weeks post‐surgery. Results: At 6 weeks post operation the Intraclass Correlation Coefficient between a formally tested and a patient self‐administered 6MWT was 0.928 (95% CI 0.832–0.970) and at 12 weeks it was 0.831 (0594–0.935). Conclusion: A patient recorded 6 minute walk test shows high agreement with a formally recorded one under research conditions. This makes this test a suitable way to monitor rehabilitation progression and research outcomes at multiple time periods and in remote situations. [ABSTRACT FROM AUTHOR]

Robot-assisted total joint arthroplasty (robotic-TJA) has become more widespread over the last 20 years due to higher patient satisfaction and reduced complications. However, robotic TJA may have longer operative times and increased operating room traffic, which are known risk factors for contamination events. Contamination of surgical instruments may be contact- or airborne-related with documented scalpel blade contamination rates up to 9%. The robot arm is a novel instrument that comes in and out of the surgical field, so our objective was to assess whether the robot arm is a source of contamination when used in robotic TJA compared to other surgical instruments. This was a prospective, single-institution, single-surgeon pilot study involving 103 robotic TJAs. The robot arm was swabbed prior to incision and after closure. Pre- and postoperative control swabs were also collected from the suction tip and scalpel blade. Swabs were incubated for 24 hours on tryptic soy agar followed by inspection for growth of any contaminating bacteria. A contamination event was detected in 10 cases (10%). The scalpel blade was the most common site of contamination (8%) followed by the robot arm (2%) and suction tip (0%). Robotic TJA is contaminated with bacteria at a rate around 10%. Although the robot arm is an additional source of potential contamination, the robot arm accrues bacterial contamination infrequently compared to the scalpel blade. Contamination of the robot arm during robotic TJA is minimal when compared to contamination of the scalpel blade. • Contamination during robotic total joint arthroplasty occurs at a rate up to 10%. • There is minimal contamination of the robot arm during robotic TJA. • The scalpel was the most common site of perioperative contamination. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursology is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: To identify physical activity (PA) trajectories in adults with or at risk of knee osteoarthritis and to evaluate the association of PA trajectories with incident knee replacement (KR). Methods: This study used data from the Osteoarthritis Initiative. The Physical Activity Scale for the Elderly and the KR were assessed annually from baseline to 9 years. Individuals were included if they did not undergo KR surgery at baseline and had data on PA at ≥ 1 visit before KR. Latent class growth mixture Modeling was used to identify the optimal trajectories of PA before KR. Log-binomial regression models were used to assess the association between PA trajectories and the risk of KR. Data analyses were conducted in all individuals and those with radiographic osteoarthritis (ROA) and significant knee pain (Western Ontario and McMaster Osteoarthritis Index pain score of ≥ 5 on a 0–20 scale) at baseline, respectively. Results: Of 4731 participants (mean age 61.1 years, 58.5% female), four distinct and slightly declined PA trajectories were identified. Compared to individuals with a "Low" PA trajectory, those with "Medium-low", "Medium-high", or "High" PA trajectories were not significantly associated with the risk of KR (risk ratios: 0.97–1.19, all p > 0.05). Similar PA trajectories and associations with the risk of KR were observed in the subgroups of individuals with radiographic osteoarthritis and those with significant knee pain at baseline, respectively. Conclusion: In participants with or at risk of knee osteoarthritis, PA slightly declines over time and may play no role in the risk of KR. [ABSTRACT FROM AUTHOR]

The application of Artificial intelligence (AI) and machine learning (ML) tools in total (TKA) and unicompartmental knee arthroplasty (UKA) emerges with the potential to improve patient-centered decision-making and outcome prediction in orthopedics, as ML algorithms can generate patient-specific risk models. This review aims to evaluate the potential of the application of AI/ML models in the prediction of TKA outcomes and the identification of populations at risk. An extensive search in the following databases: MEDLINE, Scopus, Cinahl, Google Scholar, and EMBASE was conducted using the PIOS approach to formulate the research question. The PRISMA guideline was used for reporting the evidence of the data extracted. A modified eight-item MINORS checklist was employed for the quality assessment. The databases were screened from the inception to June 2022. Forty-four out of the 542 initially selected articles were eligible for the data analysis; 5 further articles were identified and added to the review from the PUBMED database, for a total of 49 articles included. A total of 2,595,780 patients were identified, with an overall average age of the patients of 70.2 years ± 7.9 years old. The five most common AI/ML models identified in the selected articles were: RF, in 38.77% of studies; GBM, in 36.73% of studies; ANN in 34.7% of articles; LR, in 32.65%; SVM in 26.53% of articles. This systematic review evaluated the possible uses of AI/ML models in TKA, highlighting their potential to lead to more accurate predictions, less time-consuming data processing, and improved decision-making, all while minimizing user input bias to provide risk-based patient-specific care. [ABSTRACT FROM AUTHOR]

Purpose: The association between preoperative mental health and immediate postoperative ambulation in primary Total Joint Arthroplasty (TJA) has sparsely been studied. Thus, this study's objective was to investigate the association between mental health (measured by the Mental Component Score (MCS) from the Veterans RAND 12 (VR-12)) and peri-operative metrics. Methods: We conducted a retrospective study of patients who underwent primary TJA and completed a VR-12 questionnaire between January 2018 and June 2023 at a single academic hospital. Patients were stratified into terciles based on preoperative MCS. Patient demographics, ambulation within 4 h postop, LOS, and discharge location were compared. The effect of MCS on LOS while controlling discharge location was assessed using negative binomial regression. Results: 1120 patients were included in this analysis (432 THA and 688 TKA). After stratification into terciles (Low: 34.7 ± 6.6, Middle: 49.3 ± 3.7, High:62.1 ± 4.4), comparison of demographics revealed significant differences in age (p = 0.005) and sex distribution (p = 0.04) but no difference in surgery type (p = 0.857). There was no significant difference in ambulation rate between MCS groups (p = 0.789) or in distance covered during first ambulation (p = 0.251). Low MCS patients had a longer LOS (p = 0.000, p = 0.002) and a lower rate of discharged home (p = 0.016). After controlling discharge location, no significant association was found between MCS and LOS (p = 0.288). Conclusion: Patient with low MCS tended to be younger, women, and had poorer preoperative HOOS/KOOS scores. Low MCS was associated with longer LOS and lower rates of discharge home. However, MCS was not associated with early ambulation rate and LOS after controlling discharge location. [ABSTRACT FROM AUTHOR]

Introduction: Hip and knee arthroplasty surgeries are essential for treating end-stage osteoarthritis, providing significant functional improvements. Despite a global rise in these procedures, Nepal lacks a National Joint Registry, resulting in a gap in tracking the exact number of surgeries, outcomes, and complications. This study aims to address this gap regarding the demographics of hip and knee arthroplasties in Nepal. Methods: An observational study was conducted after obtaining the ethical approval from the Nepal Health Research Council (Reference number: 2024/136) with data collected from prosthesis supplier. The study included all primary hip and knee arthroplasties performed in 2022 and 2023, excluding revision cases and those requiring mega prostheses. Data analysis was performed using Microsoft Excel for descriptive statistics. Results: There were a total of 1259 surgeries, 916 (72.77%) total knee replacements were performed, with a female predominance of 741 (81.42%) and a median age of 67 years(IQR: 62-71). There were 343 (27.23%) total hip replacements surgeries of which 200 (58.31%) were done in males. Most surgeries 1148 (91.18%) occurred within the Kathmandu Valley. Conclusions: Total knee arthroplasty accounted for the majority of cases, showing a predominance of female patients with the majority of surgeries in the capital city.

Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a new proposed management for those with pain despite maximum medical management. It has historically been used to manage recurrent spontaneous haemarthrosis following total knee replacement, but newer studies are showing a positive effect in managing pre-arthroplasty knee OA. The goal of this review is to summarise current and relevant literature from searches of computerised databases and relevant journals, and analyse their results. Studies included show that GAE has promising outcomes in managing mild to moderate OA knee pain in those who have exhausted at least 3 months of conservative therapy. Most studies show improvements in VAS pain and PROM scores (including KOOS, and/or WOMAC). Minimal adverse effects have been associated in up to two years of follow up, the majority of which are self-resolving. The article précises a concise general procedural technique for performing GAE, as well as comparing and contrasting different embolic agents that may be utilised. GAE shows promising outcomes in management of mild to moderate OA knee pain. In the future, there will need to be higher volume studies to determine effectiveness, suitable candidates, and other potential adverse effects. [ABSTRACT FROM AUTHOR]

Hip OA is becoming more common, with a greater number of younger individuals undergoing total hip arthroplasty (THA). These individuals have the desire to return to considerable loading and in some instances return to sport. The purpose of this review was to investigate the current guidelines and/or protocols for hypertrophy or strengthening in individuals who have undergone total hip arthroplasty. A total of 16 papers were identified, some of which also addressed total knee arthroplasty. There is no consensus for the best practice for a hypertrophy program following THA especially regarding when a direct anterior approach was used during hip arthroplasty. Further research is needed as this is a growing area in rehabilitation. This review aims to bridge the gap by offering a comprehensive synthesis of the available literature on postoperative rehabilitation after THA, with a specific emphasis on identifying the most effective muscular strengthening and hypertrophy training programs for patients undergoing anterior approach hip surgery. [ABSTRACT FROM AUTHOR]

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Perioperative practices have been introduced over the last decade to decrease the risk of periprosthetic joint infection (PJI). We sought to determine whether rates of revision total knee arthroplasty (TKA) for PJI decreased during the period 2006-2016. Methods: This observational cohort study used data from the New York Statewide Planning and Research Cooperative System to identify patients undergoing TKA in 2006-2016. Data through 2017 were used to determine if patients underwent revision TKA for PJI (including debridement, antibiotics and implant retention) within 1 year of the primary surgery. A generalized estimating equation model, clustered by hospital, was used to examine the impact of time on likelihood of revision TKA for PJI. Results: In 2006-2016, 233,165 primary TKAs performed were included. Mean age was 66.1 (standard deviation 10.3) years, and 65% were women. Overall, 0.5% of the patients underwent revision TKA for PJI within 1 year of surgery. The generalized estimating equation model showed that for primary TKA performed in 2006-2013, year of surgery did not impact the likelihood of revision TKA for PJI (odds ratio 1.00, 95% confidence interval 0.97-1.03, P = .9221), but that for primary TKA performed in 2014-2016, the likelihood decreased by year (odds ratio 0.76, 95% confidence interval 0.66-0.88, P = .0002). Conclusions: The likelihood of revision TKA for PJI was stable from 2006 to 2013 but declined during the period 2014-2016 across patient and hospital categories. This decline could be due to infection mitigation strategies or other unmeasured factors.