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Background: Many surgeries can be performed with spinal anesthesia (SA) or general anesthesia (GA). However, there are only limited and confounding data available regarding costs and anesthesia-related times. Hip or knee replacement are common orthopedic surgeries that can be performed using SA or GA without differences regarding mortality or morbidity. Observational studies have suggested that spinal anesthesia may be associated with lower risks of death, delirium and major medical complications and with shorter lengths of stay in the hospital than general anesthesia. The aim of this study was to assess and compare the effects of spinal versus general anesthesia on postoperative outcomes in patients undergoing orthopedic surgery. Material & Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from March,2021 to March,2023. In this study we included 200 patients undergoing orthopedic surgery. The patients were randomly divided into two groups – Group A (Patients who were given general anesthesia) & Group B (Patients who were given spinal anesthesia). Results: In total 200 patients from both the groups completed the study. In our study we found majority (44.5%) of our patients were aged 60-69 years and most of our patients were female (56%) compared to male (44%).The mean age of our patients was 61.73 ± 7.92 years. The mean BMI was 31.67±3.24 kg/m.2Among all patients ,48% had mild systemic disease and followed by 31.5% had severe systemic disease. Majority (43.5%) of our patients had hypertension, 31% had diabetes. Vomiting was found 47% in group A on contrary only 23% had vomiting in spinal group. We found the mean anesthesia induction time was significantly higher in spinal group. Anesthesia time was lower in spinal group while PACU time was higher in group B. Time duration of surgery was significantly lower in spinal group. After 24 hours, spinal group showed less pain score than general anesthesia group. Conclusion: In our study, we found that SA is associated with less fixed and variable costs and lower postoperative pain scores during the stay in the PACU. Therefore, SA is a more reasonable alternative to GA in the immediate postoperative period for patients undergoing hip or knee replacement. When compared to general anaesthesia, spinal anaesthesia provides better operating circumstances, better postoperative pain control, and faster postoperative recovery.
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Objective To study the short-term variation patterns of graft viscosity after anterior cruciate ligament reconstruction (ACLR) surgery. Methods Six male New Zealand rabbits were selected. The ACLR animal model of unilateral knee was made with Achilles tendon as the graft. The experimental rabbits were euthanized 15 days after ACLR surgery, with removal of the graft, healthy anterior cruciate ligament (ACL) and Achilles tendon. The cross-sectional area and viscosity coefficient of the graft were measured, and the creep experiments were carried out under equilibrium conditions of 0.1 MPa and 1 MPa, respectively. The viscosity coefficent was calculated. Variation patterns of graft viscosity were summarize. The grafts were compared with healthy ACL. Results The cross-sectional area of the graft increased slowly within 15 days after ACLR surgery. The viscosity of ACL and graft changed nonlinearly. The viscosity coefficient was quite different under different stresses. The viscosity coefficient of the graft decreased with the time after ACLR surgery, which was more obviously under the condition of low stress. Conclusions The results are helpful to guide the implementation of early postoperative rehabilitation plan after ACLR surgery .
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Objective To explore the proprioception characteristics of knee joints for knee osteoarthritis (KOA) patients before unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods Twenty-nine single-compartment KOA patients were selected. Fifteen patients were treated with UKA (UKA group) and fourteen patients were treated with TKA (TKA group). The test was performed 1 to 3 days before the operation.The keen society scores (KSS) of KOA patients in UKA group and TKA group were compared, and their joint position sense and kinesthesia were compared with control group. Results Significant differences in KSS were found in TKA group and UKA group, and the knee joint position sense and kinesthesia showed no significant differences between TKA group and UKA group.There were no significant differences in the knee joint position sense and kinesthesia between the operated leg and unoperated leg in TKA group and UKA group, and between the left leg and right leg in control group. Compared with control group, there were significant differences between UKA group and TKA group in 60° position sense of the operated leg and unoperated leg.The kinesthesia of the operated leg and unoperated leg in UKA group and TKA group were also significantly different from that in control group. Conclusions Compared with control group, the proprioception of the knee joint in KOA patients was significantly reduced before the surgery, but the characteristics of proprioception in UKA group and TKA group were similar.
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@#Introduction: The aim of this study was to evaluate the reliability of the femoral component rotation on intraoperative data recorded in a computer-assisted navigation system (CAN-FRA) compared with the post-operative femoral component rotation observed on computed tomography (CT-FRA). Material and method: Computer-assisted total knee arthroplasty (TKA) or primary osteoarthritis of the knee was performed in 51 knees in 36 patients with a mean age of 69.51 years. All procedures were performed by a single surgeon using the same implant design. The intraclass correlation coefficient (ICC) was used to compare the intraoperative CAN-FRA with the post-operative CT-FRA. The angle between the anatomical epicondylar axis and the posterior condylar axis of the implant (CT-FRA) was measured at two separate timepoints by three observers who were blinded to the intra-operative CAN-FRA. Internal rotation was defined as rotation in the negative direction, while external rotation was defined as positive. Results: The mean intra-operative CAN-FRA was 0.1° ± 2.8° (range -5.0° to 5.5°). The mean post-operative CT-FRA was -1.3° ± 2.1° (range -4.6° to 4.4°). The mean difference between the CAN-FRA and the CT-FRA was -1.3° ± 2.2° (range -7.9° to 2.4°). The respective ICC values for the three observers were 0.92, 0.94, and 0.93, while the respective intra-observer coefficients were 0.91, 0.85, and 0.90. The ICC for the intra-operative CAN-FRA versus the postoperative CT-FRA was 0.71. Conclusion: This study shows that using a computerassisted navigation system in TKA achieves reliable results and helps to achieve optimal positioning of the femoral component and rotation alignment correction.
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Background: Total knee arthroplasty (TKA) is a surgical procedure designed to alleviate pain and improve function in patients suffering from osteoarthritis. Range of motion is one of the most important factors for patient satisfaction after total knee replacement. The purpose of this study was to assess the effectiveness of a new TKA technique involving patellar resection to enable increased flexion of the knee joint.Methods: Eighty-four patients suffering from osteoarthritis with an indication for conducting TKA underwent the novel procedure. Pre-operative and post-operative flexion measurements were assessed.Results: Mean age of patients participating in this study was 62 years. Males and females were 63% and 37 % of total population respectively. The mean pre-operative and post-operative flexion measurements were 97.39±3.33 º and 131.35±4.27 respectively. The mean in flexion measurements was improved by 33.95±5.30 º (p<0.05). The joint was kinematically stable during full flexion, mid-flexion, and extension.Conclusions: The novel patellar resection technique can be beneficial for the patients. They can able to follow their native lifestyle and perform their daily activities without any hindrance. The mean increase in the range of flexion was 33.95±5.30 º (ranged 30-35 º, p<0.05). This technique allowed patients to have a greater range of flexion as compared to standard and high flexion designs.
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Total Knee Arthroplasty (TKA) has become a standard operative procedure to relieve pain, and to restore alignment and function of patients with advanced arthritis of knees.1,2,3 Total knee arthroplasty has evolved into a very reliable surgical treatment for advanced arthritis of knee. TKA provides pain relief and improves function for patients with advanced osteoarthritis of the knee. The aim of this study is to prospectively evaluate the clinical and functional outcomes of total knee arthroplasty in arthritic knees in terms of pain relief, range of motion and stability.METHODSWe prospectively reviewed a series of 65 primary Total Knee Arthroplasties performed in 40 patients at our institute from November 2014 to November 2017. Of these patients, 12 underwent bilateral TKA in the same sitting, 13 underwent staged bilateral TKA and 15 patients underwent TKA on one side. Patients were followed up to 3 years post-operatively with an average follow up of 24 months and were evaluated with Knee Society Clinical Ratings and radiographic analysis.RESULTSPre-operative mean of clinical score (pain, ROM and stability) and functional score (walking distance and stair climbing) of patients improved from 48.33 to 92.82 and 49.65 to 88.43 respectively.CONCLUSIONSIn this short-term analysis of this prospective observational study, satisfactory results were obtained in a good percentage of arthritic knee patients
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Objective To compare and analyze the lower limb muscle activity and knee joint force during the stance periods of gait cycle in patients with osteoarthritis before and after total knee arthroplasty (TKA). Methods Based on the OpenSim platform, lower extremity musculoskeletal models of one healthy subject and three patients with osteoarthritis before and after TKA were established. A three-dimensional （3D） motion capture system and a force platform were used to collect the lower limb kinematic data and the ground reaction force during walking, which were used as input parameters to simulate the lower limb muscle activation and knee joint forces. Results The results from the musculoskeletal model were consistent with the results by inverse dynamics based on the 3D motion capture system. The patient's rectus femoris was activated in the loading response and mid stance phases, which was different from that of healthy subject. The activation timing and amplitude of the quadriceps muscle in 3 patients were significantly different before and after TKA. The peak joint forces of 3 patients before TKA were 2.95, 3.15 and 3.43 times of body weight (BW) with the constant load of more than 2 times of BW during stand phase. The peak joint force after TKA were 2.09, 2.48 and 3.96 times of BW respectively. The joint force was not improved and the knee function did not reach the normal level six months after TKA. Conclusions The results of the established musculoskeletal model have certain reliability, and this model can provide a biomechanical auxiliary method for TKA surgery in the future.
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Objective To observe the analgesia efficacy of continuous fascia iliaca compartment block (FICB) and adductor canal block (ACB) on elderly patients undergoing total knee arthroplasty (TKA) with multimodal analgesia and their early rehabilitation. Methods Sixty TKA patients (26 female and 34 male, 60-75 years old) were randomly divided into two groups and received ultrasound-guided either continuous FICB (n=30) or continuous ACB (n=30) using 0.25% ropivacaine for controlled analgesia. All the patients had no previous experiences of knee surgery. Quality of analgesia was assessed by dynamic and static visual analogue scale (VAS) based on pain intensity. In addition, rehabilitation training compliance, range of motion (ROM) and knee function were assessed at different times after rehabilitation training. Results No significant differences were found in VAS scores during resting and passive functional exercise at 6, 12, 24, 48 h after TKA surgery (P>0.05); ACB group had significant differences in rehabilitation training compliance, knee ROM and HSS scores in comparison with FICB group (P<0.05). Conclusions Ultrasound-guided continuous ACB with multimodal analgesia could promote early rehabilitation after TKA．
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@#Introduction: The only treatment for grade IV knee osteoarthritis is total knee arthroplasty (TKA) irrespective of the age of the patient.Most of the grade IV OA patient are elderly and most likely to have some comorbidities. Age and comorbidities are the major reasons for patient’s reluctance toundergo TKA. A clinical pathway with standard length of stay(LOS) could justify the patient’s hesitation for TKA. The aimof this study was to determine the factors, including age andcomorbidity, that affect the LOS of patients treated with TKA. MaterialsandMethods:This is a retrospective study ofTKA patients in Surabaya Orthopedics and TraumatologyHospital from January 2011 to July 2017. Preoperativecomorbidities were scored using Charlson ComorbidityIndex (CCI) and physical status by ASA (American Societyof Anesthesiologist), classification for age, sex, BMI, bloodloss, operation time, method of anaesthesia andpostoperative day of rehabilitation were recorded as factorspotentially affecting LOS. The discharge criteria for thepatients were ability to ambulate to the bathroom and cleanoperative wound with no complications. The data obtainedwere analysed statistically.Results:The average LOS was 5.58 days, ranging fromthree to eight days. There were no demographic factors thataffected the patients’ LOS. BMI, ASA, CCI, and blood lossdid not significantly affect LOS. Operation time wasbetween 90-140 minutes, and spinal anaesthesia showedsignificant longer LOS, but within the average.Conclusion:Age and comorbidity did not affect length of stay in TKA patients.
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Objective To explore the correlation between gait parameters at 14 days and knee function and quality of life at 3 months after total knee arthroplasty (TKA). Methods Eighteen patients who underwent TKA were analyzed by using three-dimensional gait analysis system to observe their gait parameters. Knee joint function and life quality of the patients at 3 months after TKA were evaluated with WOMAC (Western Ontario and McMaster Universities Arthritis Index) and SF-36 (short form 36-item health survey scores) assessment scale and their correlations were analyzed simultaneously. Results At 14 days after TKA, single support time (SST) and peak knee flexion at swing (PKF) of the operated side of the leg were significantly smaller than those of the healthy side of the leg. The knee flexion angle at mid-stance (MKF) and knee valgus angle at mid-stance (MKV) of the operated side of the leg were significantly larger than those of the healthy side of the leg. There was a moderate negative correlation between the spatiotemporal parameters of the operated side of the leg and the WOMAC score during gait, while a high correlation between the WOMAC score and peak knee flexion at swing (PKF), MKF and MKV. Except for the step length and forward velocity, the other gait parameters were significantly correlated with SF-36 life quality score. The single support time (SST) and PKF had a highly positive correlation, while the MKF and MKV had a moderate negative correlation with SF-36 life quality score. Conclusions The SST, MKF, MKV and PKF in postoperative early gait analysis (14 days) results can be used as the effective indicators to judge postoperative knee function and rehabilitation efficacy of life quality after TKA surgery.
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Objective:To compare the clinical effects of restrictive blood transfusion combined with hyperbaric oxygen preconditioning (HBOPC) and restrictive blood transfusion in the treatment of hip,knee arthroplasty (THA,THA).Methods:40 patients in the period of epidural anesthesia,femoral nerve hysteresis hip and knee arthroplasty were selected and randomly divided into two groups:restrictive transfusion group (maintain 80 g/L≤ Hb ＜100 g/L,n=20) and restrictive blood transfusion combined with HBOPC (HBOPC+maintain 80 g/L =Hb ＜100 g/L,n=20).The red blood cell transfusion,red blood cell transfusion rate,perioperative Hb,blood oxygen saturation (SO2),the incidence of hypotension during operation,hospitalization time and postoperative cerebral infarction,acute pulmonary embolism,pneumonia,myocardial infarction,wound infection rate and 90 days mortality rate were compared between two groups.Results:Compared with the restrictive transfusion group,the postoperative Hb,blood oxygen saturation (SO2) of restrictive blood transfusion combined with HBOPC group were significantly increased(P ＜ 0.05);the red blood cell transfusion,red blood cell transfusion rate,incidence of pneumonia,wound infection rate were significantly decreased (P＜0.05).Conclusion:Restrictive blood transfusion combined with hyperbaric oxygen preconditioning could improve the anoxic state of the hip,knee arthroplasty patients,which could effectively reduce red blood cell transfusion,reduce postoperative complications,has good clinical curative effect.
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Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To obtain biomechanical conditions of the tibia section with different osteotomy thickness under different activity states, so as to provide theoretical basis for osteotomy thickness in total knee arthroplasty (TKA) and activities of patients after operation. Methods The three-dimensional models of the lower limb were reconstructed and the proximal tibia was resected by 0 mm,5 mm,7 mm,9 mm respectively based on the principle of bone resection in TKA. The tibia model after osteotomy were assigned the material properties and the stress and strain of the tibia cross-section were analyzed under the following activity states: standing, walking, running and going upstairs. Results The stress and displacement of the tibia cross-section increased with the increase in osteotomy thickness under the same activity state. The maximum stress and displacement of tibia cross-section increased in general with the same osteotomy thickness, when the strength of activity increased. Conclusions During TKA in clinic, the stress and strain on tibia cross-section became larger as the tibia osteotomy became thicker and the postoperative activity became stronger. Excessive osteotomy in TKA and high intensive activity after TKA should be avoided, so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To study the optimal radiographic conditions for patients with knee arthroplasty (TKA) and the feasibility of clinical application.Methods According to the different exposure modes,including automatic exposure control (AEC) or manual exposure mode (FIXED),the human body specimen was exposed at a certain kV and different mA or mAs.The entrance surface dose (ESD) and dose exposure index(DEI) were recorded,and the subjective image quality was assessed.The test group with optimum parameters obtained with statistical analysis were compared with control group in radiation dose and subjective evaluation.Results In AEC group,ESD and kV showed a negative correlation (r =-0.973,P ＜ 0.05).At the same mA,DEI was firstly decreased and then increased with kV increasing.The subjective image quality score was (1.96 ± 0.56).DEI and physician ratings showed negative correlation (r =-0.840,P ＜ 0.05).In FIXED group,ESD increased with the increasing mAs (r=0.845,P＜0.05).DEI and kV,mAs indicated a positive correlation(r=0.845,P＜0.05).The subjective image quality scores was(4.33 ±0.79) without correlation with DEI.Compared with the control group,the subjective image quality scores of test group increased,and the radiation dose decreased significantly.Conclusion It is optimal using manual exposure mode with 80 kV/l.25-1 mAs,75 kV/2-1 mAs,70 kV/2.5-1.25 mAs,65 kV/3.2-1.6 mAs and 60 kV/3.2-2 mAs for patients with TKA.
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Objective To obtain panorama X-ray images of the lower extremity with a simple method,eliminate the mosai-cing error,and apply this manual stitching technique for digital radiography to the measurement of the force line in total knee arthroplasty.Methods The track of X-ray tube was preset,and Dicom format data were collected by using digital X-ray ima-ging.Then,the data were imported to photoshop CS4 for manual image registration and image fusion.The reliability of the film was tested by comparing the vertical length of the body symbols proj ection in the coronal plane with that on the panorama X-ray (AutoCAD 2010)images.Moreover,the hip-knee-ankle angle was compared before and after operation.Results The matching sample t-test showed there were no significant differences in the length(4 groups of data)between the greater trochanter femur and the fibular head,and between the fibular head and the lateral malleolus between before and after operation(P>0.05 for all) .The hip-knee-ankles angle was much greater after operation than that before operation.Conclusion This manual stitching technique for digital radiography can produce seamless and precise panorama X-ray images,which can be used to reflect the length and angle of the lower extremity before and after operation.
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Objective To reconstruct the 3D motion of the knee joint after total knee arthroplasty (TKA) and measure the kinematics and the articular contacts between the posterior stabilized TKAs. Methods Sixteen knees undergoing TKAs were scanned by fluoroscopy. An algorithm of automatic registration was developed to match the 3D TKA models and 2D images. The kinematical parameters and articular contact of the tibiofemoral joint was investigated. ResultsThe time for a single image was less than 30 seconds. The in-plane repeatability was within 0.4 mm and 0.5 degree. The application of the high-flex insert didn’t obviously improve the ability of the flexion and the internal/external tibial rotation. When the knee flexed, the contact point on the lateral side moved more posteriorly than that on the medial side. The contact between the post-cam and the femoral prosthesis occurred with the flexion at about 30 degrees. The average range of the contact was within 9 mm. Conclusions The 3D kinematics of the in vivo TKA knee joint was accurately measured by using 2D-3D automatic registration technique. The result can provide references for the biomechanical study of TKA knees and the improvement of TKA prosthesis design.
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Knee joint is the largest joint in human body, with the most complex anatomy and the highest demand on motor function. The number of patients who receive the total knee arthroplasty (TKA) grows at the rate of over 10% annually around the world. TKA was developed from total hip arthroplasty, and has been developed rapidly during the thirty years' development. In this paper, evolution of prosthesis types, geometric shape and size of prosthesis and breakthrough in biomechanics of knee joint were reviewed; controversial issues in contemporary TKA studies were discussed; and the development of TKA in future was forecasted.
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This retrospective study was undertaken to evaluate the outcome of primary total knee arthroplasty (TKA) performed from January 1986 to December 1997 at this institution. Case review included Knee Society scores and functional knee score. The records of 94 patients (128 knees) were available for analysis with the sample comprised of 76 females (80.9%) and 18 males (19.1%) and a mean age was 61.4 years. TKA was performed for osteoarthritis (OA) in 96 knees (75%) and rheumatoid arthritis (RA) in 32 knees (25