Does total knee arthroplasty affect pelvic movements? A prospective comparative study

SUMMARY OBJECTIVE: Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls. METHODS: This study was performed at the Department of Orthopedics and Traumatology Clinic of a Cankiri State Hospital between April 2021 and February 2022. This study included 84 participants. Of them, 31 patients who underwent total knee arthroplasty between 2018 and 2020 years were selected as the total knee arthroplasty group, while 28 patients with knee osteoarthritis were selected as the knee osteoarthritis group. In the control group, there were 25 healthy individuals. Exclusion criteria from the study included any kind of neurological disease, an inability to walk a distance of 100 m unassisted, or a history of surgery to the lower limb. Pelvic movements (i.e., tilt, rotation, and obliquity) and gait parameters (i.e., "gait velocity," "cadence," and "stride length") were assessed using a wireless tri-axial accelerometer. RESULTS: Total knee arthroplasty and control groups had decreased minimum anterior tilt of the pelvis, decreased maximum anterior tilt, and decreased oblique range of the pelvis compared with the knee osteoarthritis group. In comparison with the control group, gait velocity and length of stride during gait were remarkably lower in both knee osteoarthritis and total knee arthroplasty groups. CONCLUSION: In this study, total knee arthroplasty was found to affect pelvic movements. It was thought that total knee arthroplasty changed these variables, probably owing to the frontal and sagittal plane alignment correction through surgery.

Resultados preliminares de la artroplastía de revisión de rodilla con implante modular de fijación híbrida / Preliminary results of hybrid fixation modular implant in revision knee arthroplasty

Resumen: Introducción: la artroplastía total de rodilla (ATR) de revisión es un procedimiento desafiante que requiere alineación adecuada, restauración ósea y estabilidad. Los sistemas modernos de revisión ofrecen opciones de implantes modulares con fijación híbrida. Objetivo: evaluar los resultados clínicos de un implante modular de fijación híbrida con seguimiento mínimo de dos años. Material y métodos: se incluyeron retrospectivamente cirugías de revisión de ATR realizadas entre Septiembre de 2018 y Septiembre de 2019 con el mismo implante. Se registraron datos demográficos, comorbilidades y se evaluaron los resultados clínicos utilizando puntuaciones subjetivas y la Knee Society Score (KSS). Resultados: se analizaron 23 pacientes (65% mujeres, 35% hombres; edad mediana: 71.1 años). Los defectos óseos posteriores a la extracción del implante se clasificaron como F2.T2 en 39.13% de los casos, F1.T2 en 8.69%, y F1.T1 en 52.17%. Se observaron mejoras significativas en la puntuación de la KSS (preoperatoria: 53 puntos, postoperatoria: 79 puntos; p < 0.001). Se registraron tres (13%) complicaciones totales, dos relacionadas directamente con la cirugía, y dos casos requirieron una nueva cirugía de revisión. La tasa de supervivencia a los dos años fue de 91.3%. Conclusión: el uso del implante modular con fijación híbrida en la revisión de ATR mostró una alta tasa de supervivencia a dos años, mejoras significativas en las puntuaciones clínicas y baja incidencia de complicaciones a corto plazo. Estos resultados respaldan la eficacia y seguridad de este enfoque, proporcionando resultados clínicos favorables y alta satisfacción del paciente.

Abstract: Introduction: revision total knee arthroplasty (TKA) is a challenging procedure that requires proper alignment, restoration of bone loss, and prevention of instability. Modern revision systems offer progressive implant constriction with multiple options for offset, augmentation, and fixation stems. Objective: to evaluate the clinical outcomes of a modular implant with hybrid fixation in revision TKA with a minimum follow-up of two years. Material and methods: we retrospectively included all revision TKA surgeries performed between September 2018 and September 2019, using the same implant. Patient demographics, comorbidities, and data on bone defects were recorded. Clinical outcomes were assessed using subjective roles and Maudsley scores and the Knee Society Score (KSS). Complications during follow-up were also documented. Results: a total of 23 patients were analyzed, comprising 65% females and 35% males, with a median age of 71.1 years. Bone defects following implant removal were classified as F2.T2 in 39.13% of cases, F1.T2 in 8.69%, and F1.T1 in the remaining 52.17%. There were significant improvements in the KSS score (preoperative: 53 points, postoperative: 79 points; p < 0.001). Three (13%) complications were reported, two of which were directly related to the surgery, and two patients required subsequent revision surgery. The 2-year survival rate was 91.3%. Conclusion: the use of a modular implant with hybrid fixation in revision TKA demonstrated a high 2-year survival rate, significant improvements in clinical scores, and a low incidence of short-term complications. These findings support the efficacy and safety of this approach, providing favorable clinical outcomes and high patient satisfaction.

Radiografía al acceso en artroplastia de rodilla entre los beneficiarios del Fondo Nacional de Salud entre 2004 y 2021 / Access to knee arthroplasty among National Health Fund beneficiaries in Chile between 2004 and 2021

Introducción La artrosis de rodilla es una patología que afecta la calidad de vida, siendo la artroplastía de rodilla un tratamiento costo-efectivo para la etapa severa de esta enfermedad. El acceso a artroplastia de rodilla es un indicador de salud de la Organización de Cooperación y Desarrollo Económico. Los objetivos de este estudio son determinar la incidencia de artroplastia de rodilla entre 2004 y 2021 en los beneficiarios del Fondo Nacional de Salud en Chile, la proporción que se operaron en el sistema privado y estimar el gasto del bolsillo del paciente para operarse. Método Estudio transversal. Se utilizó la base de datos del Departamento de Estadística e Información de Salud. Se pesquisaron pacientes que egresaron de un centro de salud chileno que fueron intervenidos por artroplastia rodilla entre 2004 y 2021. Se analizó la proporción de pacientes por tramo del Fondo Nacional de Salud y si se realizó su cirugía en establecimiento de la red pública o privada. Resultados De las 31 526 intervenciones de artroplastia de rodilla, 21 248 (67,38%) fueron realizadas en pacientes del Fondo Nacional de Salud y 16 238 en instituciones públicas (51,49%). Los pacientes de dicho fondo presentan un alza sistemática en el volumen de artroplastías de rodilla hasta 2019, pero disminuyeron en 2020 y 2021 un 68% y un 51%. Del total de pacientes del sistema público operados de artroplastia de rodilla, 856 (9%) pertenecían al tramo A1, al tramo B 12 806 (60%), al tramo C 2044 (10%) y al tramo D 4421 (21%). Se estimó que el gasto incurrido por estos pacientes varía entre el 24,4 y 27,2%. Las proporciones históricas de acceso en instituciones privadas a esta cirugía son en el tramo A 7%, tramo B 13%, tramo C 24% y tramo D 52%. Conclusión El 50% de las cirugías de artroplastía de rodilla se realizan en instituciones públicas y dos tercios se realizan en pacientes del Fondo Nacional de Salud. El 46% de los tramos C y D se operaron en el sistema privado. La pandemia ha aumentado la brecha de acceso, lo que ha provocado un alza significativa en la proporción de pacientes del Fondo Nacional de Salud de los tramos B, C y D que han migrado al sistema privado para acceder a esta cirugía.

Introduction Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. Methods Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

Analgesia effect of dexamethasone combined with dexmedetomidine on femoral nerve block with ropivacaine after total knee replacement in elderly patients / 药学实践杂志

Objective To observe the analgesia effect of dexamethasone combined with dexmedetomidine on femoral nerve block with ropivacaine after total knee replacement in elderly patients. Methods 96 elderly patients undergoing total knee replacement with femoral nerve block analgesia from January 2019 to December 2020 in the hospital were enrolled in the study. Patients were divided into control group (C), dexamethasone group (E1), dexmedetomidine group (E2) and dexamethasone combined with dexmedetomidine group (E3) according to nerve block drug formulation. The general data and operation condition were collected, the VAS score at 6 h, 12 h, 24 h, 48 h and the Ramsay sedation score at 6 h after surgery were compared, the postoperative morphine consumption and duration of analgesia were analyzed, and the incidence of adverse reactions after operation was observed. Results Patients in four groups showed no significant differences in general data and operation time. The VAS score and Ramsay score at 6 h postoperatively in E2 and E3 were significantly lower than that in C, while there were no significant differences in VAS score at 24 h and 48 h postoperatively among four groups. Postoperative morphine consumption in E2 and E3 was significantly lower, and the duration of analgesia in E1, E2 and E3 was significantly longer than that in C. There was no statistical difference in the incidence of respiratory depression, nausea, vomiting, dizziness and other adverse reactions after operation among four groups. Conclusion Dexamethasone combined with dexmedetomidine could enhance the analgesic effect of femoral nerve block with ropivacaine in elderly patients after total knee replacement without increasing the adverse reactions, which would be both safe and effective.

Value of personalized osteotomy in primary total knee arthroplasty for severe varus knee osteoarthritis / 中国骨伤

OBJECTIVE@#To explore application value and efficacy of personalized osteotomy in primary total knee arthroplasty (TKA) for severe varus knee osteoarthritis.@*METHODS@#From June 2018 to January 2020, 36 patients (49 knees) with severe varus knee osteoarthritis were treated, including 15 males (21 knees) and 21 females (28 knees), aged from 59 to 82 years old with an average of (67.6 ± 6.5) years old;the course of disease ranged from 9.5 to 20.5 years with an average of (15.0 ± 5.0) years;11 patients (15 knees) with Kellgren-Lawrence grade Ⅲ and 25 patients (34 knees) with grade Ⅳ according to Kellgren-Lawrence grading. According to AORI clsssification of tibial bone defects, 8 patients (15 knees) were typeⅠTa and 16 patients (18 knees) were typeⅡ T2a. All patients' femor-tibial angle (FTA) was above 15°, and received primary TKA with personalized osteotomy. Thirty-three patients (45 knees) were treated with posterior-stabilized (PS) prostheses, 13 patients (15 knees) with PS prostheses combined with a metal pad and extension rod on the tibial side, and 3 patients (4 knees) with legacy constrained condylar knee (LCCK) prostheses. FTA, posterior condylar angle (PCA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) before and after operation at 1 month were measured and compared by using picture archiving and communication systems (PACS). Recovery of lower limbs before and after operation at 12 months was evaluated by American Knee Society Score(KSS), and complications were observed and recorded.@*RESULTS@#All 36 patients (49 knees) were followed up from 15 to 40 months with an average of (23.46±7.65) months. FTA, MPTA were corrected from preoperative (18.65±4.28)° and (83.75±3.65)° to postoperative (2.35±1.46)° and (88.85±2.25)° at 1 month, respectively (P<0.001). PCA was decreased from (2.42±2.16)° before operation to (1.65±1.35)° at 1 month after operation, LDFA improved from (89.56 ± 3.55)° before operation to (91.63±3.38)° at 1 month after operation (P<0.05). KSS increased from (67.58±24.16) before opertion to(171.31±15.24) at 12 months after operation, 14 patients (19 knees) got excellent result, 19 (26 knees) good, and 3 (4 knees) fair.@*CONCLUSION@#Personalized osteotomy is helpful for recovery of axial alignment of lower limbs and correct placement of prosthesis, could effectively relieve pain of knee joint, recover knee joint function.

Prevalencia de portación nasal de Staphylococcus aureus sensible y resistente a la meticilina en candidatos a artroplastia total de cadera o rodilla / Prevalence of nasal carriage of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in candidates for total hip or knee arthroplasty

INTRODUCIÓN Las infecciones perioperatorias en cirugía de reemplazo articular son fuente importante de morbimortalidad, así como de altos costos económicos y sociales, tanto para el paciente como para su entorno. La colonización preoperatoria por Staphylococcus aureus ha sido reconocida como un factor de riesgo importante para desarrollar una infección de sitio quirúrgico.El objetivo de este estudio es conocer la prevalencia de portación nasal de S. aureus, tanto sensible a la meticilina (SASM) como resistente a la meticilina (SARM), en pacientes candidatos a cirugía de reemplazo articular de cadera o rodilla. MATERIALES Y MÉTODOS Se realizó un estudio observacional de una cohorte retrospectiva de pacientes con indicación de artroplastia total de cadera (ATC) y rodilla (ATR) electiva por artrosis severa en un hospital público de Chile. Los pacientes fueron sometidos a tamizaje preoperatorio de portación, cultivándose muestras obtenidas mediante hisopado de ambas fosas nasales. Los datos del laboratorio fueron recopilados y presentados como porcentaje de portación de S. aureus. RESULTADOS Se estudiaron 303 pacientes consecutivos de ATC y 343 de ATR. En total, 483 de los 646 pacientes (74,7%) tuvieron estudio preoperatorio de portación nasal. Se identificaron 123 pacientes (25,4%) portadores de S. aureus, de los cuales sólo 2 (0,41%) casos correspondieron a SARM. CONCLUSIÓN La prevalencia de portación nasal de S. aureus obtenida fue de 25%, similar a lo reportado en otras series. La prevalencia de SARM (0.41%), sin embargo, estuvo bajo lo descrito en la literatura internacional (0,6­6%). Sería de utilidad, dada la alta prevalencia de portación descrita en nuestro trabajo y de acuerdo a evidencia publicada recientemente, realizar protocolos de descolonización universales, sin necesidad de realizar tamizaje preoperatorio.

INTRODUCTION Surgical-site infections in joint replacement surgery are an important source of morbidity and mortality that entail high economic and social burden both for the patient and their environment. Preoperative colonization by Staphylococcus aureus has been recognized as an important risk factor for the development of surgical-site infection. The aim of the present study is to determine the prevalence of nasal colonization by S. aureus, both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) in patients who are candidates for total replacement of the hip or knee joints. MATERIALS AND METHODS A retrospective observational study of a cohort of 646 patients with an indication to undergo total hip arthroplasty (THA) or total knee arthroplasty (TKA) due to severe osteoarthritis was performed in a Public Hospital in Chile. The patients were submitted to a preoperative screening for S. aureus carriage, and the culture samples were obtained by swabbing both nostrils. The laboratory data was collected and presented as a percentage of carriage. RESULTS We consecutively examined 303 THA and 343 TKA patients. A total of 483 of the 646 patients (74.7%) underwent a preoperative study of nasal carriage. We identified 123 (25.4%) S. aureus carriers, and only found 2 (0.41%) cases corresponding to MRSA. CONCLUSION We found a prevalence of nasal carriage of S. aureus of 25.4%, a rate similar to that reported in other series. The prevalence of MRSA (0.41%), however, was lower than that reported in the international literature (0.6­6%). Given the high prevalence of carriage described in our work and according to recently published data, it would be worthwhile to carry out universal decolonization protocols, without the need for preoperative screening.

Effectiveness of continuous passive motion after total knee replacement: A randomized controlled trial from North India

Background: Continuous passive motion (CPM) is a common strategy for early post-operative rehabilitation of patients who have undergone knee surgery. During an early recovery time following primary total knee replacement (TKR), the efficiency of the CPM approach was evaluated in this study. Aim and Objective: To determine the effectiveness of using a CPM device for individuals with poor ROM after a TKR as compared with non CPM device users. Materials and Methods: Fifty-four TKR patients were distributed into two groups. CPM and exercises were given to the study group, while exercises were given to the control group only. All individuals were assessed for mean active range of motion (AROM), mean Knee Society Score (KSS), and the Western Ontario and MacMaster Universities Osteoarthritis Index before and after surgery (WOMAC). Results: The study group’s mean AROM was 81.7 ± 15.1, while the control group’s was 75.4 ± 21.8. The Study group had a mean KSS score of 135.7 ± 19.7 points, while the control group had a score of 134.2 ± 15.7. Between the two groups, there were no statistical differences. The Study group’s KSS functional score was 64.6 ± 8.4, compared to 61.1 ± 7.5 for the control group, yet there was a statistically significant difference between the groups at hospital discharge (P = 0.008). A statistically significant difference in pain level, joint stiffness, and function was also found between the two groups (37.1 ± 12.3 points for the CPM group and 23 ± 14.1 points for the control). Conclusions: From these findings it suggests that CPM has no effect on improving clinical measures. The subjective assessment of pain level, joint stiffness, and functional ability, on the other hand, showed a substantial positive effect.

Fuerza isométrica máxima de cuádriceps e isquiotibiales y funcionalidad luego de la artroplastia total de rodilla / Maximum isometric force of the quadriceps and hamstrings and functionality after total knee arthroplasty

Resumen La gonartrosis es una enfermedad de alta prevalencia en adultos mayores. El objetivo de esta investigación fue identificar los cambios en la fuerza muscular del cuádriceps y su efecto en la funcionalidad de los pacientes operados de artroplastia total de rodilla (ATR) sometidos a kinesiterapia en el Hospital El Carmen de Maipú (HEC). A todos los operados de ATR se les midió, pre y post intervención, fuerza isométrica máxima (FIM), Time Up and Go, test de pararse y sentarse, apoyo unipodal y la escala WOMAC. La FIM de la rodilla operada y la no operada, es mayor en flexión y extensión al comparar ambos géneros (p < 0.0001; p < 0.0001, respectivamente). En el up and go y la prueba pararse y sentarse el rendimiento fue significativamente superior para el género masculino en relación al femenino (p = 0.001; p = 0.007, respectivamente). En el WO MAC, existieron diferencias significativas pre y post intervención en hombres y mujeres (p < 0.0001; p < 0.0001, respectivamente). Los pacientes con un índice de masa corporal (IMC) > 30 kg/m2 tienen 3 veces menos posi bilidades [OR = -3.498; IC (0.062-1.067)] de permanecer en tratamiento en un plazo menor a 50 días. Por otra parte, las lesiones en la rodilla no dominante (izquierda) tiene 4 veces más posibilidades de tratamiento inferior a 50 días [(OR = 2.71; IC (1.000-16.252)]. Existió un aumento de la FIM de la rodilla tratada post intervención, en ambos géneros. La funcionalidad aumentó en hombres y mujeres, posterior a la intervención.

Abstract Gonarthrosis is a highly prevalent disease in older adults. The objective of this re search was to identify changes in quadriceps muscle strength and their impact on the functionality of total knee replacement (TKA) operated patients undergoing kinesitherapy at Hospital El Carmen de Maipú (HEC). All TKA operated patients were measured, pre and post intervention, maximum isometric strength (MIF), Time Up and Go, Standing and sitting test, Unipodal support and the WOMAC scale. The operated and contralateral MIF is higher in flexion and extension when comparing both genders (p < 0.0001; p < 0.0001, respectively). In the up and go and the standing and sitting test, performance was significantly higher for males than for females (p = 0.001; p = 0.007, respectively). In the WOMAC, there were significant differences before and after the intervention in men and women (p < 0.0001; p < 0.0001, respectively). Patients with a body mass index (BMI) > 30 kg/m2 are 3 times less likely [OR = -3.498; CI (0.062-1.067)] to receive treatment in a period of less than 50 days. On the other hand, injuries to the non-dominant (left) knee have a 4 times greater chance of stay in treatment in less than 50 days [(OR = 2.71; CI (1.000-16.252)]. There was an increase in MIF of the knee treated post-intervention, in both genders. Functionality increased in men and women, after the intervention.

Cohorte histórica de artroplastia unicompartimental de rodilla en un hospital universitario chileno / Historical cohort of unicompartmental knee arthroplasty in a Chilean university hospital

OBJETIVO Describir el resultado funcional informado por el paciente de una cohorte de pacientes sometidos a artroplastia unicompartimental de rodilla (AUR) en un hospital universitario chileno. MÉTODOS Se diseñó un estudio de cohorte histórica. Se incluyeron todos los pacientes que se sometieron a AUR de platillo fijo entre 2003 y 2019. Un evaluador independiente se puso en contacto con los pacientes en junio de 2020. Se utilizó el índice de artritis de las universidades de Western Ontario y McMaster (WOMAC) para comparar los procedimientos de AUR (medial o lateral), la edad (mayor o menor de 70 años), y el seguimiento (más o menos de 5 años). RESULTADOS Se incluyeron 78 pacientes, en un total de 94 AURs. La mediana de edad fue de 64 años (rango: 43 a 85 años). Hubo 72 (76,6%) casos de AUR medial. Un paciente necesitó revisión para artroplastia total de rodilla (ATR). Un total de 60 pacientes (76,9%), correspondientes a 72 AURs (76,7%), fueron contactados con éxito por teléfono para el seguimiento final. La mediana del puntaje en los dominios del WOMAC fue: dolor ­ 1 (rango: 0 a 12); rigidez ­ 0 (rango: 0 a 4); y función física ­ 2 (rango: 0 a 29). La mediana del puntaje total en el WOMAC fue de 4 (rango: 0 a 44). Los pacientes sometidos a AUR lateral lograron mejores puntuaciones funcionales (p » 0,0432), y el puntaje total en el WOMAC fue similar en pacientes mayores o menores de 70 años (p » 0,3706). CONCLUSIONES La AUR es un tratamiento eficaz y reproducible para pacientes con artrosis de rodilla unicompartimental. La edad parece no afectar los resultados funcionales, y la AUR es un tratamiento eficaz en pacientes mayores de 70 años. Estos resultados deberían animar a los cirujanos de rodilla a aprender esta técnica y a los responsables de las políticas de salud pública a considerar la AUR para la osteoartritis de rodilla.

PURPOSE To describe the patient-reported functional outcome of a cohort of patients undergoing unicompartmental knee arthroplasty (UKA) in a Chilean university hospital. METHODS A historical cohort study was designed. All patients who underwent fixedbearing UKA between 2003 and 2019 were included. An independent evaluator contacted the patients in June 2020. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to compare UKA procedures (medial or lateral), age (over or under 70 years), and follow up (longer or shorter than 5 years). RESULTS A total of 78 patients, corresponding to 94 UKAs, were included. The median age was 64 years (range: 43 to 85 years). There were 72 (76.6%) cases of medial UKA. One patient needed revision to total knee arthoplasty (TKA). A total of 60 patients (76.9%), corresponding to 72 UKAs, were successfully contacted by phone for the final follow-up. The median scores on the WOMAC domains were: pain ­ 1 (range: 0 to 12); stiffness ­0 (range: 0 to 4); and physical function ­ 2 (range: 0 to 29). The median total score on the WOMAC was 4 (range: 0 to 44). Patients submitted to lateral UKA had better functional scores (p » 0.0432), and the total WOMAC score was similar among patients older or younger than 70 years of age (p » 0.3706). CONCLUSIONS For patients with unicompartmental knee osteoarthritis, UKA is an effective and reproducible treatment. Age does not seem to affect the functional results, and UKA is an effective treatment in patients over 70 years old. These results should encourage knee surgeons to learn this technique and those responsible for public health policies to consider UKA for knee osteoarthritis

Control del dolor con infiltración local transquirúrgica en postoperados de reemplazo total de rodilla / Pain control with local infiltration transsurgical in postoperative total knee replacement

Resumen: Introducción: De 15-20% de los pacientes sometidos a una artroplastía total de rodilla no quedaron satisfechos y las causas más comunes fueron dolor residual y función limitada. De manera tradicional se ha utilizado analgesia epidural o bloqueos nerviosos periféricos como analgesia. Objetivo: Evaluar la eficacia de la infiltración con solución de epinefrina, ketorolaco, morfina y ropivacaína en pacientes postoperados de reemplazo total de rodilla. Material y métodos: Estudio de cohorte observacional, transversal, retrospectivo y analítico. Se incluyeron pacientes con gonartrosis de 18 a 100 años de edad programados para cirugía de reemplazo total de rodilla de Mayo de 2018 a Agosto de 2021, con documentación de sus datos clínicos, demográficos, basales, prequirúrgicos y dolor postoperatorio a las 24 horas. Se compararon pacientes infiltrados con los que recibieron analgesia intravenosa. Resultados: Se incluyeron un total de 66 pacientes con una media de edad de 69.1; 65.2% fueron mujeres. Cuarenta y tres punto nueve por ciento tuvieron afectación del lado izquierdo, 50% tuvieron una clasificación de Kellgren-Lawrence III y 31.8% tuvieron un grado IV. Treinta y seis pacientes (54.5%) formaron el grupo control, mientras que 30 (45.5%) recibieron la intervención con el cóctel analgésico. Con respecto al dolor, se encontró una menor mediana del dolor por escala visual análoga en pacientes con la intervención (2 vs 8 puntos, p < 0.001); la mayoría con el cóctel se encontraron sin dolor (66.7%) o dolor leve (23.3%) y ningún paciente del grupo control lo alcanzó (p < 0.001). Todos los pacientes del grupo control requirieron analgesia de rescate, mientras que sólo en 30% del grupo de intervención se utilizó (p < 0.001). Conclusión: El uso de infiltración local transquirúrgica disminuye el dolor postoperatorio y el requerimiento de analgésicos y analgesia de rescate durante las primeras 24 horas.

Abstract: Introduction: 15-20% of patients undergoing total knee arthroplasty were not satisfied and the most common causes were residual pain and limited function. Epidural analgesia or peripheral nerve blocks have traditionally been used as analgesia. Objective: To evaluate the efficacy of infiltration with epinephrine, ketorolac, morphine and ropivacaine solution in postoperative total knee replacement patients. Material and methods: Observational, cross-sectional, retrospective and analytical cohort study. We included patients with gonarthrosis aged 18 to 100 years scheduled for total knee replacement surgery from May 2018 to August 2021; with documentation of their clinical, demographic, baseline, pre-surgical and postoperative pain data at 24 hours. Infiltrated patients were compared with those receiving intravenous analgesia. Results: A total of 66 patients with a mean age of 69.1 were included;65.2% were women. Forty-three point nine percent had left-sided involvement, 50% had a classification of Kellgren-Lawrence III and 31.8% had a grade IV. Thirty-six patients (54.5%) formed the control group, while 30 (45.5%)received the intervention with the analgesic cocktail. With regard to pain,a lower median pain was found by visual analog scale in patients with the intervention (2 vs 8 points, p < 0.001); most with the cocktail they found no pain (66.7%) or mild pain (23.3%) and no patient in the control group reached it (p < 0.001). All patients of the control group required rescue analgesia, while only 30% of the intervention group used it (p < 0.001). Conclusion: The use of trans-surgical local infiltration decreases postoperative pain and the requirement of analgesics and rescue analgesia during the first 24 hours.

Comparación entre suturas para cierre profundo y superficial en reemplazo total de rodilla: seguimiento a un año / A comparison of sutures for deep and superficial wound closure in total knee arthroplasty: One-year follow-up

Introducción Aunque diferentes materiales y técnicas se han desarrollado para el cierre superficial y profundo en reemplazo total de rodilla (RTR), no hay evidencia que permita dar recomendaciones respecto a una técnica especifica que disminuya complicaciones postoperatorias de la herida. El propósito de este estudio es comparar el uso de dos técnicas de cierre profundo (Sutura barbada vs. Sutura absorbible trenzada) y superficial (grapas vs. sutura de polipropileno) en RTR. Materiales y métodos Estudio observacional retrospectivo en 240 pacientes. Se excluyeron pacientes con antecedente de cirugía abierta previa de rodilla, RTR previo por lesiones tumorales o artrofibrosis. Seguimiento mínimo de 1 año. Resultados Se usaron grapas en 176 pacientes y Prolene® en 64 pacientes. El cierre profundo se realizó con Stratafix® en 164 pacientes y con Vicryl® en 75 pacientes. Encontramos complicaciones relacionadas con la herida y la funcionalidad al año de seguimiento. La infección superficial para el cierre con prolene presento un HR de 2.6 con un intervalo de confianza (IC) de 95%=1.1-6.2; p=0.029 y en el cierre profundo encontramos un HR a favor del Vicryl® de 0.22, IC 95%=0.96-5.8; p=0.05. Conclusiones Este estudio demostró un incremento significativo de la incidencia de infección superficial después de un RTR cuando el cierre profundo se realiza con suturas barbadas y el cierre superficial se realiza con sutura de polipropileno. Sin embargo, no se presentaron diferencias significativas en otras complicaciones relacionadas con la herida y en la funcionalidad postoperatoria con las diferentes técnicas de cierre superficial y profundo evaluadas.

Introduction Different materials and techniques have been developed for superficial and deep closure in total knee replacement (TKR), but there is no solid evidence that allows to recommend a specific technique that decreases the surgical post-operative complications. The purpose of this study is to compare the use of two deep closure techniques (barbed suture vs. braided absorbable suture) and superficial (staples vs. polypropylene suture) in TKR. Materials and methods An observational retrospective study was carried out in 240 patients. Those individuals were excluded with previous open knee surgery, arthrofibrosis, patients who underwent TKR due to tumor lesions or a follow up for less than one year. Results The skin was closed in 176 patients with staples and in 64 patients with Prolene®. Deep closure was performed with Stratafix® in 164 patients and with Vicryl® in 75 patients. Also, complications related to the wound and functionality were recorded in the first postoperative year. Superficial infection for closure with prolene presented an HR in favor of 2.6 with a confidence interval (CI) of 95%=1.1­6.2; p=0.029 and in deep closure a HR in favor of Vicryl® of 0.22, 95% CI=0.96­5.8; p=0.05 Conclusions This study demonstrated a significant increase in the incidence of superficial infection after TKR when deep closure is performed with barbed sutures and superficial closure with polypropylene suture. However, there were no significant differences in other complications related with the wound neither postoperative functionality with the different superficial and deep closure techniques that were evaluated.

Extensor mechanism transplantation after knee prosthesis: 70-month follow-up / Transplante de mecanismo extensor após prótese de joelho: seguimento 70 meses

ABSTRACT Objective: This article reports the range of motion, failure rate, and complications of patients with extensor mechanism injury after total knee arthroplasty (TKA) treated with extensor mechanism allograft with mid-term follow-up. Methods: Patients undergoing post-ATJ extensor mechanism transplantation from 2009 to 2018 were retrospectively evaluated. Demographics, the reason for transplantation, elapsed time from arthroplasty to transplantation, related surgical factors, immobilization time, range of motion, transplant failure, and complications were collected. The minimum follow-up was 24 months. Results: Twenty patients were evaluated. The mean follow-up was 70.8 +/- 33.6 months. The most common cause of extensor mechanism rupture was traumatic in 10 (50%) cases. Six patients underwent associated surgeries, one case of medial ligament complex reconstruction, and 5 cases of TKA revision. Eleven patients (55%) had transplant-related complications. The most common complication was an infection. Five cases presented transplant failure. Conclusion: Patients who underwent extensor mechanism allograft transplantation after total knee arthroplasty had a 25% failure rate with a mean follow-up of 6 years. Although there was no loss of flexion with the procedure and prolonged immobilization, the complication rate was not low. Level of evidence IV; case series .

RESUMO Objetivo: O objetivo do estudo foi relatar amplitude de movimento, taxa de falha e complicações de pacientes com lesão do mecanismo extensor após artroplastia total do joelho (ATJ) tratados com aloenxerto do mecanismo extensor com acompanhamento no médio prazo. Métodos: Pacientes submetidos a transplante de mecanismo extensor pós-ATJ de 2009 a 2018 foram avaliados retrospectivamente. Foram avaliados dados demográficos, motivo do transplante, tempo decorrido da artroplastia ao transplante, fatores cirúrgicos relacionados, tempo de imobilização, arco de movimento, falha do transplante e complicações. O acompanhamento mínimo foi de 24 meses. Resultados: Vinte pacientes foram avaliados. O tempo médio de acompanhamento foi de 70,8 +/- 33,6 meses. A causa mais comum de ruptura do mecanismo extensor foi traumática em 10 (50%) casos. Seis pacientes foram submetidos a cirurgias associadas, um caso de reconstrução do complexo ligamentar medial e 5 casos de revisão de ATJ. Onze pacientes (55%) tiveram complicações relacionadas ao transplante. A complicação mais comum foi a infecção. Cinco casos apresentaram falha do transplante. Conclusão: Pacientes submetidos a transplante de aloenxerto de mecanismo extensor após artroplastia total de joelho apresentam taxa de falha de 25% com seguimento médio de 6 anos. Embora não tenha havido perda de flexão com o procedimento e com a imobilização prolongada, o índice de complicações não foi baixo. Nível de evidênvia IV; série de casos .

The Needs of Orthopaedic Patients in Discharge Planning

@#Introduction: Patients' transition from hospital to home could be challenging for patients and caregivers. This is of utmost importance for patients requiring special or long-term care such as post-orthopaedic surgery. Effective discharge planning is required to ensure that patients are prepared to and get continuous care after returning home to prevent complications. Patients' need assessment is essential to develop effective discharge planning to meet the patient's needs. Materials and methods: This mixed-method study aimed to determine the patient's needs to develop a discharge planning for total knee replacement surgery. The needs for 96 total knee replacement patients were assessed using the Needs Evaluation Questionnaire (NEQ). The in-depth interview primary focus was to explore the lived experience of the post-total knee replacement patients receiving care in the hospital. Results: A total of 96 participants (100%) completed the NEQ questionnaire. Most of the needs concerned by the participants were expressed by at least 70% of them except the financial need (59.4%). The semi-structured interview found two elements which were a support group and patients’ needs in terms of emotional, physical and spiritual preparation in developing effective discharge planning. Conclusion: This study clarified that the patient needs assessment in the patient care plan.

The Outcome of Fixing Distal Femur Periprosthetic Fracture around Total Knee Replacement using a Locking Plate Non-Contact Bridging (NCB)

@#Introduction: Surgical fixation of peri-prosthetic distal femur fractures around knee replacements poses a challenge, especially in frail patients, with variable outcomes reported in the literature. This study looks at the outcomes of a consecutive series of patients presenting with such fractures and treated by using a locking plate fixation. Materials and methods: A total of 21 consecutive patients who were admitted to our trauma unit over 31 months and underwent fixation with the Non-Contact Polyaxial Locking plate system were retrospectively identified and their acute treatment with follow-up outcomes were analysed. Results: The mean age was 81 years and 71% were in ASA grades 3 and 4. Fracture morphologies were classified as per the Su classification, yielding 8 (38%) classified as Su one, 4 (19%) as Su two, and 9 (43%) as Su type three. Postoperatively, 2 patients (9.5%) died due to hospital-acquired pneumonia, and another 2 patients (9.5%) developed wound infections necessitating further return to theatre. Additionally, 2 (9.5%) patients had distal femoral replacements due to non-union. Mean discharge time was 28 days with 12 patients (55% of patients) starting protected weight-bearing six weeks after surgery. Conclusion: The incidence of morbidity, mortality was significant and re-operation was required in patients treated as described, and these were partly attributed to the patient’s average age and the pre-existing comorbidities. Significant variations were noted in the time to discharge, rehabilitation, and time to achieve fracture union. However, the majority of fractures did eventually unite. Patients with comminuted fractures and insufficient bone stock are more likely to progress to non-union and end up requiring revision knee arthroplasty.

Evaluation of perioperative mechanical prophylaxis of venous thrombosis in patients undergoing total knee and hip replacement and analysis of its obstacle factors / 中国实用护理杂志

Objective:To understand the current status of perioperative physical prevention of venous thrombosis in patients undergoing total knee and hip replacement and to analyze the barriers to clinical transformation of evidence and improve measures.Methods:Based on the evidence-based continued quality improvement model, then building a team, systematically searching, evaluating and summarizing evidences, establishing review indicators and review methods according to FAME principles (feasibility, appropriately, meanfulness, effectiveness), selecting patients undergoing total knee and hip replacement, nurses, and doctors who underwent total knee and hip replacement surgery from April 30 to August 31, 2020 in Shanxi Provincial People's Hospital as the review objects, and conducting a baseline review according to the review indicators one by one, and analyzing the obstacle factors and improvement measures based on the review results.Results:This study included 29 best evidences, and 17 review indicators were formulated based on the best evidences. Among them, the clinical compliance rate of 5 review indicators were greater than 80%, and the clinical compliance rate of 12 review indicators were less than 80%. The main obstacles were due to the imperfect venous thromboembolism (VTE) risk assessment and management process at the system level, and the low level of knowledge of VTE prevention and management among medical staff at the individual level.Conclusions:This study was based on the best evidences, scientifically and systematically developed clinical review indicators, rigorously and comprehensively analyzed obstacles, and constructed targeted improvement measures, not only for the future physical prevention of perioperative venous thrombosis in patients with total knee and hip replacement surgery transformation provides the basis but also can further promote clinical practice changes and continuous quality improvement.

Analysis of nursing effects of enhanced recovery after surgery in total knee arthroplasty under multidisciplinary cooperation / 中国实用护理杂志

Objective:To explore the nursing effect of enhanced recovery after surgery in total knee arthroplasty under multidisciplinary cooperation.Methods:From January 2017 to May 2020, the clinical data of 102 patients with total knee arthroplasty in First Hospital of Zibo were selected for retrospective analysis. According to the different nursing methods, they were divided into observation group and control group with 51 cases in each group, observation group was given enhanced recovery after surgery under multidisciplinary collaboration, and the control group was given routine nursing care. The length of hospitalization, hospitalization costs, intraoperative blood loss, 24 h postoperative hemoglobin, Visual Analogue Scale (VAS), knee range of motion (ROM), New York Hospital for Special Surgery (HSS) Knee Joint Score and complications were compared between the two groups of patients.Results:In the observation group the length of hospitalization was (7.65 ± 1.21) d, the cost of hospitalization was (92 355.21 ± 352.52) yuan, intraoperative blood loss (224.12 ± 25.32) ml, and 24 h postoperative hemoglobin was (115.12 ± 12.05) g/L,while those were (9.68 ± 2.15) d, (105 423.45 ± 544.25) yuan, (362.12 ± 38.78) ml, (102.32 ± 7.52) g/L in the control group, the difference between the two groups was statistically significant ( t values were 5.88-143.92, all P<0.05). Repeated measures analysis of variance showed that time point, between groups, interactive comparisons of VAS scores, ROM, HSS scores were significantly different between the two groups ( P<0.05). And 12, 48, 72 h after the operation, the VAS scores of the observation group were 4.12 ± 0.35, 2.62 ± 0.21, 1.65 ± 0.12, and 5.62 ± 0.58, 3.85 ± 0.41, 2.85 ± 0.24 in the control group, the difference between the two groups was statistically significant ( t=15.81, 19.07, 31.94, all P<0.05). 1 and 3 months after the operation, the ROM of the observation group were (99.78 ± 12.14)° and (108.95 ± 15.25)°, and the ROM of the control group were (81.65 ± 10.02)° and (98.77 ± 11.08)°, respectively. The difference between the two groups was statistically significant ( t=9.00, 4.22, both P<0.05). Conclusions:To give fast track surgery under multidisciplinary cooperation is beneficial to reduce the amount of bleeding in patients undergoing total knee arthroplasty, shorten the length of hospital stay, and reduce the incidence of complications.

Caracterización microbiológica y patrones de resistencia a antibióticos de las infecciones periprotésicas en pacientes sometidos a remplazo articular de rodilla o cadera, operados en la IPS Universitaria Clínica León XIII, entre el 2015 y 2018 / Microbiological characterization and antibiotic resistance patterns of periprosthetic infections in patients undergoing knee or hip joint replacement, operated at IPS Universitaria Clínica León XIII between 2015 and 2018 / Caracterização microbiológica e padrões de resistência a antibióticos das infecções periprotéticas em pacientes submetidos a artroplastia de joelho ou quadril, operados na IPS Universitária Clínica León XIII, entre 2015 e 2018

Objetivo: caracterizar desde el punto de vista microbiológico las infecciones periprotesicas (IP) de los pacientes sometidos a remplazo articular de rodilla o cadera, en la IPS universitaria Clínica León XIII, y evidenciar los patrones más comunes de resistencia a los antibióticos, en el periodo 2015-2018. Metodología: se recolectó información de 25 pacientes llevados a remplazo articular de rodilla o cadera en la IPS universitaria, sede Clínica León XIII, durante el periodo de 2015-2018, que desarrollaron IP. Se obtuvo información sobre características demográfica, clínicas y patrones de resistencia (según antibiograma), y sobre los criterios usados para diagnosticarla. Los datos se registraron, según la naturaleza y distribución de la variable, en medias o medianas para las variables cuantitativas, y en frecuencias para las cualitativas. Resultados: entre 2015 y 2018 se realizaron 541 remplazos articulares, la incidencia de infección periprotésica fue de 4.6% (25 pacientes), 22 casos (88%) con crecimiento microbiológico. El germen más frecuente fue el S. aureus, con patrón alto de resistencia para meticilina (SAMR), en el 44%. Seguido por K. pneumoniae, con un patrón de resistencia por producción de betalactamasas de espectro extendido (BLEE) de 83%. Ninguno tuvo resistencia a los carbapenémicos. Conclusiones: los resultados son similares a los reportados en la literatura internacional. Sigue siendo el S. aureus el principal causante de la infección periprotésica, seguido de los gérmenes gram negativos.

Objective: to microbiologically characterize the periprosthetic infections (PI) of patients undergoing knee or hip joint replacement at IPS Universitaria Clínica León XXIIIin the period 2015-2018, and to demonstrate the most common antibiotic resistance patterns. Methodology: the information was collected from 25 patients undergoing knee or hip joint replacement at IPS Universitaria Clínica León XXIII during the period 2015-2018 who developed PI. Data was obtained on demographic, clinical characteristics, and antibiotic resistance patterns (according to antibiograms), as well as on the diagnostic criteria used to diagnose it. The data was recorded, according to the nature and distribution of the variable, in means or medians for the quantitative variables, and in frequencies for the qualitative variables.Results:between 2015-2018, 541 joint replacements were performed. There was an incidence of periprosthetic infection in 25 patients (4.6%), 22 of whom (88%) had micro-biological growth. The most frequent germ was S. aureus, which had a high resistance pattern for methicillin-resistant S. aureus (MRSA) in 44%, followed by K. pneumoniaewith a positive extended spectrum beta-lactamase (ESBL) in 83%. None of them showed resistance to carbapenems.Conclusions: the results found are similar to those reported in the international lite-rature. This investigation evidenced that S. aureus continues to be the main cause of periprosthetic infection, followed by gram-negative germs.

Objetivo: caracterizar do ponto de vista microbiológico as infecções periprotéticas (IP) dos pacientes submetidos à artroplastia articular do joelho ou do quadril, na IPS universitário, Clínica León XIII, e demonstrar os padrões mais comuns de resistência aos antibióticos, em o período 2015-2018.Metodologia: foram coletadas informações de 25 pacientes encaminhados para prótese de joelho ou quadril no IPS universitário, sede da Clínica León XIII, no período 2015-2018, que desenvolveram IP. Foram obtidas informações sobre as características demográfi-cas, clínicas e padrões de resistência (de acordo com antibiograma) e sobre os critérios usados para diagnosticá-la. Os dados foram registrados, de acordo com a natureza e distribuição da variável, em médias ou medianas para as variáveis quantitativas e em frequências para as qualitativas.Resultados: entre 2015 e 2018, foram realizadas 541 substituições articulares, a incidência de infecção periprotética foi de 4,6% (25 pacientes), 22 casos (88%) com crescimento microbiológico. O germe mais frequente foi S. aureus, com alto padrão de resistência à meticilina (MRSA), em 44%. Seguido por K. pneumoniae, com padrão de resistência devido à produção de beta-lactamase de espectro estendido (ESBL) de 83%. Nenhum apresentou resistência aos carbapenêmicos.Conclusões: os resultados são semelhantes aos relatados na literatura internacional. S. aureus continua a ser a principal causa de infecção periprotética, seguido por germes gram-negativos.

Cirugía de salvamento en un caso de condrosarcoma de rodilla / Salvage surgery in a case of knee chondrosarcoma

El siguiente caso, se trata de una paciente de sexo femenino que acude a consulta de traumatología por dolor de rodilla y dificultad para deambular, sin antecedente de trauma. En la radiografía anteroposterior y lateral se evidencia múltiples áreas radiolúcidas y escleróticas en meseta tibial y fémur distal derecho. La biopsia reporta: Condrosarcoma indiferenciado Grado 2. Se inicia sesiones de quimioterapia profiláctica y se planifica la cirugía de salvamento, esto ante la negativa de la paciente para aceptar la cirugía de amputación. La cirugía de reconstrucción se realizó mediante la colocación de una prótesis semiconstreñida tipo Endo Model cementada. En el posoperatorio se realizó controles y curaciones semanales, con buena cicatrización de la herida, y posteriormente rehabilitación por fisioterapia. Actualmente la paciente puede deambular con apoyo y casi de manera independiente.

The following case is a female patient who came to the trauma clinic for knee pain and difficulty walking, with no history of trauma.The anteroposterior and lateral radiograph shows multiple radiolucent and sclerotic areas on the tibial plateau and the right distal femur.The biopsy reports grade 2 undifferentiated chondrosarcoma. Prophylactic chemotherapy sessions are started and salvage surgery is planned, this given the patient's refusal to accept amputation surgery. Reconstruction surgery was performed by placing a semi-constrained, cemented endo Model type prosthesis. In the postoperative period, weekly controls and dressings were carried out, with good wound healing and later rehabilitation by physiotherapy. Actually the patient can walk with support and almost independently.

Efecto de un protocolo de rehabilitación sobre la funcionalidad y calidad de vida en pacientes con reemplazo total de rodilla. estudio de cohorte transversal / Effect of a rehabilitation protocol on the functionality and quality of life in patients with total knee replacement. a cross sectional study

Introducción El reemplazo total de rodilla (RTR) es una de las cirugías con mayor tasa de éxito, y la funcionalidad y calidad de vida dependen en gran medida de la rehabilitación física adecuada. En Colombia no existe una Guía de rehabilitación física registrada ante el Ministerio de Salud. Por lo anterior el presente estudio tuvo como objetivo general determinar el efecto de la intervención fisioterapéutica en la funcionalidad y calidad de vida en pacientes sometidos a RTR. Materiales & métodos Estudio de cohorte transversal, que consto de tres evaluaciones (prequirúrgica, a los 3 y 6 meses) aplicando WOMAC, SF12, evaluación fisioterapéutica; y 36 sesiones de fisioterapia domiciliaria a 10 adultos mayores de 65 años. La muestra fue tomada de la lista de espera del cirujano participante entre noviembre de 2017 y junio de 2018. Resultados Al aplicar el cuestionario WOMAC la rigidez y el dolor obtuvieron un valor p=0.00 y 0,01 respectivamente. En la capacidad funcional se encontró una significancia de 0,009 entre el 1 y el 3 momento de la evaluación. Los resultados obtenidos al aplicar el cuestionario SF12 refirieron un mejor estado de salud, con poca limitación al realizar esfuerzos moderados o subir escaleras. En el 80% de la población la fuerza paso de 3- a 4+. En amplitud de movimiento articular se alcanzaron rangos funcionales que superan los 90° de flexión. Discusión Los resultados en la funcionalidad y calidad de vida están en consonancia con lo reportado en la literatura internacional.

Introduction Total knee replacement (TKR) has one of the highest success rates, and functionality and quality of life depend largely on appropriate physical rehabilitation. There is no physical rehabilitation guideline registered with the Ministry of Health in Colombia. Therefore, the general objective of this study was to determine the effect of physiotherapy intervention on functionality and quality of life in patients undergoing TKR. Materials & methods A cross-sectional cohort study, comprising three assessments (preoperative, at 3 and at 6 months) using the WOMAC and SF12 questionnaires, physiotherapy assessment, and 36 sessions of home physiotherapy in 10 adults over 65 years of age. The sample was taken from the participating surgeon's waiting list between November 2017 and June 2018. Results. Stiffness and pain obtained p-values of .00 and .01 respectively from the WOMAC questionnaire. A significance level of .009 was found in functional ability between the 1st and 3rd assessments. The SF12 questionnaire results reflected a better state of health, with little limitation on moderate effort or climbing stairs. Strength went from 3- to 4+ in 80% of the population. Functional ranges exceeding 90̊ of flexion were achieved in joint range of motion. Discussion Outcomes in terms of functionality and quality of life are in line with those reported in the international literature.