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1.
J Arthroplasty ; 37(6S): S350-S354, 2022 06.
Article in English | MEDLINE | ID: covidwho-1748218

ABSTRACT

BACKGROUND: Since the COVID-19 pandemic of 2020, there has been a marked rise in the use of telemedicine to evaluate patients after total knee arthroplasty (TKA). The purpose of our study was to assess a novel stem with an embedded sensor that can remotely and objectively monitor a patient's mobility after TKA. METHODS: A single anatomically designed knee system was implanted in concert with an interconnected tibial stem extension containing 3D accelerometers, 3D gyroscopes, a power source, and a telemetry transmission capability in 3 cadaveric pelvis to toe specimens. The legs were moved by hand to preset tibial positions at full knee extension, midflexion, flexion, and back to midflexion and extension for a total of 16 trials across 6 knees. RESULTS: Sensor data were successfully transmitted with good quality of signal to an external base station. Good correlation to the range of motion of the tibia was found (mean error 0.1 degrees; root mean square error 3.8 degrees). The signal from the heel drop tests suggests the sensor could detect heel strike during activities of daily living in vivo and the potential for additional signal processing to analyze vibratory and motion patterns detected by the sensors. A frequency domain analysis of a properly cemented and poorly cemented implant during the heel drop test suggests a difference in accelerometer signal in these implant states. CONCLUSION: The results confirm signals generated from an embedded TKA sensor can transmit through bone and cement, providing accurate range of motion data and may be capable of detecting changes in prosthesis fixation remotely.


Subject(s)
Arthroplasty, Replacement, Knee , COVID-19 , Knee Prosthesis , Activities of Daily Living , Arthroplasty, Replacement, Knee/adverse effects , Biomechanical Phenomena , COVID-19/prevention & control , Cadaver , Feasibility Studies , Humans , Knee Joint/surgery , Monitoring, Physiologic , Pandemics , Range of Motion, Articular , Tibia/surgery
2.
J Arthroplasty ; 37(8S): S716-S720, 2022 08.
Article in English | MEDLINE | ID: covidwho-1729545

ABSTRACT

BACKGROUND: The two-year minimum follow-up after total knee arthroplasty (TKA) required by most academic journals is based on implant survivorship studies rather than patient-reported outcome measures (PROMs). Additionally, the COVID-19 pandemic placed an unprecedented burden on patients and staff and halted asymptomatic surveillance clinic visits to minimize exposure. The purpose of this study was to determine if clinically meaningful differences were observed in PROMs beyond one year after TKA. METHODS: A retrospective review was performed on prospectively collected PROMs after 1093 primary TKAs at a suburban academic center. PROMs related to pain, function, activity level, and satisfaction were compared by subsequent follow-up intervals preoperatively, at 4 months, 1 year, and minimum 2 years using paired data analysis techniques. RESULTS: Pain with level walking and while climbing stairs improved from preoperative levels to 4-month, 1-year, and minimum 2-year follow-up. The University of California Los Angeles activity level and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement improved over the same intervals. Patient satisfaction improved over postoperative follow-up intervals (84.0%, 87.3%, and 90.9%). While PROMs improved with statistical and clinical significance preoperatively to 4-month to 1-year follow-up, improvements from 1-year to minimum 2-year follow-up were small and did not reach minimum clinically important differences for nearly all PROMs, demonstrating significant overlap of the 95% confidence intervals. CONCLUSION: While long-term follow-up after TKA remains important for implant survivorship, it appears that one-year PROMs are as clinically reliable and meaningful as two-year PROMs. Therefore, it is reasonable to question the currently accepted 2-year minimum follow-up requirement used in peer-reviewed research involving PROMs. LEVEL OF EVIDENCE: Level III.


Subject(s)
Arthroplasty, Replacement, Knee , Awards and Prizes , COVID-19 , Osteoarthritis, Knee , Arthroplasty, Replacement, Knee/methods , Humans , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Pain/surgery , Pandemics , Patient Reported Outcome Measures , Treatment Outcome
3.
JBJS Case Connect ; 12(1)2022 02 24.
Article in English | MEDLINE | ID: covidwho-1705410

ABSTRACT

CASE: We report the case of a coronavirus disease 2019 (COVID-19)-recovered, 42-year-old man with osteonecrosis and concomitant acute bacterial osteomyelitis of both hips and his left knee. The patient underwent total hip replacement for both hips and arthroscopic decompression and synovectomy of the knee joint. On follow-up, he has complete and painless range of motion with resolving osteomyelitis and no signs of active infection. CONCLUSION: Corticosteroid therapy and COVID-19-associated thrombotic microangiopathy might have caused osteonecrosis in our patient. However, concomitant osteomyelitis is extremely rare and might be overlooked because of elevated inflammatory markers after recovery from COVID-19 infection.


Subject(s)
COVID-19 , Osteomyelitis , Osteonecrosis , Adult , COVID-19/complications , Humans , Knee Joint/surgery , Male , Osteomyelitis/complications , SARS-CoV-2
4.
Orthopade ; 51(5): 403-409, 2022 May.
Article in German | MEDLINE | ID: covidwho-1603174

ABSTRACT

BACKGROUND: The aim of this study was to examine the influence of the COVID-19(coronavirus disease 2019) pandemic on the medical and physiotherapeutic follow-up care after reconstructions of the anterior cruciate ligament. METHODS: 116 patients (72 men and 44 women) who had received a reconstruction of the anterior cruciate ligament between September 2019 and December 2020 were included in this study. These patients were divided into two groups depending on the date of surgery: one group that had received surgery in 2019 before the COVID-19 pandemic and one group that had undergone surgery in 2020 and was directly affected by the COVID-19 pandemic. All patients were interviewed using a standardized questionnaire regarding the influence of the coronavirus pandemic on the medical and physiotherapeutic follow-up care, as well as the moment of return to work. In addition, the range of motion of the respective knee 3 months postoperatively was analysed based on physical examination. RESULTS: At 3 months postoperatively, patients who had undergone surgery in 2020 showed a clear trend towards a higher frequency of extension deficits of ≥ 5° (18.8% vs. 4.3%, p = 0.097) or an inability to bend the knee ≥ 120° (23.3% vs. 10%, p = 0.197) compared to those who had received surgery in 2019. Patients who had undergone surgery in 2020 reported significantly longer delays for appointments, a higher number of futile attempts to get an appointment and a higher number of cancelled appointments, regarding both medical and physiotherapeutic follow-up care. 34.9% of the patients who received surgery in 2020 indicated that they were able to reduce the duration of their sick leave due to the increased possibilities of working in a home-office situation during the pandemic. Alternative treatment options due to the pandemic were offered by 13.3% of the physiotherapists and 12.2% of the physicians. CONCLUSION: Although the physiotherapeutic and medical follow-up care was not directly affected by a "lockdown", the pandemic led to significant restrictions, which are also reflected in a clear trend towards worse clinical outcomes. Consequently, a further expansion of alternative treatment options, which were only offered by 12-13% of practices and that are presumably of comparable relevance for various other diseases, is needed.


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , COVID-19 , Aftercare , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/epidemiology , Anterior Cruciate Ligament Injuries/surgery , COVID-19/epidemiology , Female , Follow-Up Studies , Humans , Knee Joint/surgery , Male , Pandemics , Treatment Outcome
6.
Medicine (Baltimore) ; 100(6): e24141, 2021 Feb 12.
Article in English | MEDLINE | ID: covidwho-1101918

ABSTRACT

BACKGROUND: The global neo-coronary pneumonia epidemic has increased the workload of healthcare institutions in various countries and directly affected the physical and psychological recovery of the vast majority of patients requiring hospitalization in China. We anticipate that post-total knee arthroplasty kinesiophobia may have an impact on patients' postoperative pain scores, knee function, and ability to care for themselves in daily life. The purpose of this study is to conduct a micro-video intervention via WeChat to verify the impact of this method on the rapid recovery of patients with kinesiophobia after total knee arthroplasty during neo-coronary pneumonia. METHODS: Using convenience sampling method, 78 patients with kinesiophobia after artificial total knee arthroplasty who met the exclusion criteria were selected and randomly grouped, with the control group receiving routine off-line instruction and the intervention group receiving micro-video intervention, and the changes in the relevant indexes of the two groups of patients at different time points on postoperative day 1, 3 and 7 were recorded and analyzed. RESULTS: There were no statistical differences in the scores of kinesiophobia, pain, knee flexion mobility (ROM) and ability to take care of daily life between the two groups on the first postoperative day (P > .05). On postoperative day 3 and 7, there were statistical differences in Tampa Scale for kinesiophobia, pain, activities of daily living scale score and ROM between the two groups (P < .01), and the first time of getting out of bed between the two groups (P < .05), and by repeated-measures ANOVA, there were statistically significant time points, groups and interaction effects of the outcome indicators between the 2 groups (P < .01), indicating that the intervention group reconstructed the patients' postoperative kinesiophobiaand hyperactivity. The level of pain awareness facilitates the patient's acquisition of the correct functional exercises to make them change their misbehavior. CONCLUSIONS: WeChat micro-video can reduce the fear of movement score and pain score in patients with kinesiophobia after unilateral total knee arthroplasty, shorten the first time out of bed, and improve their joint mobility and daily living ability. ETHICS: This study has passed the ethical review of the hospital where it was conducted and has been filed, Ethics Approval Number: 20181203-01.


Subject(s)
Arthroplasty, Replacement, Knee/psychology , COVID-19/psychology , Phobic Disorders/psychology , Pneumonia/epidemiology , Activities of Daily Living , Aged , Arthroplasty, Replacement, Knee/adverse effects , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , China/epidemiology , Female , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Male , Middle Aged , Pain, Postoperative/diagnosis , Pain, Postoperative/psychology , Pneumonia/virology , Postoperative Period , Prospective Studies , Range of Motion, Articular , Recovery of Function , Rehabilitation/methods , Rehabilitation/psychology , SARS-CoV-2/genetics , Videoconferencing/instrumentation , Videoconferencing/statistics & numerical data
7.
Knee ; 28: 57-63, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-967347

ABSTRACT

BACKGROUND: Elective orthopaedic surgery during the Covid-19 pandemic requires careful case prioritisation. We aimed to produce consensus-based guidelines on the prioritisation of revision total knee arthroplasty (TKA) procedures. METHOD: Twenty-three revision TKA scenarios were assigned priority (NHS England/Royal College of Surgeons scale) by the British Association for Surgery of the Knee (BASK) Revision Knee Working Group (n = 24). Consensus agreement was defined as ≥70% respondents (18/24) giving the same prioritisation. Two voting rounds were undertaken; procedures achieving <70% agreement were given their most commonly assigned priority. RESULTS: 18/23 procedures achieved ≥70% agreement. Three were P1a (surgery within <24 h); DAIR for sepsis, peri-prosthetic fracture (PPF) fixation and PPF-revision TKA. Three were P1b (<72 h); debridement, antibiotics and implant retention (DAIR) for a stable patient, flap coverage for an open knee, and acute extensor mechanism rupture. Eight were P2 (<4 weeks), including aseptic loosening at risk of collapse, inter-stage patients with poor functioning spacers. Five were P3 (<3 months), including second stage revision for infection, revision for instability with limited mobility. Four were P4 (can wait >3 months) e.g. aseptic loosening. CONCLUSION: Sepsis and PPF surgery are the most urgent procedures. Although most procedures should be undertaken within one to three months (P2/3), these cases represent a small revision practice volume; P4 cases (e.g. aseptic loosening without risk of collapse) make up most surgeons' caseload. These recommendations are a guideline; patient co-morbidities, Covid-19 pathways, availability of support services and multi-disciplinary team discussion within the regional revision network will dictate prioritisation.


Subject(s)
Arthroplasty, Replacement, Knee/methods , COVID-19/epidemiology , Consensus , Knee Joint/surgery , Knee Prosthesis , Osteoarthritis, Knee/surgery , Aged , Comorbidity , Female , Humans , Male , Middle Aged , Osteoarthritis, Knee/epidemiology , Pandemics , Reoperation , SARS-CoV-2 , United Kingdom/epidemiology
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