Performance of medial pivot, posterior stabilized and rotating platform total knee arthroplasty based on anteroposterior stability and patient-reported outcome measures; a multicentre double-blinded randomized controlled trial of 210 knees.

BACKGROUND: Despite advancements in total knee arthroplasty (TKA), 10-20% of patients remain dissatisfied after surgery. Improved anteroposterior (AP) stability provided by medial pivot (MP) implants may theoretically lead to higher patient satisfaction. METHODS: AP stability and patient-reported outcome measures (PROMs) at one-year postsurgery were compared between patients who underwent TKA with MP- (n = 121), posterior stabilized (PS; n = 53) and rotating platform (RP; n = 57) implants in a double-blind multicentre randomized controlled trial (Dutch Trial Register: NL6856, 21-02-2018). AP stability was assessed at 30°, 60° and 90° of knee flexion using a KT-2000 arthrometer. PROMs were measured preoperative and one-year postsurgery. RESULTS: MP-TKA provided significant better AP stability at early flexion (30°) compared to PS- and RP-TKA (median [IQR]; 1.79 [1.14-2.77] mm vs. 3.31 [2.51-4.08] mm vs. 2.82 [1.80-4.03] mm, p < 0.001). Additionally, MP-TKA provided significant better AP stability at mid-flexion (60°) compared to PS-TKA (1.75 [1.23-2.36] mm vs. 2.14 [1.49-2.83] mm, p = 0.014). PROM improvements were comparable between implant designs. AP laxity of ≥ 4 mm at early flexion was independently of implant design associated with significantly worse Kujala scores. The incidence of ≥ 4 mm AP laxity at any knee angle was however not significantly different between implant designs. CONCLUSION: MP-, PS- and RP-TKA all provide excellent and comparable results. Although MP-TKA provided better AP stability at early flexion compared to PS- and RP-TKA, this was found to be unrelated to improved PROMs in favour of MP-TKA. More studies focusing on early and mid-flexion performance based differences between MP and other TKA designs are required to confirm our findings. Other non-implant related factors may play a more important role in the performance of TKA and are potentially worthwhile examining.

Direct Anterior Approach for One-Stage Bilateral Total Hip Arthroplasty in an ASA 3 Wheelchair-Dependent Woman.

This case report involves a 79-year-old wheelchair-dependent woman with bilateral destructive coxarthrosis, requiring total hip arthroplasty (THA). Mobilization and transfers were unbearable due to the bilateral involvement of her hips. Performing unilateral THA would not be sufficient due to the coexisting pain from the contralateral side. Therefore, the decision was made to perform bilateral THA in one stage using the direct anterior approach (DAA). One-stage bilateral THA (1-SBTHA) using the DAA in ASA 3 patients is not previously described in the literature. The procedure was completed as planned, without any major perioperative complications. Eight weeks postoperatively, the patient was able to mobilize unaccompanied using a walker. She regained her mobility and independence. This outcome suggests that 1-SBTHA using DAA can be considered for disabling coxarthrosis in carefully selected ASA 3 patients. DAA is the superior approach for 1-SBTHA, due to decreased muscle damage leading to early mobilization with improved gait. Another benefit of DAA is that both hips can be draped simultaneously without repositioning the patient during the procedure.

Surgeon satisfaction agreement after total knee arthroplasty using a visual analogue scale: a single surgeon series.

INTRODUCTION: The outcome of total knee arthroplasty (TKA) is traditionally rated by objective criteria such as the knee society clinical rating system (KSCRS). Subjective criteria, such as satisfaction, will be of more importance, because health-care is shifting towards a market model. The aim of this study was to investigate the agreement on satisfaction after TKA between two orthopaedics surgeons, when one of the surgeons reviews his own results. PATIENTS AND METHODS: We investigated a group of 57 patients (63 TKAs) using a visual analogue scale (VAS) for satisfaction. There were 53 TKAs available and were separately seen by the two orthopaedic surgeons for clinical follow-up. RESULTS: After we split the satisfaction rate as excellent-good and fair-poor (VAS smaller or equal to 20 was excellent-good), we found a substantial agreement (kappa = 0.77) between the orthopaedic surgeons. However, we found that the surgeon who viewed his own results (B) scored a significantly lower satisfaction than surgeon A when analysing the complete group. CONCLUSIONS: The interobserver agreement of satisfaction, using a VAS, was high between the two orthopaedic surgeons. The satisfaction VAS is a simple tool to quantify satisfaction of surgeons and patients after TKA and could be used to evaluate quality. Comparison between studies could be more efficient and reliable using the satisfaction VAS method.

Are surgeons equally satisfied after total knee arthroplasty?

INTRODUCTION: We performed a clinical follow-up study to investigate whether three orthopaedic surgeons were equally satisfied after total knee arthroplasty (TKA). PATIENTS AND METHODS: Thirty-six patients (39 TKAs, mean follow-up 12 months) were reviewed, using the Knee Society Clinical Rating System (KSCRS). For the assessment of satisfaction a visual analogue scale (VAS) was used. RESULTS: We did not find a significant difference in satisfaction between the surgeons. However, there was a significant difference in the knee score and function score of the KSCRS as evaluated by the orthopaedic surgeons (p=0.006 and p=0.04, respectively). The correlation between the knee score and the surgeons' satisfaction was high, which indicates that pain, range of motion and deformity are important success criteria for surgeons. CONCLUSIONS: In this study, surgeons scored differently in the KSCRS but were equally satisfied after TKA.

Patient versus surgeon satisfaction after total hip arthroplasty.

We compared patient satisfaction with surgeon satisfaction after total hip arthroplasty (THA) in a group of 193 patients (200 THAs, mean follow-up six years) using a visual analogue scale (VAS), and two objective and two subjective scoring systems. We also determined the survival rate with different endpoints. For the 121 hips available for clinical follow-up, we did not find a significant difference in satisfaction between patient and surgeon. In a subgroup with low patient satisfaction, the surgeon was more satisfied than the patient (p = 0.04). The correlation between the patient satisfaction VAS and the different subjective and objective scoring systems suggests that pain during activity is the most important factor for the patient. The survivorship at six years decreased from 96.6% to 83.7% if dissatisfaction (VAS > 20) was added to revision as an endpoint in the survival analysis. The patient satisfaction VAS provides additional information to evaluate the outcome of THA. We recommend the use of both subjective and objective scoring systems to evaluate the outcome of THA.