RESUMO
The role of computer-assisted surgery in maintaining the level of the joint in primary knee joint replacement (TKR) has not been well defined. We undertook a blinded randomised controlled trial comparing joint-line maintenance, functional outcomes, and quality-of-life outcomes between patients undergoing computer-assisted and conventional TKR. A total of 115 patients were randomised (computer-assisted, n = 55; conventional, n = 60). Two years post-operatively no significant correlation was found between computer-assisted and conventional surgery in terms of maintaining the joint line. Those TKRs where the joint line was depressed post-operatively improved the least in terms of functional scores. No difference was detected in terms of quality-of-life outcomes. Change in joint line was found to be related to change in alignment. Change in alignment significantly affects change in joint line and functional scores.
Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/reabilitação , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Cirurgia Assistida por Computador/reabilitação , Resultado do TratamentoRESUMO
We carried out a prospective, continuous study on 529 patients who underwent primary total knee replacement between January 2006 and December 2007 at a major teaching hospital. The aim was to investigate weight change and the functional and clinical outcome in non-obese and obese groups at 12 months post-operatively. The patients were grouped according to their pre-operative body mass index (BMI) as follows: non-obese (BMI < 30 kg/m(2)), obese (BMI (3) 30 to 39 kg/m(2)) and morbidly obese (BMI > 40 kg/m(2)). The clinical outcome data were available for all patients and functional outcome data for 521 (98.5%). Overall, 318 (60.1%) of the patients were obese or morbidly obese. At 12 months, a clinically significant weight loss of > or =5% had occurred in 40 (12.6%) of the obese patients, but 107 (21%) gained weight. The change in the International Knee Society score was less in obese and morbidly obese compared with non-obese patients (p = 0.016). Adverse events occurred in 30 (14.2%) of the non-obese, 59 (22.6%) of the obese and 20 (35.1%) of the morbidly obese patients (p = 0.001).
Assuntos
Artroplastia do Joelho/reabilitação , Obesidade/complicações , Aumento de Peso , Redução de Peso , Idoso , Artroplastia do Joelho/efeitos adversos , Fatores de Confusão Epidemiológicos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Obesidade Mórbida/complicações , Obesidade Mórbida/fisiopatologia , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
PURPOSE: To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA). METHODS: Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores. RESULTS: No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI=30 kg/m2 or more), computer-assisted TKA provided better alignment than the conventional technique. CONCLUSION: Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.
Assuntos
Artroplastia do Joelho/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Glove perforation during surgery represents a potential risk of infection for the surgeon. The authors postulated that thicker latex gloves may offer greater protection. The perforation rates for the Ansell Gammex glove and the thicker Baxter Triflex gloves were compared in single- and double-glove usage and no difference was found between the two brands, in either usage. The authors recommend double-gloving for all orthopaedic operations with regular glove changes during major procedures.
