Background —Randomized trials evaluating efficacy of local infiltration analgesia (LIA) have been published but many of these lack standardized analgesics. There is a paucity of reports on the effects of LIA on functional capability and quality of life.Methods —56 patients undergoing unilateral total knee arthroplasty (TKA) were randomized into 2 groups in this placebo-controlled study with 12-month follow-up. In the LIA group, a mixture of levobupivacaine (150 mg), ketorolac (30 mg), and adrenaline (0.5 mg) was infiltrated periarticularly. In the placebo group, infiltration contained saline. 4 different patient-reported outcome measures (PROMs) were used for evaluation of functional outcome and quality of life.Results —During the first 48 hours postoperatively, patients in the LIA group used less oxycodone than patients in the placebo group in both cumulative and time-interval follow-up. The effect was most significant during the first 6 postoperative hours. The PROMs were similar between the groups during the 1-year follow-up.Interpretation —Single periarticular infiltration reduced the amount of oxycodone used and enabled adequate pain management in conjunction with standardized peroral medication without adverse effects. No clinically marked effects on the functional outcome after TKA were detected.

Background and Aims: Previous studies have reported lower implant survival rates, residual pain, and higher patient dissatisfaction rates following knee arthroplasty in younger knee arthroplasty patients. We aimed to assess the real-world effectiveness of knee arthroplasty in a prospective non-selected cohort of patients aged 65 years or less with 2-year follow-up. Material and Methods: In total, 250 patients (272 knees) aged 65 years or less were enrolled into this prospective cohort study. Patient-reported outcome measures were used to assess the outcome. Results: The mean Oxford Knee Score and all Knee Injury and Osteoarthritis Outcome Score subscales increased significantly (p < 0.001) from preoperative situation to the 2-year follow-up. Significant increase (p < 0.001) in physical activity was detected in High-Activity Arthroplasty Score and RAND-36 Physical Component Score (PCS). Pain was also significantly (p < 0.001) relieved during the follow-up. Total disappearance of pain was rare at 2 years. Patients with milder (Kellgren–Lawrence grade 2) osteoarthritis were less satisfied and reported poorer patient-reported outcome measure than those with advanced osteoarthritis (Kellgren–Lawrence grade 3–4). There was no difference in the outcome (any patient-reported outcome measure) between patients who underwent total knee arthroplasty and those who received unicondylar knee arthroplasty. Conclusion: We found that measured with a wide set of patient-reported outcome measures, both total knee arthroplasty and unicondylar knee arthroplasty resulted in significant pain relief, as well as improvement in physical performance and quality of life in patients aged 65 years or less. Real-world effectiveness of these procedures seems to be excellent. 15% of patients still had residual symptoms and were dissatisfied with the outcome at 2 years after the operation.

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Background and purposeThe annual number of total knee arthroplasties (TKAs) has increased worldwide in recent years. To make projections regarding future needs for primaries and revisions, additional knowledge is important. We analyzed and compared the incidences among 4 Nordic countriesPatients and methodsUsing Nordic Arthroplasty Register Association (NARA) data from 4 countries, we analyzed differences between age and sex groups. We included patients over 30 years of age who were operated with TKA or unicompartmental knee arthroplasty (UKA) during the period 1997–2012. The negative binomial regression model was used to analyze changes in general trends and in sex and age groups.ResultsThe average annual increase in the incidence of TKA was statistically significant in all countries. The incidence of TKA was higher in women than in men in all 4 countries. It was highest in Finland in patients aged 65 years or more. At the end of the study period in 2012, Finland’s total incidence was double that of Norway, 1.3 times that of Sweden and 1.4 times that of Denmark. The incidence was lowest in the youngest age groups (< 65 years) in all 4 countries. The proportional increase in incidence was highest in patients who were younger than 65 years.InterpretationThe incidence of knee arthroplasty steadily increased in the 4 countries over the study period. The differences between the countries were considerable, with the highest incidence in Finland. Patients aged 65 years or more contributed to most of the total incidence of knee arthroplasty.

BackgroundThe focus in the reporting of results after total knee replacement (TKR) has changed from surgeon/radiologist-based scores to patient-reported outcome measures (PROMs). The questionnaires used in subjective outcome are often originally published in English and need to be validated in different languages. The aim of our study was to investigate the feasibility, validity, reliability, and responsiveness of the Finnish language version of the Oxford Knee Score (OKS-S) questionnaire.MethodsThe original OKS questionnaire was translated using a forward/backward protocol. The OKS-S questionnaire was sent to 225 patients who were scheduled to undergo TKR surgery. The assessment was repeated 1 year after the index operation. Half of the patients also received the RAND-36 questionnaire with the OKS-S questionnaire and the other half the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. 30 patients twice received the OKS-S questionnaire preoperatively for the test-retest assessment.ResultsFeasibility was acceptable with a response rate of 96% in both pre- and postoperative assessments. Correlation between OKS-S questionnaire and all domains of the KOOS questionnaire and the physical domains in the RAND-36 questionnaire was high, and confirmed both good criterion and convergent validity. Content validity was good since no ceiling or floor effect was observed. In the test-retest assessment, all but 2 patients were within the 95% limits of agreement. Responsiveness was large according to effect sizes.ConclusionsOur data suggests that the OKS-S questionnaire is suitable for the assessment of both the preoperative status and the outcome of TKR in Finnish speaking patients.