Overview of Randomized Controlled Trials in Total Knee Arthroplasty (47,675 Patients): What Have We Learnt?

Matar, Hosam E; Platt, Simon; Gollish, Jeffrey; Cameron, Hugh U.

doi:10.1016/j.arth.2020.01.065

Cited by 25 publications

(11 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Total knee arthroplasty (TKA) is an acclaimed treatment option to relive pain and provide functional improvement in patients with end-stage degenerative joint disease [ 3 , 4 ]. Although functional improvement is usually rated as good or very good and the 15-year survival rates are estimated to be up to 90%, it can be associated with a large variety of complications, including residual pain, deep joint infection, thromboembolic disease, stiffness, instability, periprosthetic fracture, neurovascular injuries, implant loosening, dislocation, and even death [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that more than 700 000 TKAs are performed each year in the USA alone, and this is predicted to increase to over 3.48 million procedures by 2030 [ 3 ]. TKAs of modern design have shown a 25-year survivorship rate of 82.3%; however, despite the satisfactory clinical outcomes, 1 out of 5 TKA patients remain unsatisfied with the outcome [ 4 ]. Prosthetic joint infection (PJI) is the most serious complication leading to TKA failure [ 5 ], while TKA dislocation is less common, with an incidence of 0.15% to 0.5% in primary TKAs [ 6 – 9 ] and 3.3% in a meta-analysis of revision TKAs [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report

et al. 2021

View full text Add to dashboard Cite

Patient: Male, 62-year-old Final Diagnosis: Arthroplasty • knee • posterior dislocation • prolonged flection contracture • septic loosening Symptoms: Knee joint pain Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology Objective: Patient complains/malpractice Background: Chronic posterior knee dislocation after total knee arthroplasty (TKA) is a rare but serious complication, especially when it coexists with septic implant loosening, flexion contracture, and extensive comorbidities. Although the severity is comparable to that in the native knee dislocation, there are few reports in the literature. When TKA dislocation is complicated with infection, bone defect, and patient’s comorbidity, treatment becomes even more difficult. For these complex complications, in order to provide stable and mobile knees, constrained total knee prostheses are used. Case Report: We present the case of a 63-year-old, non-ambulatory man, with mental retardation and multiple comorbidities, who had a 9-year history of neglected posterior TKA dislocation, which later became complicated with septic loosening and productive fistula for 4 years. The patient required use of a wheel-chair for several years, was obese with a body mass index (BMI) of 34.3, and the affected knee was in a prolonged flexion contracture at 90°. The posterior TKA dislocation was later infected by Staphylococcus hominis and Staphylococcus epidermidis . He was successfully treated with two-stage revision surgery and managed to become ambulatory after 6 years of requiring use of a wheel-chair. Conclusions: Neglected posterior dislocation of TKA is a rare and potentially limp-causing complication, especially when accompanied with chronic infection, implant loosening, severe bone loss, flexion contracture, and extensive comorbidities. A multidisciplinary approach with careful preoperative planning, exceptional surgical technique, and prolonged supervised physiotherapy are the keystones for a successful outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report

et al. 2021

View full text Add to dashboard Cite

show abstract

“…For the vast majority of patients, a standard conventional TKA, performed with a surgical approach familiar to the surgeon using well-established components with a good track record, with or without using a tourniquet, will lead to satisfactory long-term clinical outcomes. 16 …”

Section: Total Knee Arthroplastymentioning

confidence: 99%

“…12,13 Recently, we systematically reviewed all published RCTs of TKA, THA, and ACLR. 14-16 Here, we present an overview of our findings and the lessons learnt from 1,014 RCTs in 107,511 patients.…”

mentioning

confidence: 98%

Three orthopaedic operations, over 1,000 randomized controlled trials, in over 100,000 patients

Matar

Platt

Bloch

et al. 2022

Bone & Joint Research

Self Cite

View full text Add to dashboard Cite

“…Total knee arthroplasty (TKA) has been become a successful surgical procedure for relieving pain and restoring function in patients with end-stage osteoarthritis of the knee. [ 1 ] It is reported that there are approximately 600,000 TKA procedures performed in the US every year and the number of TKAs is increasing year by year. [ 2 ] Life of the implant prosthesis is influenced by many factors including the limb alignment, surgical techniques and postoperative management.…”

Section: Introductionmentioning

confidence: 99%

Comparison of intramedullary versus extramedullary alignment technique in total knee arthroplasty: A PRISMA-compliant meta-analysis

Li²,

Zhou³

et al. 2023

Medicine

View full text Add to dashboard Cite

Background: This meta-analysis aimed to compare the efficacy of intramedullary and extramedullary femoral alignment technique in treating total knee arthroplasty (TKA) patients. Methods: PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure, and Weipu databases were electronically searched. Potential clinical studies that investigated the effect and safety of intramedullary versus extramedullary femoral alignment technique in TKA patients were searched. The primary outcome was lower limb coronal alignment. Stata 12.0 was used for meta-analysis. Results: This meta-analysis included 12 prospective randomized controlled studies that reported data on 935 TKA patients. No significant difference was noted in lower limb coronal alignment, coronal alignment of femoral component, sagittal alignment of femoral component and tibial slope between intramedullary and extramedullary alignment techniques ( P > .05). Further, extramedullary alignment technique significantly decrease the total blood loss than intramedullary alignment technique (weighted mean difference: −86.52; 95% confidence interval: −115.05–−57.99; P = .000) and subsequently transfusion rate (risk ratio: 0.57; 95% confidence interval: 0.41–0.79; P = .000). Finally, there was no significant difference between intramedullary and extramedullary alignment techniques in terms of the total complications ( P > .05). Conclusions: The present meta-analysis showed that intramedullary and extramedullary femoral alignment technique had comparable precise profiles. And extramedullary femoral alignment technique could reduce blood loss and blood transfusion. Total complications were comparable between the groups. More randomized controlled trials with large samples are required to verify the comparison of intramedullary and extramedullary femoral alignment technique in TKA patients.

show abstract

Overview of Randomized Controlled Trials in Total Knee Arthroplasty (47,675 Patients): What Have We Learnt?

Cited by 25 publications

References 57 publications

Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report

Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report

Three orthopaedic operations, over 1,000 randomized controlled trials, in over 100,000 patients

Comparison of intramedullary versus extramedullary alignment technique in total knee arthroplasty: A PRISMA-compliant meta-analysis

Contact Info

Product

Resources

About