Primary care management of postoperative shoulder, hip, and knee arthroplasty

Aresti, Nick; Kassam, Jamila; Bartlett, Daniel A.; Kutty, S.

doi:10.1136/bmj.j4431

Cited by 13 publications

(7 citation statements)

References 19 publications

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“…We believed these improvements were critical for recovery, meaning that patients can start ROM and other functional exercises earlier, which would therefore reduce the incidence of postoperative deep vein thrombosis and allow patients to return to normal life earlier. 37 , 38 We also found that the outcomes of those with MA that were not on‐target were better than those with on‐target MA. This was because, in our MA group, the alignments of those not on‐target cases were inadvertently closer to the goal of rKA or KA.…”

Section: Discussionmentioning

confidence: 56%

“…The higher KOOS12 and EQ5D represented less pain and discomfort, and higher FJS may suggest a higher willingness to exercise. We believed these improvements were critical for recovery, meaning that patients can start ROM and other functional exercises earlier, which would therefore reduce the incidence of postoperative deep vein thrombosis and allow patients to return to normal life earlier 37,38 . We also found that the outcomes of those with MA that were not on‐target were better than those with on‐target MA.…”

Section: Discussionmentioning

confidence: 81%

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Computer Navigation Assisted Restricted Kinematic Alignment Improves Short‐Term Outcomes in Total Knee Arthroplasty: An Ambispective Cohort Study

Chen

et al. 2022

Orthopaedic Surgery

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Objectives Mechanical alignment (MA)‐total knee arthroplasty (TKA) has been challenged due to the excessive soft tissue release and the evidence of the clinical outcomes of computer assisted navigation is still limited. The aim of this ambispective cohort study was to: (i) investigate whether computer assisted navigation is capable to achieve restricted kinematic alignment (rKA)‐TKA; and (ii) compare the short‐term outcomes between rKA‐TKA and MA‐TKA. Methods We retrospectively included 41 patients diagnosed with osteoarthritis who received MA‐TKA between April 2019 and January 2021 and 43 patients diagnosed with osteoarthritis who received rKA‐TKA were included in the prospective cohort from January 2021 to September 2021. Demographical, peri‐operative, and radiological data were collected and compared. Unpaired two‐sample t‐test for continuous variables and χ2 test for categorical variables were used to compare various measurements in two groups. The patient‐reported outcome measures at baseline, 10 days (T1), and 6 months (T6) after surgery were statistically analyzed by generalized estimating equation (GEE) models. Results Fourty‐one patients (45 knees) and 43 patients (48 knees) were included in the MA and the rKA group respectively. Three constitutional knee phenotypes (II, I, IV) were the commonest in our population. Navigation improved the surgical accuracy (1.5° vs 3.5°, p < 0.001) and precision (interquartile range 4.0 vs 2.0, p < 0.001) in the rKA group than the MA group. The changes in Knee Injury and Osteoarthritis Outcome Score 12 (KOOS12), EuroQol five‐dimension questionnaire (EQ5D) from baseline to T1 and T6 for patients with on‐target rKA were larger than on‐target MA counterparts (26.053 vs 18.607, P < 0.001(KOOS12, T1), 0.457 vs 0.367 p < 0.001(EQ5D, T1); 51.017 vs 46.896, P = 0.023(KOOS12, T6), 0.606 vs 0.565, P = 0.01(EQ5D, T6)). Patients with on‐target rKA had better Forgotten Joint Score (FJS) at T1 (54.126 vs 40.965, P = 0.002) compared with on‐target MA counterparts. Conclusions Computer assisted navigation achieved the level of accuracy required by rKA‐TKA. rKA‐TKA offered significantly better short‐term outcomes than MA‐TKA.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 81%

Computer Navigation Assisted Restricted Kinematic Alignment Improves Short‐Term Outcomes in Total Knee Arthroplasty: An Ambispective Cohort Study

Chen

et al. 2022

Orthopaedic Surgery

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“…Low muscle strength increases the risk of falling and may lead to a loss of independence, while high muscle strength in the lower limbs is associated with a lower risk of Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 8 March 2020 doi:10.20944/preprints202003.0142.v1 mortality [16,17]. Major clinical trials and guidelines suggest that physiotherapy functional exercises after patient discharge result in short-term benefits, such as improved daily living activities, reduced pain, increased joint proprioception, and increased postural control/knee stability, after primary elective TKA [18,19,20]. However, the effectiveness of exercise rehabilitation for patients who have undergone TKA remains unclear; that is, most systematic reviews and meta-analyses demonstrate a lack of high-quality evidence, while most randomized clinical trials include a small sample size [21,22].…”

Section: Discussionmentioning

confidence: 99%

Effects of Phased Rehabilitation Programs after Total Knee Arthroplasty: A Randomized Controlled Trial

Chao¹,

Lee²,

Qi³

et al. 2020

Preprint

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This multi-center, single-blinded, randomized controlled study assessed the efficacy of phased exercise rehabilitation programs in patients who underwent a total knee arthroplasty (TKA) and investigated suitable exercise types, intensities, and frequencies for patients undergoing postoperative rehabilitation. Between January and March 2018, 494 patients who had undergone TKA were treated at two medical centers. Patients were randomized and allocated to the rehabilitation group (n=330) or the control group (n=164; treated with postoperative care). The 100mm Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), range of motion, and Short-Form 36 (SF-36) scores were assessed and compared between the two groups. The average WOMAC score was 84.40±15.20 in the rehabilitation group and 108.30±3.90 in the control group (p=0.009). The mean VAS score was 2.54±0.16 in the rehabilitation group and 2.87±0.31 in the control group (p=0.024). Furthermore, the range of motion was 125.02±6.20 in the rehabilitation group and 116.40±1.40 in the control group (p=0.017). The mean SF-36 score was 105.40±21.50 in the rehabilitation group and 83.70±5.01 in the control group (p=0.043). This study suggests that the phase rehabilitation program could be more effective at improving pain, knee function, and quality of life than condition postoperative care after TKA.

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“…Hay multitud de estudios sobre la disminución del dolor en distintas patologías con ejercicios de fisioterapia (20,21), sin embargo son escasos los que evalúan el dolor durante los mismos, destacar solo en fracturas de cadera intervenidas (22) donde consideran que el control del dolor durante el tratamiento puede ser un factor importante en la recuperación de la situación funcional previa en contraste con otros que no tienen en consideración este factor e incluso abogan por un inicio más precoz de la rehabilitación tras la fractura de cadera intervenida (23).…”

Section: Discussionunclassified