Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2023
Influence of kinematic alignment on femorotibial kinematics in medial stabilized TKA design compared to mechanical alignment.
Worldwide more and more primary knee replacements are being performed. Kinematic alignment (KA) as one of many methods of surgical alignment has been shown to have a significant impact on kinematics and function. The aim of the present study was to compare KA and mechanical alignment (MA) with regard to femorotibial kinematics. ⋯ Relating to an increased internal rotation and a more precise medial pivot point, it can be concluded that KA combined with a MS implant design may partially support the reproduction of physiological knee joint mechanics.
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Arch Orthop Trauma Surg · Jul 2023
Is there a difference in mobility and inpatient physical therapy need after primary total hip and knee arthroplasty? A decade-by-decade analysis from 60 to 99 years.
Extended inpatient rehabilitation (PT) after total hip (THA) and knee arthroplasty (TKA) has a significant impact on total care costs. As patients age, extended PT might be required following THA and TKA. This study examined the relationship between patient age, functional mobility, inpatient PT need, and discharge disposition in THA and TKA patients. ⋯ Patients in their eighth and ninth decade had less improvement in functional mobility during in-hospital rehabilitation and utilized more PT services. However, clinical results in the elderly are still satisfying and the data may be helpful for resource utilization planning and risk-adjustment in value-based payment models.
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Arch Orthop Trauma Surg · Jul 2023
Incidence of complications and revision surgery in HAART compliant HIV patients undergoing primary total hip and knee arthroplasty: an institutional review.
Human immunodeficiency virus (HIV) positive patients are at high risk for osteonecrosis along with age-related osteoarthritis, resulting in a high number of joint reconstruction surgeries at younger ages in these immunosuppressed patients. Few previous studies have reported on patient outcomes in HAART (highly active antiretroviral therapy) compliant patients undergoing primary arthroplasty. The aim of this study is to report one institution's overall rate of complications and revision in HAART-compliant patients after primary hip and knee arthroplasty. ⋯ Arthroplasty is a viable option for HAART-compliant patients. Most previous studies showing a higher risk for deep tissue infection and revision in HIV patients have not accounted for modern HAART. Our results show that compliance with HAART has vastly improved the outcomes of arthroplasty in these patients, while a history of IVDU is likely the largest risk factor for infection in this population.
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Arch Orthop Trauma Surg · Jul 2023
Periprosthetic knee infection in octogenarians: a single institution experience at midterm outcome.
Periprosthetic joint infections (PJI) of total knee arthroplasties (TKAs) in the elderly is among the clinically most challenging scenarios given multimorbidity combined with poor bone and soft tissue quality. Despite increasing prevalence, limited is known on PJI among this unique group of patients. As such, this study analyzed PJI characteristics, implant survivorship and non-surgical complications of octogenarians revised PJI for the knee. ⋯ Therapeutic level IV.
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Arch Orthop Trauma Surg · Jul 2023
Management of acute periprosthetic knee infection: a comparison of arthroscopic and open debridement.
In acute periprosthetic knee infections, debridement and implant retention (DAIR) is the preferred treatment prior to one- and two-stage revisions. The aim of this study is to compare the outcomes of arthroscopic and open debridement of infected primary total knee arthroplasties (TKA). ⋯ Open debridement for acute periprosthetic knee infection shows clear benefits in terms of infection eradication and prosthesis salvage compared to arthroscopic DAIR.