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Heijbel S, W-Dahl A, E-Naili J, Hedström M. Patient-Reported Anxiety or Depression Increased the Risk of Dissatisfaction Despite Improvement in Pain or Function Following Total Knee Arthroplasty: A Swedish Register-Based Observational Study of 8,745 Patients. J Arthroplasty 2024:S0883-5403(24)00419-4. [PMID: 38697320 DOI: 10.1016/j.arth.2024.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We investigated if patient-reported anxiety or depression increased the risk of dissatisfaction 1 year after TKA in patients who improved in pain or function. METHODS Data on primary TKAs due to osteoarthritis between 2017 and 2019 were obtained from the Swedish Knee Arthroplasty Register. Out of 14,120 patients, 9,911 completed the Knee injury and Osteoarthritis Outcome Score and satisfaction rate with the result of the surgery. According to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria patients were classified as responders (improved in pain or function) or nonresponders. Anxiety and depression were assessed through EuroQol-5 Dimension 3 levels. Log-linear regression models estimated the risk ratios (RRs) for dissatisfaction in all patients and stratified by age groups (< 65, 65 to 74, and > 74 years). There were 8,745 patients who were classified as responders whereas 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively. RESULTS Anxiety or depression increased the risk of dissatisfaction preoperatively (RR 1.23, 95% confidence interval = 1.09 to 1.40) and postoperatively (RR 2.65, confidence interval 2.33 to 3.00). Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction. CONCLUSIONS Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after TKA despite improvements in pain or function.
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Affiliation(s)
- Siri Heijbel
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden, Huddinge, Sweden; Medical Research Internship, Karolinska University Hospital, Stockholm, Sweden
| | - Annette W-Dahl
- Department of Clinical Science Lund, Lund University, Lund, Sweden; The Swedish Arthroplasty Register, Göteborg, Sweden
| | - Josefine E-Naili
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden, Huddinge, Sweden; Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
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2
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DeFrance MJ, Scuderi GR. Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. J Arthroplasty 2023; 38:594-599. [PMID: 36252743 DOI: 10.1016/j.arth.2022.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is among the most performed orthopaedic surgeries in the United States with at least 1,000,000 cases performed per year. Dissatisfaction following TKA has often been reported as 20% or more, with a multitude of causes including sociodemographic, preoperative, and postoperative factors. The purpose of this study was to re-examine the rate and causes of dissatisfaction following TKA. METHODS A systematic review of the literature was performed searching databases from 2010 to 2022. Only primary TKA cases were included and all cases of unicompartmental arthroplasty and revisions were excluded. After abstracts were reviewed, 35 articles were selected for a full-length review, which was ultimately reduced to 21 articles for final inclusion. RESULTS The average rate of patient dissatisfaction was 10%. Excluding complications, the average rate of dissatisfaction was 7.3%. The most common sociodemographic factors for dissatisfaction were age < 65 years, lower income, and non-White patients. Preoperative factors included lower Kellgren-Lawrence scores, depression/anxiety, and pain catastrophizing. Postoperatively, most dissatisfaction was due to complications, unmet expectations, persistent pain, and stiffness. CONCLUSION Based on our review, the average rate of patient dissatisfaction following TKA is 10%. Improved counseling for known risk factors may have reduced dissatisfaction rates by increasing preoperative patient optimization. Many studies in recent years have demonstrated the issue of poor patient coping skills, such as pain catastrophizing and anxiety/depression as a common cause of dissatisfaction. Ultimately, dissatisfaction following TKA still continues to affect a high portion of patients but less than historical reports of 20%.
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3
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Kim J, Park JH, Park JH, Son DW, Ahn JH. Prospective sequential comparison of femoral roll-back between cruciate-retaining and posterior-stabilized total knee arthroplasty using an intra-operative sensor. Knee 2022; 39:253-260. [PMID: 36283283 DOI: 10.1016/j.knee.2022.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/06/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Implant design and surgical techniques affect postoperative knee kinematics in total knee arthroplasty (TKA). This study aimed to compare femoral roll-back between cruciate-retaining (CR) and posterior-stabilized (PS) TKA in the same knee by objectively quantifying the contact point kinematics of the tibiofemoral joint using a sensor. METHODS In the present prospective study, we used an intraoperative sensor to compare medial and lateral roll-back during 0-120° knee flexion in 33 knees that underwent CR and PS TKA. We also examined the relationship between mediolateral balance and the lateral-to-medial roll-back ratio. We defined the contact percentage position as the vertical length to the contact point divided by the anteroposterior length of the tibial plate. RESULTS The roll-back percentage following PS TKA (19.8 ± 5.1%) was significantly higher than that after CR TKA in both the medial (19.8 ± 5.1% versus 7.1 ± 2.5%, P < 0.001) and lateral (26.8% ± 3.8% versus 18.7 ± 3.8%, P < 0.001) compartments. The medial contact pressure at 90° was significantly correlated with the increased lateral-to-medial roll-back ratio in both CR and PS TKA (both P < 0.001). CONCLUSION PS TKA resulted in a higher percentage of femoral roll-back in the medial and lateral compartments than CR TKA. CR TKA caused a higher lateral-to-medial roll-back ratio compared to PS TKA. To reproduce medial pivot knee motion similar to that of a normal knee, the medial soft tissue needed to be balanced more tightly than the lateral soft tissue during TKA. These findings provide some clinical evidence of TKA design selection and proper mediolateral balancing for successful TKA.
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Affiliation(s)
- Jaehyun Kim
- Department of Orthopedic Surgery, Moocheok Joeun Hospital, Paju, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jun Hyoung Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong-Wook Son
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
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4
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Özdemir M, Yaradılmış YU, Özdemir FE, Tarğal AS, Öztürk Ö, Altay M. Does Early-Period Patient Dissatisfaction Turn Into Satisfaction Over Time After Total Knee Replacement? MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e936792. [PMID: 35842752 PMCID: PMC9302033 DOI: 10.12659/msm.936792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is frequently used in the treatment of end-stage gonarthrosis, and the patient satisfaction rate varies. This study aimed to reveal the change in mid-term patient satisfaction results and functional scores of patients with low early postoperative satisfaction scores. MATERIAL AND METHODS We included 163 patients who underwent total knee prosthesis between September 2017 and February 2018. Among these patients, early (6 months) and mid-term (24 months) satisfaction and functional results of 34 patients with low satisfaction scores (Likert evaluations 1, 2, and 3) were evaluated. We assessed early-term functional results and satisfaction rates, mid-term analysis of patients who were not satisfied in the early period, and the relationship between functional scores and satisfaction. RESULTS The Likert score was 4 or 5 in 124 (80%) of 158 patients, and early dissatisfaction was detected in 34 patients (20%). In the early-period dissatisfied group, satisfaction scores 6 months after surgery were 1.9±1.1 (1-3) and 4.2±1 (3-5) 24 months after surgery. A statistically significant difference was observed between the dissatisfied group's early and mid-term KSS and KS values. A correlation was observed between satisfaction scores and KS and KSS scores (P<0.05). CONCLUSIONS Patients who do not have mechanical problems with total knee arthroplasty but are not satisfied with the surgery in the early period can be satisfied over time after regular follow-up, appropriate communication and information, and effective rehabilitation.
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Affiliation(s)
- Mahmut Özdemir
- Department of Orthopaedics and Traumatology, VM Medical Park Hospital, Ankara, Turkey
| | - Yüksel Uğur Yaradılmış
- Department of Orthopaedics and Traumatology, University of Health Sciences, Keçiören Health Practice and Research Center, Ankara, Turkey
| | - Fırat Emin Özdemir
- Department of Orthopaedics and Traumatology, University of Health Sciences, Keçiören Health Practice and Research Center, Ankara, Turkey
| | - Ahmet Safa Tarğal
- Department of Orthopaedics and Traumatology, Adıyaman Besni State Hospital, Ankara, Turkey
| | - Özkan Öztürk
- Department of Orthopaedics and Traumatology, Amasya University, Amasya, Turkey
| | - Murat Altay
- Department of Orthopaedics and Traumatology, University of Health Sciences, Keçiören Health Practice and Research Center, Ankara, Turkey
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Innocenti B, Bori E, Paszicsnyek T. Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension. Arch Orthop Trauma Surg 2022; 142:1213-1220. [PMID: 34046716 DOI: 10.1007/s00402-021-03966-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Applying proper tension to collateral ligaments during total knee arthroplasty surgery is fundamental to achieve optimal implant performance: low tension could lead to joint instability, over-tensioning leads to pain and stiffness. A "functional stability" must be defined and achieved during surgery to guarantee optimal results. In this study, an experimental cadaveric activity was performed to measure the minimum tension required to achieve knee functional stability. MATERIALS AND METHODS Ten knee specimens were investigated; femur and tibia were fixed in specifically designed fixtures and clamped to a loading frame; constant displacement rate was applied and resulting tension force was measured. Joint stability was determined as the slope change in the force/displacement curve, representing the activation of both collateral ligaments elastic region; the tension required to reach joint functional stability is then the span between ligaments toe region and this point. Intact, ACL (anterior cruciate ligament)-resected and ACL & PCL (posterior cruciate ligament)-resected knees were tested. The test was performed at different flexion angles; each configuration was analyzed three times. RESULTS Results demonstrated an overall tension of 40-50 N to be enough to reach stability in intact knees. Similar values are sufficient in ACL-resected knees, while significantly higher tension is required (up to 60 N) after cruciate ligaments resection. The tension required was slightly higher at 60° of flexion. CONCLUSION Results agree with other experimental studies, showing that the tensions required to stabilize a knee joint are lower than the ones applied nowadays via surgical tensioners. To reach functional stability, surgeons should consider such results intraoperatively and avoid ligament laxity or over-tension.
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Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Bruxelles, Belgium.
| | - Edoardo Bori
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Bruxelles, Belgium
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Stephens JD, Hurst JM, Morris MJ, Berend KR, Lombardi AV, Crawford DA. Correlation Between Patient-Reported "Happiness" With Knee Range of Motion and Objective Measurements in Primary Knee Arthroplasty. J Arthroplasty 2022; 37:S105-S109. [PMID: 35210146 DOI: 10.1016/j.arth.2022.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the correlation between objective knee range of motion (ROM) and patient "happiness" with knee ROM after total knee arthroplasty. METHODS This was a retrospective review of all primary total knee arthroplasties from June through December 2019, yielding 902 patients (1,009 knees). Records were reviewed for knee ROM preoperatively and postoperatively at 6-week follow-up as well as whether patients self-reported being "Happy with their ROM" (HWROM). Clinical records were reviewed for documents ROM as well as manipulation under anesthesia (MUA). RESULTS The mean preoperative ROM was 110 ± 16 degrees, and 40% of patients were happy with their ROM. Postoperatively, the mean ROM was 106 ± 13 degrees (P < .001), and 76% of patients were HWROM (P < .001). The mean change in knee ROM was (-) 5 ± 17 degrees. The mean postoperative ROM and change in ROM of patients who were HWROM after surgery were 109 ± 12 degrees and (-)2 ± 16 degrees. In patients not HWROM postoperatively, the mean ROM and change in ROM were 98 ± 14 degrees and (-)12 ± 18 degrees (P < .001). Patients with a lower preoperative ROM were statistically significantly more likely to have a positive change in their HWROM (f ratio = 41, P < .001). MUAs were performed in 7.2% of knees, and 28% of patients who underwent an MUA were HWROM before MUA. CONCLUSION Early postoperative knee ROM was correlated with patient HWROM. However, further longer term follow-up and more detailed analysis of patient happiness with ROM are needed.
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Affiliation(s)
- Joseph Dallis Stephens
- Department of Orthopedic Surgery, Grandview Medical Center, Kettering Health Network, Dayton, OH
| | - Jason M Hurst
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH; Mount Carmel Health System, New Albany, OH
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7
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Zhou Y, Weeden C, Patten L, Dowsey M, Bunzli S, Choong P, Schilling C. Evaluating willingness for surgery using the SMART Choice (Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial. BMC Musculoskelet Disord 2022; 23:179. [PMID: 35209877 PMCID: PMC8876449 DOI: 10.1186/s12891-022-05123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/16/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Approximately 1 in 5 patients feel unsatisfied after total knee arthroplasty (TKA). Prognostic tools may aid in the patient selection process and reduce the proportion of patients who experience unsatisfactory surgery. This study uses the prognostic tool SMART Choice (Patient Prognostic Tool for Total Knee Arthroplasty) to predict patient improvement after TKA. The tool aims to be used by the patient without clinician input and does not require clinical data such as X-ray findings or blood results. The objective of this study is to evaluate the SMART Choice tool on patient decision making, particularly willingness for surgery. We hypothesise that the use of the SMART Choice tool will influence willingness to undergo surgery, especially when used earlier in the patient TKA journey. METHODS This is a multicentred, pragmatic, randomised controlled trial conducted in Melbourne, Australia. Participants will be recruited from the St. Vincent's Hospital, Melbourne (SVHM) Orthopaedic Clinic, and the client base of HCF, Australia (private health insurance company). Patients over 45 years of age who have been diagnosed with knee osteoarthritis and considering TKA are eligible for participation. Participants will be randomised to either use the SMART Choice tool or treatment as usual. The SMART Choice tool provides users with a prediction for improvement or deterioration / no change after surgery based on utility score change calculated from the Veterans-RAND 12 (VR-12) survey. The primary outcome of the study is patient willingness for TKA surgery. The secondary outcomes include evaluating the optimal timing for tool use and using decision quality questionnaires to understand the patient experience when using the tool. Participants will be followed up for 6 months from the time of recruitment. DISCUSSION The SMART Choice tool has the potential to improve patient decision making for TKA. Although many prognostic tools have been developed for other areas of surgery, most are confined within academic bodies of work. This study will be one of the first to evaluate the impact of a prognostic tool on patient decision making using a prospective clinical trial, an important step in transitioning the tool for use in clinical practice. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12622000072718 . Prospectively registered - 21 January 2022.
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Affiliation(s)
- Yuxuan Zhou
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Claire Weeden
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Lauren Patten
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Peter Choong
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne, Melbourne, Australia
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8
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Kennedy BL, Currie GR, Kania-Richmond A, Emery CA, MacKean G, Marshall DA. Patient beliefs about who and what influences their hip and knee osteoarthritis symptoms and progression. Musculoskeletal Care 2022; 20:605-615. [PMID: 35166015 DOI: 10.1002/msc.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Osteoarthritis management aims to reduce pain and improve function. Many factors affect whether patients follow recommended strategies. Locus of control refers to individual beliefs around who and what influences health. Locus of control is related to the treatment strategies patients prefer. Currently, no studies explore locus of control in non-surgical management of osteoarthritis. OBJECTIVES To explore patients' beliefs about the influences on their osteoarthritis symptoms and disease progression. METHODS Semi-structured interviews were conducted with individuals experiencing self-reported hip and/or knee osteoarthritis who had at least one joint that had not undergone replacement surgery. We used a qualitative description approach and the Braun and Clarke method for thematic analysis. Participants' locus of control classifications-internal, chance, doctors, or other people-were based on the Multidimensional Health Locus of Control (MHLC) Scales Form C score. RESULTS Locus of control was discussed in relation to aetiology, progression, and symptoms. Participants' opinions varied on whether their osteoarthritis progression could be influenced. 46% of participants attributed control to other people. Most participants believed that a previous injury had caused their osteoarthritis and that both themselves and others had some influence over their osteoarthritis symptoms, regardless of their locus of control classification. CONCLUSION This research highlights the need for education about: the aetiology of osteoarthritis, the link between management and progression, and patient management of osteoarthritis. Further research is required to discern why expected patterns were not observed between participants' beliefs and locus of control classifications.
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Affiliation(s)
- Bryanne L Kennedy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ania Kania-Richmond
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Carolyn A Emery
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Álvarez-Rodríguez J, Leirós-Rodríguez R, Morera-Balaguer J, Marqués-Sánchez P, Rodríguez-Nogueira Ó. The Influence of the Locus of Control Construct on the Efficacy of Physiotherapy Treatments in Patients with Chronic Pain: A Systematic Review. J Pers Med 2022; 12:jpm12020232. [PMID: 35207720 PMCID: PMC8880621 DOI: 10.3390/jpm12020232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/27/2023] Open
Abstract
The biopsychosocial paradigm contemplates the patient’s personality traits in physiotherapy treatments for chronic pain. Among these traits, the locus of control has a direct relationship with the person’s coping strategies in the face of their health problems. The objective of this systematic review was to assess the influence of locus of control on the efficacy of physiotherapy treatments in patients with chronic pain. A systematic review of the publications of the last ten years in Pubmed, Scopus, Science Direct and Web of Science databases was conducting with the terms physical therapy modalities, chronic pain, internal-external control, self-management, physical therapy and physiotherapy. The inclusion criteria were participants with chronic pain lasting at least three months who have received at least one session of physical therapy; the studies should have collected the patient’s locus of control as a prognostic factor at the beginning of physiotherapy treatment; the variables studied should include the pain intensity or clinical variables related to pain. A total of 13 articles were found, of which three were experimental studies and ten were observational studies. The included samples had chronic knee pain, nonspecific back pain, low back pain or neck pain; were people over 65 years of age or patients who had undergone hand surgery. In patients with chronic pain for more than three months, the locus of control construct participates as a predictor of the results of physiotherapy treatment. The presence of an internal locus of control favors better results. The personality traits of the subjects represent an important factor to take into account when planning physiotherapy treatments.
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Affiliation(s)
- Julia Álvarez-Rodríguez
- Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain;
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
- Correspondence:
| | - Jaume Morera-Balaguer
- Department of Physiotherapy, Health Science Faculty, CEU-Cardenal Herrera University, CEU Universities, 03204 Elche, Spain;
| | - Pilar Marqués-Sánchez
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
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10
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Walker PS, Mhadgut A, Buchalter DB, Kirby DJ, Hennessy D. The effect of total knee geometries on kinematics: An experimental study using a crouching machine. J Orthop Res 2021; 39:2537-2545. [PMID: 33713363 DOI: 10.1002/jor.25026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Obtaining anatomic knee kinematics after a total knee is likely to improve outcomes. We used a crouching machine to compare the kinematics of standard condylar designs with guided motion designs. The standard condylars included femoral sagittal radii with constant radius, J-curve and G-curve; the tibial surfaces were of low and high constraint. The guided motion designs were a medial pivot and a design with asymmetric condylar shapes and guiding surfaces. The machine had a flexion range from 0° to 125°, applied quadriceps and hamstring loading, and simulated the collateral soft tissues. The kinematics of all standard condylar knees were similar, showing only small anterior-posterior displacements and internal-external rotations. The two asymmetric designs showed posterior displacements during flexion, but less axial rotations than anatomic knees. The quadriceps forces throughout flexion were very similar between all designs, reflecting similar lever arms. It was concluded that standard condylar designs, even with variations in sagittal radii, are unlikely to reproduce anatomic kinematics. On the other hand, designs with asymmetric constraint between medial and lateral sides, and other guiding features, are likely to be the way forward. The mechanical testing method could be further improved by superimposing shear forces and torques during the flexion-extension motion, to include more stressful in vivo functional conditions.
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Affiliation(s)
- Peter S Walker
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Aishwarya Mhadgut
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - David J Kirby
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel Hennessy
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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11
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Razmjou H, Savona A, Szafirowicz A, Deel L, Richards R. Psychosocial risk factors and physical and mental well-being following a compensable knee injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1995896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Helen Razmjou
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
| | - Alicia Savona
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Analia Szafirowicz
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lauren Deel
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robin Richards
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Seagrave KG, Lewin AM, Harris IA, Badge H, Naylor J. Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 29:2309499021992605. [PMID: 33596736 DOI: 10.1177/2309499021992605] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. METHODS A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. RESULTS 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a "much better" global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. CONCLUSION After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.
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Affiliation(s)
- Kurt G Seagrave
- 4334The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Adriane M Lewin
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen Badge
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,276979Australian Catholic University, North Sydney, New South Wales, Australia
| | - Justine Naylor
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia
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13
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Munn JS, Culliton SE, Bryant DM, MacDonald SJ, Chesworth BM. Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty? J Arthroplasty 2021; 36:1942-1946. [PMID: 33581974 DOI: 10.1016/j.arth.2021.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction. METHODS Patients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function. RESULTS Significant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly. CONCLUSION Met expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Joseph S Munn
- Health and Rehabilitation Sciences, Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Sharon E Culliton
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Steven J MacDonald
- Department of Surgery, Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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14
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Wang ZW, Wen L, Luan YC, Ma DS, Dong X, Cheng CK, Qu TB. Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities. Front Bioeng Biotechnol 2021; 9:673275. [PMID: 33996784 PMCID: PMC8116507 DOI: 10.3389/fbioe.2021.673275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022] Open
Abstract
Kinematically aligned total knee replacements have been shown to better restore physiological kinematics than mechanical alignment and also offer good postoperative satisfaction. The purpose of this study is to evaluate the extent to which an inclined joint line in a kinematically aligned knee can alter the postoperative kinematics. A multi-body dynamic simulation was used to identify kinematic changes in the joint. To accurately compare mechanical alignment, kinematic alignment and a natural knee, a “standard” patient with neutral alignment of the lower extremities was selected for modeling from a joint database. The arthroplasty models in this study were implanted with a single conventional cruciate-retaining prosthesis. Each model was subjected to a flexion movement and the anteroposterior translation of the femoral condyles was collected for kinematic analysis. The results showed that the mechanical alignment model underwent typical paradoxical anterior translation of the femoral condyles. Incorporating an inclined joint line in the model did not prevent the paradoxical anterior translation, but a 3° varus joint line in the kinematic alignment model could reduce the peak value of this motion by about 1 mm. Moreover, the inclined joint line did not restore the motion curve back to within the range of the kinematic curve of the natural knee. The results of this study suggest that an inclined joint line, as in the kinematic alignment model, can slightly suppress paradoxical anterior translation of the femoral condyles, but cannot restore kinematic motions similar to the physiological knee. This finding implies that prostheses intended to be used for kinematic alignment should be designed to optimize knee kinematics with the intention of restoring a physiological motion curve.
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Affiliation(s)
- Zhi-Wei Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liang Wen
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi-Chao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - De-Si Ma
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiang Dong
- Beijing Naton Medical Technology Innovation Center Co., Ltd., Beijing, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tie-Bing Qu
- The Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Research Center, Capital Medical University, Beijing, China
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15
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Mahdi A, Hälleberg-Nyman M, Wretenberg P. Reduction in anxiety and depression symptoms one year after knee replacement: a register-based cohort study of 403 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1215-1224. [PMID: 33426612 PMCID: PMC8282573 DOI: 10.1007/s00590-020-02860-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/25/2020] [Indexed: 12/30/2022]
Abstract
Background Anxiety and depression are associated with patient dissatisfaction after total knee arthroplasty (TKA). Understanding whether preoperative knee-related symptoms could be a cause of anxiety and depression might help prevent unnecessary delay of surgery for this group of patients. We investigated changes in prevalence of anxiety and depression symptoms one year after TKA, and compared demographic data between patients with and without anxiety and depression symptoms preoperatively. Methods This was a prospective cohort study of 403 patients scheduled for TKA. Data on patient-related outcome measures and the prevalence of anxiety and depression symptoms were collected preoperatively and one year postoperatively. Before–after differences in anxiety/depression prevalence were compared with a chi-square test, and differences in demographic data between the groups with and without anxiety and/or depression symptoms were compared with an independent t test. Results Among the 15% of patients with anxiety symptoms before surgery, 59% had improved in these symptoms one year after surgery; while among the 10% with depression symptoms before surgery, 60% had improved one year after surgery. Patients with preoperative anxiety and/or depression were younger, and had higher body mass index, lower general quality of life (EQ-5D-3L), higher pain scores (visual analog scale), and lower knee-related (KOOS) scores on all subscales except sport. Conclusion Presurgical symptoms of anxiety and depression seem to be partly caused by knee symptoms. Understanding of this issue would offer better strategies to prevent unnecessary delay of surgery in this group of patients.
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Affiliation(s)
- Aamir Mahdi
- Department of Orthopaedics, Örebro County Council, Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, Örebro County Council, Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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16
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Kurihara Y, Ohsugi H, Choda K, Endo Y, Tosaka T, Matsuda T, Tsuneizumi Y, Tsukeoka T. Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty. Knee 2021; 28:354-361. [PMID: 33494017 DOI: 10.1016/j.knee.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. METHODS Twenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. RESULTS The maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. CONCLUSION The early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.
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Affiliation(s)
- Yasushi Kurihara
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture 283-8555, Japan.
| | - Hironori Ohsugi
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture 283-8555, Japan
| | - Kohei Choda
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Yuki Endo
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tomonari Tosaka
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-1-1 Hongou Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshikazu Tsuneizumi
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture 266-0005, Japan
| | - Tadashi Tsukeoka
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture 266-0005, Japan
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17
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Prolonged Opioid Use After Primary Total Knee and Total Hip Arthroplasty: Prospective Evaluation of Risk Factors and Psychological Profile for Depression, Pain Catastrophizing, and Aberrant Drug-Related Behavior. J Arthroplasty 2020; 35:3535-3544. [PMID: 32758378 DOI: 10.1016/j.arth.2020.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Forty percent of patients continue to use opioids at 3 months after joint arthroplasty. We sought to identify clinical and psychological risk factors associated with prolonged opioid use. METHODS In this prospective study, psychological profile data were collected preoperatively. Prolonged use was defined as dispensation of an opioid after 90 days. Logistic regressions were used for univariate and multivariate modeling and to create receiver operating characteristic curves. A backward stepwise regression analysis was used to select significant factors in the multivariable model. RESULTS The study included 258 patients (163 total knee arthroplasty, 95 total hip arthroplasty). 29.84% of patients were on preoperative opioids and 14% (37 of 258) of patients had prolonged use of opioids. In the univariate analysis, age <65, associated back pain, chronic pain syndrome or fibromyalgia, prior opioid use, drug potency of more than 10 morphine equivalent, and total score on Opioid Risk Tool of more than 7 were associated with prolong use. In the multivariate analysis, age <65, associated back pain, chronic pain, and preoperative use of opioids were significant risk factors for prolonged use (combined area under the curve = 0.83). Preoperative opioid use had the highest area under the curve = 0.72 (P = .0005). Psychological profile tests did not predict prolonged opioid use. CONCLUSION Preoperative opioid use was the strongest predictor of postoperative prolonged opioid use. Younger age, associated backpain, and chronic pain syndrome were the other identified risk factors. Screening tools to detect aberrant drug-related behavior may be more helpful than those for depression or pain catastrophizing.
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18
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Broberg JS, Naudie DDR, Howard JL, Vasarhelyi EM, McCalden RW, Teeter MG. Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty. Knee 2020; 27:1501-1509. [PMID: 33010767 DOI: 10.1016/j.knee.2020.07.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goal was to evaluate the joint contact kinematics of total knee arthroplasties implanted using patient-specific instrumentation (PSI) compared to conventional instrumentation (CI). We hypothesized that use of PSI would not significantly alter contact kinematics. METHODS The study was a prospective randomized controlled trial, with equal allocation of fifty patients to PSI and CI groups. At two years post-operation, patients underwent weight-bearing stereo X-ray examinations at 0°, 20°, 40°, 60°, 80°, and 100° of flexion. The shortest tibiofemoral distance on each condyle determined the contact location. Magnitude of the shortest distance was measured and condylar separation was analyzed using thresholds of 0.5 and 0.75 mm. Kinematic measurements derived from the shortest distance included anteroposterior (AP) translation, excursion, axial rotation, and paradoxical anterior motion. Pivot position and cam/post contact were also investigated. RESULTS There were no differences (p > 0.05) in medial and lateral AP contact locations, excursions, and magnitude of anterior motion, or in axial rotation, pivot patterns, frequency of cam/post engagement, frequency of medial anterior motion, and condylar separation at a 0.75 mm threshold. Significant differences were found in frequency of lateral anterior motion (p = 0.048) and condylar separation at a 0.5 mm threshold (p = 0.010). Both groups displayed typical kinematics for a fixed-bearing posterior-stabilized implant. CONCLUSIONS We found no major differences in knee kinematics between PSI and CI groups, which suggest that PSI does not provide a significant kinematic advantage over conventional instruments.
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Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Surgical Innovation Program, Lawson Health Research Institute, 750 Base Line Road East, Suite 300, London, ON N6C 2R5, Canada.
| | - Douglas D R Naudie
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada; Surgical Innovation Program, Lawson Health Research Institute, 750 Base Line Road East, Suite 300, London, ON N6C 2R5, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
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19
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Bonnefoy-Mazure A, Favre T, Praplan G, Armand S, Sagawa Junior Y, Hannouche D, Turcot K, Lübbeke A, Miozzari HH. Associations between gait analysis parameters and patient satisfaction one year following primary total knee arthroplasty. Gait Posture 2020; 80:44-48. [PMID: 32485423 DOI: 10.1016/j.gaitpost.2020.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this prospective study was to understand the relation between gait outcomes and patient satisfaction one year after total knee arthroplasty (TKA). METHODS Seventy-nine patients were evaluated before and one year after TKA using clinical gait analysis. Specific gait outcomes were analyzed: gait speed, stance phase, range of motion (ROM) knee flexion and maximal knee flexion. The parameters of interest selected for the statistical analysis were: gait speed and maximal knee flexion during gait. The Western Ontario and MacMaster Osteoarthritis Index (WOMAC) and patient satisfaction were also assessed. The satisfaction was evaluated using a questionnaire and was splited in five categories: very unsatisfied, unsatisfied, neutral, satisfied or very satisfied. To assess associations between patient satisfaction and maximal knee flexion during gait and gait speed, an unadjusted ordinal logistic regression analysis was used. The analysis was then adjusted for covariates: age and Body Mass Index (BMI) before surgery and WOMAC pain one year after surgery. RESULTS All gait outcomes after TKA had significantly improved. The ordinal logistic regression analysis found significant associations between patient satisfaction and maximal knee flexion after TKA (unadjusted and adjusted) but not for gait speed. CONCLUSION These findings show that all patients improved their gait outcomes one year after TKA but only a higher maximal knee flexion during gait may influence the level of patient satisfaction.
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Affiliation(s)
- Alice Bonnefoy-Mazure
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland; Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medecine, Geneva, Switzerland.
| | | | | | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland; Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medecine, Geneva, Switzerland
| | - Yoshimasa Sagawa Junior
- Laboratoire d'Exploration Fonctionnelle Clinique du Mouvement, CHRU de Besançon, France; Centre d'Investigation Clinique INSERM CIT 808, CHRU de Besançon, France
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medecine, Geneva, Switzerland
| | - Katia Turcot
- Faculty of Medicine, Department of Kinesiology, Laval University, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
| | - Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medecine, Geneva, Switzerland
| | - Hermes H Miozzari
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medecine, Geneva, Switzerland
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20
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Brigati DP, Huddleston J, Lewallen D, Illgen R, Jaffri H, Ziegenhorn D, Weitzman DS, Bozic K. Manipulation Under Anesthesia After Total Knee: Who Still Requires a Revision Arthroplasty? J Arthroplasty 2020; 35:S348-S351. [PMID: 32247675 DOI: 10.1016/j.arth.2020.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stiffness after total knee arthroplasty (TKA) is a multifactorial complication involving patient, implant, surgical technique, and rehabilitation, occasionally necessitating manipulation under anesthesia (MUA) or revision. Few modern databases contain sufficient longitudinal information of all factors. We characterized MUA after primary TKA and identified independent risk factors for revision TKA after MUA from the American Joint Replacement Registry. METHODS We retrospectively reviewed primary TKAs for American Joint Replacement Registry patients ≥65 years from January 1, 2012 to 31 March, 2019. We linked these to the Centers for Medicare and Medicaid Services database to identify MUA and revision TKA procedure codes. We compared groups with chi-squared testing, identifying independent risk factors for subsequent revision with binary logistic regression presented as odds ratios with 95% confidence intervals. RESULTS Of 664,604 primary TKAs, 3918 (0.6%) underwent MUA after a median of 2.0 ± 1.0 months. Revision surgery occurred in 131 (3.4%) MUA patients after a median of 9.0 months. Timing of MUA was not different between revision and no revision patients (P = .09). Patients undergoing MUA compared to no MUA were older (age 71.5 vs 70.7, P < .01), predominantly female (63.9% vs 61.2%, P < .01), current/former tobacco users (24.2% vs 13.3%, P < .01), with osteoarthritis diagnoses (98.0% vs 84.3%, P < .01). Independent risk factors for revision after MUA were male gender (1.56, 1.09-2.22). CONCLUSION The incidence of MUA after primary TKA is low (0.6%) in Medicare patients ≥65 years of age; 3.4% progress to revision after a median of 9 months. Being male was significantly associated with revision TKA after MUA.
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Affiliation(s)
- David P Brigati
- Texas Healthcare Bone & Joint Clinic, Fort Worth, Texas, USA
| | | | | | | | - Heena Jaffri
- American Academy Orthopaedic Surgeons, Rosemont, Illinois, USA
| | | | - Dena S Weitzman
- American Academy Orthopaedic Surgeons, Rosemont, Illinois, USA
| | - Kevin Bozic
- Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
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21
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Marks R. Anxiety and Osteoarthritis Disability: Updated Overview and Commentary. Open Orthop J 2020. [DOI: 10.2174/1874325002014010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
Osteoarthritis, a widespread highly painful often incapacitating joint disease continues to impose immense personal and societal challenges among adults of all ages, especially among older adults. In the absence of any effective cure or treatment, it has become essential to explore all correlates of this chronic disabling disease, especially those that might be preventable or modifiable. Anxiety, a potentially remediable state of mental distress - found linked to chronically disabling forms of arthritis, in various imperceptible ways, and which may have an immense bearing on the outcomes of osteoarthritis, has not received as much attention in the related literature as other topics, such as surgery.
Objective:
In line with previous promising work, this narrative review elected to explore the extent to which current researchers in the field are pursuing this topic, and if so, the degree to which prevailing peer-reviewed data sources support an important role for continued research in this realm, and in what regard.
Methods:
Primarily explored were the key databases housing relevant publications that emerged over Aug 1, 2018-Feb 26, 2020 using the keywords Osteoarthritis and Anxiety. Using a descriptive approach, the relative progress made over the past five previous years in this regard was assessed, in addition to what joints have been studied and with what frequency, and how the degree of interest compares to other currently researched osteoarthritis themes. The potential for intervening in the osteoarthritis pain cycle by addressing anxiety was also examined.
Results:
Findings show a high level of current interest in this topic, and that despite the paucity of prospective studies, studies on joints other than the knee and hip joints, some equivocal conclusions, small numbers of anxiety-related studies compared to other topics, and substantive design limitations, it appears that future research in this realm is strongly indicated.
Conclusion:
This topic if examined further is likely to produce highly advantageous results at all stages of the osteoarthritic disease process and in the context of primary, secondary, as well as tertiary measures to ameliorate osteoarthritis pain and disability.
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22
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Trends in Total Knee Arthroplasty in a Developing Region: A Survey of Latin American Orthopaedic Surgeons. J Am Acad Orthop Surg 2020; 28:189-193. [PMID: 31633658 DOI: 10.5435/jaaos-d-19-00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION A number of different total knee arthroplasty techniques are available. There is also a degree of surgeon preference for these, and the variation across orthopaedic surgeons in Latin America is currently unknown. METHODS A survey on members of Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte was performed, with questions based on categories within worldwide national joint registries. In total, 315 Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte members received the survey via e-mail, and the return answers were compared with the latest worldwide national joint registry annual reports. RESULTS The survey was completed in full by 262 surgeons (83%). It was answered that 19% of surgeons perform less than 10 total knee arthroplasties per year, 54% perform less than 30, and only 9% perform more than 100. Seventy-three percent of surgeons use a posterior stabilized total knee replacement, 18% use a cruciate retaining total knee replacement, and 9% use a medial pivot design. Forty-nine percent of surgeons resurface the patella, 27% never resurface it, and 24% choose to resurface it based on an individual case scenario. Ninety-eight percent of surgeons use cemented fixation in the femur and tibia, with the remaining 2% choosing hybrid fixation and 1% using fully noncemented fixation. CONCLUSION This survey among Latin American surgeons has demonstrated important differences in surgical technique and implants choice compared with worldwide national registries.
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Xu J, Twiggs J, Parker D, Negus J. The Association Between Anxiety, Depression, and Locus of Control With Patient Outcomes Following Total Knee Arthroplasty. J Arthroplasty 2020; 35:720-724. [PMID: 31708293 DOI: 10.1016/j.arth.2019.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/29/2019] [Accepted: 10/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aimed to determine how preoperative anxiety, depression, and locus of control (LoC) might predict patient outcomes following total knee arthroplasty (TKA). METHODS Patients undergoing TKA were prospectively recruited over an 18-month period. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess TKA outcomes. The Short Form-12, Hospital Anxiety and Depression Score, and LoC surveys were completed by the patients to assess their psychosocial state. These scores were collected preoperatively and at 6 weeks, 18 weeks, and 1 year postoperation. RESULTS The final cohort consisted of 136 patients. Greater preoperative depression (P = .004) and anxiety (P = .001) scores were correlated with worse total WOMAC score at 6 weeks and 18 weeks postoperatively, respectively. A poorer preoperative Short Form-12 mental score was also correlated with a worse total WOMAC score at 6 weeks postoperatively (P = .007). Greater tendency toward an internal LoC preoperatively was correlated with better WOMAC pain (P < .001) and function (P = .003) scores at 18 weeks postoperatively. However, there was no correlation between preoperative external LoC and postoperative WOMAC score. There was also no correlation between any of the preoperative psychosocial measures and WOMAC score at 1 year postoperatively. CONCLUSION We identified a group of patients whose psychosocial markers predicted them to have worse outcomes in the short to medium term even though they normalized to satisfactory outcomes at 1 year postoperatively. Identifying this group could allow for targeted intervention with an adjustment of expectations and thus more effective recovery.
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Affiliation(s)
- Joshua Xu
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Joshua Twiggs
- 360 Knee Systems Pty Ltd, Pymble, New South Wales, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Jonathan Negus
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
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Mahdi A, Hälleberg-Nyman M, Wretenberg P. Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients. Arch Orthop Trauma Surg 2020; 140:1809-1818. [PMID: 32720002 PMCID: PMC7560918 DOI: 10.1007/s00402-020-03537-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery. MATERIALS AND METHODS A prospective cohort study was conducted on all patients who underwent TKA during 2016-2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed. RESULTS Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively). CONCLUSIONS All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Aamir Mahdi
- grid.451792.c0000 0000 8699 6304Department of Orthopaedics, Örebro County Council, Örebro, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Department of Orthopaedics, Faculty of Health and Medicine, Örebro University, SE-701 82 Örebro, Sweden
| | - Maria Hälleberg-Nyman
- grid.15895.300000 0001 0738 8966School of Health Sciences, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- grid.451792.c0000 0000 8699 6304Department of Orthopaedics, Örebro County Council, Örebro, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
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Single-item satisfaction scores mask large variations in pain, function and joint awareness in patients following total joint arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:267-274. [DOI: 10.1007/s00590-019-02560-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
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Angerame MR, Holst DC, Jennings JM, Komistek RD, Dennis DA. Total Knee Arthroplasty Kinematics. J Arthroplasty 2019; 34:2502-2510. [PMID: 31229370 DOI: 10.1016/j.arth.2019.05.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA. There is a wide range of TKA designs available today. With such variety, it is important for surgeons and engineers to understand the various geometries and kinematic profiles of available prostheses. The purpose of this review is to provide readers with the pertinent information related to TKA kinematics.
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Affiliation(s)
| | - David C Holst
- Department of Orthopedic Surgery, Duke University, Raleigh, NC
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO
| | - Richard D Komistek
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO
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Bajada S, Searle D, Toms AD. Ten-year results for a single-surgeon series of Scorpio non-restrictive geometry (NRG) posterior stabilised (PS) total knee replacement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1533-1538. [DOI: 10.1007/s00590-019-02456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
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Li Y, Chu L, Li X, Zhai W, Ma Y, He Y, Xu Y, Ding S, Gao H, Zhang J, Ye B, Wang J, Yao J, Wu C, Xiao L. Efficacy of different-frequency TEAS on acute pain after the total knee arthroplasty: a study protocol for a parallel group randomized trial. Trials 2019; 20:306. [PMID: 31142359 PMCID: PMC6542097 DOI: 10.1186/s13063-019-3379-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/22/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an optimal option for patients with middle-to-end-stage knee osteoarthritis. However, the management of postoperative acute pain remains inefficient. Transcutaneous electrical acupoint stimulation (TEAS) is a nonpharmacological method to manage postoperative acute pain. Different frequencies of TEAS have been tested using varying parameters, but the optimal analgesic frequency remains controversial. The aim of this study was to explore the optimal analgesic frequency of TEAS for treating acute pain after the primary unilateral TKA. METHODS/DESIGN This is a double-blind, randomized controlled trial. A total of 156 patients are randomly assigned to: G1, 5 Hz TEAS; G2, 100 Hz TEAS; G3, mixed TEAS (alternative use of daily 5 Hz and 100 Hz TEAS) and G4, placebo TEAS. In the G1, G2 and G3 groups, TEAS is conducted at acupoints SP9 and GB34 of the leg that was operated on (at a wave of continuous, balanced and asymmetrical biphasic square, with a pulse width of 200 μs, and a strong but comfortable current) for 30 min prior to a 30-min rehabilitation session per day for 2 weeks. In G4 group, TEAS is delivered at a strong but comfortable current for 30 s, then the current is gradually decreased to none over the next 15 s. The primary outcomes are measured before surgery, at baseline (POD 3, before TEAS intervention), week 1 and 2 after TEAS intervention with the Numeric Pain Rating Scale and The American Knee Society Score. The secondary outcomes include: (1) Active range of motion of the knee that was operated on; (2) Surface electromyography of both quadriceps; (3) Modified 30-s sit to stand test; (4) Additional usage of analgesia; and (5) SF-36. The additional outcomes include: (1) Patients' satisfaction rate; (2) Patient's expectation rate; and (3) Incidence of analgesia-related side effects. To test the blinding of participants and assessors, they are asked to guess whether the subjects received active or placebo TEAS within 5 min after the latest intervention. The safety and financial cost of TEAS are assessed. DISCUSSION Mixed TEAS has more favorable effect on acute pain control than the placebo or 5 Hz or 100 Hz TEAS. TRIAL REGISTRATION ChiCTR1800016347 . Date of registration was 26 May 2018. Retrospectively registered.
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Affiliation(s)
- Yulin Li
- Faculty of Rehabilitation Medicine, The Shanghai University of Traditional Chinese Medicine, Shanghai, 200000 China
| | - Lixi Chu
- Faculty of Rehabilitation Medicine, The Shanghai University of Traditional Chinese Medicine, Shanghai, 200000 China
| | - Xiangming Li
- Department of Orthopaedics, Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, The Shanghai University of Traditional Chinese Medicine, Shanghai, 200000 China
| | - Weitao Zhai
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Yinghui Ma
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Yong He
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Yuelin Xu
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Sheng Ding
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Huali Gao
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Jing Zhang
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Bowen Ye
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Jingchao Wang
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Jie Yao
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Chonggui Wu
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Lianbo Xiao
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
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Editor's Spotlight/Take 5: How Common Is Back Pain and What Biopsychosocial Factors Are Associated With Back Pain in Patients With Adolescent Idiopathic Scoliosis? Clin Orthop Relat Res 2019; 477:672-675. [PMID: 30844831 PMCID: PMC6437375 DOI: 10.1097/corr.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Recreational sports, workout and gym activities after total knee arthroplasty: Asian cohort study. J Orthop 2019; 16:41-44. [PMID: 30662236 DOI: 10.1016/j.jor.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/02/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate sports activities after total knee arthroplasty in an Asian cohort using 2011 Knee Society scoring system. The average scores for satisfaction and expectation about sports-related activities were 4.9 (61%) and 3.5 (70%), respectively. Most patients mainly opted for low-impact sports. Multivariate analysis showed that higher score of 'standard activities' and 'walking & standing', better range of motion, and older age were associated with higher scores of satisfaction and expectation about sports-related activities. In conclusion, improvement of activities of daily living could provide higher satisfaction and expectation about performing recreational sports, workout and gym activities.
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A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state. Knee Surg Sports Traumatol Arthrosc 2019; 27:2238-2250. [PMID: 30288569 PMCID: PMC6609829 DOI: 10.1007/s00167-018-5164-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE A balanced knee arthroplasty should optimise survivorship and performance. Equilibration of medial and lateral femorotibial load requires guided judicious pericapsular ligament release. The null hypothesis was that there would be no difference between use of a tensiometer device and a remote load sensor final load transfer across the joint through functional arc of motion. METHODS A cadaveric study, using eight knees, was performed to define the impact of an established gap distraction device against load sensor-aimed soft tissue release in a TKA setting. Using validated measures of laxity in six degrees of freedom and true real-time load sensing four states were examined: native knee, TKA using spacer blocks (TKA), TKA with soft tissue release aided by a monogram tensiometer (TKA-T) and finally where load across the tibiofemoral articulation remains unbalanced final soft tissue release using a sensor device (TKA-OS). RESULTS The laxity pattern was equivalent for TKA-T and TKA-OS. However, in only four of these seven knees despite the tensiometer confirming equivalence of rectangular flexion-extension gap dimensions and centralisation of collateral ligament distraction, there remained a > 15lb medial to lateral load difference for at least one point of the flexion arc. This was corrected by further final soft tissue release guided by the OS sensor device in the final three knees. CONCLUSION Tensiometer-guided soft tissue release at two points of flexion failed to achieve balance for three out of seven knee arthroplasty procedures. Sensor technology guided final soft tissue balancing to equilibrate load across the joint through full arc of motion. This work argues for the role of continuous sensor readings to guide the soft tissue balancing during total knee arthroplasty.
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Boffano M. Editorial. Knee 2017; 24:703-704. [PMID: 28709612 DOI: 10.1016/j.knee.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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