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Fulltext Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial

Alameri MA, Syed Sulaiman SA, Ashour AM, Al-Saati MF

Pharm Pract (Granada), 2020 09 22;18(3):2025.
PMID: 33029262 DOI: 10.18549/PharmPract.2020.3.2025

Background: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE).
Objective: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs.
Method: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation.
Results: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p<0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p<0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p<0.05).
Conclusion: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov: Identifier: NCT04031859.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Use of Cement Gun for Fixation of Tibia Component in Total Knee Arthroplasty

Yoga, R., Sivapathasundaram, N., Suresh, C.

Malays Orthop J, 2009;3(1):72-77.
MyJurnal

We evaluated the efficacy of a cement gun to improve the depth of cement penetration in total knee arthroplasty. Ninety-one consecutive patients from two hospitals were recruited for this study. For Group I cement was applied to the tibial baseplate and the proximal tibia with fingers. Group 2 had similar application of cement to the tibial baseplate but cement was pressurized into the proximal tibia using a cement gun.. The knee was kept extended until the cement hardened. Standard post-operative x-rays were reviewed to assess cement penetration into the proximal tibia. The mean cement penetration was 2.1 mm in Group 1 and 3.1 mm in Group 2 and the difference was statistically significant. The use of the cement gun improves cement penetration into the proximal tibia and facilitates early stability of the implant fixation to the bone.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Total knee replacement subsequent to severe necrotising fasciitis of the lower limb

Ling HT, Kwan MK, Saw A, Choon DS

Med J Malaysia, 2006 Aug;61(3):380-2.
PMID: 17240598 MyJurnal

The incidence of wound related complication following total knee arthroplasty is as high as 10%-20%. To perform total knee arthroplasty in a knee with extensive scarring around the knee can be a challenging task. We report a case of 55-year-old diabetic woman, who had total knee arthroplasty, performed two years after she had recovered from necrotizing fasciitis around the right knee. Understanding the vascular anatomy around the knee is of paramount importance in the planning of skin incision to ensure fewer wound related complications.

Matched MeSH terms: Arthroplasty, Replacement, Knee*
Three-Dimensional Computed Tomography Analysis of the Posterior Tibial Slope in 100 Knees

Ho JPY, Merican AM, Hashim MS, Abbas AA, Chan CK, Mohamad JA

J Arthroplasty, 2017 10;32(10):3176-3183.
PMID: 28579444 DOI: 10.1016/j.arth.2017.04.060

BACKGROUND: The posterior tibial slope (PTS) is an important consideration in knee arthroplasty. However, there is still no consensus for the optimal slope. The objectives of this study were (1) to reliably determine the native PTS in this population using 3-dimensional computed tomography scans and (2) to determine the normal reference range for PTS in this population.
METHODS: One hundred computed tomography scans of disease-free knees were analyzed. A 3-dimensional reconstructed image of the tibia was generated and aligned to its anatomic axis in the coronal and sagittal planes. The tibia was then rotationally aligned to the tibial plateau (tibial centroid axis) and PTS was measured from best-fit planes on the surface of the proximal tibia and individually for the medial and lateral plateaus. This was then repeated with the tibia rotationally aligned to the ankle (transmalleolar axis).
RESULTS: When rotationally aligned to the tibial plateau, the mean PTS, medial PTS, and lateral PTS were 11.2° ± 3.0 (range, 4.7°-17.7°), 11.3° ± 3.2 (range, 2.7°-19.7°), and 10.9° ± 3.7 (range, 3.5°-19.4°), respectively. When rotationally aligned to the ankle, the mean PTS, medial PTS, and lateral PTS were 11.4° ± 3.0 (range, 5.3°-19.3°), 13.9° ± 3.7 (range, 3.1°-24.4°), and 9.7° ± 3.6 (range, 0.8°-17.7°), respectively.
CONCLUSION: The PTS in the normal Asian knee is on average 11° (mean) with a reference range of 5°-17° (mean ± 2 standard deviation). This has implications to surgery and implant design.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Thirty-Day Morbidity and Mortality after Simultaneous Bilateral Total Knee Arthroplasty

Tai, C.C., Tan, S.H., Misnan, N.A., Nam, H.Y., Choon, S.K.

Malays Orthop J, 2008;2(1):38-43.
MyJurnal

The safety of simultaneous bilateral total knee arthroplasty (TKA) remains controversial. The objective of the current study was to investigate perioperative morbidity and mortality rates within 30 days of simultaneous bilateral TKA. A detailed analysis of medical, surgical and anaesthesia records of 183 consecutive patients who underwent total knee arthroplasty between 2002 and 2006 was performed. The mean age of the patients was 67.6 years old. More than 80% had one or more co-morbidities, but none of them had ASA score greater than class 2. The mean hospital stay was 10 days, and the mean surgical time 156 minutes. Less than half of the patients (42.6%) required blood transfusion. The rate of perimorbidity was 15.3 % and there was no mortality in this series. We believe that simultaneous bilateral total knee arthroplasty is a safe and cost effective option for our patients, provided that patients are selected and informed appropriately.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext The morphology of proximal tibia geometry amongst the Igbos of South East Nigeria and its implication in total knee replacement

Katchy AU, Agu AU, Ikele IT, Esom E, Nto NJ

Niger J Clin Pract, 2019 Oct;22(10):1423-1429.
PMID: 31607734 DOI: 10.4103/njcp.njcp_93_19

Background: The morphological parameters of the proximal tibia play a major role in total knee replacement and there are ethnic and gender variations to these parameters.
Aim: To evaluate parameters of the proximal tibia geometry amongst the Igbos of South Eastern Nigeria and discuss the clinical implications in total knee replacement.
Methods: The proximal tibia parameters of 558 adult tibiae bones, 300 right-sided and 258 left-sided, collected from the osteological unit of the department of anatomy University of Nigeria Enugu campus were measured using a Venier calipers.
Results: The values of the determined parameters are as follows: anterior posterior dimension (APD): 5.50 cm, medial lateral dimension (MLD):7.53 ± 5.56 cm, proximal length (PL): 7.32 ± 0.67 cm, proximal width (PW) CM: 4.10 ± 0.30 cm, medial tibia posterior slope (MTPS):11.36 ± 4.15° and lateral tibia posterior slope (LTPS):5.65 ± 2.72°. The correlation test between these parameters of the proximal tibia shows a strong significant correlation between LPTS and MPTS (r =0.814, P < .001). The comparison of the means of the MPTS of both sides using independent samples t test shows a mean difference that is not significant (p =0.628). A comparison of the values with other populations shows significant mean difference for MLD with that of Chinese and American populations (p < .05). The mean difference between the APD of this study and the Chinese is significant (p =0.007). A comparison of MPTS and LPTS for Malaysian, Chinese, and white Americans shows a significance difference for all the three populations (p knee replacement amongst the Igbo population.

Matched MeSH terms: Arthroplasty, Replacement, Knee*
Fulltext The levels of depression, anxiety, stress on pre and post knee Arthroplasty patients

Ardilla Hanim Abdul Razak, Ahmad Hafiz Zulkifly, Ramli Musa, Mohd Shukrimi Awang, Goh, Kian Liang

International Medical Journal Malaysia, 2017;16(11):39-39.
MyJurnal

Total knee arthroplasty represents a major advance in the treatment of
degenerative joint disease. It provides excellent restoration of joint function and pain
relief. The primary indication for total knee arthroplasty is to relieve pain caused by
severe arthritis, with or without significant deformity. This study is to assess
psychological impact pre and post arthroplasty. (Copied from article).

Matched MeSH terms: Arthroplasty, Replacement, Knee
The influence of music therapy on mental well-being among postoperative patients of total knee arthroplasty (TKA)

Aris A, Sulaiman S, Che Hasan MK

Enferm Clin, 2019 09;29 Suppl 2:16-23.
PMID: 31208927 DOI: 10.1016/j.enfcli.2019.04.004

OBJECTIVE: The objective of this study was to investigate whether music therapy affects immediate postoperative well-being among patients who had undergone TKA surgery in the recovery unit.
METHOD: A randomized controlled trial was conducted recruiting patients from Hospital Melaka, Malaysia. Postoperative TKA patients with good hearing and visual acuity, fully conscious and prescribed with patients controlled analgesia (PCA) were randomized to either intervention or control groups using a sealed envelope. Patients in the intervention group received usual care with additional music therapy during recovery, while patients in the control group received the usual care provided by the hospital. Two factors identified affecting mental well-being were the pain (measured using numerical rating scale) and anxiety (measured using a visual analog scale) at five different minutes' points (0, 10, 20, 30, and 60).
RESULTS: A total of 56 (control: 28, intervention: 28) postoperative TKA patients consented in the study. There was no difference in baseline characteristics between the two groups (p>0.05). Using Mann-Whitney U tests, patients in music therapy group showed significantly lower numerical pain score at 60min (p=0.045) whereas there was no significant difference between the two groups at all time points for anxiety scores (p>0.05). In the intervention group, Friedman tests showed that there was a significant difference in numerical pain (χ2=36.957, df=4, p<0.001) and anxiety score across times (χ2=18.545, p=0.001).
CONCLUSIONS: This study found that pain score decreases over time among patients in the music therapy group while no effect is seen for anxiety. It is suggested that music therapy could not affect postoperative TKA patients' mental well-being. Nonetheless, patients reported better pain score despite the small sample.

Matched MeSH terms: Arthroplasty, Replacement, Knee/psychology*
The effectiveness of patient-controlled epidural analgesia with ropivacaine 0.165% with fentanyl 2.0 miroc g/ml or levobupivacaine 0.125% with fentanyl 2.0 micro g/ml as a method of postoperative analgesia after major orthopaedic surgery

Misiran KB, Yahaya LS

Middle East J Anaesthesiol, 2013 Feb;22(1):59-64.
PMID: 23833852

This prospective randomized single-blinded study was conducted to determine whether there were differences in consumption, demand dosing and postoperative analgesia quality between PCEA using ropivacaine and levobupivacaine. Seventy patients with ASA classification I and II aged 18 to 80 years old scheduled for elective total knee replacement or total hip replacement were studied. All patients received CSE and then were randomly allocated to receive either ropivacaine 0.165% (Group A) or levobupivacaine 0.125% (Group B) both added with fentanyl 2.0 mcro g/ml via epidural route. PCEA regime was offered for 48 hours with additional standard orthopaedic practice of oral analgesia (etoricoxib 120 mg OD and paracetamol 1.0 gm QID) on the second postoperative day. Basal infusion of PCEA was at 3.0 ml/hour and discontinued after 24 hours following started of PCEA. The consumption of local anaesthetics used within the first 24 hours (basal + demand) and 48 hours (total basal + total demand) were recorded. The VAS pain score, sedation score, side effects and vital signs (blood pressure, heart rate and respiratory rate) were also recorded every four hours for 48 hours. This study showed that the total volume of drug used was significantly higher in Group A (163.31+/- 29.01 ml) than Group B (142.69 +/- 30.93ml) (p<0. 01). The mean dose of Group A for the first 48 hours after surgery was 251.43 +/- 70.02mg and was significantly greater than the mean dose of Group B (178.91 +/-42.33 mg) (p<0.01). The numbers of PCEA boluses delivered (D) and PCEA attempts (A) were higher in the Group A (22.37 +/-7.32 and 27.66 +/- 9.12) in contrast to Group B (17.63 +/- 7.71 and 24.40 +/- 11.51) but the differences were not statistically significant. The ratio D/A showed significantly higher in Group A (0.83 +/- 0.13) than Group B (0.74 +/- 0.15) (p<0. 02). The VAS pain score was similar for both groups. One patient in Group B had vomiting and there was no sedation, hypotension, pruritus or motor block recorded in both groups. In conclusion this study showed that both PCEA using ropivacaine 0.165% with fentanyl 2.0 micro g/ml and levobupivacaine 0.125% with fentanyl 2.0 micro g/ml provided effective postoperative analgesia within the first 48 hours of major lower limb orthopaedic surgery despite clinically significant dose difference. There was no hypotension, pruritus, sedation or motor block recorded in both groups.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext The effectiveness of music therapy for postoperative pain control among total knee replacement patients

Norhamdan, M.Y., Damrudi, M., Santhna, L.P.

Medicine & Health, 2015;10(1):66-79.
MyJurnal

Pain is an unpleasant sensation that can cause physical and psychological problems for the patient. Despite the pharmacological intervention for reducing pain, it remains as an issue after surgery. Music therapy as non-pharmacological intervention can effect post-operative pain and patients’ requirement of analgesics. The purpose of this study was to determine effect of music therapy on pain after elective total knee replacement (TKR) surgery. This study compared analgesics consumption by patients post-operatively for five days. A Quasi-experimental design with convenience sample of patient with a mean of 64.35 (49-76) who underwent TKR in UKM Medical Centre from May to December 2012 was used. Forty patients were randomly assigned in one of the two groups using a sealed-envelope technique. The experimental group listened to music for five days post-operatively and were on analgesics and control group were treated with pharmacological intervention only. Pain was measured by McGill Pain Questionnaire-Short Form (MPQ-SF) for patient on bed rest on day one, day three and day five post-operatively. Statistical (Mann- Whitney) findings between groups showed the experimental group significantly had less pain on day one and day five rather than the control group at 0.05 level using Pain Rating Intensity (PRI), Visual Analogue Scale (VAS) and Present Pain Intensity (PPI). Statistical (Friedman) tests within group showed that the patient had significantly decreased pain over time at level 0.05 using PRI, VAS and PPI. Statistical (Mann- Whitney) tests revealed that there was no significant difference when using analgesics between the two groups in five days post-operatively at milligram but comparing median showed experimental group used less analgesic than control group. Music therapy is simple, available, save and cheap effective intervention for pain management post-operatively. Pain management is one of the key roles of nursing and nurses can use music therapy as a simple intervention to reduce pain.

Matched MeSH terms: Arthroplasty, Replacement, Knee*
Fulltext The Use of PROSTALAC in Two-stage Reimplantation of Septic Total Knee and Hip Arthroplasty

Wam, B.L., Chee, E.K., Ewe, T.W.

Malays Orthop J, 2010;4(3):11-15.
MyJurnal

The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement) functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext The Use of Dual Reconstruction Plates for Failed Fixation of Patellar Fracture after Total Knee Replacement: A Case Report

Sa-Ngasoongsong P, Chulsomlee K, Wongsak S, Suphachatwong C, Kawinwonggowit V

Malays Orthop J, 2016 Nov;10(3):52-55.
PMID: 28553451 DOI: 10.5704/MOJ.1611.012

Patellar fracture after total knee replacement (TKR) is one of the challenging problems in periprosthetic fracture. Open reduction with internal fixation (ORIF), as tension band wiring (TBW), usually required in cases with extensor mechanism disruption. However, many studies reported a high failure rate after using this technique. In this report, we presented an interesting case of periprosthetic patellar fracture after TKR with TBW failure that was successfully treated with double non-locking reconstruction plates fixation and TBW augmentation.

Matched MeSH terms: Arthroplasty, Replacement, Knee
The Relationship of Transepicondylar Width with the Distal and Posterior Femoral Condyles and Its Clinical Implications: A Three-Dimensional Study

Lee M, Ho JPY, Chen JY, Ng CK, Yeo SJ, Merican AM

J Knee Surg, 2022 Feb;35(3):280-287.
PMID: 32629512 DOI: 10.1055/s-0040-1713733

BACKGROUND: Restoration of the anatomical joint line, while important for clinical outcomes, is difficult to achieve in revision total knee arthroplasty (rTKA) due to distal femoral bone loss. The objective of this study was to determine a reliable method of restoring the anatomical joint line and posterior condylar offset in the setting of rTKA based on three-dimensional (3D) reconstruction of computed tomography (CT) images of the distal femur.
METHODS: CT scans of 50 lower limbs were analyzed. Key anatomical landmarks such as the medial epicondyle (ME), lateral epicondyle, and transepicondylar width (TEW) were determined on 3D models constructed from the CT images. Best-fit planes placed on the most distal and posterior loci of points on the femoral condyles were used to define the distal and posterior joint lines, respectively. Statistical analysis was performed to determine the relationships between the anatomical landmarks and the distal and posterior joint lines.
RESULTS: There was a strong correlation between the distance from the ME to the distal joint line of the medial condyle (MEDC) and the distance from the ME to the posterior joint line of the medial condyle (MEPC) (p

Matched MeSH terms: Arthroplasty, Replacement, Knee*
Fulltext The Outcomes of Health Education Programme on Stress Level Among the Caregivers of Post Total Knee Replacement Surgery

Samsuddin MF, Karim J, Salim AA

Front Psychiatry, 2021;12:571027.
PMID: 33868035 DOI: 10.3389/fpsyt.2021.571027

Introduction: Stress level among the caregivers is often related to caregivers' lack of knowledge and skill to care for the patients. A health education program to the caregivers is one of the important elements in increasing the knowledge and skills in managing patients at home. The specific objectives of this study were to determine caregiver's stress level in managing post total knee replacement (TKR) patients pre and post of a health education program. Materials and Methods: A clinical intervention trial design was conducted in Hospital Universiti Sains Malaysia (HUSM) with a sample size of 32 caregivers. A validated Zarit Burden Interview (ZBI) questionnaire was used to measure the stress level pre and post of the health education program on the management of patients post-TKR surgery which was adopted from Fresno Surgical Hospital in California. Results: The findings showed that there was a significant difference between pre and post level of stress (p ≤ 0.001). Conclusion: This study revealed the positive outcome of the health education program. It reduced the stress level among the caregivers in caring for their relatives with post-TKR surgery.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext The Effects of Total Knee Arthroplasty on Sleep Quality

Koken M, Guclu B

Malays Orthop J, 2019 Jul;13(2):11-14.
PMID: 31467645 DOI: 10.5704/MOJ.1907.002

Introduction: Symptomatic osteoarthritis is one of the most common indications for total knee arthroplasty (TKA) operations. Pain in every stage of the disease causes sleep disturbances in patients. The primary objective of this study was to evaluate the effect of TKA on the quality of sleep in patients with symptomatic osteoarthritis. Materials and Methods: This retrospective, descriptive study was performed on 80 patients diagnosed with symptomatic osteoarthritis who underwent TKA. The patients responded to the Pittsburgh Sleep Quality Index (PSQI), which is widely used to evaluate sleep quality. Additionally, the effects of demographic and clinical variables such as age, gender, body mass index, smoking and alcohol consumption were also evaluated before and after surgery. Results: There was no correlation between demographic variables and PSQI scores pre- and postoperatively. There was a decrease in sleep quality on the sixth postoperative week compared to the preoperative period however this difference was not statistically significant. On the other hand, there was a statistically significant difference between preoperative and postoperative sixth month PSQI scores. Mean values of overall sleep quality and daily function were significantly higher in the postoperative sixth compared to the preoperative period (p<0.001) Conclusion: Treatment of symptomatic OA with TKA will improve sleep quality in the long term.
Study site: Hospital, Turkey

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Synovial Tissue Infection with Burkholderia fungorum

Loong SK, Soh YH, Mahfodz NH, Johari J, AbuBakar S

Emerg Infect Dis, 2016 10;22(10):1834-5.
PMID: 27648477 DOI: 10.3201/eid2210.151114
Matched MeSH terms: Arthroplasty, Replacement, Knee/adverse effects
Structured Total Knee Replacement Rehabilitation Programme and Quality of Life following Two Different Surgical Approaches - A Randomised Controlled Trial

Antony-Leo AP, Arun-Maiya G, Mohan-Kumar M, Vijayaraghavan PV

Malays Orthop J, 2019 Jul;13(2):20-27.
PMID: 31467647 DOI: 10.5704/MOJ.1907.004

Introduction: The key important factor influencing the outcomes following rehabilitation is the surgical approach involved in Total Knee Replacement (TKR). Most studies have analysed the functional outcome in comparing the approaches on surgical perspective rather on post-operative therapeutic interventions. The current study was to analyse the effects of structured TKR rehabilitation programme on the quality of life and joint specific outcomes between two different surgical approaches. Materials and Methods: In this double-blind randomised controlled trial, participants were randomly allocated to one of two groups: Group 1- those who underwent medial parapatellar approach and Group 2- those who underwent mid-vastus approach. Both groups received three-phase structured rehabilitation protocol for 12 weeks. The outcome measures of SF-36, knee mobility, isometric knee musculature strength and six-minute walk distance were measured at baseline, on discharge and at review after three months. Results: The quality of life and joint specific outcome scores were better in mid-vastus approach than the popular medial parapatellar approach. The outcomes of knee flexion mobility (p=0.04), knee extension mobility (p=0.03), isometric muscle strength of quadriceps (p=0.001), isometric muscle strength of hamstrings (p=0.03), six-minute walk distance (p=0.001) and Physical Cumulative Scores (PCS) (p=0.03) were found to exhibit significant improvements at three months follow up. Conclusion: The mid-vastus approach was found to exhibit better improvements following structured rehabilitation care, in physical summary scores of quality of life and joint specific outcomes than medial parapatellar approach.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Strides towards the realization of cure for cartilage defects and osteoarthritis: the limitation and regulatory challenges

Ude Chinedu Cletus, Azizi Miskon, Ruszymah Idrus

Sains Malaysiana, 2018;47(11):2757-2767.

Despite remarkable mechanical durability and strength, hyaline cartilage has very limited capacity for self-repair when injured and over time, may degenerate to osteoarthritis. We evaluated the most significant mile stones attained, in the pursuit of cure for cartilage defects and osteoarthritis. The basic treatment options include: Natural or physical therapy, medications, nutritional supplements, nutriceuticals and chondroprotective agents. Next are repairs and replacements, which include surgical procedures: Debridement/chondroplasty, microfracturing, mosaicplasty, periosteum transplantation, osteochondral autografting and allografting, high tibial osteotomy and total knee arthroplasty. But, current trend has shifted from repair, replacement, to most recently regeneration. Regenerations include the cell and gene therapies. While cell therapy involves the use of cells isolated from different tissues to cause regeneration of cartilage; gene therapy involves the selection of appropriate gene and optimal vector to incorporate cDNA. There has been much positivity reported with big animal models, which has led to several ongoing clinical trials. Translations of these findings hold high promises, though not without inherent regulatory hurdles. Considering the initial success rates, there are increasing hopes of realizing these treatments from bench to bedsides. Significant improvements in the treatment of cartilage degenerations and osteoarthritis have been made so far, but no gold standard delineated.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Spinal anaesthesia with bupivacaine and intrathecal morphine versus combined spinal-epidural anaesthesia using Bupivacaine and Epidural infusion of bupivacaine plus fentanyl for postoperative analgesia after hip and knee arthroplasty

Mohd Azizan, G., Karis, M., Noordin, Y.

Journal of Surgical Academia, 2013;3(2):46-53.
MyJurnal

This randomised single-blinded study was conducted to evaluate if there was any difference between spinal anaesthesia with hyperbaric bupivacaine 0.5% and intrathecal morphine 0.2mg and combined-spinal epidural using hyperbaric bupivacaine 0.5% with epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml for 24 hours, postoperative analgesia following hip and knee arthroplasty, in terms of pain score and side effects (nausea, vomiting, pruritus and respiratory depression). Eighty patients ASA I or ASA II, aged between 18 to 75 years who underwent knee and hip arthroplasty of approximately 3-4 hours, duration were recruited. They were randomly allocated to one of two groups by using computer generated randomised numbers. The pain score during the postoperative period was evaluated using Visual Analogue Score (VAS pain score) and the side effects were documented and treated accordingly. Results showed that patients in Group 1 and Group 2 were comparable in terms of age, gender, height, weight and race. There was no statistical difference in VAS pain score between the two groups at all times intervals. However, patients in Group 1 had a higher incidence of nausea and pruritus than patients in Group 2. None of the patients in either group, experienced respiratory depression. Thus, it was concluded that both intrathecal morphine 0.2mg and epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml were comparable in providing postoperative analgesia up to 24 hours following hip and knee arthroplasty. Nevertheless, the use of spinal morphine led to a higher incidence of side effects namely nausea and pruritus.

Matched MeSH terms: Arthroplasty, Replacement, Knee
Fulltext Simultaneous bilateral total knee replacement

Lopez JM, Sivanantham M

Med J Malaysia, 1998 Sep;53 Suppl A:102-6.
PMID: 10968191

This paper summarises our experience of twenty one patients with degenerative arthritis treated by bilateral simultaneous total knee replacement (BSTKR) in Tawakal Hospital in a period of twenty two months vis. January 1994 to November 1995. The results were analysed according to the scoring system of Hospital for Special Surgery. The preliminary observations were encouraging, 90% excellent, 8% good and 2% fair results. The benefits, safety and cost effectiveness of the procedure as compared to the unilateral staged knee replacement are discussed. We recommend that BSTKR be routinely practised for appropriate situations in all institutions where the expertise and facilities are available.

Matched MeSH terms: Arthroplasty, Replacement, Knee*

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