Orthopaedics and Trauma最新文献

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Prehabilitation and rehabilitation for total knee replacement surgery: physiotherapy interventions in personalized medicine and charting a course towards optimal outcomes

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.012

Nicholas C Clark

Physiotherapy is a critical component in the multidisciplinary team approach to supporting patients to achieve optimal outcomes after the onset of knee osteoarthritis and progression to total knee replacement (TKR) surgery. Physiotherapists possess a wide range of scientifically-informed and evidence-based intervention techniques that can be combined to differing degrees and integrated in differing contexts for the multi-modal, personalized and holistic rehabilitation of patients after TKR surgery. The purpose of this paper is to offer the reader advice and instruction on specific considerations in physiotherapy practice for people preparing for and recovering from TKR surgery. Emphasis is placed on a clinically-reasoned and rational approach with a solid foundation in science and pragmatic clinical practice. Specific comments and recommendations are made regarding defining optimal outcomes after TKR surgery, framing optimal outcomes relative to models of clinical reasoning, the association between impairments (e.g. quadriceps muscle weakness) and physical activity limitations (e.g. inability to walk), physiotherapy intervention techniques in personalized medicine, physiotherapy intervention techniques in prehabilitation and rehabilitation, physiotherapy effectiveness after TKR surgery, and physiotherapy rehabilitation session design and progression. The ideal approach to physiotherapy practice for people preparing for and recovering from TKR surgery is also considered, along with the contribution of outpatient physiotherapy to post-surgery patient satisfaction. Collaboration between the general practitioner, surgeon, physiotherapist, other allied health professionals and the patient is necessary to best influence the probability for optimal outcomes after TKR surgery.

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引用次数: 0

Technical challenges in revision total knee arthroplasty

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.007

Alexander Maslaris, Abtin Alvand

The number of revision total knee arthroplasty procedures is on the increase, and the modern-day arthroplasty surgeon must be equipped to deal with this growing challenge. Every revision can differ, in terms of the technical challenges encountered. These can include issues with exposure, joint line reconstruction, as well as bone loss and ligament deficiency. A standardized approach to these problems is required to optimize the outcome of surgery. This review aims to provide a simple yet comprehensive approach to dealing with the technical challenges encountered during revision knee arthroplasty.

引用次数: 0

Intra-articular injections for the management of knee osteoarthritis

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.001

Jonathan T Super, Navnit S Makaram, Robert F LaPrade, Iain R Murray

Osteoarthritis (OA) of the knee is a degenerative disease with complex pathophysiology which affects the whole joint, resulting in pain, stiffness and progressive functional limitation. It presents a significant global socioeconomic health burden and necessitates cost-effective, efficacious and safe solutions. Intra-articular injections of different preparations form a non-operative treatment modality for knee OA, reserved for where conservative measures such as physiotherapy and oral analgesia are insufficient, but where arthroplasty is not yet indicated. Intra-articular injections provide a large concentration of the desired agent directly to the affected tissues, avoiding the side effect profiles of systemic treatments. They can be categorized into non-biologic and biologic therapies, with different treatment protocols. ‘Orthobiologics’ is a relatively new and rapidly evolving area in the treatment of knee OA, targeting specific molecular pathways in the OA pathogenesis. The most common intra-articular injections in clinical practice are corticosteroids, viscosupplementation (hyaluronic acid, HA) and autologous blood products such as platelet-rich plasma (PRP). The efficacy of different preparations remains controversial, with both biologic and non-biologic treatments appearing in professional guidelines for the management of knee OA. Inconsistencies in the guidelines and heterogeneity in study methodology result in an academic field that is potentially difficult to navigate for clinicians, worsened by ambiguous nomenclature and low-quality evidence. The aim of this review is to provide an overview of the most frequently used intra-articular injections for knee OA, focussing on mechanism of action, current evidence and professional recommendations.

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引用次数: 0

Answers to the CME questions on Children's Orthopaedics

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.009

引用次数: 0

The infected total knee replacement: the worst and unfortunately most frequent complication

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.006

Lee M Jeys, Romir Patel, Thomas Jenkins, Semay Baydar, Joseph Pagkalos

Periprosthetic joint infection (PJI) is the most common reason for early revision following total knee replacement surgery. It is associated with poor patient outcomes, prolonged inpatient stay, costly surgical interventions and extended treatment in the community. Despite advances in surgical technique, implants and operating room technology, PJI is an unresolved problem in arthroplasty. As the volume of knee replacement procedures continues to increase, PJI continues to be a significant burden for the health service. Treatment of PJI has historically been with two-stage exchange, but with single-stage revision surgery increasing in popularity for selected cases. In this review we aim to follow the patient journey from presentation to diagnosis and treatment, and discuss contemporary management strategies when treating this devastating complication.

引用次数: 0

Unicondylar knee replacements: the Oxford perspective

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.003

Richard Myatt, William Jackson

Anteromedial osteoarthritis is a common phenomenon in degenerative conditions of the knee. This limited wear pattern is contingent on a functioning anterior cruciate ligament and medial collateral ligament, and can be managed differently to tricompartmental or inflammatory arthritis. The UK National Institute for Health and Care Excellence (NICE) stipulate that patients with this pattern of disease should be offered the choice of either unicondylar (UKA) or total knee replacements, but many knee surgeons are either unfamiliar with UKA or do not readily include it in their practice. The Oxford UKA is an established and trusted prosthesis with excellent outcomes, yet cumulative marginal gains that improve outcomes further can be achieved by following the approach of high-volume centres. In this article we discuss the Oxford perspective on this subject, touching on the design philosophy, indications, perioperative pearls, day-case protocols, outcomes and tips for starting practice. The most common number of UKAs performed by knee surgeons a year is one; this article aims to provide readers with the understanding, confidence and tips to optimize UKA use within their practice and maximize patient outcomes.

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引用次数: 0

Patellofemoral joint replacement: the Bristol perspective

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.004

Tomos A Edwards, James RA Smith, Louis Hainsworth, Jonathan D Eldridge

With improvements to implant design, a better understanding of patellofemoral biomechanics, and a sound understanding of the correct surgical indications, patellofemoral joint replacement (PFR) has become an attractive surgical option for patients with isolated patellofemoral osteoarthritis (PFOA). However, PFR is a specialist procedure, with a number of essential pre- and intraoperative considerations that surgeons preforming the procedure must be cognisant of. The aim of this paper is to discuss a number of salient points that our institutions have found to be of great importance following over 30 years of experience in assessing and managing patients with PFOA and subsequent PFR.

引用次数: 0

The National Joint Registry 22 years on: what have we learned about knee replacements?

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.008

Paul M Sutton, James S Murray

The National Joint Registry (NJR) of England and Wales was established in 2002 to collect, analyse and report high-quality data about joint replacement surgery. Submission of knee arthroplasty data has been mandated since 2003 in the private sector, and 2010 in the NHS, making the NJR the largest orthopaedic registry in the world. This powerful audit tool collects information on preoperative, intraoperative and postoperative variables, enabling advancement in most of, if not every, facet of the procedure. These data can be used to inform surgeons and other healthcare providers, healthcare commissioners, industry, and patients themselves about outcomes and best practice, ensuring informed decision-making. Drawing from NJR reports, as well as work from external authors using these data, the aim of this review is to highlight what knee surgeons can learn from 22 years of the NJR. We will discuss trends in knee surgery, changes in surgical technique, surgical outcomes and future developments.

引用次数: 0

Off-the-shelf knee replacements versus robotics versus customized implants: the reality versus the hype

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.005

Ian D McDermott, Gregory M Martin

With traditional ‘off-the-shelf’ implants for knee replacement surgery, 15–20% of patients end up unhappy with their knee. At least part of the reason for this may be the significant differences that can exist between individuals in their distal femoral and proximal tibial geometries. This article explains how patient-specific customized knee implants can address many of the deficiencies that may exist with off-the-shelf designs. Evidence is presented of how customized knee implants can lead to better alignment, better coverage, better knee kinematics, less bone resection, improved efficiency in theatre, fewer complications, better patient-reported outcomes and increased long-term prosthetic survivorship, all without any significant overall additional costs. This article also dispels some of the myths and the hype that surround the current trend towards robotic-assisted knee replacement surgery.

引用次数: 0

Focal resurfacing of the knee

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.002

Francesca de Caro

In the past decade, three distinct systems for addressing focal cartilage lesions in the knee through resurfacing have emerged, namely the Hemicap/Unicap, BioPoly and Episealer systems. These technologies provide a new approach for treating patients who might not be suitable candidates for other biological treatment options. Specifically, they target individuals considered too old to benefit from biologic repair methods, but who are also too young for a unicompartmental knee arthroplasty. The three systems have demonstrated promising clinical outcomes, with the literature showing that they can effectively relieve pain and restore knee function, with success rates comparable to other established treatments for cartilage injuries. An additional advantage of these surface replacement systems is their relatively short rehabilitation period, which allows for a quicker return to daily activities. In conclusion, they are an ideal option for ‘gap-age’ patients, representing a valuable alternative for managing knee cartilage defects in this specific patient cohort.

引用次数: 0

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