In the context in which life expectancy increases and the population becomes more active, the number of people who are affected by gonarthrosis symptoms increases proportionally. By the year 2030, in the United States of America, one in three adults is expected to suffer from gonarthrosis, this prediction will be the beginning of an epidemic. Total knee arthroplasty has been shown to relieve pain and improve joint function; however, studies have shown that active young patients still have limitations in performing high-level activities such as dancing, golfing, skiing, and gardening. Currently, modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological “medial pivot” pattern with greater compliance on the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side.
One of the most controversial topics in total knee arthroplasty is rotation of the femoral component. The current gold-standard in total knee arthroplasty consists in positioning the femoral component in 3 degrees of external rotation to the epicondylar axis, having as reference the tangent to the posterior condyles. Achieving the correct rotation of the femoral components is one of the main goals during total knee arthroplasty. Multiple complications can result from internal femoral rotation, such as lateral patellar tilt, patellar subluxation or dislocation, mobilization with movement on pain, and low survival rates of the femoral components. Postoperative rotational assessment of protective components can only be performed correctly using computed tomography. The known evaluation methods are related to anteversion of the femoral neck, femoral trans-epicondylar line, insertion of the posterior cruciate ligament from the tibia and tibial tuberosity. The purpose of this study was to evaluate the rotation of the prosthetic components in the group of patients with the methods validated by studies and to find alternatives to evaluate the rotation of the femoral component. Thirty-four patients diagnosted with gonarthrosis, proposed for total knee arthroplasty, were included in the study. This is a prospective cohort study in which applied statistics consisted of analyzing data using frequency and percentage for qualitative and mean variables and standard deviation for quantitative variables.
Diabetes and increased body mass index are two of the most associated comorbidities in patients undergoing total knee arthroplasty. With the number of patients undergoing knee arthroplasty increasing and with the incidence of diabetes and increased BMI, we can expect that in the coming decades the association of the two comorbidities will be frequent. An ethical issue arises when the patients who are refused for total knee arthroplasty are instructed to change the risk factors, and they fail either because of a mental problem or because of a physical problem. This study analyzes the effects of controlled, uncontrolled, uncomplicated and complicated diabetes on the rates of post- knee arthroplasty complications. The study proposes to evaluate obese patients in terms of functional outcomes and postoperative complications after total knee arthroplasty.
Background: Although locoregional anesthesia techniques in total knee arthroplasty (TKA) have progressed steadily, the emergence of the adductor canal block representing a step forward for postoperative evolution in preservation of the quadriceps muscle strength, analgesia of the posterior territory of the knee still remains a challenge. The emergence of IPACK, in association with earlier techniques, offers promising preliminary results in terms of its contribution to a favourable evolution and to the satisfaction of TKA patients. Materials and methods: Prospective trial performed on a group of 28 patients undergoing a total knee arthroplasty intervention; analgesia control in the postoperative period was performed either with opioid and nonopioid systemic analgesics, or by associating the continuous adductor canal block with IPACK and systemic analgesics. The primary objective is pain control at rest/on mobilization, while the secondary purpose is analysis of opioid use, their side effects and recovery of joint mobility. Results: There is a significantly better pain control in the group of patients with locoregional anesthesia, both at rest and on mobilization (p<0.005), accompanied by a decrease in opioid use (p<0.00001) and the related adverse reactions; at the same time, there is an improvement in the functional recovery of the knee joint, quantified by the flexion degree at 24 and 48 hours after surgery ( 61.5/71.12 degrees for continuous adductor canal block with IPACK versus 45.14/55.42 degrees for general anaesthesia) Conclusions: The introduction of peripheral nerve blocks in the multimodal analgesia regimen after TKA results in better control of postoperative pain, both at rest and on mobilization, in a decrease in opioid use and their related adverse reactions and in an improved recovery of joint range of motion, as well.
In an attempt to standardize the X-ray analysis and to create relevant correlations between it and the functional results, we present a pilot model of an artificial neural network based on a Bayesian belief network (BNN) designed for the automatic analysis of anteroposterior X-ray of the knee following total knee arthroplasty and more precisely the analysis of the tibial component. A prospective analysis was conducted in which 30 patients were analyzed and two groups resulted: the first was made up of 12 cases considered “normal” by the examiners (optimal positioning and cementation) and the second one, which was considered “pathological” (incorrect positioning or cementation) and included 16 cases. Based on 22 points established on the tibial component several geometric sizes (calculated parameters) were computed. Several parameters were compared and the results were up to 75% accuracy, 81.25% sensitivity, and 66.7% specificity. BBNs can be a solution for X-ray evaluation of total knee arthroplasty and can improve the understanding of its evolution. It needs confirmation in time, its accuracy rising with the number of patients introduced in the analysis algorithm.
