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Knee Arthroplasty: Therapeutic and Management Strategies

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 16972

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Special Issue Editor

Dr. Christian Carulli

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Guest Editor

Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
Interests: hip and knee arthroplasty; revision arthroplasty; traumatology; infection; sports medicine; haemophilia; fractures; bone metabolism; hip, knee, and ankle arthroscopy; femoroacetabular impingement (FAI); hand surgery

Special Issue Information

Dear Colleagues,

I am pleased to invite you to submit a paper on the topic “Knee Arthroplasty: Therapeutic and Management Strategies” as a Special Issue of Journal of Clinical Medicine, a widely known international scientific open access journal with a huge IF (4.964), providing a platform for advances in health care/clinical practicers, the study of direct observation of patients, and general medical research. The journal is indexed by the SCIE, PubMed, and many other databases.

I specifically would ask you a contribution in one of the following arguments, related to Knee Arthroplasty: primary and revision Knee Arthroplasty; knee periprosthetic fractures; infection; aseptic loosening; instability; hypersensitivity; technology in knee surgery; biomaterials; PROMs; bone metabolism.

I hope to have you as eminent Authors of this Special Issue.

Dr. Christian Carulli
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

primary and revision knee arthroplasty
knee periprosthetic fractures
infection
aseptic loosening
instability
hypersensitivity
technology in knee surgery
biomaterials
PROMs
bone metabolism

Published Papers (14 papers)

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Research

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9 pages, 937 KiB

Open AccessArticle

Enhancing Precision and Efficiency in Knee Arthroplasty: A Comparative Analysis of Computer-Assisted Measurements with a Novel Software Tool versus Manual Measurements for Lower Leg Geometry

by Ulrike Wittig, Amir Koutp, Patrick Reinbacher, Konstanze Hütter, Andreas Leithner and Patrick Sadoghi

J. Clin. Med. 2023, 12(24), 7581; https://doi.org/10.3390/jcm12247581 - 08 Dec 2023

Cited by 1 | Viewed by 591

Abstract

(1) Background: The aim of this prospective study was to evaluate measurement software in comparison with manual measurements using inter-observer and intra-observer variability on radiographs in the preoperative planning of total knee arthroplasty. (2) Methods: Two independent observers retrospectively measured the mechanical lateral proximal femoral angle (mLPFA), the mechanical lateral distal femoral angle (mLDFA), the joint line convergence angle (JLCA), the mechanical medial proximal tibial angle (mMPTA), the mechanical lateral distal tibial angle (mLDTA), the hip–knee angle or mechanical tibial–femoral axis angle (HKA), and the anatomical–mechanical angle (AMA) on 55 long-leg anteroposterior radiographs manually twice, followed by measurements using dedicated software. Variability between manual and computer-aided planning was assessed, and all measurements were performed a second time after 14 days in order to assess intra-observer variability. (3) Results: Concerning intra-observer variability, no statistically significant difference was observed regarding the software-based measurements. However, significant differences were noted concerning intra-observer variability when measuring the mLDFA and AMA manually. Testing for statistical significance regarding variability between manual and software-based measurements showed that the values varied strongly between manual and computer-aided measurements. Statistically significant differences were detected for mLPFA, mLDFA, mMPTA, and mLPTA on day 1, and mLPFA, mMPTA, and mLPTA on day 15, respectively. (4) Conclusions: Preoperative planning of leg axis angles and alignment using planning software showed less inter- and intra-observer variability in contrast to manual measurements, and results differed with respect to manual planning. We believe that the planning software is more reliable and faster, and we would recommend its use in clinical settings. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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9 pages, 2121 KiB

Open AccessArticle

Implant Preference and Clinical Outcomes of Patients with Staged Bilateral Total Knee Arthroplasty: All-Polyethylene and Contralateral Metal-Backed Tibial Components

by Luboš Nachtnebl, Vasileios Apostolopoulos, Michal Mahdal, Lukáš Pazourek, Pavel Brančík, Tomáš Valoušek, Petr Boháč and Tomáš Tomáš

J. Clin. Med. 2023, 12(23), 7438; https://doi.org/10.3390/jcm12237438 - 30 Nov 2023

Viewed by 613

Abstract

Numerous studies have compared metal-backed components (MBTs) and all-polyethylene tibial components (APTs), but none of them specifically analysed the clinical results and the overall patient preference in patients who had undergone a staged bilateral knee replacement. The purpose of this study is to compare clinical results, perceived range of motion, and overall implant preference among patients who had undergone staged bilateral knee replacement with an APT and contralateral knee replacement with MBTs. A dataset of 62 patients from a single centre who underwent staged bilateral TKA between 2009 and 2022 was selected and retrospectively analysed. Tibial component removal was performed in three knees overall, all of which had MBTs. The mean measured Knee Score (KS) of knees with APTs was 78.37 and that of contralateral knees with MBTs was 77.4. The mean measured Function (FS) of knees with APTs was 78.22, and that of contralateral knees with MBs was 76.29. The mean flexion angle of knees with APTs was 103.8 and that for knees with MBTs was 101.04 degrees. A total of 54.8% of the patients preferred the knee that received APTs over contralateral MBTs. In our cohort, TKA with an APT in one knee and an MBT in the contralateral knee recorded similar clinical results and perceived ranges of motion. Patients in general preferred the knee that received an APT over contralateral knee with an MBT. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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13 pages, 1100 KiB

Open AccessArticle

The Correlation between Objective Ligament Laxity and the Clinical Outcome of Mechanically Aligned TKA

by Stefano Campi, Rocco Papalia, Carlo Esposito, Vincenzo Candela, Andrea Gambineri and Umile Giuseppe Longo

J. Clin. Med. 2023, 12(18), 6007; https://doi.org/10.3390/jcm12186007 - 16 Sep 2023

Viewed by 605

Abstract

Instability is one of the causes of failure in total knee arthroplasty (TKA). The aim of this study was to analyze the correlation between objective ligament laxity and the clinical outcome of mechanically aligned TKA. Fifty-one knees in 47 patients were evaluated at a minimum follow-up of 6 months. The correlation between the angular displacement and functional scores (Knee Society Score and Knee Injury and Osteoarthritis Score) was analyzed. A negative correlation (p-value < 0.05) was observed between medial laxity ≥5° at 0, 30, 60, and 90° of flexion and the outcome measures. Lateral laxity did not correlate with the clinical outcome. At 30° of knee flexion, a total varus and valgus laxity ≥10° was related to poorer outcomes. The same amount of angular displacement did not influence the outcome in the other flexion angles. There was no difference in single-radius vs multi-radius implants in terms of medial and lateral laxity and clinical outcome. A valgus displacement ≥5° measured at 0, 30, 60, and 90 degrees of flexion correlated with an inferior clinical outcome. In contrast, the same amount of displacement measured on the lateral compartment did not influence the clinical outcome after TKA. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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7 pages, 801 KiB

Open AccessArticle

Large Osteophytes over 10 mm at Posterior Medial Femoral Condyle Can Lead to Asymmetric Extension Gap Following Bony Resection in Robotic Arm–Assisted Total Knee Arthroplasty with Pre-Resection Gap Balancing

by Jong Hwa Lee, Ho Jung Jung, Joon Kyu Lee, Ji Hyo Hwang and Joong Il Kim

J. Clin. Med. 2023, 12(18), 5980; https://doi.org/10.3390/jcm12185980 - 15 Sep 2023

Viewed by 875

Abstract

Robotic arm–assisted total knee arthroplasty (TKA) involves a pre-resection gap balancing technique to obtain the desired gap. However, the expected gap may change owing to the soft-tissue release effect of unreachable osteophytes. This study evaluated the effect of unreachable osteophytes of the posterior medial femoral condyle on gap changes following bony resection. We retrospectively analysed 129 robotic arm–assisted TKAs performed for varus knee osteoarthritis. Knees were classified according to the size of osteophytes on the posterior medial femoral condyle using preoperative computed tomography measurement. After the removal of reachable osteophytes, the robotic system measured pre- and post-resection medial extension (ME), lateral extension (LE), medial flexion (MF), and lateral flexion (LF) gaps. No extension gap changes were observed for 25 (19.4%), and no flexion gap changes were observed 41 (31.8%) knees, following bone cuts. ME, LE, MF, and LF gaps increased with the osteophyte size (p < 0.05). For osteophytes <10 mm, all the gaps increased symmetrically. However, for osteophytes >10 mm, the ME gap increased asymmetrically more than LE, MF, and LF gaps (p < 0.05). The gap changes due to bony resection were correlated to the osteophyte sizes of the posterior medial femoral condyle. Surgeons should plan a slightly tight medial extension gap to attain the desired gaps for >10 mm osteophytes. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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9 pages, 844 KiB

Open AccessFeature PaperArticle

Characteristics of Preoperative Arteriosclerosis Evaluated by Cardio-Ankle Vascular Index in Patients with Osteoarthritis before Total Knee Arthroplasty

by Yoshinori Ishii, Hideo Noguchi, Junko Sato, Ikuko Takahashi, Hana Ishii, Ryo Ishii, Kei Ishii, Kai Ishii and Shin-ichi Toyabe

J. Clin. Med. 2023, 12(14), 4685; https://doi.org/10.3390/jcm12144685 - 14 Jul 2023

Viewed by 678

Abstract

Purpose: Cardiovascular disease (CVD) is a major risk factor for mortality in patients with osteoarthritis, and comorbidities increase postoperative complications after total knee arthroplasty (TKA). Arteriosclerosis plays a main role in hemodynamic dysfunction and CVD; however, arteriosclerosis has not been preoperatively evaluated before TKA using the cardio-ankle vascular index (CAVI). In this study, we evaluated the degree of preoperative arteriosclerosis using the CAVI in patients undergoing TKA, as well as its correlations with several preoperative patient factors. Methods: Arteriosclerosis was evaluated in 209 consecutive patients (251 knees) with osteoarthritis who underwent TKA at our institution between May 2011 and June 2022. The CAVI was measured in the supine position 1 day before TKA, and the correlations between the CAVI and several clinical factors were analyzed. Results: The CAVI was normal in 62 knees (25%), borderline in 71 knees (28%), and abnormal in 118 knees (47%). Univariate analysis revealed a moderate positive correlation between preoperative CAVI and age (r = 0.451, p < 0.001) and a weak negative correlation between preoperative CAVI and body weight (r = −0.306, p < 0.001) and body mass index (BMI) (r = −0.319, p < 0.001). Multivariate analysis showed that age (β = 0.349, p < 0.001) and BMI (β = −0.235, p < 0.001) were significantly correlated with preoperative CAVI. Conclusion: Arteriosclerosis should be carefully managed intraoperatively and postoperatively in patients with osteoarthritis undergoing TKA, particularly in older patients and patients with a low BMI. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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9 pages, 405 KiB

Open AccessArticle

Effectiveness of Robotic Arm-Assisted Total Knee Arthroplasty on Transfusion Rate in Staged Bilateral Surgery

by Jong Hwa Lee, Ho Jung Jung, Byung Sun Choi, Du Hyun Ro and Joong Il Kim

J. Clin. Med. 2023, 12(14), 4570; https://doi.org/10.3390/jcm12144570 - 09 Jul 2023

Cited by 1 | Viewed by 1064

Abstract

The transfusion rate in staged bilateral total knee arthroplasty (TKA) remains high despite the application of blood management techniques. The potential of robotic arm-assisted TKA (R-TKA) in reducing the transfusion rate in staged bilateral surgery has not yet been investigated. Therefore, we aimed to evaluate the effectiveness of R-TKA on transfusion reduction compared with conventional TKA (C-TKA) in staged bilateral surgery. This retrospective study involved two groups of patients who underwent 1-week interval staged bilateral TKA—the C-TKA group and the R-TKA group—using MAKO SmartRobotics (Stryker, Kalamazoo, MI, USA). Each group comprised 53 patients after propensity score matching and was compared in terms of nadir hemoglobin (Hb) level and transfusion rate after each stage of surgery. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb level. The R-TKA group showed a significantly higher nadir Hb level than the C-TKA group after the second TKA (p = 0.002). The transfusion rate was not significantly different between the two groups after the first TKA (p = 0.558). However, the R-TKA group showed a significantly lower transfusion rate in the TKA (p = 0.030) and overall period (p = 0.023) than the C-TKA group. Patients who undergo staged bilateral R-TKA have lower transfusion rate than those who undergo C-TKA. R-TKA may be effective in minimizing unnecessary allogeneic transfusions in staged bilateral surgery. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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11 pages, 1667 KiB

Open AccessArticle

Total Knee Arthroplasty in Haemophilia: Long-Term Results and Survival Rate of a Modern Knee Implant with an Oxidized Zirconium Femoral Component

by Christian Carulli, Matteo Innocenti, Rinaldo Tambasco, Alessandro Perrone and Roberto Civinini

J. Clin. Med. 2023, 12(13), 4356; https://doi.org/10.3390/jcm12134356 - 28 Jun 2023

Cited by 1 | Viewed by 876

Abstract

(1) Background: Total Knee Arthroplasty (TKA) in patient with haemophilia (PWH) has usually been performed with the use of cobalt-chrome femoral and titanium tibial components, coupled with standard polyethylene (PE) inserts. The aim of this retrospective study was to evaluate the long-term outcomes and survival rates of TKA in a series of consecutive PWH affected by severe knee arthropathy at a single institution. (2) Methods: We followed 65 patients undergoing 91 TKA, implanted using the same implant, characterized by an oxidized zirconium femoral component, coupled with a titanium tibial component, and a highly crosslinked PE. At 1, 6, and 12 months; then every year for 5 years; and finally, every other 3 years, all patients were scored for pain (VAS), function (HJHS; KSS), ROM, and radiographic changes. Kaplan–Meier survivorship curves were used to calculate the implant survival rates. (3) Results: The mean follow-up was 12.3 years (4.2–20.6). All clinical and functional scores improved significantly from preoperatively to the latest follow-up (VAS: from 6.9 to 1.3; HJHS: from 13.4 to 1.9; KSS: from 19.4 to 79; ROM: from 42.4° to 83.6°). The overall survivorship of the implants was 97.5% at the latest follow-up. (4) Conclusions: The present series showed a high survival rate of specific implants potentially linked to the choice of an oxidized zirconium coupled with a highly crosslinked PE. We promote the use of modern implants in these patients in order to ensure long-lasting positive outcomes. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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9 pages, 662 KiB

Open AccessArticle

Prognostic Factors in Staged Bilateral Total Knee Arthroplasty—A Retrospective Case Series Analysis

by Krystian Kazubski, Łukasz Tomczyk, Andrzej Bobiński and Piotr Morasiewicz

J. Clin. Med. 2023, 12(10), 3547; https://doi.org/10.3390/jcm12103547 - 18 May 2023

Viewed by 888

Abstract

Background: Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure. Methods: We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications. Results: All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371). Conclusions: We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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11 pages, 1097 KiB

Open AccessArticle

Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study

by Melanie Schindler, Stephanie Schmitz, Jan Reinhard, Petra Jansen, Joachim Grifka and Achim Benditz

J. Clin. Med. 2022, 11(23), 7204; https://doi.org/10.3390/jcm11237204 - 04 Dec 2022

Cited by 3 | Viewed by 1994

Abstract

Background: Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. Methods: A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. Results: The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. Conclusions: The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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Review

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11 pages, 727 KiB

Open AccessReview

New Horizons of Cementless Total Knee Arthroplasty

by Giuseppe Polizzotti, Alfredo Lamberti, Fabio Mancino and Andrea Baldini

J. Clin. Med. 2024, 13(1), 233; https://doi.org/10.3390/jcm13010233 - 30 Dec 2023

Viewed by 1029

Abstract

Background: Considering the increasing number of young and active patients needing TKA, orthopedic surgeons are looking for a long-lasting and physiological bond for the prosthetic implant. Multiple advantages have been associated with cementless fixation including higher preservation of the native bone stock, avoidance of cement debris with subsequent potential third-body wear, and the achievement of a natural bond and osseointegration between the implant and the bone that will provide a durable and stable fixation. Discussion: Innovations in technology and design have helped modern cementless TKA implants to improve dramatically. Better coefficient of friction and reduced Young’s modulus mismatch between the implant and host bone have been related to the use of porous metal surfaces. Moreover, biologically active coatings have been used on modern implants such as periapatite and hydroxyapatite. These factors have increased the potential for ingrowth by reducing micromotion and increasing osteoconductive properties. New materials with better biocompatibility, porosity, and roughness have been introduced to increase implant stability. Conclusions: Innovations in technology and design have helped modern cementless TKA implants improve primary stability in both the femur and tibia. This means that short-term follow-up are comparable to cemented. These positive prognostic factors may lead to a future in which cementless fixation may be considered the gold-standard technique in young and active patients. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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14 pages, 1031 KiB

Open AccessReview

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

by Emerito Carlos Rodriguez-Merchan, Hortensia De la Corte-Rodriguez, Teresa Alvarez-Roman, Primitivo Gomez-Cardero, Carlos A. Encinas-Ullan and Victor Jimenez-Yuste

J. Clin. Med. 2022, 11(21), 6244; https://doi.org/10.3390/jcm11216244 - 23 Oct 2022

Cited by 2 | Viewed by 1235

Abstract

Total knee arthroplasty (TKA) is a commonly used option in advanced stages of knee arthropathy in people with hemophilia (PWH). The objective of this article is to determine what the complication rates and implant survival rates in PWH are in the literature. A literature search was carried out in PubMed (MEDLINE), Cochrane Library, Web of Science, Embase and Google Scholar utilizing the keywords “hemophilia TKA complications” on 20 October 2022. It was found that the rate of complications after TKA in PWH is high (range 7% to 30%), although it has improved during the last two decades, possibly due to better perioperative hematologic treatment. However, prosthetic survival at 10 years has not changed substantially, being in the last 30 years approximately 80% to 90% taking as endpoint the revision for any reason. Survival at 20 years taking as endpoint the revision for any reason is 60%. It is possible that with a precise perioperative control of hemostasis in PWH, the percentage of complications after TKA can be diminished. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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18 pages, 2084 KiB

Open AccessReview

Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty

by Emerito Carlos Rodriguez-Merchan and Alberto D. Delgado-Martinez

J. Clin. Med. 2022, 11(20), 6128; https://doi.org/10.3390/jcm11206128 - 18 Oct 2022

Cited by 15 | Viewed by 3413

Abstract

Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient’s perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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Other

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11 pages, 3119 KiB

Open AccessSystematic Review

Effects of Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty: Meta-Analysis

by Jung-Wee Park, Tae Woo Kim, Chong Bum Chang, Minji Han, Jong Jin Go, Byung Kyu Park, Woo-Lam Jo and Young-Kyun Lee

J. Clin. Med. 2023, 12(20), 6656; https://doi.org/10.3390/jcm12206656 - 20 Oct 2023

Cited by 1 | Viewed by 885

Abstract

The effectiveness of Floseal, a thrombin-based hemostatic matrix, in total knee arthroplasty (TKA) in minimizing blood loss and transfusion requirements remains a topic of debate. This meta-analysis aims to evaluate the up-to-date randomized controlled trials (RCTs) on the efficacy and safety of Floseal in TKA. A comprehensive search was conducted in electronic databases to identify relevant RCTs. The methodological quality of the included studies was assessed, and data extraction was performed. The pooled effect sizes were calculated using standardized mean difference (SMD) or odds ratios (OR) with 95% confidence intervals (CIs). Eight studies involving 904 patients were included in the meta-analysis. The use of a thrombin-based hemostatic agent significantly reduced hemoglobin decline (SMD = −0.49, 95% CI: −0.92 to −0.07) and the risk of allogenic transfusion (OR = 0.45, 95% CI: 0.25 to 0.81) but showed no significant difference in the volume of drainage or total blood loss. Funnel plots showed no evidence of publication bias. This meta-analysis provides robust evidence supporting the effectiveness of Floseal in reducing hemoglobin decline and transfusion in TKA. Further well-designed RCTs with longer follow-up periods are warranted to assess long-term efficacy and safety. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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11 pages, 769 KiB

Open AccessSystematic Review

Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

by Caspar W. J. Hulleman, Tommy S. de Windt, Karin Veerman, Jon H. M. Goosen, Frank-Christiaan B. M. Wagenaar and Gijs G. van Hellemondt

J. Clin. Med. 2023, 12(15), 5026; https://doi.org/10.3390/jcm12155026 - 31 Jul 2023

Cited by 1 | Viewed by 1397

Abstract

Goal: The purpose of this review is to provide a systematic and comprehensive overview of the available literature on the treatment of an early prosthetic joint infection (PJI) after revision total knee arthroplasty (TKA) and provide treatment guidelines. Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using the electronic databases of PubMed, Trip, Cochrane, Embase, LILACS and SciElo. After the inclusion of the relevant articles, we extracted the data and results to compose a treatment algorithm for early and acute PJI after revision TKA. Results: After applying the in- and exclusion criteria, seven articles were included in this systematic review focusing on debridement, antibiotics and implant retention (DAIR) for PJI following revision TKA, of which one was prospective and six were retrospective. All studies were qualified as level IV evidence. Conclusions: The current literature suggests that DAIR is a valid treatment option for early infections after revision TKA with success rates of 50–70%. Repeat DAIR shows success rates of around 50%. Further research should be aimed at predicting successful (repeat/two-stage) DAIRs in larger study populations, antibiotic regimes and the cost effectiveness of a second DAIR after revision TKA. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

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