Object: Although pain relief is a primary goal of a total knee arthroplasty (TKA) and partial knee arthroplasty (PKA), a significant number of arthroplasty patients experience unexplained pain. This study attempts to ...Object: Although pain relief is a primary goal of a total knee arthroplasty (TKA) and partial knee arthroplasty (PKA), a significant number of arthroplasty patients experience unexplained pain. This study attempts to determine preoperative or intraoperative factors that may predict pain after knee arthroplasty. Methods: 2585 primary TKAs and 423 PKAs were performed between 1993 and 2013. Infections, loosening, and revision arthroplasty were excluded. Knee Society scores, demographics, component sizes, pre- and postoperative alignment, treatment of the posterior cruciate ligament, range of motion, and diagnosis were analyzed. Statistical analysis utilized repeated measures ANOVA. Results: Significant predictors of increased pain after TKA were pre-operative varus alignment >5° (p = 0.0042), postoperative flexion range of motion 5° (p = 0.0006), small tibial component sizes (p = 0.0080), excision of the posterior cruciate ligament (p = 0.0259), and diagnosis as osteonecrosis (p = 0.0077). Factors not associated with pain included age, body mass index, gender, postoperative alignment and bone quality. For PKA, age was the only factor associated with pain. Conclusions: Six factors were found to be relevant to postoperative pain in TKA. For PKA, reported pain is not associated with any of the same factors, but is associated with age. Surgeons should be aware of these risk factors as we continue to understand pain after total and partial knee arthroplasty.展开更多
Intraoperative fracture rates in total hip arthroplasty (THA) have been associated with uncemented stems, anterolateral surgical approach, diagnoses other than osteoarthritis, and female gender. The purpose of this st...Intraoperative fracture rates in total hip arthroplasty (THA) have been associated with uncemented stems, anterolateral surgical approach, diagnoses other than osteoarthritis, and female gender. The purpose of this study was to investigate if changes in stem design would influence intraoperative fracture rates. 1497 THA with Bi-Metric stems were compared to 1277 THA with Echo Bi-Metric Full Proximal Profile stems and 366 THA with Echo Bi-Metric Reduced Proximal Profile stems. The intraoperative fractures rates were 5.48%, 1.41% and 1.37% for Bi-Metric and Echo Bi-Metric with standard and reduced proximal geometry stems, respectively. Stem survivorship with aseptic loosening as an endpoint was 100% in all cohorts at the final follow-up. We conclude that changes in femoral stem geometry in uncemented THA reduce intraoperative fracture rates while preserving fixation.展开更多
文摘Object: Although pain relief is a primary goal of a total knee arthroplasty (TKA) and partial knee arthroplasty (PKA), a significant number of arthroplasty patients experience unexplained pain. This study attempts to determine preoperative or intraoperative factors that may predict pain after knee arthroplasty. Methods: 2585 primary TKAs and 423 PKAs were performed between 1993 and 2013. Infections, loosening, and revision arthroplasty were excluded. Knee Society scores, demographics, component sizes, pre- and postoperative alignment, treatment of the posterior cruciate ligament, range of motion, and diagnosis were analyzed. Statistical analysis utilized repeated measures ANOVA. Results: Significant predictors of increased pain after TKA were pre-operative varus alignment >5° (p = 0.0042), postoperative flexion range of motion 5° (p = 0.0006), small tibial component sizes (p = 0.0080), excision of the posterior cruciate ligament (p = 0.0259), and diagnosis as osteonecrosis (p = 0.0077). Factors not associated with pain included age, body mass index, gender, postoperative alignment and bone quality. For PKA, age was the only factor associated with pain. Conclusions: Six factors were found to be relevant to postoperative pain in TKA. For PKA, reported pain is not associated with any of the same factors, but is associated with age. Surgeons should be aware of these risk factors as we continue to understand pain after total and partial knee arthroplasty.
文摘Intraoperative fracture rates in total hip arthroplasty (THA) have been associated with uncemented stems, anterolateral surgical approach, diagnoses other than osteoarthritis, and female gender. The purpose of this study was to investigate if changes in stem design would influence intraoperative fracture rates. 1497 THA with Bi-Metric stems were compared to 1277 THA with Echo Bi-Metric Full Proximal Profile stems and 366 THA with Echo Bi-Metric Reduced Proximal Profile stems. The intraoperative fractures rates were 5.48%, 1.41% and 1.37% for Bi-Metric and Echo Bi-Metric with standard and reduced proximal geometry stems, respectively. Stem survivorship with aseptic loosening as an endpoint was 100% in all cohorts at the final follow-up. We conclude that changes in femoral stem geometry in uncemented THA reduce intraoperative fracture rates while preserving fixation.
