Total Knee Arthroplasty for Patients with Ankylosing Spondylitis
Barend J. van Royen, Ben A. C. Dijkmans in Ankylosing Spondylitis Diagnosis and Management, 2006
Total knee arthroplasty is a viable treatment option for AS patients who have significant and debilitating degenerative arthritis in the knees. Patients can expect excellent pain relief, although functional outcomes are more variable. Therefore, medical management should be exhausted and patients should be counseled about the unique risks involved in the procedure. In particular, postoperative care should be aimed at maximizing range of motion and surgeons should consider prophylaxis against heterotopic ossification in high-risk patients. Lastly, surgeons should avoid performing bilateral total knee replacements in AS patients because of the increased morbidity, difficult rehabilitation, and less predictable outcome.
Emotional Health and Well-Being
Deborah Fish Ragin in Health Psychology, 2017
The biopsychosocial model was the first to include psychological and social determinants as contributors to health outcomes. The wellness model includes the same psychological, social, and emotional factors included in the biopsychosocial model, but it adds two new dimensions: quality of life and spirituality. Quality of Life The wellness model defines health according to an individual’s assessment of his or her own state of physical, mental, emotional, and spiritual well-being. For example, in a case study by Dinh and Groleau (2008), a Laotian man, Mr. B., summarizes his assessment of his overall well-being using quality of life and spirituality (see Box 6.1). In this study, Mr. B. unwillingly undergoes an emergency amputation of two fingers to protect him from a likely infection. According to the medical doctors on his case, the operation restored him to a state of good physical health. But, according to Mr. B., when surgeons removed his two fingers they also took part of his life and his life force. For Mr. B., the operation that Western medical doctors thought of as a lifesaving procedure diminished his quality of life and negatively affected his spiritual and overall well-being. Similar examples of an individual’s perception of wellness that departs from a biopsychosocial concept of health are found in the research literature on total knee replacement surgery, an increasingly common surgery for older adults in many Western cultures. Total knee replacement surgery usually is performed when a person’s knee osteoarthritis, a form of arthritis in the knee that can become disabling over time, worsens to the point that surgery is required to relieve the pain or to correct a functional disability (see Chapter 10, Chronic Pain Management and Arthritis). Interestingly, research by Toye, Barlow, Wright, and Lamb (2006) shows that, for most patients, a decision to replace a dysfunctional knee is rarely explained by painful physical symptoms. Instead, Toye and colleagues (2006) found that a patient’s feelings of vulnerability because of the unreliable knee, the desire not to depend on others for mobility, and the fatigue associated with an increased effort when performing daily tasks, in other words, quality of life issues, were the driving factors for knee replacement surgery. Thus Toye and colleagues (2006) suggest that decisions to have knee replacement surgery are based on the value placed on mobility, independence, and improved energy levels rather than on pain or discomfort. These concepts represent quality of life values that may not be considered important in a biomedical or biopsychosocial model of health but are essential factors in a wellness model. Spirituality The wellness model also addresses spiritual health, faith, and religion—topics that are not usually included in psychological research. Some scientists consider spirituality a pseudoscience or a primitive superstition and therefore not something to be included in rigorous studies that explain individual health outcomes. Recently, however, more researchers have examined the relationship between spirituality and health (see Chapter 7, Stress and Coping). The new research suggests a change among current scientists, at least those in the health fields, who believe that spirituality is essential for some individuals to obtain optimal health (Diaz, 1993; Myslakidou et al., 2008; Seaward, 1991). By spirituality, researchers are not necessarily referring to religious dogma. Rather, studies focus on the impact of an individual’s philosophy, values, and meaning of life (Mullen, McDermott, Gold, & Belcastro, 1996) on health status.
Principles of management of osteoporotic fractures
Peter V. Giannoudis, Thomas A. Einhorn in Surgical and Medical Treatment of Osteoporosis, 2020
Fractures of the acetabulum are increasing in prevalence and challenging in the osteoporotic patient, commonly involving the anterior column more than young patients (156). Of those receiving internal fixation, over 50% are not anatomically reduced. THA is used in approximately 25% of patients as a salvage option. This however is an operation with greater complexity, and the revision rate of THA from acetabular ORIF salvage is 20% (157). A role exists for combining acetabular column fixation and primary arthroplasty in the osteoporotic patient. Either through one extensile posterior approach or combining with an anterior approach if the anterior column is involved, a stable acetabulum can be created for standard preparation of a primary total hip (158). At 4-year follow-up, the majority of patients have excellent results (159). Comminuted distal femoral fractures involving the joint surface usually require rigid fixation achieved through plating constructs. The ability to weight-bear immediately is often delayed, despite emerging evidence suggesting otherwise (26). On the contrary, weight-bearing, load-sharing nail constructs are often inadequate at reducing complex intra-articular fractures. Total knee arthroplasty allows early weight-bearing and negates the need for anatomical articular reconstruction. Highly constrained modular prostheses allow for most distal fracture patterns to be suitable. The procedure is not without complications, with 1-year mortality up to 40%, reflecting the frailty of the cohort, and a reoperation rate of 18% over 3 years (160). More recent literature reports very few complications or deaths (161). There is a need for high-quality studies to define for which patient arthroplasty would be best suited. Tibial plateau fractures are often complex intra-articular fracture patterns, in which full weight-bearing is unusual post osteosynthesis. These fractures are associated with an increased risk of needing subsequent total knee arthroplasty (hazard ratio: 5.29) (162). Complications tend to be increased after revision surgery (fixation converted to arthroplasty) compared to primary arthroplasty (163). Total knee replacement has been used as the primary procedure in tibial plateau fractures with low complications, attributed to early, full weight-bearing mobilization. Semiconstrained components can be used in simpler fracture patterns (B1–B3) with hinged prostheses used for more complex patterns (B3–C3) (164). The comminuted proximal humerus has shown little advantage with fixation or hemiarthroplasty over nonoperative management in an elderly population (109).
The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy
Published in Acta Orthopaedica, 2015
Mona Badawy, Anne M Fenstad, Kari Indrekvam, Leif I Havelin, Ove Furnes
Background and purpose — Previous studies have found different outcomes after revision of knee arthroplasties performed after high tibial osteotomy (HTO). We evaluated the risk of revision of total knee arthroplasty with or without previous HTO in a large registry material. Patients and methods — 31,077 primary TKAs were compared with 1,399 TKAs after HTO, using Kaplan-Meier 10-year survival percentages and adjusted Cox regression analysis. Results — The adjusted survival analyses showed similar survival in the 2 groups. The Kaplan-Meier 10-year survival was 93.8% in the primary TKA group and 92.6% in the TKA-post-HTO group. Adjusted RR was 0.97 (95% CI: 0.77–1.21; p = 0.8). Interpretation — In this registry-based study, previous high tibial osteotomy did not appear to compromise the results regarding risk of revision after total knee arthroplasty compared to primary knee arthroplasty.
Surgeon variability in total knee arthroplasty component alignment: a Monte Carlo analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2014
Christopher J. Gatti, Brian R. Hallstrom, Richard E. Hughes
Component mal-alignment in total knee arthroplasty has been associated with increased revision rates and poor clinical outcomes. A significant source of variability in traditional, jig-based total knee arthroplasty is the performance of the surgeon. The purpose of this study was to determine the most sensitive steps in the femoral and tibia arthroplasty procedures. A computational model of the total knee arthroplasty procedure was created, and Monte Carlo simulations were performed that included surgeon variability in each step of the procedure. The proportion of well-aligned components from the model agrees with clinical literature in most planes. When components must be aligned within ±3° in all planes, component alignment was most sensitive to the accuracy of identifying the lateral epicondyle for the femoral component, and to the precision of the transverse plane alignment of the extramedullary guide for the tibial component. This model can be used as a tool for evaluating different procedural approaches or sources of variability to improve the quality of the total knee arthroplasty procedure.
Influence of landmark and surgical variability on virtual assessment of total knee arthroplasty
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2014
Y. Dai, J. Seebeck, A.D. Henderson, J.E. Bischoff
Given advances in recent years in imaging modalities and computational hardware/software, virtual analyses are increasingly valuable and practical for evaluating total knee arthroplasty (TKA). However, the influence of variabilities at each step in computational analyses on predictions of TKA performance for a population has not yet been thoroughly investigated, nor the relationship between these variabilities and expected variations in surgical practice. Understanding these influences is nevertheless essential for ensuring the clinical relevance of theoretical predictions. Here, a morphological analysis of proximal tibial resections within TKA is proposed and investigated. The goals of this analysis are to quantify the influence of variability in landmark detection on resection parameters and to evaluate this sensitivity relative to expected clinical variability in TKA resections. Results here are directly applicable to population-level computational analyses of morphological and functional TKA performance.
Related Knowledge Centers
- Arthroplasty
- Psoriatic Arthritis
- Arthritis
- Osteoporosis
- Osteoarthritis
- Replacement Arthroplasty
- Rheumatoid Arthritis