581 research outputs found
Accuracy Evaluation of Post-Operative 3D Implant Position Based on BI-Planar X-Rays
No full textEvaluation of the post-operative implant position is not straightforward given the significant scatter during magnetic resonance imaging (MRI) and computed tomography (CT). In the contrary, bi-planar post operative x-rays are standard of care. Using these bi-planar x-rays, the 3D implant can now be determined when combining these images with 3D implant files and pre-operative CT data. Using data from 20 patients, this paper compares the obtained implant positions to the positions obtained from post-operative CT scans. On average, the differences between both measurement techniques are below 1mm and 1degree for the translational and rotational degrees of freedom respectively. It is therefore concluded that using post-operative x-rays is an effective method to assess the implant position and alignment.</jats:p
Increasing Patient Empowerment in TKA-Recovery Via a Mobile Application: an Observational Study
No full textTotal knee arthroplasty : improving outcome and patient satisfaction by evidence-based patient selection
No full textAre TKA kinematics during closed kinetic chain exercises associated with patient-reported outcomes? A preliminary analysis
Get PDFBackgroundKinematic patterns after TKA can vary considerably from those of the native knee. It is unknown, however, if there is a relationship between a given kinematic pattern and patient satisfaction after TKA.Questions/purposesIs there an association between kinematic patterns as measured by AP translation during open kinetic chain flexion-extension and closed kinetic chain exercises (rising from a chair and squatting) and a custom aggregate of patient-reported outcome measures (PROMs) that targeted symptoms, pain, activities of daily living (ADL), sports, quality of life (QOL), and patient satisfaction after TKA?MethodsThirty patients who underwent TKA between 2014 and 2016 were tested at a minimum follow-up of 6 months. As three different implants were used, per implant the first 10 patients who presented themselves at the follow-up consultations and were able to bend the knee at least 90 degrees, were recruited. Tibiofemoral kinematics during an open kinetic chain flexion-extension and closed kinetic chain exercises-rising from a chair and squatting-were analyzed using fluoroscopy. A two-step cluster analysis was performed, resulting in two clusters of patients who answered the Knee Injury and Osteoarthritis Outcome Score and the satisfaction subscore of the Knee Society Score questionnaires. Cluster 1 (CL1) consisted of patients with better (good-to-excellent) patient-reported outcome measures scores (high-PROMs cluster); Cluster 2 (CL2) consisted of patients with poorer scores (low-PROMs cluster). Tibiofemoral kinematics were compared between patients in these clusters by performing a Mann-Whitney U test with Bonferroni correction.ResultsConcerning open kinetic chain flexion-extension, there was no difference in kinematic patterns between the patients in the high-PROMs cluster and those in the low-PROMs cluster, with the numbers available. However, during the closed-chain kinetic exercises, medially, initial anterior translation (femur relative to tibia) was found in patients in Cluster 1 during early flexion, but in those in Cluster 2, translation was steeper and ran more anteriorly (CL1 -1.5 7.3%; CL2 -8.5 4.4%); mean difference 7.0% [95% CI 0.1 to 13.8]; p = 0.046). In midflexion, the femur did not translate anterior nor posterior in relation to the tibia, resulting in a stable medial compartment in Cluster 1, whereas Cluster 2 had already started translating posteriorly (CL1 -0.7 +/- 3.5%; CL2 3.4 +/- 3.6%; mean difference -4.1% [95% CI -7.0 to -1.2]; p = 0.008). There was no difference, with the numbers available, between the two clusters with respect to posterior translation in deep flexion. Laterally, there was small initial anterior translation in early flexion, followed by posterior translation in midflexion that continued in deep flexion. Patients in Cluster 1 demonstrated more pronounced posterior translation in deep flexion laterally than patients in Cluster 2 did (CL1 8.3 +/- 5.2%; CL2 3.5 +/- 4.5%); mean difference 4.9% [95% CI 0.6 to 9.1]; p = 0.026).ConclusionsThis study of total knee kinematics suggests that during closed kinetic chain movements, patients with poor PROM scores after TKA experience more anterior translation on the medial side followed by a medial mid-flexion instability and less posterior translation on the lateral side in deep flexion than patients with good PROM scores. The relationship of kinematic variations with patient-reported outcomes including satisfaction must be further elaborated and translated into TKA design and position.
Reproduction of optimal kinematic patterns during TKA could be instrumental in improving patient satisfaction after total knee replacement. Future expansion of the study group is needed to confirm these findings.Level of Evidence Level II, therapeutic study
Three dimensional detection of CAM type lesions in femoroacetabular impingement and validation of currently used measurement protocols
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Can we predict the natural course of femoroacetabular impingement?
No full textWe conducted a multivariate regression analysis (including both radiographic and activity related variables) in patients with osteoarthritis of the hip and structural changes related with femoroacetabular impingement. The purpose of this study was to investigate whether the age at which total hip arthroplasty may have to be performed, can be predicted in patients with femoroacetabular impingement (FAI). In 121 patients with FAT-related osteoarthritis, radiographic variables describing FAT-related parameters were obtained and the patients were questioned about their activity during early adulthood by means of the validated Baecke et al questionnaire. None of the variables significantly correlated with the final outcome parameter : age at surgery. As expected, based on the low correlation ratios of the different parameters investigated, a multiple-regression model was not accurate enough to allow any prediction on the natural course of FAI. We found that it is difficult to accurately predict the age at which a patient with FAI will develop early osteoarthritis. From our findings it appears that a hip with FAI is not always prone to early end-stage osteoarthritic degeneration, not even in patients with a high level of physical activity. Hence, considering the high prevalence of FAI-related radiographic findings, we conclude that not every radiographic abnormality requires treatment
Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study
No full textInternational audienceRehabilitation for total knee replacement (TKA) often involves in-person therapy sessions, which can be time consuming and costly. Digital rehabilitation has the potential to address these limitations, but most of these systems offer standardized protocols without considering the patient's pain, participation, and speed of recovery. Furthermore, most digital systems lack human support in case of need. The aim of this study was to investigate the engagement, safety, and clinical effectiveness of a personalized and adaptative app-based human-supported digital monitoring and rehabilitation program. In this prospective multi-center longitudinal cohort study, 127 patients were included. Undesired events were managed through a smart alert system. Doctors were triggered when there was a suspicion of problems. The drop-out rate, complications and readmissions, PROMS, and satisfaction were collected through the app. There was only 2% readmission. Doctor actions through the platform potentially avoided 57 consultations (85% of alerts). The adherence to the program was 77%, and 89% of the patients would recommend the use of the program. Personalized humanbacked-up digital solutions can help to improve the rehabilitation journey of patients after TKA, lower healthcare-related costs by lowering the complication and readmission rate, and improve patient reported outcomes
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