Compartment syndrome is a rare complication of total knee arthroplasty that requires early recognition and prompt decompression in order to prevent long-term disability. We have found only one previous case report in the literature. We...
moreCompartment syndrome is a rare complication of total knee arthroplasty that requires early recognition and prompt decompression in order to prevent long-term disability. We have found only one previous case report in the literature. We present a series of seven cases from four hospitals and five surgeons. Six of the cases resulted in the loss of at least one compartment, and one resulted in amputation. Four of the cases resulted in legal action. We suggest that important risk factors contributing to the development of this condition include complex surgery, soft-tissue compromise, previous surgery, and possibly vascular disease. Delay in the diagnosis and hence delay in decompression was common in our series, and in five cases appeared to be related to the use of a postoperative epidural infusion for pain relief. The presence of associated neurological compromise may have also been a significant factor in the delay to diagnosis in two cases.
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Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects, although the correlation between clinical and radiological outcomes after surgery is poorly understood. To...
moreMatrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects, although the correlation between clinical and radiological outcomes after surgery is poorly understood. To determine the correlation between clinical and radiological outcomes throughout the postoperative timeline to 5 years after MACI. Cohort study (diagnosis); Level of evidence, 3. This retrospective study was undertaken in 83 patients (53 male, 30 female) with complete clinical and radiological follow-up at 1, 2, and 5 years after MACI. The mean age of patients was 38.9 years (range, 13-62 years), with a mean body mass index (BMI) of 26.6 kg/m(2) (range, 16.8-34.8 kg/m(2)), mean defect size of 3.3 cm(2) (range, 1-9 cm(2)), and mean preoperative duration of symptoms of 9.2 years (range, 1-46 years). Patients indicated for MACI in this follow-up were 13 to 65 years of age, although they were excluded if they had a BMI >35 kg/m(2), had undergone prior ext...
To accurately assess subsidence, rotation and clinical scores in two cementless femoral stems. 260 patients received either K2 or Apex femoral stems and were studied over 2y, with RSA and clinical scores. Mean Oxford Hip score for both...
moreTo accurately assess subsidence, rotation and clinical scores in two cementless femoral stems. 260 patients received either K2 or Apex femoral stems and were studied over 2y, with RSA and clinical scores. Mean Oxford Hip score for both stems was excellent (45.78 and 46.76). Very little subsidence or rotation were noted on RSA in either stem. There were no statistically significant differences in clinical scores, or radiological motion between stems. Revision rate was 0.8% over the study period. Excellent clinical and RSA scores over the 2y study period predict good long term outcomes for these stems.
Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. While a number of factors may affect the clinical outcome, little is known about the influence of subchondral...
moreMatrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. While a number of factors may affect the clinical outcome, little is known about the influence of subchondral bone abnormalities at the time of surgery on pain and graft outcomes after MACI. To investigate the association between subchondral bone marrow edema within 3 months before MACI surgery on preoperative and postoperative reported pain and symptoms as well as postoperative graft outcomes. Cohort study; Level of evidence, 3. This retrospective study was undertaken in 56 patients undergoing MACI with clinical and radiological assessments before surgery and at 3, 12, 24, and 60 months after surgery. Patients were assessed using the Pain and Symptoms subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). High-resolution magnetic resonance imaging (MRI) was used to evaluate the severity of preoperative subchondral bone marrow edema, while gra...
Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic...
moreMatrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic technique, which may decrease the associated comorbidity of arthrotomy, potentially allowing for faster rehabilitation. To compare postoperative outcomes between arthroscopic and open arthrotomy techniques of MACI and present a case for faster recovery and accelerated rehabilitation after surgery. Retrospective cohort study. Private functional rehabilitation facility. 78 patients (41 arthroscopic, 37 open) treated with MACI for full-thickness cartilage defects to the femoral condyles. According to surgeon preference, patients recruited over the same time period underwent MACI performed arthroscopically or via a conventional open arthrotomy. Both surgical groups were subjected to an identical rehabilitation protocol. Patient-reported (Knee Injury and Osteoarthritis Outcome Score, Short Form Health Survey, and visual analogue scale) and functional (6-minwalk test, 3-repetition straight-leg-raise test [3R-SLR]) outcomes were compared presurgery and at 3, 6, and 12 mo postsurgery. Active knee range of motion (ROM) was additionally assessed 4 and 8 wk postsurgery. MRI evaluation was assessed using magnetic-resonance observation of cartilage-repair tissue (MOCART) scores at 3 and 12 mo. The length of hospital stay was evaluated, while postsurgery complications were documented. Significant improvements (P < .05) for both groups were observed over the 12-mo period for patient-reported and functional outcomes; however, the arthroscopic cohort performed significantly better (P < .05) in active knee-flexion and -extension ROM and the 3R-SLR. No differences were observed in MOCART scores between the 2 groups at 12 mo. Patients who received arthroscopic implantation required a significantly reduced (P < .001) hospital stay and experienced fewer postoperative complications. Arthroscopic MACI in combination with…
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ABSTRACT Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of full thickness chondral defects in the knee. Until recently, the implantation of these grafts was only possible via...
moreABSTRACT Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of full thickness chondral defects in the knee. Until recently, the implantation of these grafts was only possible via an open mini-arthrotomy. However, while the MACI technique permits an arthroscopic approach and several arthroscopic techniques have now been described, limited published work has been reported on the early post-operative outcome and associated benefits following an arthroscopic approach. This study presents the early clinical and radiological outcomes to 12 weeks in patients treated with arthroscopic MACI, compared with a matched-control patient cohort undergoing MACI through a standard open mini-arthrotomy within the same time period, highlighting the potential benefits of arthroscopically performed MACI.
To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion. Prospective randomized controlled trial....
moreTo investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion. Prospective randomized controlled trial. Private hospital and functional rehabilitation clinic. Consecutive sample of patients (N=43; 53 knees) scheduled for TKA. MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy. Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score. A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes. MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care.
Patient-reported outcome (PRO) instruments are employed to assess outcomes after matrix-induced autologous chondrocyte implantation (MACI), although the PRO most responsive to change after surgery remains unknown. To compare the...
morePatient-reported outcome (PRO) instruments are employed to assess outcomes after matrix-induced autologous chondrocyte implantation (MACI), although the PRO most responsive to change after surgery remains unknown. To compare the responsiveness of 4 commonly used PRO instruments at 5 years after MACI. Cohort study (diagnosis); Level of evidence, 2. The Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, the Tegner activity scale, and the 36-item Short Form Health Survey (SF-36) were administered to 104 patients before and at 5 years after MACI knee surgery. The Self-administered Patient Satisfaction Scale was employed at 5 years to investigate each patient's overall level of satisfaction as well as satisfaction with relieving pain and improving the ability to perform daily activities, partake in recreational activities, and participate in sport. The effect size (ES) and standardized response mean (SRM) were used to compare PRO responsiveness. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the extent to which PRO changes were associated with satisfaction. The minimal clinically important difference (MCID) according to the criterion of patient satisfaction was identified as the PRO instrument change score maximizing classification accuracy. The most responsive PRO measures were the KOOS sport/recreation (ES, 1.63; SRM, 1.43) and quality of life (QOL) (ES, 1.37; SRM, 1.18) subscales. The least responsive were the SF-36 mental component summary (MCS) (ES, 0.38; SRM, 0.40) and the Tegner activity scale (ES, 0.91; SRM, 0.59). Of the 104 patients, 54 (51.9%) reported being "very satisfied," 38 (36.5%)…
While structured postoperative rehabilitation after matrix-induced autologous chondrocyte implantation (MACI) is considered critical, very little has been made available on how best to progressively increase weightbearing and exercise...
moreWhile structured postoperative rehabilitation after matrix-induced autologous chondrocyte implantation (MACI) is considered critical, very little has been made available on how best to progressively increase weightbearing and exercise after surgery. A significant improvement will exist in clinical and magnetic resonance imaging (MRI)-based scoring measures to 5 years after surgery. Furthermore, there will be no significant differences in outcomes in MACI patients at 5 years when comparing a traditional and an accelerated postoperative weightbearing regimen. Finally, patient demographics, cartilage defect parameters, and injury/surgery history will be associated with graft outcome. Randomized controlled trial; level of evidence, 1. Clinical and radiological outcomes were studied in 70 patients who underwent MACI to the medial or lateral femoral condyle, in conjunction with either an "accelerated" or a "traditional" approach to postoperative weightbearing…
Background: The availability remains limited of midterm clinical and radiologic results into matrix-induced autologous chondrocyte implantation (MACI). Outcomes are required to validate the efficacy of MACI as a suitable surgical...
moreBackground: The availability remains limited of midterm clinical and radiologic results into matrix-induced autologous chondrocyte implantation (MACI). Outcomes are required to validate the efficacy of MACI as a suitable surgical treatment option for articular cartilage defects in the knee.Hypothesis: A significant improvement in clinical and magnetic resonance imaging—based (MRI-based) outcomes after MACI will exist throughout the postoperative timeline to 5
