Background: here is little information on whether patients who are converted to knee arthroplasty after previous high tibial osteotomy (HTO) differ from those who are operated on by a knee arthroplasty as the first measure regarding patient characteristics, pre- and postoperative motion, function, and satisfaction with the surgery.
Objectives: The purpose of this study was to evaluate and compare the satisfaction, cost and functional results between both knees of patients who had undergone total knee arthroplasty (TKA) following a HTO for one knee, and primary TKA for the other.
Study Design & Methods: 19 patients who had undergone total knee arthroplasty following an HTO for one knee, and primary TKA for the other were included in the study. Pre and post-operative knee range of motions and Hospital for Special Surgery (HSS) knee scores, recorded in patient files were
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evaluated. Also the patients was administered a satisfaction survey consisting of a single question which evaluated both knees separately. Cost analysis was performed by calculating the prices of knee prostheses for both knees individually. Statistical analysis was performed using Student's t test. Results: 18 of the 19 patients included in the study were females and only one was male.
The average age of the patients was 68,89 (58-86). Preoperative knee flexion measurements of the patients treated with TKA after HTO was significantly lower compared to the group treated with primary TKA (p =0,01). There was no statistically significant difference between the two groups when postoperative knee flexion measurements were compared. (p = 0,21). Measurements of preoperative HSS scores of the patients treated with primary TKA was significantly higher than the patients treated with TKA after HTO. In the group of patients who were applied primary TKA, postoperative HSS scores were higher; however the difference was not statistically significant (p = 0,175). Satisfaction scores, based on the results of postoperative satisfaction surveys, was higher in primary TKA group compared to the scores of patients who had previously undergone HTO surgery. Cost values obtained according to the applied prostheses was lower in primary TKA group, but this difference was not statistically significant (p=
0,902). Conclusions: There is stil debate on the adverse effect of HTO over following arthroplasty procedures. We have observed that previously HTO operated knees have statistically significant lower flexion degrees and HSS scores before TKA implantation in contrast with contralateral non-operated knee. But we have also determined that these adversities can be corrected, and almost the same knee flexion degrees and functional outcomes can be reached by appropriate application of knee arthroplasty. We have noticed that patients were more satisfied from primary TKA, although no significant differences in postoperative function and range of motion was detected between two knees. In addition, when cost rates for both knees were assessed prostheses applied after HTO surgery despite being a bit more expensive than primary TKA implants, we did not find a statistically significant difference. In the literature, for evaluation of patients having TKA operation after HTO, different patients who had undergone primary TKA were taken as control groups. As far as we know, there are no studies comparing these two operations in the same patient. However, in this comparison to obtain more comprehensive results studies on larger series are needed. In this way, a more uniform and objective data can be achieved.
Baseball players and fans call it Tommy John surgery, after the pitcher who was the first to have the surgery 29 years ago. By any designation, it is one of the major advancements in sports medicine in the last quarter century. Technically it is a ulnar collateral ligament replacements procedure.
I carried out this case study on Mrs. Casey (Pseudonym), any 86 year old woman who underwent an elective left total hip replacement (THR). After the OT student studied Mrs. Casey's past medical history in her medical chart, it was noted that she had previously undergone a right THR in 2011, which had been successful and free from complications. Ms. Casey had no other significant past medical history and had been an independent and active woman before the progression of her arthritis. Ms. Casey was required to have total hip replacements carried out on both hip joints as a result of severe Osteoarthritis (OA), which lead to stiffness, pain, and an eventual decrease in mobility, affecting her quality of life and involvement in meaningful occupations.
This case involved a 53 year old man who sustained a significant tear of his rotator cuff while playing baseball. He underwent surgical repair and was given a referral for physical therapy. The referral was to begin passive ROM 3 times per week for 2 weeks then initiate a supervised home program of active exercise for 2 weeks, and elastic resistance exercises for internal and external rotation every other day for a month. 2 weeks after surgery, he had his first PT visit in a sports medicine clinic that was managed by an athletic trainer (ATC).”
This article is about the results of a survey conducted by three PhD’s; Janet Simon, Matthew Donahue, and Carrie Docherty, and was published by the International Journal of Athletic Therapy and Training. The purpose of the survey was to determine Athletic Trainers current utilization of ankle support, and to determine ATs current attitudes towards the use of ankle taping and bracing. It gives some history and benefits of ankle bracing and taping, and how it has become a multimillion dollar industry, considering that 66-73% of all college athletes have reported an ankle sprain. Also, a third of people with ankle sprains will either re-sprain the ankle or report feelings of instability after the initial sprain. Ankle taping has become essential part of sports medicine,
In November of 2010, I was playing basketball in the fifth game of my senior season. It was just like any other game. However, I would soon find out otherwise. It was late in the game; I drove into the lane and got fouled hard. I was knocked so off-balance that I speared the floor with my knee. As soon as my knee hit the floor I heard a “snap” that I will never forget for the rest of my life. Little did I know at the time, that would be the last shot of my high school basketball career. Not long after my injury, I consulted a doctor. After getting an x-ray and an MRI, the doctor informed me that I had completely torn my ACL and would need to have surgery. An ACL tear can be a very devastating injury. The anterior cruciate ligament (ACL) is one of the four major ligaments within the knee. The ACL is one of the most commonly injured ligaments, injured by an estimated 200,000 patients each year. Of the 200,000 annual ACL injuries, surgery is performed in approximately 100,000 cases. There are many types of reconstructive surgery on the ACL. However, there is an alternative to surgery in the form of physical therapy.
Nisell R. (1985) Mechanics of the knee: A study of joint and muscle load with clinical applications. Acta Orthop Scand 216; 1-42.
The musculoskeletal system offers support and stability for your body so we can properly function and move around. Different types of muscle within the muscular system include cardiac, skeletal, and smooth. The reason our bodies are capable of producing movement is because of the way our muscles contract. Our adult skeletal structure is made up of 206 bones that all differ in shapes and sizes. The composing parts that make up the system include the bones, joints, and muscles that all connect so we’re capable of moving. These components allow for our bodies to maintain a stable structure that can keep us upright. The axial skeleton refers to the skull, the vertebral column which supports the spinal cord, ribs, and sternum. It offers protections
Retrieved September 16, 2000 from: http://www. www.sechrest.com/mmg/knee/kneeacl.html. Arthroscopic ACL Reconstruction -. et al. (July 11, 1999).:Arthroscopy.com. Retrieved September 16, 2000 from: http://www.arthroscopy.com/sp05018.htm.
Räsänen, P., Paavolainen, P., Sintonen, H., Koivisto, A., Blom, M., Ryynänen, O., & Roine, R. P. (2007). Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthopaedica, 78(1), 108-115.
Starting my freshman year at County High School, I played basketball and loved every minute of it. I wouldn’t be conceited enough to say I was good, but God did bless me with the talent to play. My life revolved around the sport of basketball; some would say I slept, ate, and breathed every part of it. I spent all my time training and practicing to make myself a more dedicated athlete. This dedication not only helped me as a player, but also molded me into the person I am today. It somehow helped to prepare me for what defeat I would face with back surgery in the future.
After surgical joint replacement patients need pain management and analgesia because there is an increased amount of pain and stimuli that are usually not painful suddenly become bothersome (Scholz & Yaksh, 2010). For rehabilitation of the joint to occur, the patient must undergo physiotherapy. This therapy includes strengthening the joint and its surrounding muscles. If an intolerable amount of pain is present, the time for recovery could be prolonged and even chronic complications may result. The natural progression is that the amount and intensity of the pain perceived varies from patient to patient but as the incisions heal the pain intensity gradually declines (Scholz & Yaksh, 2010). “However, some patients experience deep pain or pain referred to the dermatomes that correspond to the operated organ, which persists for months or even years” (Scholz & Yaksh, 2010 p. 512). In the literature a clear distinction is not made in the description of post-operative pain. For instance post-operative pain could occur as a result of aggravation of the affected area by exercise, friction, or some other manipulation that occurs in the post-operative and recovery period (Scholz & Yaksh, 2010). Scholz and Yaksh (2010) ask “are the mechanisms responsible for sustained pain the same as those underlying acute postsurgical pain, or does, in this subgroup of patients, the trauma associated with the surgical intervention provoke different changes in sensory processing?” (Scholz & Yaksh, 2010 p.511)” The post-operative pain that is under examination in this paper is that which is produced as result of the acute joint rehabilitation process. The goal of this project is t...
Anterior knee pain plagues the athletic community, the most common being runner’s knee or patellofemoral pain syndrome (PFPS). One point or another in an athlete’s career they have experienced this kind of pain. When comparing between male and female athletes and who has the higher chance of knee pain, female athletes have a higher prevalence than male athletes (Dolak KL). There are several different mechanisms of patellofemoral pain a few being: pes planus,an increased Q angle, weak, tight or an imbalance in the quadriceps or hip muscles. Recently in my clinic site as the spring sports such as, baseball, soccer and track and field the athlete’s perform a lot of squatting, running, and kneeling which load the patellofemoral joint. We are now starting to see several and treat several athletes with patellofemoral knee pain. Each of them experiencing the pain from a different mechanism. As an athletic trainer we want to treat not only the symptoms, but the mechanism of injury to prevent further injuries down the road. If patellofemoral pain syndrome is not properly treated it can develop into chronic diseases such as chondromalacia or arthritis, maybe eventually leading to a total knee plan. (Lee SE) Treatment while the athletes are young and symptoms aren’t severe is key to preventing further injury.
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
Total Hip Replacement (THR) is a surgical procedure that relieves pain from most kinds of hip arthritis, thus helping to improve the quality of life for the majority of the patients that undergo the operation. Arthritis simply means "inflammation of a joint." Arthritis can occur in any joint in the body. The main symptom of arthritis is pain which usually worsens with activity and weight bearing. This pain may be relieved most of the time through rest. There are over 100 types of arthritis but less than a handful account for over than 95 percent of the hip replacements that are performed. Some of these include Osteoarthritis (causes deterioration of the cartilage and the growth of bone spurs), Rheumatoid arthritis and Osteonecrosis of the femoral head. Doctors suggest that before considering hip replacement surgery for arthritis that the patient tries a number of non-operative interventions. Your doctor may have you consider little things such as weight loss (most arthritis is caused due to the weight bearing on a joint), activity modification or even the use of a cane. Patients should consider THR when daily living activities become harder to accomplish due to the pain. These activities would include walking, climbing stairs or other moderate pastimes. Anti-inflammatory medications which will help reduce the inflammation from the arthritis and reduce your pain may also be prescribed by the patient's doctor.
The most common musculoskeletal disorder and a major cause of disability in people over 65 years is osteoarthritis (OA) (Felson DT et al, 1987) (1). According to World Health Organization (WHO) report, OA of knee is more likely to become the fourth most important cause of disability in women, and the eighth most important cause in men (Murray CJL, Lopez AD, 1997)(2) . Primary prevention of knee OA has become a major health care aim and a clear understanding of the risk factors is required to design preventive strategies. Many investigations reported obesity, previous history of knee injury, sedentary life style, hand OA (Heberden’s nodes), and a familial history of the disease are major risk factors for OA of knee (Cyrus Cooper et al, 2000) (3). In spite of recent advancements the causes and pathogenesis of knee OA remains largely unknown (A Teichtahl, A Wluka, F M Cicuttini, 2003) (4) but however there is increasing research interest in the contribution of biomechanical variables on progression and management of the disease (Andriacchi TP, 1991) (5).