Online ISSN: 2515-8260

Keywords : total knee arthroplasty


SKINTED: An unfamiliar and overlooked complication of total knee arthroplasty

Dr. Farzana Ansari, Dr. Nidheesh Agarwal, Dr. Anuj Kothari, Dr. Manish Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 122-125

Surgery of the Knee, injury to the infrapatellar branch of the saphenous nerve, Traumatic Eczematous Dermatitis (SKINTED) is a neuropathic dermatitis secondary to iatrogenic injury to infrapatellar branch of the saphenous nerve during the surgeries around the knee, mainly total knee arthroplasty (TKA). The infrapatellar branch of the saphenous nerve is most often resected during total knee replacement surgery using median para-patellar incision. It is an underreported entity in dermatology literature. In this paper, we report 5 cases of SKINTED who presented with eczematous rash over knee after several months of TKA. Dermatologists as well as orthopedicians should be well aware of this manageable condition as its timely diagnosis and treatment can prevent unnecessary dissatisfaction in patients who have undergone TKA.

Comparison of Outcomes of Posterior Cruciate Ligament Substituting Versus Retaining in Total Knee Arthroplasty

B V Adhitya, Mangalapuri Rajesh, Venkata Sivaram G V

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2406-2412

Background:To compare the gait patterns between posterior cruciate retention (CR) and posterior cruciate substitution (PS) in total knee arthroplasty (TKA).
Materials and Methods: This is a prospective, randomized study of 35 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior- cruciate-ligament substituting total knee arthroplasty. The results of the WOMAC 35 score which were subdivided into pain, stiffness and function showed high scores for cruciate substituting groups for pain as compared to the cruciate retaining groups whereas, other parameters were same in both the groups.
Results: The comparison in the two designs of the CL retaining and CL substituting for TKR was made right from the pre-operative deformity and comparison outcomes of the two procedures by health surveys, WOMAC surveys, knee society score.
Conclusion: The present study found almost similar results for Cruciate ligament retaining and substituting procedures in long term follow up at 3 months, with slightly better outcomes for Cruciate ligament retaining groups at the earliest phases pre-operatively and post operatively

“A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF TOTAL KNEE REPLACEMENT IN OSTEOARTHRITIS OF KNEE”

Dr. K.M. Gopinath, Dr. Ravi N. Bavalatti, Dr. Roshan kumar B.N., Dr. Suresh I .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2651-2672

AIM AND OBJECTIVES: To evaluate the functional outcomes of Total Knee Arthroplasty.
METHODS: This is a prospective study of 20 cases who underwent Total knee replacement at Rajarajeshwari medical college and hospital, Bengaluru between June 2019 and May2021. Cases were taken according to inclusion and exclusion criteria. Patients were evaluated using Knee Society Score at regular follow up. In our study we had 28 female patients and 13male patients. Indications were OA in 19, RA in 1.. The average follow-up period was 22weeks.
RESULTS : In our study, pre-operatively all of our patients had moderate to severe pain, post- operatively 20 cases had mild pain. Preoperative average Flexion of 76 degrees was increased to 95 degrees post operatively. All the 20 knees had poor knee score of <60 preoperatively, postoperatively 42 knees had excellent score (80- 100) and 17 knees with good score (70-79). 38 patients had poor functional score(<60) and 3 patients with fair functional score (60-69) pre-operatively. Postoperatively 21 patients had excellent score (80-100), 11 patients with good score (70-79), 6 patients had fair score (60-69) and 3 patients had poor score(<60).

           CONCLUSION: Total knee arthroplasty is now a common and established surgical procedure. The functional outcome of the procedure is dramatic, durable, and satisfactory with high patient acceptance.

Comparison of Analgesic Effect of a Single Dose of PerineuralRopivacaine With and Without Dexamethasone on Ultrasound-Guided Femoral Nerve Block After Total Knee Arthroplasty

Dr. Rajmohan Rao Tumulu, Dr. Dilshad Kauser, Dr. Sunil Kumar Swain, Pranay Kumar Tumulu, Tanisha Garg, Mohammed Amer Mohiuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4696-4701

Background:
Postoperative pain after total knee replacement surgery is an unpleasant memory for the patients.
Different techniques have been tried to elevate the post-operative pain. A femoral nerve block
with local anaesthetics is considered to bethe gold standard for postoperative pain.But the painfree
period after the femoral nerve block lasts for a few hours only.Several adjuvants have been
triedwith local anaestheticsto prolong analgesics’ duration and avoid the adverse effects of
NSAIDsandopioid use.
Objective:
In this study, we have used dexamethasone as an adjuvant withropivacaine to prolong the
duration of analgesia effect, in a single dose of perineural femoral nerve block after total knee
arthroplasty.
Methods:
It was a prospective, randomized, controlled study, sixty patients were randomly assigned to one
of two groups:Group R or Group RD. In Group R, 40 mL of 0.375% ropivacaine was used, and
in Group RD 8 mg of dexamethasone was used as an adjuvant to 40 mL of 0.375%
ropivacaine.The primary endpoint was to check the duration of analgesia after the femoral nerve
block and the secondary endpoint was to check the amount of rescue analgesic consumed in the
first 24 hours, postoperatively.A visualanalogue scale (VAS) score was used to access the pain
with 1 being the least pain and 10 being the highest. The adverse reactions to the drugs were also
noted in both groups.

Continuous epidural analgesia versus continuous femoral nerve block in management of post-operative pain in patients undergoing unilateral total knee arthroplasty: An open labelled randomized controlled trial

Dr. Mukthapuram Sreenath,Dr. Avinash Kumar Katukam, Dr. Karthik Manchala, Dr. Doddoju Veera Bhadreshwara Anusha, Dr. BattuVijayeswar Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 711-718

Introduction: The most common concern associated with TKR is post-operative pain for
both the patient and the surgeon. It is associated with multiple adverse physical and
psychological consequences, which hinder postoperative mobilisation, increase the incidence
of post-operative complications and the overall outcome.A number of modalities have been
recommended of which regional techniques are preferred. Current study aims to compare
post-operative management of pain in patients undergoing Total Knee arthroplasty (TKA)
with epidural analgesia versus femoral nerve block.
Material and methods: Study was done in 100 patients posted for unilateral TKA. After
obtaining written consent and ethical committee clearance patients were randomized in to two
groups. Group “CEA”-8 mL 0.2% ropivacaine was given epidurally and Group “CFB”-bolus
of 20 mL of 0.2% ropivacaine was given through femoral catheter.
Outcomes assessed were
1) Acute postoperative pain (during rest and movement).
2) Postoperative rescue analgesic consumption/rescue analgesia.
3) Quality of early postoperative rehabilitation (functional assessments).
4) Postoperative complications if any.
Results: There was no significant difference in Vas score during rest and activity in both the
groups at 6 hrs,12, 24, 48 and 72 hours. There was no significant difference in both the
groups with respect to rehabilitation indices and adverse events. Only 43.4% of patients
belonging to group CFB, received rescue analgesia which was less when compared to patients
in group CEA(57.6%) which was significant.
Conclusion: CFA have the advantage over CEA in terms of decreased need for rescue.
analgesia with no neuraxial side effects.

To determine difference of pain-free range of motion in patient of total knee replacement with midvastus vs subvastus approach at 6 months

Dr. Sandip Rathod, Dr. Mitul Mistry, Dr. Chirag Prajapati, Dr. Bimal Modi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 389-394

Background: Total knee arthroplasty (TKA) is the best choice for the treatment of end-stage
osteoarthritis, and it can restore knee function, relieve pain, and improve quality of life
(QOL), with 95% of patients achieving a good prosthesis survival rate. The aim of the study
is to determine difference of pain-free range of motion in patient of total knee replacement
with midvastus vs subvastus approach at 6 months.
Methods: 200 patients were included in the present study who were scheduled to undergo
bilateral total knee arthroplasty during a single anesthetic session were followed for 6 months
postoperatively
Result: There were more females than males in the present study. All patients were followed
up for 6 months. No significant differences were found for demographic parameters between
the MV group and the SV group.The VAS, and KSS in the MV group were better than those
in the SV group within 6 months (p < 0.05), but no significant differences were found at 1
month, and 6 months after surgery (p > 0.05)
Conclusion: The better quality of life can be achieved by performing a TKA via the MV
approach. In addition, compared with the SV approach, the MV approach may offer less
postoperative pain and a faster recovery

Multimodal Post-Operative Pain Management Using Intraoperative Periarticular Cocktail Injection In Total Knee Arthroplasties

Dr. Kailash Karur , Prof Nandakumar R , Dr. Santhosh Kumar G , Dr. Sripriya R

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2994-3005

INTRODUCTION: Total knee arthroplasty (TKA) is one of the best methods for end stage osteoarthritis of knee joint that relieves pain and improves joint function. Most important problem which the patient suffers is postoperative pain, which has harmful effects on patient’s rehabilitation. The aim of our study was to assess the postoperative pain relief and functional outcome following use of combination of drugs which we used as intraoperative, periarticular cocktail injection.
MATERIALS AND METHODS: It is a prospective interventional study consisting of 40 TKA’s done in a single unit. All patients underwent TKA under spinal anaesthesia and underwent standard postoperative protocol. Intraoperative periarticular cocktail consisting of Bupivacaine 0.5% (20ml), Adrenaline 0.3 ml (1:1000), ketorolac 30mg/1ml, methylprednisolone 40mg//1ml, cefuroxime 750mg/10ml with 27.7 ml of normal saline to make total of 60ml solution was given. Assessment of pain was done by visual analogue scale (VAS) and functional assessment by knee society score postoperatively. The number of rescue analgesia used was recorded. 
RESULTS: Mean age of patients was 64 years (47-76) with females predominantly affected than males. Mean static VAS at 6 hours was 4.3 and dynamic VAS at 1st recording was 4.9. there was a strong correlation between Body Mass Index and Dynamic VAS at 1st and Dynamic VAS at 3rd   recording with p < 0.05. Patient satisfaction and functional scores improved postoperatively and there was a statistically significant improvement in knee ROM (P< 0.05). only 2 patients received more than 3 doses of rescue analgesia due to high BMI. No complications related to the infiltration of the local anaesthetic were observed.