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ABSTRACT: A double-blind, placebo-controlled study of a selective cyclooxygenase (COX)-2 inhibitor administered in 107 patients for 6 weeks after total knee arthroplasty was done to determine any benefits. All patients received celecoxib preoperatively and during hospitalization. At hospital discharge, patients were randomized to receive celecoxib or placebo for 6 weeks. Narcotic use, knee flexion, Knee Society Score, Oxford Knee Score, and Short-Form 12 scores were determined preoperatively and at postoperative intervals to 1 year. Visual analog scale scores documented pain at rest, at night, and with activities. The celecoxib group used fewer narcotics and had significantly better visual analog scale scores, knee flexion, Knee Society Score scores, Oxford Knee Score scores, and Short-Form 12 physical composite scores than the placebo group. Knee flexion remained significantly improved through 1 year. These results demonstrate that patients who took celecoxib for 6 weeks after total knee arthroplasty had a less painful and more rapid recovery.
The Journal of arthroplasty 06/2011; 26(6 Suppl):2-7. · 1.79 Impact Factor
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ABSTRACT: Fifty patients underwent isokinetic muscle strength testing before surgery and at 6 weeks, 3 months, 6 months, and 1 year after unilateral total knee arthroplasty using the minisubvastus surgical technique. Quadriceps muscle strength returned to preoperative levels by 3 months postoperatively and was 17% stronger at 6 months and 30% stronger at 1 year than preoperative levels (P < .05). At 1 year, the quadriceps strength of the involved knee was equivalent to that of the uninvolved knee (P = .81). When the entire study population was subdivided by age, weight, sex, and the presence of arthritis in the uninvolved knee, each subgroup still had equivalent quadriceps strength between the involved and uninvolved knees. This prospective study demonstrated that the minisubvastus total knee arthroplasty technique led to a more rapid and more complete recovery of muscle strength than has been previously demonstrated after total knee arthroplasty with a medial parapatellar arthrotomy.
The Journal of arthroplasty 01/2009; 25(2):274-9. · 1.79 Impact Factor
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ABSTRACT: The effect of increased total knee arthroplasty (TKA) surgical volume on the incidence of knee complications within a single surgeon's practice was determined. Data were collected prospectively on 600 primary TKAs. Major complications required knee reoperation. Minor complications were wound concerns requiring increased surveillance or oral antibiotics. Twelve major (2.0%) and 40 minor (6.7%) complications occurred at minimum 2-year follow-up. Surgical volume increased from 57 to 150 procedures per 6 months through the course of the study. Multivariate analysis determined that increased surgical volume was associated with lower rates of both major and minor complications, adjusted odds ratio 0.62 (95% confidence interval [CI], 0.40-0.96) and 0.56 (95% CI, 0.43-0.73), respectively. For each additional 50 procedures performed within a 6-month interval, major complications were reduced by 38% (P = .03), and minor complications were reduced by 44% (P < .0001). All complications were significantly decreased when the surgeon was performing 112 +/- 44 TKAs compared with 85 +/- 49 TKAs per 6-month interval.
The Journal of arthroplasty 10/2008; 23(6 Suppl 1):61-7. · 1.79 Impact Factor
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ABSTRACT: A total of 50 total knee arthroplasty (TKA) patients, 25 traditional and 25 minimally invasive surgical (MIS), underwent computed tomography scans to determine if a loss of accuracy in implant alignment occurred when a surgeon switched from a traditional medial parapatellar arthrotomy to a mini-subvastus surgical technique. Surgical accuracy was determined by comparing the computed tomography measured implant alignment with the surgical alignment goals. There was no loss in accuracy in the implantation of the tibial component with the mini-subvastus technique. The mean variance for the tibial coronal alignment was 1.03 degrees for the traditional TKA and 1.00 degrees for the MIS TKA (P = .183). Similarly, there was no difference in the mean variance for the posterior tibial slope (P = .054). Femoral coronal alignment was less accurate with the MIS procedure, mean variance of 1.04 degrees and 1.71 degrees for the traditional and MIS TKA, respectively (P = .045). Instrumentation and surgical technique concerns that led to this loss in accuracy were determined.
The Journal of Arthroplasty 07/2008; 23(4):543-9. · 2.38 Impact Factor
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ABSTRACT: This study reviewed 747 consecutive posterior stabilized total knee arthroplasty (TKA) to explain the increased incidence of patella clunk syndrome that occurred when the surgeon switched from a medial parapatellar arthrotomy to a mini-subvastus (MIS) TKA technique. The incidence of patella clunk syndrome increased with increased postoperative knee flexion. Six weeks after surgery, knees that developed patella clunk had a mean flexion of 124 degrees vs 117 degrees for knees that did not develop this syndrome (P = .016). As the MIS approach resulted in increased knee flexion, this approach was indirectly associated with the increased incidence of patella clunk. Knee flexion at 6 weeks postoperatively was 117 degrees for the MIS knees vs 108 degrees for traditional medial parapatellar arthrotomy knees (P < .001). The effect of increased knee flexion achieved with the MIS approach, which resulted in an increase in patella clunk, was mitigated by using a new posterior stabilized femoral component designed to minimize soft tissue entrapment.
The Journal of arthroplasty 03/2008; 24(2):281-7. · 1.79 Impact Factor
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ABSTRACT: The mini-subvastus surgical technique avoids both quadriceps arthrotomy and patella eversion. Since March 2003, this quad-sparing minimally invasive surgical (MIS) technique has been applied to more than 98% of our primary total knee arthroplasty (TKA) patients. This study compares our first 150 MIS TKA patients to our previous 150 traditional TKA patients. Quadriceps recovery was rapid in the MIS group with 83% able to do a straight leg raise the day after surgery. Hospital length of stay was decreased in the MIS group, 3.4 days, vs the traditional group, 4.1 days (P = .00013). Fewer MIS patients required skilled nursing or rehabilitation center admission. Increased knee flexion was seen for the MIS patients throughout the first 2 years of follow-up. Mean knee flexion at 1 year was 127 degrees for the MIS patients vs 114 degrees in the traditional TKA patients (P < .0001). Comparison between the MIS and traditional techniques demonstrated no increase in the number or severity of complications and no difference in operating room time.
The Journal of Arthroplasty 01/2008; 23(1):19-25. · 2.38 Impact Factor
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The Journal of Bone and Joint Surgery 11/2007; 89 Suppl 3:76-81. · 3.27 Impact Factor
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ABSTRACT: Recent total knee arthroplasty (TKA) studies suggest a more rapid functional recovery with minimally invasive surgical (MIS) techniques. These studies often fail to disclose the percentage of primary TKA that underwent the MIS technique, raising the concern that positive clinical outcomes are a result of patient selection. This study evaluates the applicability of the mini-subvastus technique in one surgeon's consecutive primary TKA patients. The applicability was determined utilizing a computer record review to determine the percentage of primary TKA patients in which the surgeon utilized a MIS surgical technique. The mini-subvastus approach was applied to 99% of 732 consecutive primary TKA. There was no patient selection based on age or weight. Traditional TKA, utilizing a medial parapatellar arthrotomy, was more likely to be performed on patients with a diagnosis of traumatic arthritis and in knees that required stems or augments. Preoperative tibiofemoral angle and mean knee deformity were not predictors of which procedure would be utilized. Despite employing this new surgical approach in nearly all primary TKAs, there was no increase in the complication rate. This high applicability rate with the mini-subvastus technique obviates concerns that the positive clinical outcomes in these patients are a result of patient selection.
Journal of surgical orthopaedic advances 02/2007; 16(3):131-7.
