Increased workload on our healthcare system calls for more automation, this too in the pre-operative planning of total knee arthroplasty (TKA) surgery. This should keep in mind however that success in TKA is measured through having proper limb alignment. This thesis project implemented a virtual positioning assessment software that provides an initial position based on its bone and implant inputs with their specific landmarks. Positions can be furtherly adapted and evaluated based on flexion facets, obtaining decreased pre-operative workloads. The software was validated through an analysis comparison of the femur positioning of nine cases with the former used analysis tool of the university Hospital of Ghent. The newly implemented software was concluded to approximate the patients’ pre-operative alignment better for all translational and rotational parameters, except anteroposterior translation and internal/external rotation of the femur.

No description available.

No description available.

Bakgrund: Under senare år har det satsats på att effektivisera den elektiva vården (Fast-track”). Vårdtiden efter en total knäprotesoperation (TKA) är i dag bara några enstaka dagar. Studier har visat att det finns en oro hos patienter att bli utskrivna för tidigt. Det finns också studier som visar att operationssjuksköterskan genom perioperativ omvårdnad kan lägga grunden för en effektiv rehabilitering hos patienten efter ett kirurgiskt ingrepp. Denna studie fokuserar på patienters upplevelse av en TKA-operation och hela vårdförloppet med utgångspunkt i den korta vårdtiden.Syfte: Syftet med studien var att beskriva patientens upplevelse av att genomgå en TKA operation och den korta vårdtiden.Metod:En intervjustudie genomfördes med tio patienter som genomgått en TKA-operation utifrån ett strategiskt urval. Patienternas smärta skattades enligt VAS skalan. Intervjuerna spelades in, skrevs ut ordagrant och analyserades med kvalitativ innehållsanalys.Resultat: Sex underkategorier som i sin tur skapade tre kategorier framkom; information, bemötande och symtomlindring. Samtliga patienter var väldigtnöjda med upplevelsen av hela vårdprocessen. Bemötandet och information från vårdpersonalen var en del av det som gjorde patienterna nöjda. VAS-skattning visade på hög smärta hos patienterna.Slutsats: Patienternas upplevelse av att genomgå en TKA-operation och den korta vårdtiden sågs som positiv.Trots det positiva resultatet förespråkas mer forskning utifrån ett större antal patienter för att få ett mer generaliserbart resultat av patienternas upplevelser av TKA och den korta vårdtiden. Operationssjuksköterskans delaktighet i den perioperativa vården kan med fördel tas upp i diskussion på rådande sjukhus. / Background:During the past years, there have been investments to make the elective healthcare more effective (Fast-track). The hospital stay after a knee replacement (TKA) is today just a few days. Studies indicate that there is a concern among patients to be discharged too early. There are also studies that shows that the theatre nurse through perioperative care can lay the foundation for an effective rehabilitation of the patient after surgery. This study focuses on the patients experience of a TKA surgery and throughout the care process based on the short hospital stay.Purpose:The purpose with this study was to describe the patient`s experience of undergoing a TKA surgery and the short hospitalization.Method:An interview study was made with ten patients who have undergone a TKA-operation from a strategic selection. The patient`s pain was evaluated with VAS scale.The interviews were recorded, transcribedverbatim and analysed using qualitative content analysis.Outcome:Six subcategories which in turn created three categories emerged; information, treatment and symptom relief. All the patients were very satisfied with the experience of the care process. The treatment and information given from the medical staff was part of what made the patient satisfied. VAS estimation showed that patients scored high pain. Conclusion:The patient ́s experience of undergoing a TKA surgery and the short hospitalization was seen as positive. Despite the positive result further research from a larger number of patients to get a more generalizable result of the patient ́s experiences from TKA and the short hospitalization is advocated. Theatre nurses ́ participation in theperioperative healthcare can advantageously be discussed at the current hospital.

Class of 2017 Abstract / Objectives: The first aim is to assess efficacy of aspirin versus enoxaparin in preventing a venous thromboembolism (VTE) after a total knee arthroplasty (TKA) or total hip arthroplasty (THA) within 30 days after discharge. The second aim is to assess the safety of aspirin versus enoxaparin in preventing major bleeding events after a TKA or THA within 30 days after discharge. Methods: This study was a retrospective cohort study with data obtained from an online Veterans Affairs (VA) hospital database. For analysis, the primary outcome was assessed with a Chi-Square test, and the secondary outcome was reported with descriptive statistics.Results: Results: Demographics for 374 patients (TKA, n = 275; THA, n = 99): 90% male, average age of 65, average body mass index (BMI) of 32, 26% smokers, 72% had a history of hypertension, and 60% had a history of dyslipidemia. VTE events 30 days post-operatively: enoxaparin (n = 2), enoxaparin/aspirin (n = 1), and aspirin (n = 2) (P-value = 0.78). Safety events (major bleeding events): enoxaparin (n = 42), enoxaparin/aspirin (n = 7), and aspirin (n = 4). Conclusions: There was no significant difference between the treatment groups for VTE rate 30 days post- operation. The enoxaparin treatment group had the greatest number of safety events compared to the other groups.

Class of 2013 Abstract / Specific Aims:  To determine the efficacy of apixaban when compared to LMWH (enoxaparin) when used as thromboprophylaxis for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and medically ill patients  To determine the safety of apixaban when compared to LMWH (enoxaparin) when used as thromboprophylaxis for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and medically ill patients Methods: A systematic search of the literature for randomized controlled trials of apixaban thromboprophylaxis therapy versus enoxaparin was conducted using three databases: PubMed, EMBASE, and the Cochrane library. Data from five studies with 12,938 total patients were analyzed using Bayesian random effects meta-analysis. To evaluate efficacy, a composite of venous thromboembolism and death during follow-up was measured. To evaluate safety, major and total bleeding events were considered. Main Results: The odds ratio (OR) for the composite outcome of thromboembolism/death was 0.66 (95% CI: 0.33 to 1.29) for apixaban compared to enoxaparin, while there was a similar risk of major bleeding (OR=1.03, 95%CI: 0.36 to 3.73) and total bleeding (OR=0.92, 95%CI: 0.64 to 1.20). Conclusion: These results suggest a lack of clear superiority of apixaban relative to enoxaparin. Apixaban is an oral alternative with similar efficacy and safety to existing anticoagulant therapies.

Gibt es Unterschiede der subjektiven Schmerzempfindung auf der NRS vom 1. bis 7. posto-perativen Tag nach Knie-TEP von Patienten, die einen kombinierten Femoralis- und Ischiadikuskatheter erhielten und Patienten die mit einer lokalen Infiltration plus lokalem Schmerzkatheter versorgt wurden? Zur Beantwortung dieser Frage wurden 140 Patienten in einer prospektiv, randomisierten, monozentrischen Vergleichsstudie in zwei Gruppen aufgeteilt. 72 Patienten erhielten eine Regionalanästhesie. Unter Sonografiekontrolle und lokaler inguinaler Betäubung erfolgten präoperativ die Infiltration von 20 ml Ropivacain 0,5% perineural um den N. femoralis und das Anlegen eines entsprechenden Schmerzkatheters (Sonolong Curl, Fa. Pajunk, Geisingen, Deutschland). Anschließend wurde um den N. ischiadicus ein Bolus von 20 ml Prilocain 1,5% appliziert, und ebenfalls ein Schmerzkatheter perineural belassen. Beide Katheter wurden mit jeweils 6ml/h Ropivacain 0,2% über ca. 72 h befahren. 67 Patienten wurden mit Methoden der Lokalanästhesie versorgt. Sie erhielten eine LIA mit 50 ml Ropivacain 2% intraoperativ und einen lokalen Schmerzkatheter (Fa. Pajunk, Geisingen, Deutschland), über welchen kontinuierlich 350 ml Ropivacain 2% mit 8 ml/h über 44 h intraartikulär verabreicht wurden. Untersucht wurden die Schmerzwerte der Patienten auf der NRS 2x tgl., der Opioidverbrauch, die Mobilisation, sowie die Rate an Komplikationen, in der ersten Woche postoperativ. Es wurden folgende wesentlichen Ergebnisse erhalten: 1. Die Patienten mit kombinierten NFK und PIK berichteten im Durchschnitt über eine ge-ringere Schmerzstufe am OP-Tag (p=0,014) und am Morgen des POD1 (p=0,013), danach waren beide Gruppen hinsichtlich der Schmerzangabe vergleichbar. 2. Es zeigte sich ein signifikant höherer Verbrauch an Morphinäquivalenten am POD1 (p=0,003) und POD2 (p=0,021) in der Gruppe L (LIA + lokalen Schmerzkatheter) 3. 15,3% der Patienten mit kombinierten NFK und PIK hatten motorische Defizite über den POD2 hinaus. In den 3-Monatskontrollen zeigten sich bei den be-troffenen Patienten keine motorischen Beeinträchtigungen. 4. 44,1% der Patienten mit kombinierten NFK und PIK benötigten zur OP zusätzlich eine Vollnarkose oder Spinalanästhesie. Die Arbeit liefert Hinweise auf die Überlegenheit des regionalen Schmerzkatheters gegenüber einem intraartikulären Schmerzkatheter hinsichtlich der postoperativen Schmerztherapie in den ersten 24 h. Dafür war die Rate an motorischen Defiziten über den 2. postoperativen Tag hinaus in der Gruppe der regionalen Schmerzkatheter deutlich höher, was die Mobilisation ungünstig beeinflusste. Letztendlich zeigt die Arbeit auch, dass beide Verfahren der postoperativen Schmerztherapie nach Knie-TEP, eine sichere und effiziente Analgesie bieten.:Inhaltsverzeichnis 1 Abbildungsverzeichnis III 2 Tabellenverzeichnis IV 3 Abkürzungsverzeichnis VI 4 Einleitung 1 4.1 Gonarthrose 1 4.2 Klinisches Management der Gonarthrose 4 4.2.1 Diagnostik und Therapie 4 4.2.2 Knieendoprothetik 5 4.2.3 Postoperative Schmerztherapie 8 4.3 Regionalanästhesie in der Knieendoprothetik 10 4.4 Lokalanästhesie in der Knieendoprothetik 13 4.5 Motivation zur Arbeit 14 5 Material und Methoden 16 5.1 Studiendesign 16 5.2 Fallzahlplanung 17 5.3 Patientenrekrutierung 17 5.4 Randomisierung 18 5.5 Operative Methodik 19 5.5.1 Knie-Totalendoprothese 19 5.5.2 Regionale Schmerzkatheter 20 5.5.3 Lokaler Schmerzkatheter 22 5.5.4 Anästhesie 24 5.6 Postoperatives Management 24 5.6.1 Postoperative Schmerztherapie 24 5.6.2 Dokumentation 26 5.7 Datenschutz und Datenerhebung 26 5.8 Statistische Datenauswertung 27 6 Ergebnisse 28 6.1 Aufteilung und Homogenität der Gruppen 28 6.2 Ergebnisse des Schmerztagebuchs 30 6.3 Funktionelle Ergebnisse der Mobilisation 35 6.4 Ergebnisse der postoperativen Schmerztherapie 38 6.4.1 Der Schmerzmittelverbrauch 38 6.4.2 Komplikationen 43 6.5 Weiterführende Betrachtungen 47 6.6 Score-Ergebnisse 51 7 Diskussion 53 7.1 Zusammenfassung der wesentlichen Ergebnisse 53 7.2 Vergleich der vorliegenden mit externen Ergebnissen 54 7.3 Limitierungen der eigenen Arbeit 63 7.4 Schlussfolgerungen 65 7.5 Ausblick 67 8 Zusammenfassung 68 9 Summary 70 Anlage 1 71 Anlage 2 72 10 Literaturverzeichnis 73 11 Anhang 80 12 Danksagung 90 / Is there any difference in pain sensation in the first week after Total Knee Arthroplasty (TKA) between patients who received a preoperative combined femoral and sciatic nerve block and those that got intraoperative local infiltration analgesia and a postoperative local catheter? To answer this question, a total of 140 patients were enrolled in a randomized, prospective and monocentric trial and were divided into two groups. 72 patients underwent methods of regional anaesthesia. 20 ml Ropivacain 0.5% was injected around the femoral nerve and 20 ml Prilocain 1.5 % was applied to the sciatic nerve under ultrasound guidance. Further-more, the patients received two catheters (Sonolong Curl, Fa.Pajunk, Geisingen, Germany), which were administered with 6 ml/h Ropivacain 0.2% for nearly 72h to get optimal analgesia quality. The second group, made up of 67 patients, was infiltrated with 50 ml Ropivacain 2% into the joint cavity and subcutaneous tissue and received a local catheter (Fuser Pump, Fa.Pajunk, Geisingen, Germany) that administered 350 ml Ropivacain 2%, 8 ml/h in 44 h in the joint. The patient’s pain scores were measured twice a day, using the NRS-pain scale. In addition, we examined opioid consumption, mobilisation and satisfaction of the patients. The mean results are summarized as follows: 1. Patients who received the combined femoral and sciatic catheter reported on aver-age a lower NRS-pain score of one point in the first 24h after operation (p=0,014). At ≥ 24h after surgery there was no significant difference between the groups. 2. Patients in the group with the infiltration + local catheter acquired significantly more morphine equivalents on the first (p=0,003) and second (p=0,021) day after surgery. 3. 15.3% of the patients got the combined femoral and sciatic catheter had motoric complications throughout the second day after operation. 4. 44.1% of the patients with a combined femoral and sciatic catheter needed additional general anaesthesia or spinal anaesthesia in the operation . This investigation shows aspects of a moderate superiority of the regional anaesthesia in contrast to the local catheter in the first 24 h of postoperative pain management after TKA. On the other the study revealed that regional anaesthesia had more complications which resulted in a prolonged mobilisation. In conclusion, it seems that both techniques provide an effective and secure analgesia after TKA.:Inhaltsverzeichnis 1 Abbildungsverzeichnis III 2 Tabellenverzeichnis IV 3 Abkürzungsverzeichnis VI 4 Einleitung 1 4.1 Gonarthrose 1 4.2 Klinisches Management der Gonarthrose 4 4.2.1 Diagnostik und Therapie 4 4.2.2 Knieendoprothetik 5 4.2.3 Postoperative Schmerztherapie 8 4.3 Regionalanästhesie in der Knieendoprothetik 10 4.4 Lokalanästhesie in der Knieendoprothetik 13 4.5 Motivation zur Arbeit 14 5 Material und Methoden 16 5.1 Studiendesign 16 5.2 Fallzahlplanung 17 5.3 Patientenrekrutierung 17 5.4 Randomisierung 18 5.5 Operative Methodik 19 5.5.1 Knie-Totalendoprothese 19 5.5.2 Regionale Schmerzkatheter 20 5.5.3 Lokaler Schmerzkatheter 22 5.5.4 Anästhesie 24 5.6 Postoperatives Management 24 5.6.1 Postoperative Schmerztherapie 24 5.6.2 Dokumentation 26 5.7 Datenschutz und Datenerhebung 26 5.8 Statistische Datenauswertung 27 6 Ergebnisse 28 6.1 Aufteilung und Homogenität der Gruppen 28 6.2 Ergebnisse des Schmerztagebuchs 30 6.3 Funktionelle Ergebnisse der Mobilisation 35 6.4 Ergebnisse der postoperativen Schmerztherapie 38 6.4.1 Der Schmerzmittelverbrauch 38 6.4.2 Komplikationen 43 6.5 Weiterführende Betrachtungen 47 6.6 Score-Ergebnisse 51 7 Diskussion 53 7.1 Zusammenfassung der wesentlichen Ergebnisse 53 7.2 Vergleich der vorliegenden mit externen Ergebnissen 54 7.3 Limitierungen der eigenen Arbeit 63 7.4 Schlussfolgerungen 65 7.5 Ausblick 67 8 Zusammenfassung 68 9 Summary 70 Anlage 1 71 Anlage 2 72 10 Literaturverzeichnis 73 11 Anhang 80 12 Danksagung 90

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No description available.

Knee osteoarthritis affects approximately 25 million adults. In severe cases, total knee arthroplasty (TKA) is the most common solution. TKA is effective at addressing pain and reducing continued degeneration of articular cartilage. However, effective physical therapy (PT) following TKA is vital for a full functional recovery. Despite the importance of PT, half of patients never achieve a full functional recovery. Decreases in proprioceptive feedback, severe atrophy, and pain inhibition all likely contribute to the variability in effectiveness. Surface electromyography-based biofeedback (sEMGBF) may allow clinicians to address some of these barriers by supplementing proprioceptive feedback and targeting small muscle contractions before eventually increasing the contraction requirement. Using a between group design, we compare the effectiveness of sEMGBF (7) to neuromuscular stimulation (NMES) (6), and a control group (6) in recovery following TKA. Effectiveness was evaluated across 4 metrics (quadriceps strength, range of motion, functional improvement, and quality of life) in a pre-test/post-test fashion. At the statistical level this study suggest that sEMGBF leads to greater improvements in quadriceps strength relative to the NMES and control group. Additionally, visual analysis suggests that sEMGBF may also lead to greater improvements in range of motion, and functional improvement relative to the NMES and control group. The results for quality of life are mixed. Overall, the study provides initial clinical support for the utility of sEMGBF following TKA.