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- Ali, Abdulemir, et al.
(författare)
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Dissatisfied patients after total knee arthroplasty
- 2014
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 85:3, s. 229-233
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2-7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients. Patients and methods - 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009-2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0-100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD). Results - Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography. Interpretation - The patients who reported poor response after TKA continued to be unhappy after 8-13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.
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| 2. |
- Ali, Abdulemir, et al.
(författare)
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Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty.
- 2015
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:3, s. 373-377
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Local infiltration analgesia (LIA) is well established for effective postoperative pain relief in total knee arthroplasty (TKA). To prolong the effect of LIA, infusion pumps with local intraarticular analgesia can be used. We evaluated the effect of such an infusion pump for the first 48 h postoperatively regarding pain, knee function, length of stay (LOS) in hospital, and complications. Patients and methods - 200 patients received peroperative LIA and a continuous intraarticular elastomeric infusion pump set at 2 mL/h. The patients were randomized either to ropivacaine (7.5 mg/mL) or to NaCl (9 mg/mL) in the pump. Visual analog scale (VAS) pain (0-100 mm), analgesic consumption, side effects of medicine, range of motion (ROM), leg-raising ability, LOS, and complications during the first 3 months were recorded. Results - On the first postoperative day, the ropivacaine group had lower VAS pain (33 vs. 40 at 12 noon and 36 vs. 43 at 8 p.m.; p = 0.02 and 0.03, respectively), but after that all recorded variables were similar between the groups. During the first 3 months, the ropivacaine group had a greater number of superficial and deep surgical wound infections (11 patients vs. 2 patients, p = 0.02). There were no other statistically significant differences between the groups. Interpretation - Continuous intraarticular analgesia (CIAA) with ropivacaine after TKA has no relevant clinical effect on VAS pain and does not affect LOS, analgesic consumption, ROM, or leg-raising ability. There may, however, be a higher risk of wound-healing complications including deep infections.
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| 3. |
- ALI, ABDULEMIR MUHAMMED NURI
(författare)
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Pain, Function, and Dissatisfaction after Total knee Arthroplasty
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoarthritis (OA) is a progressive degenerative joint disorder, and the prevalence increases with age. In Sweden, about one in 4 people over the age of 45 years has OA in at least one joint. As the population ages and the prevalence of obesity increases, OA is expected to increase even more. The knee joint is one of the most commonly affected joints. Total knee arthroplasty (TKA) is the most common method of major surgical intervention for OA of the knee in Sweden. About 13,000 knee arthroplasty procedures were performed in Sweden in 2015. During the past 4 decades, there have been continuous improvements in prosthesis design, preoperative templating, and surgical technique including navigation, pain management, and infection prophylaxis, but still a relatively large proportion of patients (up to 20%) are not satisfied with the outcome after surgery.All knee arthroplasty procedures in Sweden are reported to the Swedish Knee Arthroplasty Register (SKAR), which started in 1975. The purpose of the SKAR is to monitor early and long-term surgical outcomes and complications, especially revision procedures.Through the SKAR, we identified 114 non revised dissatisfied patients in Skåne County, Sweden, and a matched control group of 113 patients who were very satisfied after TKA. The patients had an average of 10.5 years of follow-up and were matched by age, sex, hospital, and date of surgery. There were similar clinical findings, performance tests, and radiographic findings in both groups. In the dissatisfied group, the proportion of patients with anxiety and/or depression was higher, mean VAS pain score was higher, and mean range of motion (ROM) was less.Local infiltration analgesia is used for early postoperative pain relieve in TKA. To prolong the postoperative analgesic effect, continuous intraarticular analgesia for 48 hours has been used. In a prospective double-blind randomized study, 200 TKA patients were given either ropivacaine or NaCl intraarticularly by pump. There were no significant differences regarding postoperative VAS pain, length of hospital stay, analgesic consumption, or ROM between the groups. There were, however, significantly more superficial and deep surgical wound infections in the ropivacaine group.Patella-related problems are an important reason for pain after TKA. In Sweden, patellar resurfacing in primary TKA has decreased since the 1980s, from more than 70% to about 2,5% today. In a prospective randomized study of 74 patients undergoing TKA, we randomized to either patellar resurfacing or no resurfacing. We found no significant differences between the groups regarding VAS pain, physical performance, patient satisfaction, or KOOS 5 subscale scores. None of the patients were reoperated within 6 years. In a prospective cohort study of 186 TKA patients with 4 years of follow-up, preoperative anxiety/depression was a strong indicator of postoperative dissatisfaction. The risk increment for dissatisfaction was more than 6 fold, twice that in patients who had to undergo further surgical procedures because of deep infection postoperatively.Anxiety/depression is an important reason for dissatisfaction after TKA. Continuous intraarticular analgesia is unnecessary in TKA, and patellar resurfacing does not appear to be beneficial in patients with primary OA.
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| 4. |
- Ali, Abdulemir, et al.
(författare)
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Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty : A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up
- 2017
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Ingår i: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 32:3, s. 767-770
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: After more than 4 decades experience of total knee arthroplasty (TKA), there is still a group of patients who are not satisfied with the outcome. In spite of the improvement of many aspects around the procedure, for unexplainable reasons, patient dissatisfaction is still approximately the same. We conducted this study to analyze correlations between preoperative psychological aspects and dissatisfaction after TKA.METHODS: A total of 186 patients were operated with a primary TKA. Patients filled out the Hospital Anxiety and Depression Scale, Visual Analog Pain Scale (0-100), and Knee injury and Osteoarthritis Outcome Score preoperatively and 4 years postoperatively. Four years postoperatively, the patients also scored their satisfaction degree with the outcome of the surgery.RESULTS: Of 186 patients, 27 (15%) reported that they were dissatisfied or uncertain with the result of their TKA 4 years postoperatively. Sixteen of those 27 patients had reported anxiety/depression preoperatively compared with 11 of 159 (7%) in the satisfied or very satisfied groups. Patients with preoperative anxiety or depression had more than 6 times higher risk to be dissatisfied compared with patients with no anxiety or depression (P < .001). Patients with deep prosthetic infection had 3 times higher risk to be dissatisfied with the operation outcome (P = .03). Dissatisfied patients had 1-day longer hospital stay compared with the satisfied group (P < .001).CONCLUSION: Preoperative anxiety and/or depression is an import predictor for dissatisfaction after TKA. Psychological assessment and treatment preoperatively might improve degree of satisfaction.
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| 5. |
- Ali, Abdulemir, et al.
(författare)
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Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing : A randomized study of 74 patients with 6 years of follow-up
- 2016
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Ingår i: Acta Orthopaedica. - : Informa UK Limited. - 1745-3674 .- 1745-3682. ; 87:3, s. 274-279
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Knee pain after total knee arthroplasty (TKA) is not uncommon. Patellar retention in TKA is one cause of postoperative knee pain, and may lead to secondary addition of a patellar component. Patellar resurfacing in TKA is controversial. Its use ranges from 2% to 90% worldwide. In this randomized study, we compared the outcome after patellar resurfacing and after no resurfacing. Patients and methods — We performed a prospective, randomized study of 74 patients with primary osteoarthritis who underwent a Triathlon CR TKA. The patients were randomized to either patellar resurfacing or no resurfacing. They filled out the VAS pain score and KOOS questionnaires preoperatively, and VAS pain, KOOS, and patient satisfaction 3, 12, and 72 months postoperatively. Physical performance tests were performed preoperatively and 3 months postoperatively. Results — We found similar scores for VAS pain, patient satisfaction, and KOOS 5 subscales at 3, 12, and 72 months postoperatively in the 2 groups. Physical performance tests 3 months postoperatively were also similar in the 2 groups. No secondary resurfacing was performed in the group with no resurfacing during the first 72 months Interpretation — Patellar resurfacing in primary Triathlon CR TKA is of no advantage regarding pain, physical performance, KOOS 5 subscales, or patient satisfaction compared to no resurfacing. None of the patients were reoperated with secondary addition of a patellar component within 6 years. According to these results, routine patellar resurfacing in primary Triathlon TKA appears to be unnecessary.
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