Search

Background: Wound closure in total knee arthroplasty (TKA) is an essential part of the procedure that affects the outcome of the surgery. Traditionally, closure of capsular and subcutaneous layer is performed using absorbable sutures placed in an interrupted manner. Skin closure usually used non-absorbable sutures placed in an interrupted fashion. A bidirectional, barbed suture that is self-anchoring and that does not require to tie knots during closure have recently begun to gain more popularity. Objective: To evaluate the efficacy of barbed suture for closure of wound in TKA as compared with traditional suture. The main outcome measures were wound-related complications, wound closure time, Knee Society Score (KSS), and cost. Materials and Methods: The authors recruited 60 patients planned to undergo TKA. Patients were randomly divided in two groups, group 1 (conventional group; 30 patients) and group 2 (barbed group; 30 patients). In the conventional group, the capsular closure and subcutaneous closure were performed in an interrupted fashion using size 1 and size 2-0 vicryl. Skin closure was performed in running subcuticular suture using size 4-0 vicryl. In the barbed group, the capsular closure, subcutaneous closure, and skin closure were performed in running manner using size 2, size 0, and size 2-0 barbed suture. Patient demographics, preoperative KSS, and operative data were record. All patients were seen for follow-up at two and six weeks and three months postoperatively. Results: Wound-related complications were similar in both groups. Significant shorter wound closure time in barbed group (12.35 minutes versus 24.45 minutes, p<0.001). Both groups demonstrated improvement in KSS after surgery, but no significant difference was found between the two groups. The average cost of barbed sutures was found to be 2,420 baht more than the conventional sutures per arthroplasty (3,300 baht versus 880 baht, p<0.001). Conclusion: Use of barbed suture for closure of surgical wounds in TKA leads to satisfied outcomes without adverse effect to wound security and healing process. Wound-related complications were comparable to conventional sutures. Use of barbed suture was associated with shorten wound closure time. The average cost of barbed sutures was found to be more expensive than the conventional sutures. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis is a common cause of severe pain and functional limitation. Total knee arthroplasty is an effective procedure to relieve pain, restore knee function, and improve quality of life for patients with end stage knee arthritis. The aim of this study was to investigate the inflammatory process in patients with primary knee osteoarthritis before surgery and in subsequent periods following total knee arthroplasty. A prospective study of 49 patients undergoing primary total knee replacements was conducted. The patients were evaluated by monitoring serum interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), knee skin temperature, and clinical status. Measurements were carried out preoperatively and postoperatively on day one and at two, six, 14, and 26 weeks during follow-up review in the knee clinic. The serum IL-6 and CRP were elevated on the first postoperative day but fell to preoperative values at two weeks postoperatively. Both returned to within the normal range by six weeks postoperatively. In addition, the postoperative ESR showed a slow rise with a peak two weeks after surgery and returned to the preoperative level at 26 weeks postoperatively. The difference in skin temperature between operated and contralateral knees had a mean value of +4.5°C at two weeks. The mean value decreased to +3.5°C at six weeks, +2.5°C at 14 weeks, and +1.0°C at 26 weeks. The difference in skin temperature decreased gradually and eventually there was no statistically significant difference at 26 weeks after surgery. A sustained elevation in serum IL-6, CRP, ESR, and skin temperature must raise the concern of early complication and may suggest the development of postoperative complication such as haematoma and/or infection.

The objective of this study was to investigate bone morphogenetic protein-7 (BMP-7) levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to determine their relationship to disease severity. Thirty-two patients with knee OA and 15 healthy subjects were enrolled in the study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. BMP-7 levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay. The mean plasma BMP-7 concentration of the knee OA patients was significantly higher compared with that of healthy controls (12.1 +/- 1.6 vs 3.5 +/- 0.9 pg/ml, P = 0.001). Although BMP-7 levels in plasma were higher with respect to paired synovial fluid samples, the difference was not statistically significant (12.1 +/- 1.6 vs 10.5 +/- 2.2 pg/ml, P = 0.3). Subsequent analysis showed that plasma BMP-7 levels significantly correlated with disease severity (r = 0.77, P < 0.001). Furthermore, the synovial fluid levels of BMP-7 also correlated with disease severity (r = 0.60, P < 0.001). In addition, plasma BMP-7 levels showed a positive correlation with synovial fluid BMP-7 levels (r = 0.71, P < 0.001). Overexpression of BMP-7 in plasma and synovial fluid is related to progressive joint damage in knee OA. These findings suggest that BMP-7 might serve as a biochemical parameter for determining disease severity in primary knee OA and could play a potential role in cartilage protection and repair of OA.

Objectives: The purposes of this study were to examine osteopontin levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease., Design and Methods: Thirty-two patients aged 53-83 years with knee OA and 15 healthy controls were enrolled in this study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren-Lawrence criteria. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay., Results: The mean plasma osteopontin concentration of the knee OA patients was significantly higher compared with that of healthy controls (168.8+/-15.6 vs 67.2+/-7.7 ng/mL, P<0.0001). Osteopontin levels in synovial fluid were significantly higher with respect to paired plasma samples (272.1+/-15.0 vs 168.8+/-15.6 ng/mL, P<0.001). In addition, plasma osteopontin levels showed a positive correlation with synovial fluid osteopontin levels (r=0.373, P=0.035). Subsequent analysis showed that plasma osteopontin levels significantly correlated with severity of disease (r=0.592, P<0.001). Furthermore, the synovial fluid levels of osteopontin also correlated with disease severity (r=0.451, P=0.01)., Conclusion: The data suggest that osteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity and could be predictive of prognosis with respect to the progression of knee OA.

We compared the distance of patellar subluxation (lateral patellar displacement) during MIS TKA arthrotomy among sequential variations of tourniquet application and soft tissue release in a consecutive series of 40 knees. The distance of patellar subluxation from the Whiteside's line was measured for every knee under four consecutive conditions; A) the tourniquet inflated with knee in full extension, B) no tourniquet pressure applied, C) the tourniquet inflated with knee in deep flexion, and D) the tourniquet inflated with knee in deep flexion and lateral tibial release (a limited subperiosteal soft tissue dissection including limited patellar fat pad excision and limited capsular release from the upper lateral tibial plateau). There were 28 women and 12 men with the average age of 70 years and the average BMI of 25.5. All knees had preoperative flexion more than 110 degrees . The tourniquet pressure ranged from 280 to 300 mm Hg. The average skin incision length was 9 cm. The average measured distance of condition A, B, C and D were 10, 14.5, 15.8 and 22 mm, respectively with significant difference (p<0.001). The distance of patellar subluxation correlated between conditions A) and C) (r(2), 0.67) and between conditions C) and D) (r(2), 0.72) in the studied group. However, there was no statistical difference of measured distance between group with condition B and C (p=0.40). In conclusion, when MIS TKA is performed using the tourniquet, inflating the tourniquet with knee in deep flexion provided better arthrotomy exposure than the knee in full extension. Combined inflating tourniquet in deep knee flexion and lateral tibial release provided the greatest arthrotomy visualization.