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Utilization of a pneumatic exoskeleton after total knee arthroplasty.

ABSTRACT: Exoskeletons are wearable, powered devices intended to support and augment limb function. With the aging population and increasing demand for total knee arthroplasty, exoskeletons could prove a valuable tool for regaining function and minimizing the number of patients discharged to skilled nursing facilities. However, the safety of these devices in postoperative populations remains unexplored. A lightweight pneumatic device was piloted on three patients after primary total knee arthroplasty. The patients were asked to perform simple locomotive tasks followed by a questionnaire to assess their experience and safety using the exoskeleton. All patients indicated the exoskeleton did not interfere with their wound and made them feel stable on their feet, and two of the three patients stated it was manageable and safe to operate. This report pilots the general safety of a pneumatic exoskeleton, laying the groundwork for larger and more comprehensive studies.

SUBMITTER: Ezzibdeh R

PROVIDER: S-EPMC6728434 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Utilization of a pneumatic exoskeleton after total knee arthroplasty.

Ezzibdeh Rami R Arora Prerna P Amanatullah Derek F DF

Arthroplasty today 20190405 3

Exoskeletons are wearable, powered devices intended to support and augment limb function. With the aging population and increasing demand for total knee arthroplasty, exoskeletons could prove a valuable tool for regaining function and minimizing the number of patients discharged to skilled nursing facilities. However, the safety of these devices in postoperative populations remains unexplored. A lightweight pneumatic device was piloted on three patients after primary total knee arthroplasty. The ...[more]

PMID: 31516973

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Expression data from total knee arthroplasty patients

Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.

2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress

Expression data from total knee arthroplasty patients

2010-04-02 | GSE21164 | GEO

Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010.

Project description:Total knee arthroplasty (TKA) is one of the most common and costly surgical procedures performed in the United States.To examine longitudinal trends in volume, utilization, and outcomes for primary and revision TKA between 1991 and 2010 in the US Medicare population.Observational cohort of 3,271,851 patients (aged ?65 years) who underwent primary TKA and 318 563 who underwent revision TKA identified in Medicare Part A data files.We examined changes in primary and revision TKA volume, per capita utilization, hospital length of stay (LOS), readmission rates, and adverse outcomes.Between 1991 and 2010 annual primary TKA volume increased 161.5% from 93,230 to 243,802 while per capita utilization increased 99.2% (from 31.2 procedures per 10,000 Medicare enrollees in 1991 to 62.1 procedures per 10,000 in 2010). Revision TKA volume increased 105.9% from 9650 to 19,871 while per capita utilization increased 59.4% (from 3.2 procedures per 10,000 Medicare enrollees in 1991 to 5.1 procedures per 10,000 in 2010). For primary TKA, LOS decreased from 7.9 days (95% CI, 7.8-7.9) in 1991-1994 to 3.5 days (95% CI, 3.5-3.5) in 2007-2010 (P < .001). For primary TKA, rates of adverse outcomes resulting in readmission remained stable between 1991-2010, but rates of all-cause 30-day readmission increased from 4.2% (95% CI, 4.1%-4.2%) to 5.0% (95% CI, 4.9%-5.0%) (P < .001). For revision TKA, the decrease in hospital LOS was accompanied by an increase in all-cause 30-day readmission from 6.1% (95% CI, 5.9%-6.4%) to 8.9% (95% CI, 8.7%-9.2%) (P < .001) and an increase in readmission for wound infection from 1.4% (95% CI, 1.3%-1.5%) to 3.0% (95% CI, 2.9%-3.1%) (P < .001).Increases in TKA volume have been driven by both increases in the number of Medicare enrollees and in per capita utilization. We also observed decreases in hospital LOS that were accompanied by increases in hospital readmission rates.

| S-EPMC4169369 | biostudies-literature

Muscle transcriptome analysis following Total Knee Arthroplasty with Tourniquet

Project description:Transcriptome profiling was performed on muscle biopsies from patients immediately before Total Knee Arthroplasty and two hours after TKA and tourniquet application.

2016-02-01 | GSE75432 | GEO

Robotic Total Knee Arthroplasty vs Conventional Total Knee Arthroplasty: A Nationwide Database Study.

Project description:BackgroundAs robot-assisted equipment is continuously being used in orthopaedic surgery, the past few decades have seen an increase in the usage of robotics for total knee arthroplasty (TKA). Thus, the purpose of the present study is to investigate the differences between robotic TKA and nonrobotic TKA on perioperative and postoperative complications and opioid consumption.MethodsAn administrative database was queried from 2010 to Q2 of 2017 for primary TKAs performed via robot-assisted surgery vs non-robot-assisted surgery. Systemic and joint complications and average morphine milligram equivalents were collected and compared with statistical analysis.ResultsPatients in the nonrobotic TKA cohort had higher levels of prosthetic revision at 1-year after discharge (P < .05) and higher levels of manipulation under anesthesia at 90 days and 1-year after discharge (P < .05). Furthermore, those in the nonrobotic TKA cohort had increased occurrences of deep vein thrombosis, altered mental status, pulmonary embolism, anemia, acute renal failure, cerebrovascular event, pneumonia, respiratory failure, and urinary tract infection during the inpatient hospital stay (all P < .05) and at 90 days after discharge (all P < .05). All of these categories remained statistically increased at the 90-days postdischarge date, except pneumonia and stroke. Patients in the nonrobotic TKA cohort had higher levels of average morphine milligram equivalents consumption at all time periods measured (P < .001).ConclusionsIn the present study, the use of robotics for TKA found lower revision rates, lower incidences of manipulation under anesthesia, decreased occurrence of systemic complications, and lower opiate consumption for postoperative pain management. Future studies should look to further examine the long-term outcomes for patients undergoing robot-assisted TKA.Level of evidenceLevel III.

| S-EPMC7772451 | biostudies-literature

Adolescent total knee arthroplasty.

Project description:BackgroundManagement of adolescent patients with end-stage arthritis is challenging. Nonoperative treatments may be ineffective and total knee arthroplasty (TKA) is rarely performed. Currently, minimal long-term data are available on the outcomes in this patient population. Our goal was to describe TKA for patients with end-stage arthritis who were aged 20 years and younger.MethodsThe Joint Registry at our institution was used to identify 19 patients (29 TKAs) aged 20 years and younger that underwent a primary TKA. The average age was 18 years (range 14-20 years) and follow-up was 14.5 years (range: 2.1-25.5 years).ResultsThe preoperative diagnoses were juvenile idiopathic arthritis (n = 19), avascular necrosis (n = 4), sepsis (n = 2), trauma (n = 2), dysplasia (n = 1), and hemophilia (n = 1). There was a decrease in the number of TKAs performed for inflammatory arthritis over the last several decades. Implant survivorship at 5 and 10 years was 96% and 94%, respectively.ConclusionsWe identified a 95% 10-year implant survivorship utilizing standard TKA components in pediatric patients. Performing a TKA in adolescent patients has long-term potential risks including infection and bone loss but may provide pain relief and good long-term results and should be used with caution.

| S-EPMC5484984 | biostudies-literature

Racial and ethnic disparities in utilization of total knee arthroplasty among older women.

Project description:ObjectiveTo evaluate racial and ethnic disparities in utilization of total knee arthroplasty (TKA) in relation to demographic, health, and socioeconomic status variables.DesignProspective study of 102,767 Women's Health Initiative postmenopausal women initially aged 50-79, examining utilization rates of primary TKA between non-Hispanic Black/African American, non-Hispanic White, and Hispanic/Latina women (hereafter referred to as Black, White, and Hispanic). A total of 8,942 Black, 3,405 Hispanic, and 90,420 White women with linked Medicare claims data were followed until time of TKA, death, or transition from fee-for-service coverage. Absolute disparities were determined using utilization rates by racial/ethnic group and relative disparities quantified using multivariable hazards models in adjusting for age, arthritis, joint pain, mobility disability, body mass index, number of comorbidities, income, education, neighborhood socioeconomic status (SES), and geographic region.ResultsTKA utilization was higher among White women (10.7/1,000 person-years) compared to Black (8.5/1,000 person-years) and Hispanic women (7.6/1,000 person-years). Among women with health indicators for TKA including diagnosis of arthritis, moderate to severe joint pain, and mobility disability, Black and Hispanic women were significantly less likely to undergo TKA after adjusting for age [Black: HR (95% confidence interval) = 0.70 (0.63-0.79); Hispanic: HR = 0.58 (0.44-0.77)]. Adjustment for SES modestly attenuated the measured disparity, but significant differences remained [Black: HR = 0.75 (0.67-0.89); Hispanic: HR = 0.65 (0.47-0.89)].ConclusionsCompared to White women, Black and Hispanic women were significantly less likely to undergo TKA after considering need and appropriateness for TKA and SES. Further investigation into personal-level and provider-level factors that may explain these disparities is warranted.

| S-EPMC6875623 | biostudies-literature

Regional Differences in Primary Total Knee Arthroplasty Utilization, Physician Reimbursement, and Patient Characteristics.

Project description:BackgroundThe primary purpose of this study was to evaluate how utilization, physician reimbursement, and patient populations have changed for primary total knee arthroplasty (TKA) from 2013 to 2021 at both a regional and national level within the Medicare population.MethodsThe Medicare Physician and Other Practitioners database was queried for all episodes of primary TKA between years 2013 and 2021. TKA utilization per 10,000 beneficiaries, inflation-adjusted physician reimbursement per TKA, and patient demographics of each TKA surgeon were extracted each year. Data were stratified geographically, and Kruskal-Wallis tests were utilized.ResultsBetween 2013 and 2021, TKA utilization per 10,000 beneficiaries increased at the greatest rate in the Northeast (+15.1%). In 2021, TKA utilization was highest in the Midwest (97.6/10,000; P < .001). The Midwest had the greatest decline in average physician reimbursement per TKA between 2013 and 2021 (-26.3%) and the lowest average reimbursement ($988.70, P < .001) in 2021. Alternatively, the Northeast had the smallest decline in average TKA reimbursement (-22.6%). Nationally, the average number of beneficiaries per TKA surgeon declined (-6.8%), while the average number of TKAs per surgeon (+5.7%) and average services per beneficiary (+24.3%) both increased. The average number of patient comorbidities and proportion of patients with dual Medicare-Medicaid eligibility decreased over time across all regions.ConclusionsThis study demonstrates that TKA utilization is increasing and average physician reimbursement per TKA is declining at varying rates across the country, with the Northeast and Midwest most affected. These findings should be addressed in policy discussions to ensure equitable arthroplasty care.

| S-EPMC11295465 | biostudies-literature

Continuing versus discontinuing antiplatelet drugs, vasodilators, and/or cerebral ameliorators on perioperative total blood loss in total knee arthroplasty without pneumatic tourniquet.

Project description:BackgroundAlthough studies have supported the utility of perioperative continuation of antiplatelet drugs, vasodilators, and cerebral ameliorators in most procedures, no study compared total volume of blood loss after total knee arthroplasty (TKA) in patients continuing and discontinuing these drugs.MethodsWe retrospectively reviewed 266 consecutive patients undergoing TKA, and included 67 patients (25.2%) taking antiplatelet drugs, vasodilators, or cerebral ameliorators in this study. All TKAs were performed without a pneumatic tourniquet. The primary outcome was perioperative total blood loss calculated from blood volume and change in hemoglobin. As subgroup analysis, we compared perioperative total blood loss in patients taking antiplatelet drugs.ResultsThere was no significant difference between the continuing group (n = 38) and discontinuing group (n = 29) in terms of the perioperative total blood loss (1025 ± 364 vs 1151 ± 327 mL, respectively; mean difference 126 mL; 95% confidence interval -45 to 298 mL; P = .15). No major bleeding or thrombotic events occurred in either group until postoperative 3-month follow-up. In patients taking antiplatelet drugs (n = 51), no significant difference was observed in the total blood loss between the continuing group (n = 30) and discontinuing group (n = 21) (1056 ± 287 vs 1151 ± 305 mL, respectively; mean difference 95 mL; 95% confidence interval -75 to 264 mL; P = .27).ConclusionsNo significant differences in terms of perioperative total blood loss were observed between patients continuing and discontinuing study drugs. Continuing these drugs may be preferable in the perioperative period of TKA.

| S-EPMC5859674 | biostudies-literature

Robotic-assisted Total Knee Arthroplasty Reduces Radiographic Outliers for Low-volume Total Knee Arthroplasty Surgeons.

Project description:BackgroundMost studies evaluating robotic-assisted total knee arthroplasty (RA TKA) analyzed the advantages offered to high-volume surgeons. This study aims to determine if RA TKA improves radiographic or clinical outcomes for low-volume, non-arthroplasty-trained surgeons.MethodsRadiographic and early clinical outcomes of 19 RA TKAs and 41 conventional TKAs, all performed by a single, non-arthroplasty-trained orthopaedic surgeon, were compared. Radiographic outliers were based on surgeon targets and defined as tibial posterior slope outside of 0°-5°, tibial tray varus outside of 0°-3°, and the presence of notching. Clinical outcomes included inpatient narcotic usage, length of stay, range of motion, and Patient-Reported Outcome Measurement Information System scores.ResultsThere was a significant decrease in tibial slope outliers (RA TKA 0% vs non-RA TKA 22%, P = .024) and notching incidence (RA TKA 0% vs non-RA TKA 19.5%, P = .044) in the RA group. Tibial tray varus/valgus outliers trended lower in the RA TKA group (10.0% vs 26.8%, P = .189). Length of stay was significantly shorter in RA patients (48.0 hours [standard deviation: 25.5] vs 67.7 hours [34.3], P = .038). RA patients trended toward lower in postoperative inpatient total mean morphine equivalents usage (79.9 [89.2] vs 140.1 [169.3], P = .142) and inpatient mean morphine equivalents usage per day (30.36 [26.9] vs 45.6 [36.7], P = .105). There was no significant difference in Patient-Reported Outcome Measurement Information System scores or range of motion at first and second postoperative follow-up within 3 months.ConclusionsRA TKA reduced the incidence of radiographic outliers when compared to conventional TKA for a low-volume arthroplasty surgeon.

| S-EPMC10834457 | biostudies-literature

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