The use of tourniquet in total knee arthroplasty does not impact the functional outcome: a randomised controlled study.

Background: This study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use.

Questions/purposes: The aims were to determine if the tourniquet has an impact on [1] Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; [2] postoperative strength and function; [3] postoperative pain and opioid analgesic use; and [4] operative time, bleeding, and length of stay (LOS).

Less inflammatory response in the direct anterior than in the direct lateral approach in patients with femoral neck fractures receiving a total hip arthroplasty: exploratory results from a randomized controlled trial.

Background And Purpose: It is still debatable which is the least invasive approach to the hip joint in arthroplasty for a femoral neck fracture (FNF). We compared the traditional direct lateral approach (DLA) with the direct anterior approach (DAA) regarding creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb).

Methods: In a randomized controlled trial, 130 elderly patients with dislocated FNFs treated with total hip arthroplasty (THA) were included.

The tourniquet's effects on skeletal muscle during total knee arthroplasty.

This study investigates the impact of perioperative tourniquet on skeletal muscle cells during total knee arthroplasty (TKA) and its effects on the gene expression of apoptotic, inflammatory, and angiogenic pathways. The randomized controlled trial included 44 patients undergoing TKA. The patients were randomized to undergo surgery with (n = 23) or without (n = 21) tourniquet.

Surgical approach had minor association with femoral stem migration in total hip arthroplasty: radiostereometric analysis of 61 patients after 5-year follow-up.

Background And Purpose: Total hip arthroplasty (THA) is usually performed using 1 of 3 surgical approaches: direct lateral (DLA), posterior (PA), or anterior (AA). AA is different from DLA and PA owing to limited intraoperative visibility of the femoral canal. This could affect stem positioning and therefore migration.

The extent of first-time THA revision is not associated with patient-reported outcomes at 1-year follow-up: a study of 426 aseptic revisions.

Background And Purpose: Studies evaluating pain and patient-reported outcome measures (PROMs) related to type of revision total hip arthroplasty (rTHA) are sparse. Our aim was to compare pain, physical function, quality of life, and patient satisfaction among different types of aseptic rTHA at 1-year follow-up.

Patients And Methods: We performed a retrospective study from an institutional registry with 426 primary THAs scheduled for rTHA in a fast-track setting between 2012 and 2021.

Higher Dissatisfaction Rate Following Revision Compared With Primary Total Knee Arthroplasty: 1-Year Follow-up of 2151 Primary and 235 Aseptic Revision Surgeries.

Postoperative patient satisfaction is related to preoperative expectations. Information regarding expected results following surgery is therefore important. This study evaluated patient-reported outcome measures (PROMs) and patient satisfaction up to 1 year after primary and aseptic revision total knee arthroplasty (TKA).

The indication for aseptic revision TKA does not influence 1-year outcomes: an analysis of 178 full TKA revisions from a prospective institutional registry.

Background And Purpose: Outcomes following revision total knee arthroplasty (TKA) may depend on the indication for revision surgery. We compared pain, patient-reported outcome measures (PROMs), and patient satisfaction among different indications for an aseptic TKA revision.

Patients And Methods: This was a retrospective study of prospective data from an institutional registry of 178 primary TKAs revised between 2012 and 2020.

Patient-reported outcome after primary and aseptic revision hip arthroplasty: 1-year follow-up of 3,559 primary and 406 revision THAs in an institutional registry.

Background and purpose - Patient-reported outcomes (PROMs) after primary total hip arthroplasty (THA) and revision THA are important information in the preoperative shared decision-making process. We present 1-year results on pain, function, and quality of life following primary and revision THA. Patients and methods - From 2010 to 2018, 3,559 primary THA and 406 revision THAs were included in our institutional quality registry.

Antibiotic-Loaded Bone Cement in Prevention of Periprosthetic Joint Infections in Primary Total Knee Arthroplasty: A Register-based Multicentre Randomised Controlled Non-inferiority Trial (ALBA trial).

Introduction: The current evidence on the efficacy of antibiotic-loaded bone cement (ALBC) in reducing the risk of periprosthetic joint infections (PJI) after primary joint reconstruction is insufficient. In several European countries, the use of ALBC is routine practice unlike in the USA where ALBC use is not approved in low-risk patients. Therefore, we designed a double-blinded pragmatic multicentre register-based randomised controlled non-inferiority trial to investigate the effects of ALBC compared with plain bone cement in primary total knee arthroplasty (TKA).

Does the line-to-line cementing technique of the femoral stem create an adequate cement mantle?

Background: The line-to-line cementing technique is proposed to create a press-fit in the femoral canal, which is contrary to modern cementing techniques. The term 'French paradox' has been used to describe the acceptable results associated with this technique. It has been suggested that the quality of the mantle may not be satisfactory, predisposing to early failure and aseptic loosening.

Muscular strength and function after total hip arthroplasty performed with three different surgical approaches: one-year follow-up study.

Background: Surgical approach influences short-term muscular strength, and leg-strength asymmetry has been demonstrated after total hip arthroplasty (THA). We evaluated muscular strength, physical function and patient-reported outcome measures (PROMs) up to 12 months postoperatively, in patients operated on using 3 different surgical approaches.

Methods: 60 patients scheduled for primary THA were allocated to the direct lateral (DLA), posterior (PA) or anterior (AA) approach.

A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty.

Background and purpose - Total hip arthroplasty (THA) patients have reduced muscle strength after rehabilitation. In a previous efficacy trial, 4 weeks' early supervised maximal strength training (MST) increased muscle strength in unilateral THA patients <65 years. We have now evaluated muscle strength in an MST and in a conventional physiotherapy (CP) group after rehabilitation in regular clinical practice.

Load transfer in the proximal femur and primary stability of a cemented and uncemented femoral stem: An experimental study on cadaver femurs.

There are principally two fixation methods in total hip arthroplasty, cemented and uncemented. Both methods have in general good long-time survival. Studies comparing cemented and uncemented femoral stems indicate that the cemented stems perform somewhat better, at least in the elderly population.

Randomized controlled trial of maximal strength training vs. standard rehabilitation following total knee arthroplasty.

Background: Total knee arthroplasty (TKA) alleviates pain, but muscle strength and function is reduced for a long period postoperatively.

Aim: To investigate whether maximal strength training (MST) is more effective in improving muscle strength than standard rehabilitation (SR) after TKA.

Design: A randomized, controlled study.

Impact of maximal strength training on work efficiency and muscle fiber type in the elderly: Implications for physical function and fall prevention.

Although aging is typically associated with a decreased efficiency of locomotion, somewhat surprisingly, there is also a reduction in the proportion of less efficient fast-twitch Type II skeletal muscle fibers and subsequently a greater propensity for falls. Maximal strength training (MST), with an emphasis on velocity in the concentric phase, improves maximal strength, the rate of force development (RFD), and work efficiency, but the impact on muscle morphology in the elderly is unknown. Therefore we evaluated force production, walking work efficiency, and muscle morphology in 11 old (72±3years) subjects before and after MST of the legs.

Muscular strength after total hip arthroplasty. A prospective comparison of 3 surgical approaches.

Background And Purpose: Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. PATIENTS AND METHODs: In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach.

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty.

Background And Purpose: The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA.

1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track.

Background: Fast-track has become a well-known concept resulting in improved patient satisfaction and postoperative results. Concerns have been raised about whether increased efficiency could compromise safety, and whether early hospital discharge might result in an increased number of complications. We present 1-year follow-up results after implementing fast-track in a Norwegian university hospital.

Small and similar amounts of micromotion in an anatomical stem and a customized cementless femoral stem in regular-shaped femurs. A 5-year follow-up randomized RSA study.

Background And Purpose: High primary stability is important for long-term survival of uncemented femoral stems. Different stem designs are currently in use. The ABG-I is a well-documented anatomical stem with a press-fit design.

The migration pattern of the Charnley femoral stem: a five-year follow-up RSA study in a well-functioning patient group.

Background: Implant stability is considered vital to long-time implant survival in total hip arthroplasty (THA), since loose implants are reported to be a major cause of hip revision. There is an association between early implant micromotion and increased risk of revision. More implant-specific data are needed to establish acceptable levels of early implant movement.

Unilateral vs. bilateral total hip arthroplasty - the influence of medial femoral head offset and effects on strength and aerobic endurance capacity.

The purpose of the present study was to determine whether unilaterally operated total hip arthroplasty (THA) patients were superior to bilaterally operated THA patients with respect to aerobic endurance capacity, muscle strength and gait patterns 3-5 years after surgery, and to what extent medial femoral head offset (FO) influenced hip abductor strength. 10 unilaterally operated THA patients with normal FO (UNO), 10 bilaterally operated THA patients with normal FO (BNO) and 10 bilaterally operated THA patients with abnormal offset (BDO) participated in the study. Improved muscle strength in the healthy leg of the UNO did not result in differences compared to the BNO and the BDO in work efficiency, gait patterns or maximal oxygen consumption (VO2max ) A reduced FO in the BDO did not result in lower hip abduction strength compared to the BNO.

A prospective randomised radiostereometric analysis trial of SmartSet HV and Palacos R bone cements in primary total hip arthroplasty.

Background: Introduction of new bone cements into clinical practice should include radiostereometric studies.

Materials And Methods: A prospective randomised radiostereometric study was performed, comparing SmartSet HV and Palacos R acrylic bone cements (without antibiotics) using third-generation cementing techniques in primary total hip arthroplasty. Thirty-five patients (36 hips) undergoing Charnley total hip arthroplasty were randomised to receive either of the two cements and were followed with repeated clinical, radiographic and radiostereometric examinations over 24 months.

Early postoperative maximal strength training improves work efficiency 6-12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years.

Objective: To assess physical outcome of early maximal strength training after total hip arthroplasty.

Design: Six- and 12-mo follow-up of 24 (22) total hip arthroplasty patients randomly assigned to 4 wks of maximal strength training and conventional rehabilitation and to conventional rehabilitation only was conducted. After the intervention period, all patients attended conventional rehabilitation.

Early maximal strength training is an efficient treatment for patients operated with total hip arthroplasty.

Unlabelled: Husby VS, Helgerud J, Bjørgen S, Husby OS, Benum P, Hoff J. Early maximal strength training is an efficient treatment for patients operated with total hip arthroplasty.

Objective: To compare muscle strength, work efficiency, gait patterns, and quality of life in patients undergoing total hip arthroplasty (THA) randomly assigned to either maximal strength training or a conventional rehabilitation program.