Total knee replacement

Zohar E, EUis M, Ifrach N, Stern A, Sapir O, Eredman B. The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement. Anesth Analg 2004 99 1679-83. 

Farag E, Dilger J, Brooks P, Tetzlaff JE. Epidural analgesia improves early rehabilitation after total knee replacement. J Clin Anesth. 2005 17 281-285. 

Francis CW, Berkowitz SD, Comp PC, et al, Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement. N EnglJ Med 2003 349 1703-1712. 

Two major clinical studies14 (621 patients who underwent elective total knee replacement, and 706 patients who underwent elective total hip replacement) have evaluated the efficacy and safety of rivaroxaban in the prophylaxis of thrombosis in patients undergoing orthopedic surgery. In these studies, rivaroxaban (2.5-10 mg b.i.d.) compared favorably with enoxaparin (40 mg once daily). 

In summary, rivaroxaban 1 is an oral direct factor Xa inhibitor and is the first approved factor Xa inhibitor on the European and Canadian market. This class of inhibitors is expected to expand, with new members currently in late-stage clinical development. Rivaroxaban is indicated for the prevention of venous thromboembolic events in patients who have undergone elective total hip or total knee replacement surgery. Rivarobaxan was underwent extensive clinical program that included three Phase III trials of rivaroxaban involving a total of nearly 12,000 patients. The results from these three studies demonstrated the superior efficacy of the factor Xa inhibitor, both in head-to-head comparisons with enoxaparin and when comparing extended-duration (5 weeks) rivaroxaban with short-duration (2 weeks) enoxaparin. In all three... 

Mr KT is a 58-year-old man who has been admitted to the surgical ward on which you work for a total knee replacement. He lives with his wife and two sons. He smokes 15 cigarettes a day and usually drinks about 35 units of alcohol a week. He is slightly overweight with a BMI of 27 kg/m2. His current medication includes... 

A 53-year-old woman received postoperative epidural analgesia by nurse-administered bolus doses after a total knee replacement (16). She received her first epidural bolus of 0.25% bupivacaine 6 ml with morphine 2 mg 2 hours after the operation, with good effect. Six hours later she was accidentally given a second top-up dose intravenously. She became distressed and complained of tinnitus, palpitation, and dizziness. She was able to cooperate and was in sinus rhythm with a tachycardia of 120/minute. She was observed overnight on ICU and made a full recovery. 

An 85-year-old woman undergoing elective right total knee replacement had prolonged motor blockade of her left leg when her epidural ropivacaine (0.2% at 8-10 ml/hour) infusion was discontinued on the third postoperative day normal motor function had returned by the sixth postoperative day (139). 

Worland, R.L. Arredondo, J. Angles, F. Lopez-Jimenez, F. Jessup, D.E. Home continous passive motion machine versus professional physical therapy following total knee replacement. J. Arthroplast. 1998, 13, 784-787. 

She has osteoarthritis in her left knee, is under the care of an orthopaedic consultant, and is being considered for total knee replacement. 

A sedative hypnotic to a 65-year-old female client with a total knee replacement. 

The nurse is preparing to administer the morning medications to the client who is 1-day postoperative total knee replacement. Which medication would the nurse question administering ... 

Cyclosporine is not an expected medication to be prescribed for a client with total knee replacement. 

Sierra R, Trousdale R, Pagnano M. Above-the-knee amputation after a total knee replacement prevalence, etiology, and functional outcome. J Bone Joint Surg 2003 85 1000-1004. 

Carbon fibers have been incorporated in the high density polyethylene used in total knee replacements (Figure 41.5). The standard ultra high molecular weight polyethylene (UHMWPE) used in these implants... 

The prostheses for total knee replacement (Figure 45.9) can be divided according to the extent to which they rely on the Hgaments for stability (1) Constrained these implants have a hinge articulation, with a fixed axis of rotation, and are indicated when all of the ligaments are absent, for example in reconstructive procedures for tumoral surgery. (2) Semi-constrained these implants control posterior... 

Total knee replacements can be implanted with or without cement, the latter relying on porous coating for fixation. The femoral components are typically made of CoCr alloy and the monolithic tibial components are made of UHMWPE. In modular components, the tibial polyethylene component assembles onto a titanium alloy tibial tray. The patellar component is made of UHMWPE, and a titanium ahoy back is added to components designed for uncemented use. The relatively small size of the pateUar component compared to the forces that travel through the extensor mechanism, and the small area of bone available for anchorage of the prosthesis, make the pateUa vulnerable. 

Andriacchi T.P., Stanwyck T.S., and Galante J.O. 1986. Knee biomechanics in total knee replacement. /. Arthroplasty 1 211. 

Walker P.S., G.W. Blunn, and P.A. Lilley. 1996. Wear testing of materials and surfaces for total knee replacement. ] Biomed Mater Res 33 159-175. 

Photograph of an LCS rotating platform mobile bearing total knee replacement. (Images provided courtesy of J.B. VanMeter, DePuy Orthopedics, Warsaw, IN.)... 

Bartel D.L., A.H. Burstein, E.A. Santavicca, and J.N. Insall. 1982. Performance of the tibial component in total knee replacement. ] Bone Joint Surg 64 1026-1033. 

Buechel F.F., Sr. 2002. Long-term followup after mobile-bearing total knee replacement. Clin Orthop 404 40-50. 

Ewald RC. 1975. Metal to plastic total knee replacement. Orthop Clin North Am 6 811-821. 

Rodriguez J.A., N. Baez, V. Rasquinha, and C.S. Ranawat. 2001. Metal-backed and aU-polyethylene tibial components in total knee replacement. Clin Orthop 392 174—183. 

Walker RS. 1989. Requirements for successful total knee replacements. Design considerations. Orthop Clin North 20 15-29. 

Total knee replacement with UHMWRE was clinically introduced in the... 

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