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What’s new in adult reconstructive knee surgery

• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • Increase in both primary and revision TKR*; primary TKR vol. at 313 per 100,000 in 1990-1994, to 634 per • Shifting towards Sub-specialty surgeons • Avg. duration for TKR declined 160min in 1997 to • Morbidities and mortalities also declined in general • Implementation of National Guidelines, clinical *Kutz et al; J Arthroplasty. 2009;24:195-203 • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • AAOS guidelines* • Literature since 1996 shows no significant differences in the rate of symptomatic PE with the use of LMW Heparin, warfarin, or mechanical devices and ASA alone • Bleeding as a serious side effect • The American College of Chest Physicains study concluded that ASA is as affective, but study flaws exist • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • Computer Navigation vs. case-specific cutting jigs • Mechanical axis restoration as a predicator of • Computer navigation associated with higher number of knees iethin 3 degrees of a neutral mechanial alignment (88% vs. 61%)** • Increase in surgical time but an average of *Fang etal. J Arthroplasty. 2009;24:39-43 **Choong PF etal. J Arthoplasty. 2009;24:560-9 • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • Tendon preserving, muscle preserving, and smaller incision • Increased surgical time, potential of malalignment and wound complications and limited early benefit* • Effect of anterior tibial translation and patellar eversion. No significant difference in early recovery in a randomized • Serum levels (Creat. Phospokinase, myoglobin, aldolase, lact. Dehy., creat.) ; no difference *** • Higher revision rates in unicompartmental **** *Karpman et al. J Arthroplasty. 2009;24-681-8 **Da;ury DF et al. JBJS Am. 2009;91:1339-43 ***Niki et al. J Arthroplasty. 2009;24:499-504 ****Hamilton et al. J Arthroplasty. 2010;25:735-40 • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • Pain management: use of nerve blocks after TKR, there is an early post op benefit (up to 24-72 hrs) of decrease in pain and opioid use, but no clinical benefit or improved outcomes beyond this period • Tourniquet down before or after wound *Shum et al. J Arthroplasty. 2009;24:204-9 **Steffin et al. J Arthroplasty. 2009;24:539-42 • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • No significant improvement of range of motion in multiple prospective randomized studies up to 2 years* • Await long term survival results to determine • Rotation may facilitate optimal patellar • Randomized prospective studies of up to 5 years showed no clinical benefit in any of the above Gioe et al. JBJS Am. 2009;91:2104-12 Engh et al. J Arthroplasty. 2009;24:28-32 prospective study of pts. That underwent a cruciate retaining TKR for OA with and with out patellar replacement: no difference in the two groups in terms of ROM, Knee Society Score, anterior knee pain or overall revision; however rate of patellar revision was higher in the unresurfaced group (12% vs. 3%) • 15 yrs f/up of modular posterior stabilized TK • 10 yr f/up of all-polyethylene and metal backed tibial components. Both implants had a survival rate of 97%** • Uncemented trabecular metal tibial component at 3 years follow up shows a consistent stable fixation compared to cemented implants*** *Lachiewicz et al. JBJS Am. 2009;91:1419-23 **Bettinson et al. JBJS Am. 2009;91:1587-94 ***Dunbar et al. JBJS Am. 2009;91:1578-86 • Hospital volume and surgeon volume affect outcome , but studies indicate that hospitals with standardized processes had equal outcomes to high volume hospitals* • Staged vs. simultaneous TKR: no difference in a new study from the New Zealand National Joint Registry** • No support of use of antibiotic cement for primary TKR*** • Outcome and satisfaction may be improved if TKR done at *Manley et al. J Arthroplasty. 2009;24:1061-7. **Hooper et al. J Arthroplasty. 2009;24:1174-7. ***Namba et al. J Arthroplasty. 2009;24(6 suppl):44-7. ****Gandhi et al. J Arthroplasty. 2009;24:716-21 • In the morbid obese, comparing BMI of <30, 30-39 and >39: no difference in outcomes but increase in patellar radiolucency in BMI >39 at a mean f/up of 5.4 years* • Neuropathic arthropathy with mean f/up of 12 years: showed improvements in Knee score. Complications incl. knee dislocation** *Dewan et al. J Arthroplasty. 2009;24:89-94 **Bae et al. J Arthroplasty. 2009;24:1152-6 • Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications • Infection: rates of .5% for primary and 2% for revision. Risk factors: male, Rheumatoid Arth., Fx about the knee, and use of hinged or constrained • Patients with un-controlled diabetes had higher risk of stroke, UTI, ileus, post-hematoma, transfusion, wound infection and death. Routine Endocrinology consultation is recommended to *Jameson et al. JBJS BR. 2010;92:123-9 **Marchant et al. JBJS Am. 2009;91:1621-9

Source: http://www.hdh.com.sa/web/downloads/presentations/1.pdf

Microsoft word - fluoxebell cmi.doc

FLUOXEBELL Consumer Medicine Information What is in this leaflet Do not take FLUOXEBELL together with pimozide, a drug to treat neuroleptic disorders. FLUOXEBELL should not be used in children and adolescents under 18 years of age as the safety and efficacy of FLUOXEBELL in this age group has not been established. Ask your doctor or pharmacist

Nps59(ssssc).indd

The abstracts are only available online, free of charge, at www.karger.com/doi/10.1159/000230666Annual Conference of the Swiss Society of Sleep Research, Sleep Medicine and Chronobiology (SSSSC) and the Swiss Society of Biological Psychiatry (SSBP)Chairmen (SSSSC) Christian Cajochen, Basel Johannes Mathis, BernBasel · Freiburg · Paris · London · New York · Bangalore ·Bangkok · Shanghai

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