Talk:Knee replacement

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 26 August 2019 and 10 May 2020. Further details are available on the course page. Student editor(s): Deb flaherty, Flaherty Deb. Peer reviewers: Deb flaherty.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 23:42, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): DouglasChambersIII. Peer reviewers: DouglasChambersIII.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 01:50, 17 January 2022 (UTC)

Tryout

This page is a try-out for a template for orthopaedic procedures viz Name of Procedure; Description; Synonyms; Technique; Variations; Indications; Contra-Indications; Pre-Operative Work-up; Post-Operative Rehabilitation; Timecourse of recovery; Risks and Complications; Controversies; Prognosis; History.

Please compare the organization and information on this page to that on the Hip replacement page. I believe that this template would help us cover the most important things that people want to know about orthopaedic operations. --Mylesclough 07:32, 4 October 2005 (UTC)

link to healthyjoints.com

I think that a link should be added at the bottom of the knee replacement page to healthyjoints.com. Healthy Joints is an online support group and informational exchange for people with an interest in knee replacement and other joint problems. It would be a great resource for anyone on the knee replacement page.

Here's a link to the site: [1]

Thanks, Daphne Daphne90210 01:20, 4 March 2007 (UTC)

My opinion - it doesn't pass WP:EL, the external link guidelines. The content on the site is pretty shallow. Much of it is just links to other sites like http://www2.ejbjs.org. One page is basically a bunch of links back to Wikipedia: http://www.healthyjoints.com/resources/term-glossary.php. Linking to forums is strongly advised against, and in this case there are maybe 1 or 2 posts. Really not a notable site and it seems like it gets mosts of its useful content from other sites. Plus, linking a general site on an article about a specific subject is advised against. (By the way, this link was also proposed on the Hip replacement and Arthritis pages as well. I'll post these comments there as well.) Nposs 03:21, 4 March 2007 (UTC)

when joint fails

does anyone knows what happens when the new joint fails ? I google it and others say that the revision is easier and others that it isn't and that the new joint lasts even less(and rehab is a lot more difficult too...) can anyone provide information ?

A: Depends on the reason of failure. In osteolysis it is generally easier to do revision before the bony defects are too large. Also, if there is a problem with stability, i would personally advocate not delaying the revision because instability could compromise the remaining soft tissues. Infection is a totally own chapter for revision. Generally revision surgery is much more demanding than primary surgery, but of course a "revision" can only be a resurfacing of patella or changing a polyethylene bearing which would be smaller procedures -- 21 May 07

Copyedit request

I've tagged this article as needing a copyedit to fix grammar, structure, and so on. It also needs reliable sources, the lead needs work, and possibly those redlinks could be written as articles. Just throwing that out there if anybody is a regular editor to this page. DarthGriz98 05:30, 21 August 2007 (UTC)

what future holds

I was wondering if there are any thoughts of how total knee replacement be like in the future , for example in the next ten years or if there are any new innovations on the loose.. —Preceding unsigned comment added by 79.130.218.111 (talk) 22:15, 22 October 2008 (UTC)

This is a talk page, and is meant to discuss improvements to the main page, not the place to speculate on future issues or request information for personal use. WLU (t) (c) ^{(rules - simple rules)} 01:46, 23 October 2008 (UTC)

What the future holds, according to the NEJM 2011 article, is total knee implants with improved durability, approved under the 510(k) process based on similarity to existing devices but without clinical trials, raising "safety concerns." --Nbauman (talk) 01:16, 1 November 2011 (UTC)

Hip and Knee Network

Please could the following website be considered for inclusion into the links section: www.hipandkneenetwork.co.uk[2]. The site is entirely independent of any knee product companies or healthcare companies. The content is provided by and checked by a panel of orthopaedic surgeons and is intended as a free information resource for patients undergoing this type of surgery. The development of the site was part funded by the EU. Many thanks for considering this. Hipandknee (talk) 11:40, 1 December 2008 (UTC)

NEJM 2011 article

I just read this NEJM article which has a nice summary of the state of total knee arthroplasty, although it cites another source that I don't have access to. The interesting thing is the figure that 85% of recipients report functional improvement, and the annual failure rate is 0.5-1.6%, which is not exactly what our article says.

The main point of the NEJM article was that the FDA approves new systems, designed for improved durability, through the 510(k) clearance process, which allows them to market devices based on laboratory studies, not clinical trials.

http://www.nejm.org/doi/full/10.1056/NEJMp1109285
Perspective
Medical Device Innovation — Is “Better” Good Enough?
Lisa G. Suter, M.D., A. David Paltiel, Ph.D., Benjamin N. Rome, B.A., Daniel H. Solomon, M.D., M.P.H., Ilya Golovaty, B.S., Hanna Gerlovin, B.A., Jeffrey N. Katz, M.D., and Elena Losina, Ph.D.
N Engl J Med 2011; 365:1464-1466 October 20, 2011

Last year, the United States spent $95 billion on medical devices, nearly half of the $200 billion spent on devices worldwide.1 Our investment in devices has yielded impressive gains in length and quality of life from products such as implantable cardioverter–defibrillators, pacemakers, and artificial joints (cardiovascular and orthopedic devices account for more than 35% of the market¹). Roughly 10 million Americans have symptomatic knee osteoarthritis,2 a leading cause of disability and the most common indication for total knee arthroplasty. More than 600,000 total knee arthroplasty procedures are performed annually in the United States; 85% of recipients report functional improvement, and the annual failure rate is 0.5 to 1.6%.³

http://jbjs.org/article.aspx?articleid=35605
3. Paxton EW, Namba RS, Maletis GB, et al. A prospective study of 80,000 total joint and 5000 anterior cruciate ligament reconstruction procedures in a community-based registry in the United States.
J Bone Joint Surg Am 2010;92:Suppl 2:117-132
(Note: Paxton didn't monitor pain as an outcome)

--Nbauman (talk) 23:20, 31 October 2011 (UTC)

Two more from the NEJM:

http://www.nejm.org/doi/full/10.1056/NEJMct0806027 Clinical Therapeutics Minimally Invasive Total Knee Arthroplasty for Osteoarthritis Seth S. Leopold, M.D. N Engl J Med 2009; 360:1749-1758 April 23, 2009

http://www.nejm.org/doi/full/10.1056/NEJMra040181 Review Article Current Concepts Prosthetic-Joint Infections Werner Zimmerli, M.D., Andrej Trampuz, M.D., and Peter E. Ochsner, M.D. N Engl J Med 2004; 351:1645-1654 October 14, 2004

--Nbauman (talk) 23:34, 7 March 2012 (UTC)

Lancet

Seminar doi:10.1016/S0140-6736(11)60752-6 JFW | T@lk 20:23, 29 April 2012 (UTC)

Published Online: 06 March 2012

Non-subscription summary: http://www.medpagetoday.com/Orthopedics/Orthopedics/31500 Knee Replacement Outcome Data Fall Short By JOHN GEVER MedPage Today Senior Editor March 5, 2012

Good comment about why the Lancet article is important: http://www.healthnewsreview.org/2012/03/important-shared-decision-making-questions-on-knee-replacement-surgery/ Mar 7 2012 Important shared decision-making questions on knee replacement surgery Gary Schwitzer (Briefly, the outcomes data on knee replacement surgery is limited and inadequate.) --Nbauman (talk) 03:05, 17 August 2012 (UTC)

References

Jane Brody articles in New York Times

Jane Brody, the veteran New York Times health reporter, had a total knee replacement herself at age 63, and wrote about it in good detail. The most striking thing she reported was that her orthopedic surgeon didn't adequately control her severe, unnecessary pain. The other striking thing, in her 2008 story, was a "British study" that followed 4,677 replacements 10 years after surgery, and found that 22% had constant or regular pain, 13% had severe pain. (That British study was apparently J Bone Joint Surg Br 2005 vol. 87-B SUPP III 325, A. Bennett et al., Ten-year outcome of knee arthroplasty surgery -- results from a UK joint register. This study is important because, according to the Lancet article, there are so few outcome studies that measure patient-centered outcomes, which includes pain.)

• A New Set of Knees Comes at a Price: A Whole Lot of Pain By Jane E. Brody, The New York Times, February 8, 2005
• When It Comes to Severe Pain, Doctors Still Have Much to Learn By Jane E. Brody, The New York Times, February 15, 2005
• A Year With My New Knees: Much Pain but Much Gain By Jane E. Brody, The New York Times, December 20, 2005
• 3 Years Later, Knees Made for Dancing, By Jane E. Brody, The New York Times, June 3, 2008
• Relief for Joints Besieged by Arthritis, By Jane E. Brody, The New York Times, July 9, 2012

--Nbauman (talk) 01:31, 20 October 2012 (UTC)

photograph

May I suggest that the photograph of the surgical incision be replaced? I had a knee replacement eight months ago and was told by my surgeon that the preferred incision would be in the outer side of the knee, though in my case it was done in the manner pictured as I had a previous operation that had been done through the side of the knee (he added that entering the knee from the front was done in cases such as mine.) So the photo shows what is probably the exception, rather than the rule. — Robert Greer (talk) 22:00, 8 January 2014 (UTC)

risks and post-operative rehabilitation

I would like to expand upon the risks associated with obesity and knee replacement surgeries. I would like to mention the increased risk of osteoarthritis involved with obesity, and explain why a doctor may recommend a patient lose weight before undergoing surgery. I would like to expand upon the deep vein thrombosis risk section, explaining what it is, what it looks like, and its association to obesity. Additionally, in the post-operative rehabilitation section I would like to improve the section lacking citations by adding missing information and expanding upon the process of recovering from a knee replacement surgery. Greenc12345 (talk) 16:50, 26 July 2016 (UTC)

These suggested changes sound like worthwhile additions to this article. Amyc29 (talk) 17:11, 26 July 2016 (UTC)

Early Mobilization

I would like to add some information on early mobilization and the benefits that research has shown. Mobility is an important aspect of human biology that has many beneficial effects on the body. It is well documented in literature that physical immobility affects every body system and contributes to functional complications of prolonged illness (Leah, 2013). In medical-surgical hospital units, ambulation—the ability to walk or move about freely—is a key aspect of nursing care that is promoted to patients. Early ambulation can decrease the risk of complications associated with immobilization such as pressure ulcers, deep vein thrombosis (DVT), impaired pulmonary function, and loss of functional mobility. Nurses’ promotion and execution of early ambulation on patients has found that it greatly reduces the complications listed above, as well as decreases length of stay and costs associated with further hospitalization (Teodoro, 2016). — Preceding unsigned comment added by DouglasChambersIII (talk • contribs) 14:22, 5 December 2017 (UTC)

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Benefits or not of weight-loss surgery before TKR

As a layman, the following statements seem to be contradictory:

• In Pre-operative preparation: "weight loss surgery before a knee replacement does not appear to change outcomes."
• In Risks: "There is increased risk of complications for obese people going through total knee replacement. The morbidly obese should be advised to lose weight before surgery and, if medically eligible, would probably benefit from bariatric surgery."

Is there a way to reconcile these statements? --Gronk Oz (talk) 07:21, 10 November 2019 (UTC)

Risks

I think the most serious complication is death, which was reported in the NEJM Danish study as 0.5%. --Nbauman (talk) 20:37, 3 July 2022 (UTC)