IntroductionFast-track protocols (FP) are used more and more to optimize results after total knee arthroplasty (TKA). Many studies evaluating FP in TKA concentrate on clinical outcome and medium to long-term results. Since discharge from hospital after TKA is achieved increasingly quicker worldwide using FP in an increasingly younger and active patient population, the effects of FP on functional outcome in the first days after TKA become more important. The purpose of the current study was to compare FP with a regular joint care protocol (RP), with an emphasis on the first 7 days after surgery.Materials and methodsA non-blinded randomized controlled clinical pilot study was performed with 25 patients assigned to a FP group and 25 patients assigned to a RP group. Primary outcome was functional outcome, clinical outcome, pain, and complications for each day in the first week after surgery. Patients were followed up to 5 years after surgery.ResultsSignificantly lower VAS scores for knee pain, faster Timed-Up and Go test times and more mobility on functional tests were seen on several days in the first week in the FP group compared to the RP group. Few other significant differences were found at 2, 6 weeks, and no significant differences were found at 12 weeks and 1, 2 and 5 years after surgery.ConclusionsFast-track protocol for primary TKA showed significantly lower knee pain scores and improved functional outcome in the first 7 days after TKA compared to a regular protocol.
IntroductionThe present case report describes a patient who presented with an early complication after a unicompartmental knee arthroplasty. It is not the first case in this subject but the unique aspect of this case report rests on the timing in which the failure occurred.Case presentationA 64-year-old Caucasian man received a medial unicompartmental knee arthroplasty (Oxford® Partial Knee) due to isolated anteromedial osteoarthritis of his right knee. His initial recovery was good, however, after 3 months he presented with acute pain and a locked knee. Radiographs showed a complete loosening and migration of the femoral component. During revision surgery no clear explanation was found for failure of the femoral component.ConclusionsThe most likely explanation for loosening is the combination of peak stresses on the posterior facet of the femoral components of a unicompartmental knee arthroplasty in a patient in a cross-legged knee position causing bone–cement or cement–implant interface failure. Further research is necessary in prosthetic designs and applications of the unicompartmental knee arthroplasty to determine the origin of this early complication.
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