Cutaneous Hypesthesia and Kneeling Ability After Total Knee Arthroplasty: A Randomized Controlled Trial Comparing Anterolateral and Anteromedial Skin Incision

Tsukada, Sachiyuki; Kurosaka, Kenji; Nishino, Masami; Hirasawa, Naoyuki

doi:10.1016/j.arth.2018.06.010

Cited by 29 publications

(25 citation statements)

References 31 publications

(43 reference statements)

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“…53 A randomized controlled trial (RCT) found that patients who received an anterolateral skin incision had a smaller area of cutaneous hypesthesia and better observed kneeling ability compared to patients with an anteromedial skin incision. 54 The findings from these studies indicate that skin incision may have an impact on kneeling ability through numbness. Many studies have compared the clinical outcome of fixed vs mobile-bearing TKR designs; however, few studies have evaluated kneeling ability, and those that have report conflicting results.…”

Section: Aetiologymentioning

confidence: 89%

Kneeling ability after total knee replacement

et al. 2019

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Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60–80% of patients reporting difficulty kneeling or an inability to kneel. Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients. Research has found that there is no association between range of motion and self-reported kneeling ability. More research is needed to understand if and how surgical factors contribute to difficulty kneeling after TKR. Discrepancies between patients’ self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation. There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improve patient care and allow patients to return to this important activity. Cite this article: EFORT Open Rev 2019;4:460-467. DOI: 10.1302/2058-5241.4.180085

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Section: Aetiologymentioning

confidence: 89%

Kneeling ability after total knee replacement

et al. 2019

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“…However, the effects on clinical outcomes are unknown. There have been speculations that lack of sensation around a total knee incision may result in poor patient outcomes, difficulty with day-to-day activities such as kneeling, and overall worse patient satisfaction [11][12][13][14][15]18].…”

Section: Discussionmentioning

confidence: 99%

“…The unknown effects of skin numbness have driven some surgeons to explore alternative approaches and minimally invasive techniques [3,7,15,19]. Tsukada et al [15] demonstrated better kneeling ability and lower occurrence of skin numbness after an anterolateral approach than a traditional midline incision. Although the authors did not report any additional complications during their follow-up, long-term effects of an anterolateral approach are still unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Up to 20% of patients undergoing total knee arthroplasty are not satisfied after the surgery, and although the reasons are still unknown, postoperative numbness may be a contributing factor [9][10][11]. In particular, the inability to kneel after surgery as a result of sensory deficit has been hypothesized to account for patient dissatisfaction [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

et al. 2021

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Background Skin numbness after total knee arthroplasty is a common complication. The incidence in the literature is variable from 27% to 100%. However, there is conflicting evidence about the consequences of this complication. The purpose of this study was to evaluate if postoperative numbness influenced patient satisfaction or kneeling ability. Methods We recruited patients who underwent a total knee arthroplasty for osteoarthritis one to 5 years before the study. Sensation was measured using a Semmes-Weinstein, 10-gram monofilament. Measurements were taken in several zones around the incision, and overall sensory status was classified as full numbness, partial numbness, and no numbness. Patients completed a questionnaire evaluating their subjective numbness, overall satisfaction, and kneeling ability. We evaluated the effect of numbness on satisfaction and function. Results A total of 96 patients were enrolled. Thirty-four patients were classified as no sensory deficit, 29 as partial deficit, and 33 as full deficit. There were no differences in demographics. Out of all the patients that were found to have a sensory deficit, 54.8% of them did not report any subjective numbness. Average patient-reported satisfaction scores were 8.76/10, 8.97/10, and 8.48/10 for no numbness, partial numbness, and full numbness, respectively. Eleven out of 96 patients noted an inability to kneel. There was no statistical difference for satisfaction scores or kneeling ability between the groups. Conclusion Sensory deficit after total knee arthroplasty is a frequently reported complication. However, the majority of the patients do not report subjective sensory deficits. Postoperative numbness does not appear to affect patient satisfaction or kneeling ability.

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“…No pneumatic tourniquet was used during the study period. An anterolateral incision was used in all surgeries [14]. A subvastus approach without patellar eversion was used except in patients with valgus knee alignment, for whom a lateral approach was used.…”

Section: Methodsmentioning

confidence: 99%

Intra-articular tranexamic acid as an adjunct to intravenous tranexamic acid for simultaneous bilateral total knee arthroplasty: a randomized double-blind, placebo-controlled trial

Tsukada

Kurosaka

Nishino

et al. 2019

BMC Musculoskelet Disord

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BackgroundIntra-articular tranexamic acid (TXA) as an adjunct to intravenous TXA was reported to decrease perioperative blood loss during unilateral total knee arthroplasty (TKA). However, there have been no randomized controlled trials comparing intravenous versus combined intravenous and intra-articular TXA administration in patients undergoing simultaneous bilateral TKA.MethodsWe randomly assigned 77 patients with 154 involved knees undergoing simultaneous bilateral TKA to the intravenous TXA group (intra-articular placebo for each knee) or combined TXA group (1000 mg of intra-articular TXA for each knee) with 1:1 treatment allocation. In both groups, 1000 mg of TXA was given intravenously twice, just before surgery and 6 h after the initial administration. Other perioperative medications, surgical procedures, and blood management strategies were the same for all patients. The primary outcome was perioperative blood loss calculated from blood volume and change in hemoglobin from preoperative to postoperative day 3.ResultsIntention-to-treat analysis showed no statistically significant differences in perioperative blood loss until postoperative day 3 (1067 ± 403 mL in the intravenous TXA group vs. 997 ± 345 mL in the combined TXA group [95% CI, − 240 to 100 mL], P = 0.42). No patients required allogenic blood transfusion. The incidence of thrombotic events did not differ between groups (12% in the intravenous TXA group vs. 9% in the combined TXA group; P = 0.73).ConclusionsThe addition of intra-articular TXA did not reduce perioperative blood loss in patients undergoing simultaneous bilateral TKA compared with placebo.Trial registrationUniversity Hospital Medical Information Network UMIN000026137. Registered 14 February 2017.

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Cutaneous Hypesthesia and Kneeling Ability After Total Knee Arthroplasty: A Randomized Controlled Trial Comparing Anterolateral and Anteromedial Skin Incision

Abstract: Compared with anteromedial skin incision, anterolateral skin incision may provide less cutaneous hypesthesia and better kneeling ability after TKA without increasing complication rate.

Cited by 29 publications

References 31 publications

Kneeling ability after total knee replacement

Kneeling ability after total knee replacement

The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

Intra-articular tranexamic acid as an adjunct to intravenous tranexamic acid for simultaneous bilateral total knee arthroplasty: a randomized double-blind, placebo-controlled trial

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