Adjustment of Knee Extension to the Latest Measurement Device - Coursework Example

Knee Replacement devices By Lecturer’s and The main purpose of this research study was on the analysis of the accuracy on the commonly used techniques for measuring and adjustment of knee extension and making substantial comparisons with the latest measurement device. The main bars of external fixator were utilized in determination of knee extensions for fifteen human cadavers. Their angles were subjected to comparison with knee extension measurements on radiographs that were limited to knee joint. The extensions for various knee positions were hence determined by use of a generic novel long arm and a goniometer (ADAM, MCDUFFIE, et. al., 2012).  In the resultant clinical extension, various independent examiners have to categorize the performance of knee extension with accordance to IKDC. Here, 16 knees that have got deficits with regards to the range of motion should be rated by use of a generic goniometer as well as the measurement device for novel extension. The radiological dimensions of the knee expansion angles that should be restricted to the tibia and femur shaft is allowed to only have a systematic absolute error of about -5.2 +/- 1.9 degrees as compared to the lines established by the rotational centres. In an experimental setup, the average absolute deviations should be at around 3.92 +/- 1.41 with a goniometer and around 1.22 +/- 0.20 degrees when it comes to the other measurement device. Radiological knee extension measurements that are limited to the knee joint area systematically deviate from the total axis measurements with regards to bones. A goniometer that uses the tibia and femur bony landmarks is often superior in terms of accuracy as compared with the long arm and standard goniometer techniques (ADAM, MCDUFFIE, et. al., 2012).  Over a few decades, there has been a substantial improvement with regards to Knee replacement surgery, mainly due to improved methodologies and techniques, improved devices and improved conversancy of knee and function and physiology. More durable and successful knee replacement schedules have had a big effect on various clinical practices (DURIG, 2013). GPs have to understand something on some of the advancements that have been attained as well as how the clinical practices have transformed as a result, specifically in the segment of patient selection and patient assessment surgery. GPs should have the ability of distinguishing between abnormal and normal progress after such a surgery. A review of the knee replacement technology: Knee Replacement refers to a surgical procedure whereby prosthesis or an artificial joint is used to replace a broken knee joint. The major Total Knee Replacement Indication (TKR) is usually pain, and then followed by the functional ability. An individual’s daily activities should usually be affected significantly by functional limitations and pain for him or her to be fully considered as a TKR candidate. Most referrals to the orthopaedic surgeons regarding functional or pain limitations often come from family the physicians; however, some of them emerge from rheumatologists. The mean time period of the hospital wait for a TKR patient is usually 5 days (KURTZ & KURTZ, 2009). Most of these patients often undergo the spinal anaesthesia. The procedure normally lasts for 2 hours. After discharge from the hospital, rehabilitation process is hence prescribed, either based on an inpatient set-up within the hospital or through the outpatient care within the Community Care Centre (CCC). A patient often undergoes short-term vein thrombosis preventive treatment for around one to six weeks, following joint replacement. Patients also receive antibiotics for almost 24 hours immediately after the surgery so as to prevent any form of infection. Follow-up thus occurs within a time sequence of six weeks for up to one or two year time period. The kind of the offered prosthesis depends on the patients age, gender, anatomy, weight, activity level, general health and medical history (KURTZ & KURTZ, 2009). The performance record of the device as well as the surgeon’s level of experience with the consequent device also tends to influence the ultimate decision. Generally, there are only a few manufacturers who have been licensed for distribution of the knee replacement devices and components. Assessment for knee replacement Before undertaking a consequent knee replacement procedure that often encompass the use of a number of knee replacement devices, various forms of assessments have to be put in place. This kind of assessments is mainly aimed towards the aspect of ascertaining the most probable and efficient knee replacement devices that should be utilized. So, the basic element is to entirely focus on all the impending factors with regards to the knee replacement menace (BARTEL, DAVY, et.al., 2006).  The main form of indications is normally pain and even loss of functionality. However, such an assessment is complex in one way or the other, hence making it difficult to define a clearer consensus on the action that should be undertaken. The ultimate selection for any form of surgery or the entire knee replacement process must take into consideration the severity of the existing symptoms, the integrated impacts of these varied symptoms, the combination of all these, as well as the patients level of motivation. National Institute for Health and Care Excellence (NICE) suggests that; a joint replacement device or surgery should be taken into consideration for individuals with osteoarthritis or those who tend to experience symptoms such as pain, reduced function, and stiffness; that have substantial effects on their lives and are at-times refractory to various non-surgical treatments (TRIER & GREENWALD, 2012).In line with this, the type of knee replacement component or device that should be used is also of a greater importance. This is because, some devices are more adaptive to particular situations or severity than others and hence proper understanding of the entire concept is deemed as being very essential before making any sort of recommendations. There are various factors that should be put into dire consideration before making any cognitive move with regards of selecting a knee replacement device. First and for most, age is often taken as one of the main factors. For the young patients, the most preferred knee devices are often the externally-based ones. This is simply because there is often less likelihood of subjecting younger patients towards surgery (TRIER & GREENWALD, 2012). The amount of pain also plays a very critical role. This is predominantly based on weight-bearing capacity at the initial point before it becomes constant in one way or the other. It might be localised or generalised to a single medical compartment. Pain grading can either be done based on the classification of it being mild, severe or even moderate. Those patients with severe rest pains often calls for substantive operations that involve the use of sufficient internal knee replacement devices that suits the patients entire knee curvature. There are other varying functional impairments that should also be put into consideration. This has to do with an individual’s daily activities. For instance, this comprise of the existence of aids or walking devices that are used, the individuals maximum walking distance, the issue of climbing stairs, individual’s self-management, as well as many other impending activities that would require the aspect of knee bending (BONNIN, 2009). So, before selecting any form of knee replacement device, various scoring systems should be utilized in research with an attempt of quantifying disability and measurement of outcomes. These mainly include the measures of common health status as well as the specific knee scoring devices and systems (BARTEL, DAVY, et.al., 2006).  Types of knee replacement prosthesis: There are three basic kinds of the knee replacement prostheses. These include the non-constrained, semi-constrained and the constrained. The non-constrained technique is the most common form of prosthesis with regards to knee replacement. Here, the prosthesis components that are introduced into the entire knee are not connected to each other in any way. The patient’s muscles and ligaments offer the prosthesis stability (NUNEZ, 2013).  On the other hand, the semi-constrained technique is termed as a type of prosthesis that provides some knee stability and does not entirely rely on the patient’s muscles and ligaments for provision of stability. This type is often utilized in situations whereby the orthopaedic surgeons have to remove all the inner knee ligaments. Finally, the constrained or what is also termed as the hinged technique has to do with the concept whereby the prosthesis components are hinged or linked together. This kind of prosthesis technique is utilized when the patient’s muscles and ligaments are not unable to offer some sort of stability for the entire knee prosthesis. It is more frequent in patients who are undergoing the revision surgery. This form of device often has a shorter life-span as compared to the other forms of prostheses. The knee replacement process or prosthesis is often encompassed with three main options for holding the knee in place. These options can be taken to include the non-cemented prosthesis, cemented prosthesis, or the one that is attached by use of a hybrid fixation method. The cemented system fixes prosthesis with polymethylmethacrylate to the bones (NUNEZ, 2013).  The cement often permits the entire prosthesis to perfectly fit to the ultimate bone, even if some bone irregularities exists. A cemented prosthesis tends to stabilize more rapidly, and so patients can be able to walk almost immediately after the surgery. The only shortcoming occurs if the cement loosens, since then bone might be ground by the joint movement, hence making the subsequent revisions to be more difficult (SINGH, CARTER, et.al., 2010). The non-cemented system utilizes a prosthesis characterized with a rough and porous surface. This is a surface that is designed to allow bone growth into it, hence eliminating the entire need for cement. It is often precisely fitted closer to the bone while being fixed into the ultimate place with screws and metal pegs while the entire bone witnesses growth and fixation into the knee substitution prosthesis. As expected, this procedure is accompanied with much longer recovery time with regards to walking as compared to the use of cemented prostheses. The main advantage is that; in case of the prosthesis loosening over time, lesser bone loss will occur due to unavailability of the irritant and rough cement. Hybrid fixation on the other hand is has to do with combination of both the non-cemented and cemented procedures. Here, the femur is often cemented, whereas the tibia is not cemented. Hybrid fixation has got a little resemblance to the non-cemented procedures. This is due to the fact that they are relatively new and more advanced procedures as compared to the cemented procedure. They are mainly characterized and have been proved to be highly encompassed with the approved long-term outcomes regarding the subsequent patients undergoing such types of the fixation techniques. So, the above technique is the most currently used since the statistics have indicated that the complications and risks that are Associated With this system of Knee Replacement are very minimal. Often, the most usual complications and risks associated with knee replacement are taken to include; infection, stiffness, deep venous thrombosis, loosening, as well as osteolysis (SINGH, CARTER, et.al., 2010).  Deep Venous Thrombosis refers to blood clot formation in the large veins, mainly in the pelvis or legs. It has a more likelihood of occurring after surgery that involves the lower part of the body as compared to other forms of surgeries. To prevent this menace, patients are often given and encouraged to wear support stockings. Another associated complication is termed as stiffness. Mostly, it can be duly avoided through ensuring the act of knee movement during those days and weeks after surgery. With regards to revisions, the main reason why this aspect of joint replacement often fails is because of prosthesis loosening from the bone. As technology advances, improvements are yet to be ensued to the entire fixation methods so as to prevent such loosening mishaps. Osteolysis also happens to be another main reason that calls for revision. This is characterized with bone breakages that might occur especially due to worn-out plastic or cement, resulting in deposits of tiny particles. Such particles often migrate into bones hence leading to its massive damage. Uni-compartmental Knee Replacement (UKR) is often confused with Total Knee Replacement (TKR), but there is a slight substantial difference. This is simply because; this process has to do with the replacement of only a knee portion (SCOTT & INSALL, 2012).  The development of UKR occurred at the same time with that of TKR. However, the entire procedure has not yet been widely accepted within the orthopaedic community due to early reports involving poor results associated that were associated with this procedure. These initial studies were somehow misleading, in that, further review regarding these studies showed out that those poor results that were associated with this procedure may have been due to the aspects patient selection, the type of surgical technique, or even the used prosthesis technique. Identifying and correcting of such surgical technique pitfalls, plus the establishment of much better implant formats, have so far renewed the UKR enthusiasm in particular selected patients. The past few years, have seen UKR becoming more popular. UKR is often done under a general anaesthetic or spinal section. The rough edges of the femur and the tibia’s top are cut flat and cleaned, before the appropriate device is hence cemented (SCOTT & INSALL, 2012).  Evaluation and assessment of knee devices should also incorporate greater levels of examinations. Such examinations are aimed towards ascertaining whether to use the internal or external devices. Here, the knee examination should be totally examined based on various factors. For instance, thorough inspection has to be carried out so as to look for scars, soft tissue defects and skin sepsis around the knee. Such defects or scarring might affect the healing process. Palpation rate should also be determined through checking of pulses so as to ensure there are no cases of peripheral arterial ailment. Look for wasting of the quadriceps and check there is good extensor function. Finally, the range of fixed flexion deformity and any joint movement should be measured and recorded for analysis (BUECHEL & PAPPAS, 2011). This is due to the fact that, the best movement range predictor after operation is often the range before the operation. Investigation The knee replacement device selection and assessment should also encompass a number of investigations. X-ray is often taken as the most common investigative component. These should entirely correlate with clinical findings. The Radiographic destruction of the joint space, as well as its symptoms, is needed for substantive findings. Cysts, osteophytes, and sub-chondral sclerosis are also taken into consideration. Knee Society also approved a scoring system specifically for X-rays especially after arthroplasty. The other component is the use of MRI scan. This is particularly done when assessing very crucial ligaments and patella-femoral compartments (KURTZ & KURTZ, 2009). The scanning of indium white cell and many other techniques are often rarely required before operation. The only point whereby various techniques can be used is especially on a complex revision arthroplasty, whereby infection needs differentiation from the aseptic loosening. Bone densitometry methodology on the other hand is utilized in situations where there are extensive risk elements for osteoporosis. Finally, the Arthroscopy technique is often utilized on younger patients for symptoms’ evaluation, injury, among others. Generally, the variations in most of these components occur mainly due to the element of their operational set-ups. Each and every device has been essentially designed to server specific purposes. Measures to delay or avoid knee replacement Being a somehow cumbersome process, knee replacement patients are often encouraged to cope up with some of the conservative measures. Such measures are often aimed towards reduction of knee pains that might even end up towards postponement or avoidance of the ultimate replacement. This often includes the use of various knee support devices that have been designed in such a manner that they cope with the entire knee movements. This is often taken to include oral analgesics, among other essential components (KURTZ & KURTZ, 2009). The other personal measures that should be undertaken includes: weight loss, physiotherapy that will assist with gait, muscle strengthening, patient education, walking aids, and joint mobility; Occupational therapy that aids with daily activities such as bath aids, grab rails, toilet aids, etc.; Walking aids (bracing of joints, shoe adjustments, etc.); as well as exercise. Before subjection of any form of operation, it might be useful for to have details concerning the entire operation process with regards to the level of bearing on postoperative development and the possible complications. Most of these details are very essential and can be taken to include; mode of anaesthetic that often utilize epidurals, tourniquet time, and the operative approach. On the other hand, there should be a dire consideration on whether proper mechanical alignments with proper patellofemoral alignment are achieved, whether knee there was significant contraction of knee ligaments, whether there was need of patellofemoral surgery (reefing, resurfacing or even release). Finally, there should be prosthesis details and whether it was cemented or not. In hospitals, postoperative early knee joint movement should be done within 24 hours and is often encouraged with the aspects of Good analgesia. This is the aspect where there is often greater application of patient-control methodologies. Epidural techniques are also regularly utilized. There is also the element of utilizing the aspects of Cryotherapy and release that are often used for reduction of swelling. Early discharge is usually encouraged between 5 days and 2 weeks, based on the progress; but only if: there is a satisfactory Wound healing, satisfactory mobility, achievement of 90° Knee flexion, or when complications have not been identified. The Orthopaedic follow-up is normally at the range of 6 weeks in the outpatients. Generally, it can be concluded that there are various emerging development s and advancements with regards to knee replacement techniques and devices. These might be taken to include; the use of un-cemented designs, new joint surfaces, mobile-bearing knee replacements, improved kinematics, improved fixation as well as the utilization of navigation-guided surgery. Mini-incision for knee joint replacement is another term for use of navigation-guided devices and instruments that allows smaller incisions and hence less destruction of tissues. Reference List ADAM, S. S., MCDUFFIE, J. R., LACHIEWICZ, P. F., ORTEL, T. L., & WILLIAMS, J. W. (2012). Comparative effectiveness of newer oral anticoagulants and standard anticoagulant regimens for thromboprophylaxis in patients undergoing total hip or knee replacement. http://www.hsrd.research.va.gov/publications/esp/Anticoagulants.pdf. ASTM SYMPOSIUM ON MOBILE BEARING KNEE DEVICES, TRIER, K. K., & GREENWALD, A. S. (2012). Mobile bearing total knee replacement devices. West Conshohocken, PA, ASTM International. BARTEL, D. L., DAVY, D. T., & KEAVENY, T. M. (2006). Orthopaedic biomechanics: mechanics and design in musculoskeletal systems. Upper Saddle River, N.J., Pearson/Prentice Hall. BEREND, K. R., & CUSHNER, F. D. (2012). Partial knee arthroplasty techniques for optimal outcomes. Philadelphia, PA, Elsevier/Saunders. http://site.ebrary.com/id/10494937. BONNIN, M. (2009). The knee joint surgical techniques and strategies. Paris, Springer. http://dx.doi.org/10.1007/978-2-287-99353-4. BUECHEL, F., & PAPPAS, M. J. (2011). Principles of human joint replacement design and clinical application. Berlin, Springer. http://dx.doi.org/10.1007/978-3-642-23011-0. DURIG, N. E. (2013). Characterization of potential wear sources in knee arthroplasty prostheses after in vivo function. Thesis (M.S.) -- Clemson University, 2013. KURTZ, S. M., & KURTZ, S. M. (2009). UHMWPE biomaterials handbook ultra-high molecular weight polyethylene in total joint replacement and medical devices. London, Academic. http://www.sciencedirect.com/science/book/9780123747211. NUNEZ, L. (2013). Post-market surveillance of total knee replacement combining clinical outcomes and quantitative image processing techniques. Thesis (M.S.) -- Clemson University, 2013. SCOTT, W. N., & INSALL, J. N. (2012). Insall & Scott surgery of the knee. Philadelphia, PA, Elsevier/Churchill Livingstone. http://www.mdconsult.com/public/book/view?title=Scott:+Insall+&+Scott+Surgery+of+the+Knee. SINGH, K., CARTER, M., & SHIELDS, M. (2010). If you have-- knee surgery. [S.l.], Pinnacle Rehabilitation. WISE, D. L. (2000). Orthopaedic, dental, and bone grafting applications. Totowa, NJ, Humana Press. http://site.ebrary.com/id/10181391. Read More