Posterior Tibial Slope

Osteoarthritis (OA) is a chronic joint disorder; knee is the joint that most frequently affected.1 During 1988 to 1994, among US adults, the prevalence of knee OA was 37.4%, and the prevalence was greater among women than men (42.1% vs 31.2%).2 Knee OA will impair lower extremity function, and influencing the quality of life. The most common complaints from the patients with knee OA are the pain, daily functional decline, joint deformity, and gait deviation3,4. Symptomatic OA knee patients have shown that significantly less knee angular velocity and knee range of motion during gait. The normal joint load line can be altered with possible varus angulation of the knee, eventually affecting

Mean follow-up was 117 months. 86% are male. Average age of 26 years at surgery. 35 patients had partial meniscectomy (53% internal, 31% external, 16% bimeniscal). A significant improvement (p<0.001) between pre and postoperative parameters was demonstrated (pre-operative mean IKDC score 47 points; post-operative 94 points). 92% perform moderate demand activities, of which 40% returned to pre-injury activity levels without complaints. An increase in the time between rupture of the ACL and surgery was not associated with higher rates of meniscal lesions, osteoarthritis or lower IKDC scores. There was a correlation between clinical results and associated meniscal or chondral lesions. Clinically 6% had symptoms/signs of anterior instability (Lachman 2 A). Radiologically 25% had an anterior displacement of the tibia with an average distance of 3.9 mm [3.3-7.2]. 10% shown femoral tunnel enlargement (with a average of 1.8 mm) and 60% present with subchondral sclerosis in tibial plates. All patients with symptoms suggesting anterior instability shown anterior displacement of the tibia and sclerosis areas, yet only one has femoral tunnel

A total knee replacement (TKA) is the most common joint surgery performed in the United States (Turner, 2011, pp. 27-32). Each year, over 650,000 Americans undergo this surgery (Wittig-Wells, 2015, pp. 45-49). It is an invasive surgery that involves an incision on top of the knee and replacing damaged parts of the knee with artificial parts that are either metal, ceramic or plastic. Someone would get a total knee replacement for damage of the joint, osteoarthritic, posttraumatic, or inflammatory arthritis. The cartilage is damaged, wears away and then you develop bony deformity and contracture of ligaments but it starts out with specific defects or wear of cartilage. The top nursing priorities for a total knee arthroplasty is to “prevent complications, promote optimal mobility, alleviate pain, and provide information about diagnosis, prognosis, and treatment needs” (Doenges, 2014, pg. 627). A possible nursing diagnosis from the patient who is undergoing a TKA might be ‘impaired physical mobility related to pain and discomfort as evidenced by reluctance to attempt movement.’ Another one could be ‘acute pain related to chronic joint disease as evidenced by reports of pain’ (Vera, 2014).

In this study, a randomized and concealed method supported by a computer was conducted prospectively for patients who showed signs of radiographic knee OA. In addition, without knowing further about the clinical status of participants, knee radiographs were assessed in the study of baseline and follow ups by an experienced surgeon. The baseline characteristics of subjects such as age and BMI were not significantly different. Criteria included were the radiographically confirmed as knee OA (a score ≥ 1 out of 4 on the K/L scale), ability to walk to the site, understand and make signature on the written consent of information form and report the data required. However, the research did not include the participants

It is expected that the forms are equivalent. To analyze this idea, comparisons were made between the form, with different scoring methods as well as the IDKC to determine the similarities with responsiveness, and whether the construct of the ADLS form changed. This evaluation is imperative to confirm that the ADLS is comparable to other standardized forms, such as the IDKC. Therefore, this knowledge would be able to further the advancement of knee quality for patients in limitations, results, techniques and accuracy in surgeries after

Outcome measures: Pain will be assessed with Numeric Pain Rating Scale (NPRS), functional performance will be assessed with Kujala score, Patellofemoral Disability Index (PDI), and Lateral Step-up Test. Palpation meter (PALM) Inclinometer will be used to measure pelvic tilt angle, and the Baseline Bubble Inclinometer will be used to measure hip internal, external rotation and adduction. Global Rating of Change Scales (GROC) will be used to assess the overall

late postoperative phase71: The frequency of treatment in this phase (weeks 6 to 8) is the based on the remaining impairment, the important point in this frame is quadriceps index greater than 80%, optimal full knee ROM and the normal gait pattern with the less effusion. This indicator (80%) shows a minimal deficit in strength and also use the cut off the NMES to augment quadriceps

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

Introduction: Because life expectancy is increasing, the number of performed primary knee prostheses is projected to increase 673% by 2030 (Westrich et al.). 20% of patients are unsatisfied with the outcome (Klit et al). The implant misalignment has been reported as a decisive factor in outcome and the primary reason for revision in 7% of revised prostheses (Ritter et al). Misalignment definition however varies among studies, making it difficult to compare the results.

Observational prospective cohort study: An advantage of this design is a careful analysis of the trends and relationships and differences among the variables can be explored. Rationale: to determine the relationship and trends of early activity with postoperative total knee replacement.

The fifth article critiqued is the first update of a clinical practice guideline (CPG) authored by the American Academy of Orthopedic Surgeons (AAOS). The purpose of this systematic review is to evaluate the best available evidence associated with nonsurgical treatment of knee OA. To be included in this study, the subjects must be original research treating knee OA with pain, function, and disability status as the primary outcome measures. Studies were excluded based on design and if they were of very limited strength of evidence. The authors searched the databases PubMed, EMBASE, CINAHL, and Cochrane Register of Controlled Trials. The recommendations in this CPG are based upon the evidence found in these studies. When critiquing the articles, the authors analyzed the quality and applicability of the studies using the Grade Evidence Appraisal System and the PRECIS Instrument. The authors made the following recommendations for braces and insoles.

Objectives: The hypothesis is that averaging the SL and PCA will decrease the risk of femoral component malrotation in total knee arthroplasty.

Osteoarthritis, also known as degenerative joint disease, is an endemic condition that affects 20 million people in the United States alone. Osteoarthritis is the most common type of arthritis and is defined as a gradual process of destruction and degeneration or wearing away of the joint cartilage which typically occurs in the older individual age 50 and over (http://emedicine.medscape.com/article/330487-overview#a0101). . Although this diease is well known for its association with the natural aging process, it is also prevalent in athletes. Specifically, osteoarthritis of the knee has been said to be the most commonly affected area as a majpr weight bearing joint and is a growing epidemic in relation to sports injuries in the young adult. http://www.webmd.com/osteoarthritis/guide/ostearthritis-of-the-knee-degenerative-arthritis-of-the-knee. According to, (Vincent), among upper and lower reported extremity sites, the most common region for osteoarthritis to manifest is p’in the medial compartment of the knee. The risk of knee osteoarthritis from knee joint injury is high; approximately 50% of individuals with an ACL or meniscus tear develop knee osteoarthritis [10-15]. A long-term prospective study indicated a relative risk for knee osteoarthritis of approximately 5 for any previous injury of the knee [13]. As cited in, _____, Thelin and colleagues determined that injury of the knee joint was associated with all knee OA in a

The posterior tibial tendon is one of the vital foot supporting structures. This fibrous begins in the calf muscles, stretching behind the ankle, then attaches to a midfoot bone. That bone is known as the navicular. It is very important in the structure of the arch. The posterior tibial tendon has an important role of securing the navicular in the right position. This in turn holds the arch of the foot in place, while providing support when tension is transferred from the toes to the rest of the foot. When this particular bone loses position due to tendon malfunction, the arch starts to sag, and eventually disappears. This leads to a flatfoot deformity. Post

54% have been for revision knee arthroplasties. One patient had both a problematic hip and knee replacement. In 43% of the cases there was a recommendation to change the management plan following discussion in the meeting. In several cases, there has been a significant alteration to the treatment plan; including changing the planned procedure from a single stage to a two stage approach, cancelling planned revision surgery to aspirate the affected joint and obtain a microbiological diagnosis prior to revision, and even changing the joint to be operated on. Following discussion, seven cases (4%) have been transferred to NUH for revision surgery. Analysis of the operative plan and the theatre inventories at each hospital revealed that in 59 cases (35%) extra loan kit was likely to be