http://xoomer.virgilio.it/lusebra/NuoviFile/PrevenzioneTVP.pdf

Prevention of venous thromboembolism

https://www.chpso.org/sites/main/files/file-attachments/chest-2008-geerts-381s-453s.pdf

Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition)

Prevention of Venous Thromboembolism : The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy

Modern techniques have reduced the frequency of infections that are associated with prosthetic joints, but such infections continue to pose difficult problems in clinical management. Advances in understanding biofilms and the pathogenesis of microbial interactions with the implant have led to more rational approaches to therapy. This review offers guidance in establishing the diagnosis correctly and an algorithm summarizing the appropriate medical and surgical options.

/pdf/prosthetic-joint-infections-qrunwr5dn0.pdf

Prosthetic-Joint Infections

https://www.just.edu.jo/DIC/ClinicGuidlines/Management%20of%20hip%20and%20knee%20Osteoarthritis.pdf

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines

A new total knee rating system has been developed by The Knee Society to provide an up-to-date more stringent evaluation form. The system is subdivided into a knee score that rates only the knee joint itself and a functional score that rates the patient's ability to walk and climb stairs. The dual rating system eliminates the problem of declining knee scores associated with patient infirmity.

Rationale of the Knee Society clinical rating system.

A method for deriving a more convenient expression of patella position than those currently in use is described. Lateral radiographs of 114 normal knees were measured and the diagonal length of the patella was compared with the length of the ligamentum patellae. It was found that both measurements were approximately equal and that normal variation did not exceed 20%. The ratio of the patella to the patellar ligament may therefore be used as an index of patella height.

Patella Position in the Normal Knee Joint

Section I: Basic Science Section II: Biomechanics Section III: Articular Cartilage and Meniscal Considerations Section IV: Ligament Injuries Section V: Patellar and Extensor Mechanism Disorders Section VI: Miscellaneous Conditions and Treatments Section VII: Plastic Surgery Section VIII: Fracture About the Knee Section IX: The Pediatric Knee Section X: Joint Replacement and Its Alternatives Section XI: Tumors About the Knee

Surgery of the knee

Twenty-nine knees with unicondylar, sixty-four with duocondylar, fifty with Guepar, and fifty with geometric prostheses were studied. The follow-up ranged from two to three and one-half years. The unicondylar prosthesis was used in the mildest cases and gave the least complications, but the quality of results was not superior to that achieved with the other prostheses. The duocondylar model was best suited for knees with rheumatoid arthritis and mild deformity. The geometric prosthesis was the best condylar prosthesis for osteoarthritis with moderate to severe deformity, but gave the worst results in knees with rheumatoid arthritis. The Guepar prosthesis was used in the worst knees and gave the best results, but it had the highest infection rate and was the most difficult to salvage. A radiolucency was observed in about 60 per cent of the condylar replacements around the tibial component and in 45 per cent of the Geupar replacements around the femoral component. The significance of this cannot yet be determined but it suggest that the fixation may not be ideal. In all types, residual pain was most frequently attributed to the patellar compartment. Patellectomy was not a solution.

A comparison of four models of total knee-replacement prostheses

The standard prosthesis for most arthritic conditions is a tricompartmental type. Patellar resurfacing should be done in most cases. The question of cruciate preservation or substitution is unresolved, and both types give equivalent clinical results. No advantage has been shown for left or right components. Correction of deformity occurs by soft-tissue release and ligament balancing, rather than by bone resection. Most primary replacements can be performed in this manner, but alignment is critical to the function and survival of a functioning arthroplasty. Most failures can be attributed to incorrect ligament balance or incorrect alignment. Cement fixation of the components has proved effective, and there is no immediate need for alternative methods such as bone ingrowth; new methods will have to prove themselves against the standard already established for cemented prostheses. Patellar complications such as fatigue fracture of the patellar bone now constitute the majority of problems following total knee arthroplasty.

John N. Insall

Papers

Rationale of the Knee Society clinical rating system.

Patella Position in the Normal Knee Joint

Surgery of the knee

A comparison of four models of total knee-replacement prostheses

Total knee arthroplasty.