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Pascalandre Vendittoli - One of the best experts on this subject based on the ideXlab platform.
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64 hypoesthesia after total knee arthroplasty a randomised controlled trial comparing lateral parapatellar to mini medial incision in total knee arthroplasty
Orthopaedic Proceedings, 2011Co-Authors: Anna Potapov, Jeanmichel Laffosse, Martin Lavigne, Pascalandre Vendittoli, Michel Fallaha, Michel MaloAbstract:Purpose: Antero-medial parapatellar skin incision in total knee arthroplasty (TKA) provides excellent surgical exposure with minimal skin incision length. However, it is associated with the infrapatellar branch of the saphenous nerve section, leading to antero-lateral knee hypoesthesia and sometimes painful nevroma. We hypothesized that antero-lateral skin incision in TKA produces a lower rate of hypoesthesia compared to the medial parapatellar cutaneous approach, and reduced hypoesthesia is linked with less discomfort and possibly a better clinical outcome. Method: A total of 69 knees in 64 patients who underwent TKA were randomized for antero-medial (n=35) or antero-lateral (n=34) skin incision. Mean age was 66.4±8.2 years. Functional outcome was assessed by WOMAC, KOOS and SF-36 scores pre-operatively and at six weeks, six months and one year follow-up. Range of motion (active and passive flexion and extension) was measured. The area of hypoesthesia was analyzed in a standardized manner by an independent observer using a calibrated Semme-Weinstein monofilament applied on 13 reference points. A digital photograph was taken, and the area of hypoesthesia was then measured informatically (Mesurim Pro ® software). Patient satisfaction with their scar and their surgery was evaluated. Statistical analysis was carried out with p Results: The two groups were comparable pre-operatively. There was no significant difference in functional outcome (WOMAC, KOOS, SF-36 scores) at six weeks, six months and one year between the two groups. Active and passive ranges of motion were comparable. The area of hypoesthesia and the number of non-perceived points in the monofilament test were significantly lower after antero-lateral incision at six weeks (p=0.007 and p=0.02, respectively) and 6 months (p=0.02 and p=0.005, respectively). At one year, the area of hypoesthesia was lower in the antero-lateral group, but was not significant (p=0.08). Antero-lateral incision patients reported a lower rate of subjective sensitivity loss and anterior knee pain at six weeks, six months and one year. Conclusion: Antero-medial and antero-lateral parapatellar skin incisions in TKA have a similar functional outcome. However, antero-lateral cutaneous incision produces a lower rate of hypoaesthesia and less anterior knee pain in the early recovery period.
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64 – HYPOESTHESIA AFTER TOTAL KNEE ARTHROPLASTY: A RANDOMISED, CONTROLLED TRIAL COMPARING LATERAL PARAPATELLAR TO MINI MEDIAL INCISION IN TOTAL KNEE ARTHROPLASTY
2011Co-Authors: Anna Potapov, Jeanmichel Laffosse, Martin Lavigne, Pascalandre Vendittoli, Michel Fallaha, Michel MaloAbstract:Purpose: Antero-medial parapatellar skin incision in total knee arthroplasty (TKA) provides excellent surgical exposure with minimal skin incision length. However, it is associated with the infrapatellar branch of the saphenous nerve section, leading to antero-lateral knee hypoesthesia and sometimes painful nevroma. We hypothesized that antero-lateral skin incision in TKA produces a lower rate of hypoesthesia compared to the medial parapatellar cutaneous approach, and reduced hypoesthesia is linked with less discomfort and possibly a better clinical outcome. Method: A total of 69 knees in 64 patients who underwent TKA were randomized for antero-medial (n=35) or antero-lateral (n=34) skin incision. Mean age was 66.4±8.2 years. Functional outcome was assessed by WOMAC, KOOS and SF-36 scores pre-operatively and at six weeks, six months and one year follow-up. Range of motion (active and passive flexion and extension) was measured. The area of hypoesthesia was analyzed in a standardized manner by an independent observer using a calibrated Semme-Weinstein monofilament applied on 13 reference points. A digital photograph was taken, and the area of hypoesthesia was then measured informatically (Mesurim Pro ® software). Patient satisfaction with their scar and their surgery was evaluated. Statistical analysis was carried out with p Results: The two groups were comparable pre-operatively. There was no significant difference in functional outcome (WOMAC, KOOS, SF-36 scores) at six weeks, six months and one year between the two groups. Active and passive ranges of motion were comparable. The area of hypoesthesia and the number of non-perceived points in the monofilament test were significantly lower after antero-lateral incision at six weeks (p=0.007 and p=0.02, respectively) and 6 months (p=0.02 and p=0.005, respectively). At one year, the area of hypoesthesia was lower in the antero-lateral group, but was not significant (p=0.08). Antero-lateral incision patients reported a lower rate of subjective sensitivity loss and anterior knee pain at six weeks, six months and one year. Conclusion: Antero-medial and antero-lateral parapatellar skin incisions in TKA have a similar functional outcome. However, antero-lateral cutaneous incision produces a lower rate of hypoaesthesia and less anterior knee pain in the early recovery period.
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153. HYPOESTHESIA AFTER TOTAL KNEE ARTHROPLSATY: PROSPECTIVE COMPARATIVE RANDOMISED STUDY OF A LATERAL INCISION VERSUS A MINI-MEDIAL INCISION 5657
2011Co-Authors: Jeanmichel Laffosse, Anna Potapov, Michel Malo, Martin Lavigne, Michel Fallaha, Julien Girard, Pascalandre VendittoliAbstract:Purpose of the study: A medial incision for implantation of a total knee arthroplasty (TKA) offers an excellent surgical exposure while minimising the length of the skin opening. This incision however implies section of the proximal portion of the infrapatellar branch of the medial saphenous nerve, potentially associated with lateral hypoesthesia and formation of a neuroma (painful scar). We hypothesised that an anterolateral skin incision would produce less hypoesthesia and postoperative discomfort. Material and methods: We conducted a prospective randomised study to compare the degree of hypoesthesia after a medial or lateral skin incision for the implantation of a TKA. Fifty-knees in 43 patients, mean age 65.9±8.4 years were included; 26 knees for the lateral incision and 24 for the medial. All patients had the same type of implant. Clinical results were assessed with WOMAC, KOOS and SF36. Semme-Weinstein monofilaments were applied to measure sensitivity at 13 characteristic points. Patients were assessed at six weeks and six months. The zone of hypoesthesia was delimited and photographed for measurement with Mesurim Pro9 ® . Satisfaction with the surgery and the scar was noted. Data were processed with Statview ® ; p Results: The two groups were comparable preoperatively regarding age, gender, body weight, height, body mass index, body surface area, aetiology, and clinical score. Operative time, blood loss, and number of complications were comparable. The functional outcomes (WOMAC, KOOS, SF36) were comparable at six weeks and six months. Active flexion was significantly greater at six months in the lateral incision group (p=0.03). The zone of hypoesthesia was significantly smaller in the lateral incision group at six weeks (p 0.05). This was associated subjectively, with less loss of sensitivity and less anterior pain reported by the patient at six months. Discussion: Lateral and medial incisions enable comparable functional outcomes. The lateral incision produces less hypoesthesia and less anterior pain. This improves the immediate postoperative period and facilitates rehabilitation as is shown by the gain in flexion at six months.
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Hypesthesia after anterolateral versus midline skin incision in tka a randomized study
Clinical Orthopaedics and Related Research, 2011Co-Authors: Jeanmichel Laffosse, Anna Potapov, Michel Malo, Martin Lavigne, Pascalandre VendittoliAbstract:Background The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous Hypesthesia and neuroma formation.
Burton L Speiser - One of the best experts on this subject based on the ideXlab platform.
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Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis.
Journal of neurosurgery, 2002Co-Authors: C Leland Rogers, Andrew G Shetter, Francisco A Ponce, Jeffrey A Fiedler, Kris A Smith, Burton L SpeiserAbstract:The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN). There were 15 patients with MS-associated TN (MS-TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm isocenter targeting the ipsilateral trigeminal nerve at its junction with the pons with the 50% isodose. Pain was appraised by each patient by using Barrow Neurological Institute (BNI) Scores I through IV: I, no pain; II, occasional pain not requiring medication; IIIa, no pain but continued medication; IIIb, some pain, controlled with medication; IV, some pain, not controlled with medication; and V, severe pain/no pain relief. With a mean follow up of 17 months (range 6-38 months), 12 (80%) of 15 patients experienced pain relief. Three patients (20%) reported no relief (BNI Score V). For responders, the mean latency from treatment to the onset of pain relief was 13 days (range 1-61 days). Maximal relief was achieved after a mean latency of 56 days (range 1-157 days). Five patients underwent a second GKS after a mean interval of 534 days (range 231-946 days). The mean maximum dose at this second treatment was 48 Gy. The target was unchanged from the first treatment. All five patients who underwent repeated GKS improved. Complications were limited to delayed facial Hypesthesias. Two (13%) of 15 patients experienced onset of numbness after the first GKS, as well as two of five patients following a second GKS. The patients found this mild and not bothersome. Each patient who developed Hypesthesias also experienced complete pain relief. Gamma knife radiosurgery is an effective treatment for MS-TN. Radiosurgery carries an acceptable small risk of mild facial Hypesthesias, and Hypesthesia appears predictive of a favorable outcome.
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Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis
Journal of Neurosurgery, 2002Co-Authors: C Leland Rogers, Andrew G Shetter, Francisco A Ponce, Jeffrey A Fiedler, Kris A Smith, Burton L SpeiserAbstract:Object. The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN). Methods. There were 15 patients with MS-associated TN (MS—TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm isocenter targeting the ipsilateral trigeminal nerve at its junction with the pons with the 50% isodose. Pain was appraised by each patient by using Barrow Neurological Institute (BNI) Scores I through IV: I, no pain; II, occasional pain not requiring medication; IIIa, no pain but continued medication; IIIb, some pain, controlled with medication; IV, some pain, not controlled with medication; and V, severe pain/no pain relief. With a mean follow up of 17 months (range 6–38 months), 12 (80%) of 15 patients experienced pain relief. Three patients (20%) reported no relief (BNI Score V). For responders, the mean latency from treatment to the onset of pain relief was 13 days (range 1–61 days). Maximal relief was achieved after a mean latency of 56 days (range 1–157 days). Five patients underwent a second GKS after a mean interval of 534 days (range 231–946 days). The mean maximum dose at this second treatment was 48 Gy. The target was unchanged from the first treatment. All five patients who underwent repeated GKS improved. Complications were limited to delayed facial Hypesthesias. Two (13%) of 15 patients experienced onset of numbness after the first GKS, as well as two of five patients following a second GKS. The patients found this mild and not bothersome. Each patient who developed Hypesthesias also experienced complete pain relief. Conclusions. Gamma knife radiosurgery is an effective treatment for MS—TN. Radiosurgery carries an acceptable small risk of mild facial Hypesthesias, and Hypesthesia appears predictive of a favorable outcome.
Jeanmichel Laffosse - One of the best experts on this subject based on the ideXlab platform.
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64 hypoesthesia after total knee arthroplasty a randomised controlled trial comparing lateral parapatellar to mini medial incision in total knee arthroplasty
Orthopaedic Proceedings, 2011Co-Authors: Anna Potapov, Jeanmichel Laffosse, Martin Lavigne, Pascalandre Vendittoli, Michel Fallaha, Michel MaloAbstract:Purpose: Antero-medial parapatellar skin incision in total knee arthroplasty (TKA) provides excellent surgical exposure with minimal skin incision length. However, it is associated with the infrapatellar branch of the saphenous nerve section, leading to antero-lateral knee hypoesthesia and sometimes painful nevroma. We hypothesized that antero-lateral skin incision in TKA produces a lower rate of hypoesthesia compared to the medial parapatellar cutaneous approach, and reduced hypoesthesia is linked with less discomfort and possibly a better clinical outcome. Method: A total of 69 knees in 64 patients who underwent TKA were randomized for antero-medial (n=35) or antero-lateral (n=34) skin incision. Mean age was 66.4±8.2 years. Functional outcome was assessed by WOMAC, KOOS and SF-36 scores pre-operatively and at six weeks, six months and one year follow-up. Range of motion (active and passive flexion and extension) was measured. The area of hypoesthesia was analyzed in a standardized manner by an independent observer using a calibrated Semme-Weinstein monofilament applied on 13 reference points. A digital photograph was taken, and the area of hypoesthesia was then measured informatically (Mesurim Pro ® software). Patient satisfaction with their scar and their surgery was evaluated. Statistical analysis was carried out with p Results: The two groups were comparable pre-operatively. There was no significant difference in functional outcome (WOMAC, KOOS, SF-36 scores) at six weeks, six months and one year between the two groups. Active and passive ranges of motion were comparable. The area of hypoesthesia and the number of non-perceived points in the monofilament test were significantly lower after antero-lateral incision at six weeks (p=0.007 and p=0.02, respectively) and 6 months (p=0.02 and p=0.005, respectively). At one year, the area of hypoesthesia was lower in the antero-lateral group, but was not significant (p=0.08). Antero-lateral incision patients reported a lower rate of subjective sensitivity loss and anterior knee pain at six weeks, six months and one year. Conclusion: Antero-medial and antero-lateral parapatellar skin incisions in TKA have a similar functional outcome. However, antero-lateral cutaneous incision produces a lower rate of hypoaesthesia and less anterior knee pain in the early recovery period.
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64 – HYPOESTHESIA AFTER TOTAL KNEE ARTHROPLASTY: A RANDOMISED, CONTROLLED TRIAL COMPARING LATERAL PARAPATELLAR TO MINI MEDIAL INCISION IN TOTAL KNEE ARTHROPLASTY
2011Co-Authors: Anna Potapov, Jeanmichel Laffosse, Martin Lavigne, Pascalandre Vendittoli, Michel Fallaha, Michel MaloAbstract:Purpose: Antero-medial parapatellar skin incision in total knee arthroplasty (TKA) provides excellent surgical exposure with minimal skin incision length. However, it is associated with the infrapatellar branch of the saphenous nerve section, leading to antero-lateral knee hypoesthesia and sometimes painful nevroma. We hypothesized that antero-lateral skin incision in TKA produces a lower rate of hypoesthesia compared to the medial parapatellar cutaneous approach, and reduced hypoesthesia is linked with less discomfort and possibly a better clinical outcome. Method: A total of 69 knees in 64 patients who underwent TKA were randomized for antero-medial (n=35) or antero-lateral (n=34) skin incision. Mean age was 66.4±8.2 years. Functional outcome was assessed by WOMAC, KOOS and SF-36 scores pre-operatively and at six weeks, six months and one year follow-up. Range of motion (active and passive flexion and extension) was measured. The area of hypoesthesia was analyzed in a standardized manner by an independent observer using a calibrated Semme-Weinstein monofilament applied on 13 reference points. A digital photograph was taken, and the area of hypoesthesia was then measured informatically (Mesurim Pro ® software). Patient satisfaction with their scar and their surgery was evaluated. Statistical analysis was carried out with p Results: The two groups were comparable pre-operatively. There was no significant difference in functional outcome (WOMAC, KOOS, SF-36 scores) at six weeks, six months and one year between the two groups. Active and passive ranges of motion were comparable. The area of hypoesthesia and the number of non-perceived points in the monofilament test were significantly lower after antero-lateral incision at six weeks (p=0.007 and p=0.02, respectively) and 6 months (p=0.02 and p=0.005, respectively). At one year, the area of hypoesthesia was lower in the antero-lateral group, but was not significant (p=0.08). Antero-lateral incision patients reported a lower rate of subjective sensitivity loss and anterior knee pain at six weeks, six months and one year. Conclusion: Antero-medial and antero-lateral parapatellar skin incisions in TKA have a similar functional outcome. However, antero-lateral cutaneous incision produces a lower rate of hypoaesthesia and less anterior knee pain in the early recovery period.
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153. HYPOESTHESIA AFTER TOTAL KNEE ARTHROPLSATY: PROSPECTIVE COMPARATIVE RANDOMISED STUDY OF A LATERAL INCISION VERSUS A MINI-MEDIAL INCISION 5657
2011Co-Authors: Jeanmichel Laffosse, Anna Potapov, Michel Malo, Martin Lavigne, Michel Fallaha, Julien Girard, Pascalandre VendittoliAbstract:Purpose of the study: A medial incision for implantation of a total knee arthroplasty (TKA) offers an excellent surgical exposure while minimising the length of the skin opening. This incision however implies section of the proximal portion of the infrapatellar branch of the medial saphenous nerve, potentially associated with lateral hypoesthesia and formation of a neuroma (painful scar). We hypothesised that an anterolateral skin incision would produce less hypoesthesia and postoperative discomfort. Material and methods: We conducted a prospective randomised study to compare the degree of hypoesthesia after a medial or lateral skin incision for the implantation of a TKA. Fifty-knees in 43 patients, mean age 65.9±8.4 years were included; 26 knees for the lateral incision and 24 for the medial. All patients had the same type of implant. Clinical results were assessed with WOMAC, KOOS and SF36. Semme-Weinstein monofilaments were applied to measure sensitivity at 13 characteristic points. Patients were assessed at six weeks and six months. The zone of hypoesthesia was delimited and photographed for measurement with Mesurim Pro9 ® . Satisfaction with the surgery and the scar was noted. Data were processed with Statview ® ; p Results: The two groups were comparable preoperatively regarding age, gender, body weight, height, body mass index, body surface area, aetiology, and clinical score. Operative time, blood loss, and number of complications were comparable. The functional outcomes (WOMAC, KOOS, SF36) were comparable at six weeks and six months. Active flexion was significantly greater at six months in the lateral incision group (p=0.03). The zone of hypoesthesia was significantly smaller in the lateral incision group at six weeks (p 0.05). This was associated subjectively, with less loss of sensitivity and less anterior pain reported by the patient at six months. Discussion: Lateral and medial incisions enable comparable functional outcomes. The lateral incision produces less hypoesthesia and less anterior pain. This improves the immediate postoperative period and facilitates rehabilitation as is shown by the gain in flexion at six months.
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Hypesthesia after anterolateral versus midline skin incision in tka a randomized study
Clinical Orthopaedics and Related Research, 2011Co-Authors: Jeanmichel Laffosse, Anna Potapov, Michel Malo, Martin Lavigne, Pascalandre VendittoliAbstract:Background The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous Hypesthesia and neuroma formation.
Maarten Van Kleef - One of the best experts on this subject based on the ideXlab platform.
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relationship between sensory stimulation and side effects in percutaneous radiofrequency treatment of the trigeminal ganglion
Pain Practice, 2014Co-Authors: Mark V Koning, Nick J Koning, Henk M Koning, Maarten Van KleefAbstract:Introduction The objective of this study was to determine the efficacy of percutaneous radiofrequency (RF) treatment of the trigeminal ganglion for treating patients with trigeminal neuralgia, to determine which patients have a long-term benefit, and to evaluate the effect of RF parameters. Methods A retrospective study in 28 consecutive patients in combination with a follow-up questionnaire (n = 26, 93% response). Results An initial treatment effect of 89% was observed, 60% sustained at 12-month follow-up. Major side effects were Hypesthesia (56%), dry eye (20%), and masseter muscle weakness (12%). A lower sensory stimulation threshold during treatment was associated with better patient satisfaction (P = 0.016), improved pain relief (P = 0.039), and trended toward more Hypesthesia (P = 0.077). Discussion This low-volume study reported treatment effects in an older population that were similar to previous studies. Only a higher incidence of Hypesthesia was detected by long-term follow-up. This study supported the high efficiency of RF treatment, but there was a high level of side effects. Most notable, low sensory stimulation was associated with increased Hypesthesia, whereas higher stimulation levels yielded less effectiveness. Further investigation of an optimal sensory stimulation range for percutaneous RF treatment of the trigeminal ganglion was found to be warranted.
Naoyuki Hirasawa - One of the best experts on this subject based on the ideXlab platform.
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Cutaneous Hypesthesia and Kneeling Ability After Total Knee Arthroplasty: A Randomized Controlled Trial Comparing Anterolateral and Anteromedial Skin Incision.
The Journal of arthroplasty, 2018Co-Authors: Sachiyuki Tsukada, Kenji Kurosaka, Masahiro Nishino, Naoyuki HirasawaAbstract:Abstract Background Anterolateral skin incision can preserve the skin sensory of the anterior aspect of the knee and may improve kneeling ability after total knee arthroplasty (TKA). Methods This is a prospective, 2-arm, parallel-group, randomized, controlled trial involving patients scheduled for TKA. A total of 118 patients (162 knees) were randomly assigned to receive anterolateral skin incision or anteromedial skin incision with 1:1 treatment allocation. The surgical techniques other than skin incision were identical in both groups. The area of cutaneous Hypesthesia was measured by a nonblinded assessor, and kneeling ability was evaluated by 2 blinded assessors at 12 months after surgery. Results The area of cutaneous Hypesthesia was significantly smaller in the anterolateral skin incision group than the anteromedial skin incision group (3.0 ± 8.7 cm2 vs 10.6 ± 18.6 cm2; 95% confidence interval, 2.8-12.3 cm2; P = .0019). The rates of patients judged to be able to kneel were significantly higher in the anterolateral skin incision group by both assessors (81% vs 60%; P = .025 and 81% vs 59%; P = .015, respectively) with almost perfect agreement between the 2 assessors (kappa value = 0.94). There were no significant differences in terms of complication rate, including wound complications, between the 2 groups (P > .05). Conclusion Compared with anteromedial skin incision, anterolateral skin incision may provide less cutaneous Hypesthesia and better kneeling ability after TKA without increasing complication rate.