Blood loss after revision knee arthroplasty is 1.38- to 2.17-fold higher than after primary knee arthroplasty: A retrospective analysis of 898 cases

Представлен случай использования модульной эндосистемы АМТ при ревизионном эндопротезировании коленного сустава у больного с ингибиторной формой гемофилии В. Эндопротезирование суставов у больных гемофилией занимает ведущую роль в оперативном ортопедическом лечении гемофилической артропатии. Хирургические вмешательства у пациентов с гемофилией связаны с высоким риском кровотечения и инфекции и проводятся на фоне заместительной гемостатической терапии. Выживаемость первичных эндопротезов коленного сустава у пациентов с гемофилией составляет около 80% при сроке наблюдения 10 лет. Тем не менее встречаются случаи, когда использование эпифизарных эндопротезов невозможно технически в связи с недостаточным массивом костной ткани. В таких случаях может потребоваться замещение дефекта костной ткани на значительном протяжении. Использование модульных эндопротезов позволяет частично или полностью замещать дефекты костей. В современной литературе описаны лишь единичные случаи использования модульных эндопротезов у больных гемофилией. Представлен клинический случай успешного применения модульного эндопротеза АМТ коленного сустава у больного с ингибиторной формой гемофилии В. The case is presented of modular endosystem AMT use in revision knee arthroplasty in a patient with an inhibitory form of hemophilia B. Arthroplasty in patients with hemophilia plays a leading role in the surgical orthopedic treatment of hemophilic arthropathy. Surgical treatment in patients with hemophilia is associated with a high risk of bleeding and infection, and is performed in conjunction with hemostatic therapy. The survival rate of primary knee arthroplasty in patients with hemophilia is about 80% with a follow-up period of 10 years. Nevertheless, there are cases when epiphyseal endoprostheses use is technically impossible, due to insufficient bone tissue. In these cases, it may be necessary to replace the bone defect over a considerable length. The use of modular endoprostheses allows partial or complete replacement of bone defects. Only a few cases of modular endoprostheses use in patients with hemophilia are described in the modern literature. The article presents a clinical case of successful application of a modular knee replacement AMT in a patient with an inhibitory form of hemophilia B.

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Blood Loss and Transfusion Risk in Robotic‐Assisted Knee Arthroplasty: A Retrospective Analysis

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1002/rcs.2308 ◽

2021 ◽

Author(s):

Hasaan Khan ◽

Kieran Dhillon ◽

Piyush Mahapatra ◽

Ravi Popat ◽

Omar Zakieh ◽

...

Keyword(s):

Blood Loss ◽

Retrospective Analysis ◽

Knee Arthroplasty ◽

Robotic Assisted

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MANIPULATION UNDER ANAESTHETIC FOLLOWING PRIMARY KNEE ARTHROPLASTY IS ASSOCIATED WITH A HIGHER RATE OF SUBSEQUENT REVISION KNEE ARTHROPLASTY

The Knee ◽

10.1016/j.knee.2020.07.018 ◽

2020 ◽

Vol 27 ◽

pp. S6

Author(s):

S. Abram ◽

B. Yusuf ◽

A. Alvand ◽

S. Sabah ◽

W. Jackson ◽

...

Keyword(s):

Knee Arthroplasty ◽

Revision Knee Arthroplasty ◽

Primary Knee Arthroplasty ◽

Subsequent Revision

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Blood management in total knee arthroplasty: state-of-the-art review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000168 ◽

2018 ◽

Vol 3 (6) ◽

pp. 358-366 ◽

Cited By ~ 3

Author(s):

Antony Palmer ◽

Antonia Chen ◽

Tomoyuki Matsumoto ◽

Mike Murphy ◽

Andrew Price

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Autologous Blood ◽

Primary Total Knee Arthroplasty ◽

Coronary Syndrome ◽

Revision Knee Arthroplasty ◽

Total Knee ◽

Knee Arthroplasty Surgery ◽

Arthroplasty Surgery

Total blood loss from primary total knee arthroplasty may exceed 2 L with greater blood loss during revision procedures. Blood loss and allogeneic transfusion are strongly associated with adverse outcomes from surgery including postoperative mortality, thromboembolic events and infection. Strategies to reduce blood loss and transfusion rates improve patient outcomes and reduce healthcare costs. Interventions are employed preoperatively, intraoperatively and postoperatively. The strongest predictor for allogeneic blood transfusion is preoperative anaemia. Over 35% of patients are anaemic when scheduled for primary and revision knee arthroplasty, defined as haemoglobin <130 g/L for men and women, and the majority of cases are secondary to iron deficiency. Early identification and treatment of anaemia can reduce postoperative transfusions and complications. Anticoagulation must be carefully managed perioperatively to balance the risk of thromboembolic event versus the risk of haemorrhage. Intraoperatively, tranexamic acid reduces blood loss and is recommended for all knee arthroplasty surgery; however, the optimal route, dose or timing of administration remains uncertain. Cell salvage is a valuable adjunct to surgery with significant expected blood loss, such as revision knee arthroplasty. Autologous blood donation is not recommended in routine care, sealants may be beneficial in select cases but further evidence of benefit is required, and the use of a tourniquet remains at the discretion of the surgeon. Postoperatively, restrictive transfusion protocols should be followed with a transfusion threshold haemoglobin of 70 g/L, except in the presence of acute coronary syndrome. Recent studies report no allogeneic transfusions after primary knee arthroplasty surgery after employing blood conservation strategies. The current challenge is to select and integrate different blood conserving interventions to deliver an optimal patient pathway with a multidisciplinary approach.

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Thromboembolism prophylaxis with dabigatran leads to lower perioperative blood loss than with dalteparin in primary knee arthroplasty

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-011-1335-0 ◽

2011 ◽

Vol 131 (12) ◽

pp. 1739-1743 ◽

Cited By ~ 4

Author(s):

Doerte Matziolis ◽

Georg Matziolis ◽

Carsten Perka

Keyword(s):

Blood Loss ◽

Knee Arthroplasty ◽

Thromboembolism Prophylaxis ◽

Perioperative Blood Loss ◽

Primary Knee Arthroplasty

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Rotating Hinge Implants in Knee Arthroplasty

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0896-2862 ◽

2019 ◽

Vol 158 (04) ◽

pp. 383-389

Author(s):

Alexander Petershofer ◽

Klemens Trieb

Keyword(s):

Clinical Outcomes ◽

Knee Arthroplasty ◽

Demographic Transition ◽

Revision Arthroplasty ◽

Implant Design ◽

Knee Prostheses ◽

Revision Knee Arthroplasty ◽

Primary Knee Arthroplasty ◽

Rotating Hinge ◽

Rotating Hinge Knee

AbstractDue to demographic transition an increasing number of primary knee arthroplasty is expected. A consequence is a rise in frequency in revision knee arthroplasty. Rotating hinge prostheses are a development of former hinge prostheses, due to changes in implant design the outcome of modern rotating hinge implants clearly improved in comparison to former models. Interpretation of outcome in present literature is difficult due to the small number of cases and the heterogeneous indications. Nevertheless the use of rotating hinge knee prostheses in primary and revision arthroplasty is associated with good clinical outcomes, when indicated appropriately.

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Differences in mortality and complication rates following revision knee arthroplasty performed for urgent versus elective indications

The Bone & Joint Journal ◽

10.1302/0301-620x.103b10.bjj-2020-2590.r1 ◽

2021 ◽

Vol 103-B (10) ◽

pp. 1578-1585 ◽

Cited By ~ 1

Author(s):

Simon G. F. Abram ◽

Shiraz A. Sabah ◽

Abtin Alvand ◽

Andrew J. Price

Keyword(s):

Myocardial Infarction ◽

Pulmonary Embolism ◽

Adverse Events ◽

Knee Arthroplasty ◽

Revision Arthroplasty ◽

Complication Rates ◽

Serious Adverse Events ◽

Revision Knee Arthroplasty ◽

Primary Knee Arthroplasty ◽

Subsequent Revision

Aims To compare rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications), and compare these with primary arthroplasty and re-revision arthroplasty. Methods Patients undergoing primary knee arthroplasty were identified in the national Hospital Episode Statistics (HES) between 1 April 1997 to 31 March 2017. Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes, including infection (undergoing surgery), pulmonary embolism, myocardial infarction, and stroke. Urgent indications for revision arthroplasty were defined as infection or fracture, and all other indications (e.g. loosening, instability, wear) were included in the elective indications cohort. Results A total of 939,021 primary knee arthroplasty procedures were included (939,021 patients), of which 40,854 underwent subsequent revision arthroplasty, and 9,100 underwent re-revision arthroplasty. Revision surgery for elective indications was associated with a 90-day rate of mortality of 0.44% (135/30,826; 95% confidence interval (CI) 0.37 to 0.52) which was comparable to primary knee arthroplasty (0.46%; 4,292/939,021; 95% CI 0.44 to 0.47). Revision arthroplasty for infection was associated with a much higher mortality of 2.04% (184/9037; 95% CI 1.75 to 2.35; odds ratio (OR) 3.54; 95% CI 2.81 to 4.46), as was revision for periprosthetic fracture at 5.25% (52/991; 95% CI 3.94 to 6.82; OR 6.23; 95% CI 4.39 to 8.85). Higher rates of pulmonary embolism, myocardial infarction, and stroke were also observed in the infection and fracture cohort. Conclusion Patients undergoing revision arthroplasty for urgent indications (infection or fracture) are at higher risk of mortality and serious adverse events in comparison to primary knee arthroplasty and revision arthroplasty for elective indications. These findings will be important for patient consent and shared decision-making and should inform service design for this patient cohort. Cite this article: Bone Joint J 2021;103-B(10):1578–1585.

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