scholarly journals Impact of Dexmedetomidine on Tourniquet-Induced Systemic Effects in Total Knee Arthroplasty under Spinal Anesthesia: a Prospective Randomized, Double-Blinded Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Cheol Lee ◽  
Cheolhyeong Lee ◽  
Cheolhwan So ◽  
Jiheui Lee ◽  
Insung Choi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Systemic Effects ◽  
Normal Limits ◽  
Pain Outcomes ◽  
Calculated Volume ◽  
Tourniquet Release ◽  
Total Knee ◽  
Double Blinded ◽  
The Impact

Background. Clinical studies on the impact of dexmedetomidine on tourniquet-induced systemic effects have been inconsistent. We investigated the impact of dexmedetomidine on tourniquet-induced systemic effects in total knee arthroplasty. Methods. Eighty patients were randomly assigned to either control (CON) or dexmedetomidine (DEX) group. The DEX group received an intravenous loading dose of 0.5 μg/kg DEX over 10 minutes, followed by a continuous infusion of 0.5 μg/kg/h from 10 minutes before the start of surgery until completion. The CON group received the same calculated volume of normal saline. Pain outcomes and metabolic and coagulative changes after tourniquet application and after tourniquet release were investigated. Results. The frequency of fentanyl administration postoperatively, patient-controlled analgesia (PCA) volume at 24 hours postoperatively, total PCA volume consumed in 48 hours postoperatively, and VAS score for pain at 24 and 48 hours postoperatively were significantly lower in the DEX group than in the CON group. Ten minutes after the tourniquet release, the DEX group showed significantly higher pH and lower lactate level than those in the CON group. Antithrombin III activity and body temperature 10 minutes after tourniquet release were significantly lower in the DEX group than in the CON group. Ca2+, K+, HCO3-, base excess, and PCO2 levels 10 minutes after tourniquet release were not significantly different between the two groups. Conclusion. We showed that DEX attenuated pain and hemodynamic, metabolic, and coagulative effects induced by the tourniquet. However, these metabolic and coagulative changes were within normal limits. Therefore, DEX could be used as an analgesic adjuvant, but should not be considered for routine use to prevent the systemic effects induced by tourniquet use.

scholarly journals The impact of dexmedetomidine on tourniquet induced systemic effects in total knee arthroplasty under spinal anesthesia: a prospective randomized, double-blinded study.

2020 ◽  
Author(s):  
Cheol Lee ◽  
Cheolhyeong Lee ◽  
Cheolhwan So ◽  
Insung Choi ◽  
Jiheui Lee ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Systemic Effects ◽  
Normal Limits ◽  
Pain Outcomes ◽  
Tourniquet Release ◽  
Total Knee ◽  
Double Blinded ◽  
The Impact

Abstract Background: Clinical studies on the impact of dexmedetomidine on tourniquet-induced systemic effects have been inconsistent. We investigated the impact of dexmedetomidine on tourniquet-induced systemic effects including pain outcomes in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: Eighty patients were randomly assigned to either control (CON) or dexmedetomidine (DEX) group. DEX group received an intravenous loading dose of 0.5 µg/ kg DEX over 10 minutes, followed by a continuous infusion of 0.5 µg/ kg/h from 10 minutes before the start of surgery until completion. The CON group received the same calculated volume of normal saline. Pain outcomes and metabolic and coagulative changes after tourniquet application and after tourniquet release were investigated.Results: The frequency of fentanyl administration postoperatively, patient-controlled analgesia (PCA) volume at 24 hours postoperatively, total PCA volume consumed in 48 hours postoperatively, and VAS score for pain at 24 and 48 hours postoperatively were significantly lower in the DEX group than in the CON group.Ten minutes after tourniquet release, the DEX group showed significantly higher pH and lower lactate level than those in the CON group. Antithrombin III activity and body temperature 10 minutes after tourniquet release were significantly lower in the DEX group than in the CON group. Ca2+, K+, HCO3-, base excess, and PCO2 levels 10 minutes after tourniquet release were not significantly different between the two groups.Conclusion: We showed that DEX attenuated pain and hemodynamic, metabolic, and coagulative effects induced by tourniquet. However, these metabolic and coagulative changes were within normal limits. Therefore, DEX could be used as an analgesic adjuvant, but should not be considered for routine use to prevent the systemic effects induced by tourniquet use.

scholarly journals Effects of Tourniquet Application on Faster Recovery after Surgery and Ischemia-Reperfusion Post–Total Knee Arthroplasty, Cementation through Closure versus Full-Course and Nontourniquet Group

2021 ◽  
Author(s):  
Qinggang Cao ◽  
Qiong Wu ◽  
Yun Liu ◽  
Zhiwei He ◽  
Yu Cong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Ischemia Reperfusion ◽  
Inflammatory Factors ◽  
Thigh Circumference ◽  
Lower Pain ◽  
Total Knee ◽  
Double Blinded ◽  
Special Time ◽  
Time Point

AbstractPneumatic tourniquets are used in total knee arthroplasty (TKA) for surgical field visualization and improved cementation; however, their use is controversial. This study aimed to assess the effects of tourniquet application on faster recovery post-TKA. Our hypothesis was that inflammation and limb function would be similar with different tourniquet applications. A prospective randomized double-blinded trial assessed tourniquets effects on postoperative pain, swelling, and early outcome in TKA. In present study, 50 TKAs were enrolled in each group as follows: full course (FC), cementation through closure (CTC), and no tourniquet (NT), CTC as treatment group while FC and NT as control groups. Topical blood samples of 3 mL from the joint cavity and drainage bags were obtained at special time point. At last, all samples such as tumor necrosis factor-a (TNF-a), C-C motif chemokine ligand 2 (CCL2), pentraxin 3 (PTX3), prostaglandin E2 (PGE2), superoxide dismutase 1 (SOD1), and myoglobin (Mb) were detected by ELISA. Active and passive range of motion (ROM) values, pain score by the visual analog scale (VAS), change of thigh circumference were recorded at special time point as well. In topical blood, the change of inflammatory factors, such as TNF-a, PTX3, CCL2, PGE2, SOD1, and Mb, was lower in CTC and NT groups than in FC group (p < 0.01 and 0.05). Although VAS and ROM were comparable preoperatively in three groups (p > 0.05), the perimeter growth rate was lower, pain scores (VAS) were reduced, and ROM values were improved in CTC and NT groups compared with FC group at T4, T5, and T6 postoperatively (p < 0.01 and 0.05). Improved therapeutic outcome was observed in the CTC group, indicating patients should routinely undergo TKA with cementation through closure tourniquet application.

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

The Impact of Gastric Bypass Surgery Compared to Total Knee Arthroplasty on Knee Symptoms

2018 ◽  
Vol 04 (02) ◽  
Author(s):  
Hafiz Kassam ◽  
Allan Okrainec ◽  
Timothy Jackson ◽  
Michael G Zyweil ◽  
Anthony V Perruccio ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Gastric Bypass ◽  
Knee Arthroplasty ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Total Knee ◽  
The Impact

Bone ingrowth in total knee arthroplasty: The impact of HA-coatings and the relation with mechanical stability

1998 ◽  
Vol 31 ◽  
pp. 26
Author(s):  
L. Labey ◽  
H. Van Campenhout ◽  
J. Vander Sloten ◽  
R. Van Audekercke ◽  
G. Van der Perre ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Stability ◽  
Bone Ingrowth ◽  
Total Knee ◽  
The Impact

Effect of Gait on Patellofemoral Mechanics

2008 ◽  
Author(s):  
Jeffrey E. Bischoff ◽  
Justin S. Hertzler
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Clinical Studies ◽  
Patellofemoral Joint ◽  
Knee Kinematics ◽  
Component Design ◽  
Total Knee ◽  
The Impact ◽  
Reconstructed Knee

Computational modeling of the reconstructed knee is an important tool in designing components for maximum functionality and life. Utilization of boundary conditions consistent with in vivo gait loading in such models enables predictions of knee kinematics and polyethylene damage [1–4], which can then be used to optimize component design. Several recent clinical studies have focused on complications associated with the patellofemoral joint [5–6], highlighting the need to better understand the mechanics of this compartment of total knee arthroplasty (TKA). This study utilizes a computational model to characterize the impact of gait loading on the mechanics of the patella in TKA.

The impact of residual varus alignment following total knee arthroplasty on patient outcome scores in a constitutional varus population

The Knee ◽  
2018 ◽  
Vol 25 (6) ◽  
pp. 1278-1282 ◽  
Author(s):  
Brent A. Lanting ◽  
Harley A. Williams ◽  
Nicholas F. Matlovich ◽  
Pieter-Jan. Vandekerckhove ◽  
Matthew G. Teeter ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Alignment ◽  
Outcome Scores ◽  
Total Knee ◽  
The Impact ◽  
Constitutional Varus

scholarly journals Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double-blinded Controlled Trial

2018 ◽  
Vol 10 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Yan-yan Bian ◽  
Long-chao Wang ◽  
Wen-wei Qian ◽  
Jin Lin ◽  
Jin Jin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Multimodal Analgesia ◽  
Total Knee ◽  
Double Blinded

scholarly journals The Impact of Pre-emptive Large Dose of Methylprednisolone Combined With Gabapentin on Pain Treatment and Convalescence After Total Knee Arthroplasty in Elderly. A Randomized Control Study

2021 ◽  
Author(s):  
Henryk Liszka ◽  
Małgorzata Zając ◽  
Artur Gądek
Keyword(s):  
Total Knee Arthroplasty ◽  
Single Dose ◽  
Knee Arthroplasty ◽  
Opioid Analgesic ◽  
Control Group ◽  
Study Group ◽  
Intensity Level ◽  
Old Patients ◽  
Total Knee ◽  
The Impact

Abstract Background The aim of the study was to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). Material and Methods One hundred seventy, above 65 years old patients were qualified for the study, and 10 patients were excluded due to clinical situation. One hundred sixty patients were double-blind randomized into two groups: the study (eighty patients) and controls (eighty patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral gabapentin and 125 mg intravenous methylprednisolone, while the others placebo. Perioperatively, all the patients received opioid and nonopioid analgesic agents calculated for 1 kg of body weight. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein - CRP), pain intensity level at rest (numerical rating scale - NRS), the life parameters and all complications. Results Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia CRP values being lower on all postoperative days ( 1, 2 days - p<0,00001, 3 day – p=000538), leukocytosis on day 2 (p<0,0086) and 3 (p<0,00042), the NRS score at rest 6, 12 (p<0,000001), 18 (p<0,00004) and 24 (p=0,005569) hours postoperatively . Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p=0,000006). The duration time of analgesia was significantly longer in study group (p<0,000001). No infectious complications were observed; in the control group, one patient manifested transient ischaemic attack (TIA). Conclusion The use of gabapentin and methylprednisolone at a single dose decreases the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, the level of inflammatory parameters without infectious processes.

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