scholarly journals Does intraoperative mechanical prophylaxis prevent venous thromboembolism in total knee arthroplasty? – effectiveness of passive-assisted ankle motion in surgical/non-surgical side

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Toshiyuki Tateiwa ◽  
Tsunehito Ishida ◽  
Toshinori Masaoka ◽  
Takaaki Shishido ◽  
Yasuhito Takahashi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Compression Stocking ◽  
Mechanical Prophylaxis ◽  
Ankle Motion ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background Gradual compression stocking (GCS) and intermittent pneumatic compression device (IPCD) are used for intraoperative mechanical prophylaxis against venous thromboembolism (VTE) during total knee arthroplasty (TKA). In this study, we applied a passive-assisted ankle motion in combination with GCS and IPCD during TKA and evaluated its effectiveness in preventing postoperative VTE. Methods We included 77 patients who underwent primary unilateral TKA. Patients were divided into group A (53 patients who underwent GCS and IPCD on their non-surgical side limb) and group B (24 patients who underwent passive ankle dorsiflexion motion in addition to GCS and IPCD on their non-surgical side limb). Deep vein thrombosis (DVT) was assessed using lower extremity ultrasonography (US). The incidence of VTE in each affected limb was compared between the two groups. Results US was performed 4 days after surgery on average. The incidence of DVT in groups A and B was 47.2 and 70.8 %, respectively. In group A, 22.6 % of DVTs were found only on the surgical side, 11.3 % on the non-surgical side, and 13.2 % on both sides. On the other hand, in group B, 41.7 % of DVTs were found only on the surgical side, 4.2 % on the non-surgical side, and 25.0 % on both sides. No significant difference in the incidence of VTE was noted between the 2 groups. Conclusions The intraoperative application of passive ankle motion plus GCS and IPCD might not further reduce the incidence of postoperative DVT in TKA patients.

scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Maolin Sun ◽  
Ying Zhang ◽  
Yang Peng ◽  
Dejie Fu ◽  
Huaquan Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Swing Phase ◽  
Flexion Angle ◽  
Gait Parameters ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B

Background. With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods. Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results. The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P<0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P<0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion. 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

Comparison the Postoperative Blood Loss in Total Knee Arthroplasty with and without Perioperative Tourniquet Release

2021 ◽  
Vol 15 (5) ◽  
pp. 1142-1143
Author(s):  
S. Aziz ◽  
S. Ahmed ◽  
S. A. Mahar ◽  
S. Ali ◽  
J. Kumar
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Postoperative Blood Loss ◽  
Keywords Total Knee Arthroplasty ◽  
Significant Difference ◽  
Tourniquet Release ◽  
Group A ◽  
Total Knee ◽  
Group B

Objective: To compare the postoperative blood loss in total knee arthroplasty with and without perioperative tourniquet release. Study Design: Randomized control trial Place & Duration of Study: Department of Orthopaedic, M. Islam Teaching Hospital Gujranwala 1st January 2020 to 31st December 2020. Methodology: Ninety patients of both genders undergoing total knee arthroplasty were included in this study. Patient’s demographics were recorded after written consent. Patients were equally divided into two groups. Group A (45 patients) received total knee arthroplasty with tourniquet while group B (45 patients) received total knee arthroplasty without tourniquet. Postoperative blood loss was measured by suction drain, levels of haemoglobin were examined and compare between two groups. Results: The mean age of the patients in group A was 57.76±2.4 years while in group B it was 58.16±7.8 years. 32 (71.11%) and 34 (75.56%) were males while 13 (28.89%) and 11 (24.44%) were females in group A and B. We observed patients at the three different points and found lower blood loss in patients who received total knee arthroplasty with tourniquet as compared to no tourniquet group (p-value <0.05). No significant difference was observed regarding hemoglobin at 2 hours and significant differences were observed at 24 and 48 hour postoperatively. Conclusion: Tourniquet is useful to decrease loss of blood in patients undergoing total knee arthroplasty. Keywords: Total knee arthroplasty (TKA), Tourniquet, Blood loss

Early Aseptic Loosening with Increased Presence and Severity of Backside Burnishing in the Optetrak Logic Posterior-Stabilized Total Knee Arthroplasty Femoral Component

2021 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
David A. Iacobelli ◽  
Lisa Torres ◽  
Carolena Rojas Marcos ◽  
Allina A. Nocon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Severe Degree

AbstractConcerns persist that the Optetrak Logic posterior-stabilized (PS) total knee arthroplasty (TKA) femoral component might correlate with early failures due to aseptic loosening. The primary aim of this study was to examine if the use of the Optetrak Logic PS femoral component is associated with early (<5 years) and more extensive aseptic loosening compared with other PS femoral components. This is a single-institution retrieval analysis and revision registry study (based on prospectively collected data) of 27 failed primary PS TKA patients with loose femoral components that underwent revision TKAs between 2016 and 2019. Patients were stratified by components type: Group A (n = 16) received the Optetrak Logic PS femoral component, while Group B (n = 11) received other PS femoral components. Burnishing (macroscopic polishing of the component's backside) was observed and graded as a marker for relative motion at the cement-implant interface. No significant differences were found between the two groups regarding the baseline demographic, radiographic, and clinical characteristics. Mean length of implantation for Group A (3.8 ± 2.9 years) was significantly shorter (p < 0.001) than that of Group B (12.0 ± 6.7 years). A significant difference (p = 0.009) was found in presence of backside femoral burnishing between Group A (15 of 16 patients; 93.8%) and group B (5 of 11 patients; 45.6%). Furthermore, we found a significant difference (p < 0.001) in the severity of burnishing between Group A (13 of 16 patients with severe degree of burnishing; 81.3%) and Group B (1 of 11 patients with severe degree of burnishing; 9.1%). In contrast to Group B, a distinctive macroscopic pattern found in Logic retrieved femoral components (Group A) was the total absence of cement in the backside surface. The use of the Optetrak Logic PS TKA femoral component was associated with early aseptic loosening and increased presence and severity of backside burnishing with early cement-implant interface debonding compared with other commercially available types of PS TKA femoral components. The earlier failure rate with this implant is of concern.

scholarly journals Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Sanjay Bhalchandra Londhe ◽  
Ravi Vinod Shah ◽  
Amit Pankaj Doshi ◽  
Shubhankar Sanjay Londhe ◽  
Kavita Subhedar ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Forgotten Joint Score ◽  
Group A ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Group B ◽  
Discharge From Hospital

Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.

scholarly journals The influence of previous arthroscopic treatment on subsequent primary total knee arthroplasty: the comparison between bilateral knees of the same patient

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuishuai Xu ◽  
Liang Zhang ◽  
Rui Shen ◽  
Cailin Wang ◽  
Tianyu Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Arthroscopic Treatment ◽  
Functional Scores ◽  
Group A ◽  
Vas Scores ◽  
Total Knee ◽  
Group B

Abstract Background To explore whether previous arthroscopic knee surgery affects future total knee arthroplasty (TKA) results or not. Methods A total of 56 patients with the previous arthroscopic treatment on one knee underwent subsequent bilateral total knee arthroplasty in our hospital from September 2012 to July 2018. Data on each patient were collected in regards to changes in postoperative clinical and functional scores, various other scores, as well as postoperative functional recovery and complications. We defined the knees with a previous arthroscopic history as group A, and the counter side as group B. The Knee Society clinical score, functional scores, range of motion (ROM), finger joint size (FJS), visual analogue scale (VAS) scores were assessed before and after surgery. Using the Kolmogorov-Smirnov Test to test the normality of continuous variables, and the chi-square test to compare the rate of reoperation and complications between two groups. For all statistical comparisons, P < 0.05 was considered significant. Results There were no statistically significance differences found in postoperative Knee Society clinical scores and functional scores between group A and group B, as well as in ROM, FJS, VAS scores and local complications. Conclusion There were no statistically significant differences found in postoperative functional recovery and complications in patients, who underwent total knee arthroplasty with previous knee arthroscopy.

Acute normovolemic hemodilution in total knee arthroplasty, a prospective study

2016 ◽  
Author(s):  
Jin Kyu Lee ◽  
Mi Ae Cheong ◽  
Choong Hyeok Choi
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Allogeneic Blood ◽  
Acute Normovolemic Hemodilution ◽  
Allogeneic Transfusion ◽  
Group A ◽  
Total Knee ◽  
Normovolemic Hemodilution ◽  
Group B

Abstract Objective: In this prospective, randomized, controlled trial we sought to evaluate the effectiveness of acute normovolemic hemodilution (ANH) in terms of decreasing the need for allogeneic transfusion after conventional unilateral total knee arthroplasty (TKA). Summary of Background Data: TKA is often performed with an occlusive tourniquet, and thus, it could be considered ideally suited for ANH, because the chief benefit of ANH is red blood cell loss reduction and the shedding of whole blood perioperatively at lower hematocrit levels. Methods: Between January 2012 and May 2012, 40 consecutive patients scheduled to undergo elective, primary, cemented, unilateral TKA for knee osteoarthritis were enrolled. Patients were randomized to either a study (ANH) group (n=20) (Group A) or a control group (n=20) (Group B). Unit of allogeneic blood transfused was considered the primary outcomes. Results : In the ANH group, less allogeneic blood transfusion (6 units in Group A vs 15 units in Group B) was required after operation. Six patients, who required a transfusion in Group A received 1 unit of allogeneic blood. In contrast, 6 of 9 patients, who required transfusion in Group B, received at least 2 units of allogeneic blood (p&lt;0.05). There was no complication related to the methods of the protocol. Conclusions: ANH is likely to reduce postoperative allogeneic transfusion requirement in patients undergoing unilateral TKA. However, adjunctive strategies are required to further reduce allogeneic blood transfusion requirements.

scholarly journals Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

2020 ◽  
Author(s):  
Kaiyuan Liu ◽  
Dong Yang ◽  
Tianyang Xu ◽  
Wenwei Jiang ◽  
Lin Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Minimally Invasive ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Femoral Prosthesis ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Varus Angle

Abstract Purpose: We hypothesized that patellar positioning during minimally invasive total knee arthroplasty (MIS-TKA) would affect soft tissue balance and postoperative outcome.Methods: From December 2018 to February 2019, 55 patients receiving primary MIS-TKA were enrolled. The gap-balance technique was used, with patients randomly assigned to undergo osteotomy and balance of soft tissue with the patella reduced (group A; n = 27) or with the patella subluxated (group B; n = 28). The soft tissue balance achieved with the patella reduced and subluxated were compared. Femoral prosthesis rotation, mechanical femoral axis–to–tibial axis angle, Knee Society Score (KSS), pain score, and range of flexion were compared between the groups. Follow-up was for 6 months.Results: The flexion gap and the varus angle were significantly greater after patella reduction than before reduction, but the extension joint gap and varus angle were comparable before and after patella reduction. The femoral prosthesis tended to be internally rotated in group B. Range of flexion was better in the group A than in group B at 1 month after surgery, but the differences were not significant at 3 and 6 months. KSS and pain score were comparable between the groups after surgery.Conclusion: During MIS-TKA, as far as possible, soft tissue balance should be achieved with the patella reduced; otherwise, the femoral prosthesis may be installed more internally and, after patella reduction, the flexion gap and varus would increase.

Low-Dose Aspirin is Safe and Effective for Venous Thromboembolism Prevention in Patients Undergoing Revision Total Knee Arthroplasty: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Alex Tang ◽  
Stephen G. Zak ◽  
Daniel Waren ◽  
Richard Iorio ◽  
James D. Slover ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Total Joint Replacement ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Bleeding Complications ◽  
Vte Prophylaxis ◽  
Significant Difference ◽  
Total Knee

AbstractVenous thromboembolism (VTE) events are rare, but serious complications of total joint replacement affect patients and health care systems due to the morbidity, mortality, and associated cost of its complications. There is currently no established universal standard of care for prophylaxis against VTE in patients undergoing revision total knee arthroplasty (rTKA). The aim of this study was to determine whether a protocol of 81-mg aspirin (ASA) bis in die (BID) is safe and/or sufficient in preventing VTE in patients undergoing rTKAs versus 325-mg ASA BID. In 2017, our institution adopted a new protocol for VTE prophylaxis for arthroplasty patients. Patients initially received 325-mg ASA BID for 1 month and then changed to a lower dose of 81-mg BID. A retrospective review from 2011 to 2019 was conducted identifying 1,438 consecutive rTKA patients and 90-day postoperative outcomes including VTE, gastrointestinal, and wound bleeding complications, acute periprosthetic joint infection, and mortality. In the 74 months prior to protocol implementation, 1,003 rTKAs were performed and nine VTE cases were diagnosed (0.90%). After 26 months of the protocol change, 435 rTKAs were performed with one VTE case identified (0.23%). There was no significant difference in rates or odds in postoperative pulmonary embolism (PE; p = 0.27), DVT (p = 0.35), and total VTE rates (p = 0.16) among patients using either protocol. There were also no differences in bleeding complications (p = 0.15) or infection rate (p = 0.36). No mortalities were observed. In the conclusion, 81-mg ASA BID is noninferior to 325-mg ASA BID in maintaining low rates of VTE and may be safe for use in patients undergoing rTKA.

scholarly journals A sagittal reference line using the preoperative radiograph in total knee arthroplasty

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092414
Author(s):  
Hee-June Kim ◽  
Jeong-Woo Kim ◽  
Ji-Yeon Shin ◽  
Junekyu Kim ◽  
Hyun-Joo Lee ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Slope Angle ◽  
Reference Line ◽  
Shaft Line ◽  
Group A ◽  
Total Knee ◽  
The Difference ◽  
Group B ◽  
Preoperative Radiograph

Background: We evaluated the accuracy of a sagittal alignment of tibial component in total knee arthroplasty (TKA) with the sagittal reference line using the preoperative radiograph. Methods: We evaluated 151 patients who underwent primary TKA with posterior cruciate substituting type implant. For 75 patients, the sagittal reference line using preoperative radiograph (group A) was used, while for 76 patients the sagittal reference using intraoperative fibular shaft line (group B) was used. The parallel line (line S) to the anatomical axis of the tibia in the lateral plain radiograph was used as the sagittal reference. The distance from line S to proximal tibia cutting area and to skin surface 20 cm distal to the cutting area was measured in preoperative radiographs. Next, the distance to the extramedullary guide rod was applied intraoperatively, reflecting the results. The intraoperative fibular shaft line was determined using the connecting line between the tip of fibular head and the lateral malleolus. The postoperative tibial component slope angle and the difference to the target slope angle were compared. Results: The difference to the target angle was 1.8 ± 1.3° in group A, whereas the difference was 2.5 ± 1.4° in group B ( p = 0.04). The patients with difference within 3° to the target angle were 78.7% in group A and 61.8% in group B ( p = 0.024). Conclusion: The sagittal reference line using the preoperative lateral radiograph was helpful as a reference guide for the tibial slope in TKA.

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