scholarly journals Outpatient total knee arthroplasty: is it worth considering?

2020 ◽  
Vol 5 (3) ◽  
pp. 172-179
Author(s):  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Discharge Planning ◽  
Young Patients ◽  
Cost Effective ◽  
Medical Outcomes ◽  
Vein Thrombosis ◽  
Cost Effective Treatment ◽  
Total Knee ◽  
Deep Vein

Some authors have reported that outpatient total knee arthroplasty (TKA) is a successful, safe and cost-effective treatment in the management of advanced osteoarthritis. The success obtained has been attributed to the coordination of the multidisciplinary team, standardized perioperative protocols, optimal hospital discharge planning and careful selection of patients. One study has demonstrated a higher risk of perioperative surgical and medical outcomes in outpatient TKA than inpatient TKA, including component failure, surgical site infection, knee stiffness and deep vein thrombosis. There remains a lack of universal criteria for patient selection. Outpatient TKA has thus far been performed in relatively young patients with few comorbidities. It is not yet clear whether outpatient TKA is worth considering, except in very exceptional cases (young patients without associated comorbidities). Outpatient TKA should not be generally recommended at the present time. Cite this article: EFORT Open Rev 2020;5:172-179. DOI: 10.1302/2058-5241.5.180101

Prevention of Deep-Vein Thrombosis After Total Knee Arthroplasty in Asian Patients

2004 ◽  
Vol 86 (1) ◽  
pp. 136-140 ◽  
Author(s):  
Ching-Jen Wang ◽  
Jun-Wen Wang ◽  
Lin-Hsiu Weng ◽  
Chia-Chen Hsu ◽  
Chung-Cheng Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Deep Vein Thrombosis ◽  
Knee Arthroplasty ◽  
Vein Thrombosis ◽  
Asian Patients ◽  
Total Knee ◽  
Deep Vein

scholarly journals Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Siyuan Zhang ◽  
Kway Swar Htet ◽  
Xin Yang Tan ◽  
Xinyu Wang ◽  
Wilson Wang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Deep Vein Thrombosis ◽  
Short Duration ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Mechanical Prophylaxis ◽  
Vein Thrombosis ◽  
Asian Patients ◽  
Total Knee ◽  
Deep Vein

Abstract Background Venous thromboembolism (VTE) is a serious complication that may occur after total knee arthroplasty (TKA), leading to the recommendation of routine chemoprophylaxis by international guidelines. This study aims to determine if short-duration chemoprophylaxis after TKA reduces the incidence of VTE in an Asian population. Methods A retrospective study of 316 patients who underwent unilateral primary TKA between 1 January 2011 and 31 December 2013 was conducted. All patients received mechanical prophylaxis. One hundred seventeen patients (37%) received additional chemoprophylaxis, whereas 199 patients (63%) did not. A Doppler ultrasound (DUS) of both lower limbs was conducted for all patients within 6 days after surgery (median = 3 days) to assess for both proximal and distal DVT. Chemoprophylaxis in the form of enoxaparin (low molecular weight heparin; LMWH), aspirin, or heparin was administered until patients had a normal DUS, for a median duration of 4 days. Patients were followed up clinically for a minimum of 6 months to monitor for delayed or recurrent VTE and at least 2 years for patient-reported outcome measures. Results Overall, 24 patients (7.59%) developed deep vein thrombosis (DVT): three proximal and 21 distal DVTs. Twenty-three of the 24 patients were asymptomatic. Twenty of 199 patients (10.05%) with only mechanical prophylaxis developed DVT, whereas four of 117 patients (3.42%) with additional chemoprophylaxis developed DVT. Multivariate analysis showed that chemoprophylaxis use was associated with reduced incidence of DVT (odds ratio = 0.19, p value = 0.011). Other factors associated with increased DVT incidence include female gender (odds ratio = 5.45, p value = 0.034), positive history of cancer (odds ratio = 5.14, p value = 0.044), and increased length of stay in hospital (odds ratio = 1.19, p value < 0.001). Conclusions Our study has shown that despite the low incidence of DVT in Asian patients undergoing TKA, short-duration chemoprophylaxis might be effective in reducing the incidence of DVT. However, most DVTs observed in our study were distal and may be of limited clinical significance. Further studies are needed to investigate the impact of chemoprophylaxis use on the incidence of PE and overall mortality rates among Asian patients.

Influence of the Tourniquet on Pain and Function in Total Knee Arthroplasty: a Systematic Review and Meta-Analysis

2019 ◽  
Vol 158 (06) ◽  
pp. 630-640 ◽  
Author(s):  
Ahmed Jawhar ◽  
Dania Skeirek ◽  
Vera Stetzelberger ◽  
Udo Obertacke
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Society Score ◽  
Vein Thrombosis ◽  
Analgesic Consumption ◽  
Total Knee ◽  
Without Tourniquet ◽  
Deep Vein

Abstract Background The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. Material and Methods This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words “tourniquet”, “total knee arthroplasty”, “TKA” and “knee endoprosthesis” up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. Results 18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. Conclusion The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.

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