scholarly journals Changes in thromboelastography to predict ecchymosis after knee arthroplasty: a promising guide for the use of anticoagulants: a case control study

2021 ◽  
Author(s):  
Yuelong Chen ◽  
Leilei Qin ◽  
Jiawei Wang ◽  
Xuan Gong ◽  
Ning Hu
Keyword(s):  
Risk Factors ◽  
Knee Arthroplasty ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Threshold Value ◽  
Youden Index ◽  
Functional Rehabilitation ◽  
Hidden Blood Loss ◽  
Total Knee ◽  
Control Study

Abstract BackgroundEcchymosis is one of the worrisome complications after total knee arthroplasty (TKA) and interferes with functional rehabilitation. Current clinical guidelines do not provide individualized approaches for patients with ecchymoses. In this study, we used thromboelastography (TEG) to determine the coagulation state after TKA and to then explore markers that predict the occurrence of ecchymosis events after TKA.MethodsIn our cohort, patients were divided into ecchymosis (n=55) and nonecchymosis (n=137) groups according to whether ecchymosis events occurred after TKA. Rivaroxaban 10 mg/d was taken orally for thromboprophylaxis after surgery. All patients completed TEG testing. Correlation analysis was used to determine the risk factors for ecchymosis after TKA, and receiver operating characteristic (ROC) curves for variables with significant correlation were plotted.ResultsIn all, 55 of the 192 patients (28.65%) developed ecchymosis surrounding the surgical site. Multivariate analysis showed that hidden blood loss (OR = 1.003 and p =.005) and changes in the coagulation index (ΔCI) values (OR = 0.351 and p =.001) were risk factors for ecchymosis after TKA. Using the Youden index, 0.1805 was determined as the optimal threshold value of ΔCI for predicting the occurrence of ecchymosis, with a sensitivity of 74.55% and specificity of 72.99%.ConclusionsΔCI is a promising marker as an alarm for the occurrence of ecchymosis after TKA.Trial registrationChinese Clinical TrialRegistry, ChiCTR, NO. ChiCTR1800017245. Registered 19 July 2018 - Prospective registered, http://www.chictr.org.cn

Risk factors for nerve injury after total knee arthroplasty: a case control study

2018 ◽  
Vol 28 ◽  
pp. S24
Author(s):  
T. Shetty ◽  
J.T. Nguyen ◽  
M. Sasaki ◽  
A. Wu ◽  
E. Bogner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Nerve Injury ◽  
Knee Arthroplasty ◽  
Case Control Study ◽  
Case Control ◽  
Total Knee ◽  
Control Study

scholarly journals The Analysis of Risk Factors in No Thumb Test in Total Knee Arthroplasty

2011 ◽  
Vol 3 (4) ◽  
pp. 274 ◽  
Author(s):  
Jee Hyoung Kim ◽  
Song Lee ◽  
Dong Oh Ko ◽  
Chang Wook Yoo ◽  
Tae Hwan Chun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Total Knee

scholarly journals Wound Issues after Total Knee Arthroplasty

2015 ◽  
Vol 5 (1) ◽  
pp. 10-13
Author(s):  
Douglas A Dennis
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Wound Complications ◽  
Operative Techniques ◽  
Proper Selection ◽  
Wound Healing Problems ◽  
Total Knee ◽  
Selection Of

ABSTRACT Wound healing problems following total knee arthroplasty (TKA) are infrequent, but if present may lead to devastating results. Occurrence may be minimized by modifying patient risk factors, proper selection of skin incisions, and using operative techniques that protect soft tissues. When wound complications arise, prompt management is imperative to assure the best outcome after TKA. Jennings JM, Dennis DA. Wound Issues after Total Knee Arthroplasty. The Duke Orthop J 2015;5(1):10-13.

scholarly journals Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults

2009 ◽  
Vol 13 (4) ◽  
pp. 488-495 ◽  
Author(s):  
Ahmet Selçuk Can ◽  
Emine Akal Yıldız ◽  
Gülhan Samur ◽  
Neslişah Rakıcıoğlu ◽  
Gülden Pekcan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Risk Factor ◽  
Cardiometabolic Risk ◽  
Roc Curves ◽  
Cross Sectional Study ◽  
Cardiometabolic Risk Factors ◽  
Youden Index ◽  
Cross Sectional ◽  
Men And Women

AbstractObjectiveTo identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults.DesignCross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score ≥2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 − specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity − 1).SettingTurkey, 2003.SubjectsAdults (1121 women and 571 men) aged 18 years and over were examined.ResultsAnalysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0·55 and 0·60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0·63 and 0·81, the specificities were between 0·42 and 0·71 and the accuracies were between 0·65 and 0·73, for men and women. The cut-off point of 0·59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR ≥ 0·59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0·59, except for diabetes in men.ConclusionsWe show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0·59 in Turkish adults.

Blood loss and knee function after unicompartment knee arthroplasty(UKA) without tourniquet

2020 ◽  
Author(s):  
Zhanfeng Zhang ◽  
Jianming Zhong ◽  
Jikang Min ◽  
Dan Wang ◽  
Lidong Wu
Keyword(s):  
Blood Loss ◽  
Knee Arthroplasty ◽  
Knee Function ◽  
Whole Process ◽  
Hidden Blood Loss ◽  
Total Knee ◽  
American Society ◽  
Without Tourniquet ◽  
And Function ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe characteristics of blood loss and knee function after unicompartment knee arthroplasty(UKA) remains unclear. Utilization of tourniquet is considered to compromise the outcome of knee arthroplasty. This study aims to evaluate the hidden blood loss and function restoration of UKA without tourniquet by comparing with total knee arthroplasty(TKA).MethodsIn this retrospective study, a total of 112 patients were included from August 2017 to October 2018. Both the UKA group (n = 56) and the TKA group (n = 56) underwent procedure without utilization of tourniquet during the whole process. The gender, age, body mass index, American Society of Anesthesiologists score, Kellgren-Lawrence grade, preioperative Hb, and volume of hidden blood loss (HBL) were recorded and analysed. Knee function was assessed at 3 month and 12 month after procedure by using HSS score.ResultThe mean volume of HBL was significant lower in UKA group (324.23ml ± 147.05, 864.82ml ± 206.37, P = 0.001). The HSS score was higher in UKA group 3 month after procedure (88.16 ± 5.57, 83.04 ± 4.88, P = 0.033). No HBL difference was observed in either groups in terms of gender nor age. Hb level dropped to the bottom at the 4th day postoperatively. No correlation was observed between HBL and knee function.ConclusionWithout utilization of tourniquet, the HBL could not be ignored in UKA though it is much less than TKA, and the knee function was not compromised by it.Trial registrationCurrent trial ISRCTN85133278 (Retrospectively registered on 06 April 2020).

scholarly journals Comparative responsiveness of the PROMIS-10 Global Health and EQ-5D questionnaires in patients undergoing total knee arthroplasty

2019 ◽  
Vol 101-B (7) ◽  
pp. 832-837 ◽  
Author(s):  
J. Shim ◽  
D. F. Hamilton
Keyword(s):  
Total Knee Arthroplasty ◽  
United Kingdom ◽  
Global Health ◽  
Physical Health ◽  
Knee Arthroplasty ◽  
Roc Curves ◽  
Change Scores ◽  
The United Kingdom ◽  
Patient Reported ◽  
Total Knee

AimsResponsiveness to clinically important change is a key feature of any outcome measure. Throughout Europe, health-related quality of life following total knee arthroplasty (TKA) is routinely measured with EuroQol five-dimension (EQ-5D) questionnaires. The Patient-Reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10 Global Health) score is a new general heath outcome tool which is thought to offer greater responsiveness. Our aim was to compare these two tools.Patients and MethodsWe accessed data from a prospective multicentre cohort study in the United Kingdom, which evaluated outcomes following TKA. The median age of the 721 patients was 69.0 years (interquartile range, 63.3 to 74.6). There was an even division of sex, and approximately half were educated to secondary school level. The preoperative EQ-5D, PROMIS-10, and Oxford Knee Scores (OKS) were available and at three, six, and 12 months postoperatively. Internal responsiveness was assessed by standardized response mean (SRM) and effect size (Cohen’s d). External responsiveness was assessed by correlating change scores of the EQ-5D and PROMIS-10, with the minimal clinically important difference (MCID) of the OKS. Receiver operating characteristic (ROC) curves were used to assess the ability of change scores to discriminate between improved and non-improved patients.ResultsAll measures showed significant changes between the preoperative score and the various postoperative times (p < 0.001). Most improvement occurred during the first three months, with small but significant changes between three and six months, and no further change between six and 12 months postoperatively. SRM scores for EQ-5D, PROMIS-10, and OKS were large (> 0.8). ROC curves showed that both EQ-5D and PROMIS-10 were able to discriminate between patients who achieved the OKS MCID and those who did not (area under the curve (AUC) of 0.7 to 0.82).ConclusionThe PROMIS-10 physical health tool showed greater responsiveness to change than the EQ-5D, most probably due to the additional questions on physical health parameters that are more susceptible to modification following TKA. The EQ-5D was, however, shown to be sensitive to clinically meaningful change following TKA, and provides the additional ability to calculate health economic utility scores. It is likely, therefore, that EQ-5D will continue to be the global health metric of choice in the United Kingdom. Cite this article: Bone Joint J 2019;101-B:832–837.

Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

2019 ◽  
Vol 101-B (11) ◽  
pp. 1356-1361 ◽  
Author(s):  
Brian P. Chalmers ◽  
Kapil G. Mehrotra ◽  
Rafael J. Sierra ◽  
Mark W. Pagnano ◽  
Michael J. Taunton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Cox Regression Analysis ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

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