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

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.

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

BioMed Research International ◽

10.1155/2020/4208597 ◽

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.

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Association between perioperative statin use and postoperative pain after total knee arthroplasty

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000018 ◽

2019 ◽

Vol 44 (2) ◽

pp. 221-226 ◽

Cited By ~ 1

Author(s):

Tak Kyu Oh ◽

Chong Bum Chang ◽

Hyun-Jung Shin ◽

Sunghee Han ◽

Sang-Hwan Do ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Spinal Anesthesia ◽

Knee Arthroplasty ◽

Medical Records ◽

Statin Group ◽

Pain Outcomes ◽

Total Knee ◽

Morphine Equivalent ◽

Statin Use

Background and objectivesData is insufficient to determine whether perioperative statin use increases or decreases postoperative pain. This study aimed to investigate the association between perioperative statin use and pain outcomes after total knee arthroplasty performed under spinal anesthesia.MethodsThis is a retrospective, observational study based on medical records from a tertiary hospital between January 2005 and October 2017. Medical records of patients who underwent elective total knee arthroplasty under spinal anesthesia as inpatients were analyzed. Pain outcomes were compared through postoperative day (POD) 3 in patients who were taking statins perioperatively versus patients who were not taking statins.ResultsA total of 1088 propensity-matched participants were included in the final analysis (544 patients in the statin group and 544 patients in the non-statin group). The total morphine equivalent consumption through POD 3 was higher in the statin group than in the non-statin group (mean (SD), statin group: 525.4 (119.7) vs non-statin group: 495.3 (115.3), 95% CI of the difference: 15.9 to 44.4, p<0.001). In the linear regression analysis, the total morphine equivalent consumption through POD 3 was 30.14 mg higher in the statin group compared with the non-statin group (95% CI 15.93 to 44.35; p<0.001).ConclusionsPerioperative statin use is associated with a significant increase in postoperative opioid consumption after total knee arthroplasty performed under spinal anesthesia; however, this increase was so marginal that its clinical importance remains controversial.

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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

The Journal of Knee Surgery ◽

10.1055/s-0041-1728814 ◽

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04512-1 ◽

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)

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

journal of Clinical & Experimental Orthopaedics ◽

10.4172/2471-8416.100058 ◽

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

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

Journal of Biomechanics ◽

10.1016/s0021-9290(98)80055-9 ◽

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

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Re: Short-term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double-blinded controlled trial

ANZ Journal of Surgery ◽

10.1111/ans.13677 ◽

2016 ◽

Vol 86 (10) ◽

pp. 845-846 ◽

Cited By ~ 1

Author(s):

Lawrence Kohan ◽

Dennis Kerr

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Controlled Trial ◽

Short Term ◽

Local Infiltration ◽

Randomized Controlled ◽

Total Knee ◽

Double Blinded

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Effect of Gait on Patellofemoral Mechanics

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-192451 ◽

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.

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