scholarly journals Sympathetic Predominance Before Tourniquet Deflation is Associated With a Reduction in Arterial Blood Pressure After Tourniquet Deflation During Total Knee Arthroplasty

2021 ◽  
pp. 401-412
Author(s):  
E KIM ◽  
M CHO ◽  
S BYUN ◽  
J A LIM ◽  
S CHAE ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Knee Arthroplasty ◽  
Sympathetic Activity ◽  
Sympathovagal Balance ◽  
Arterial Blood ◽  
Total Knee ◽  
Tourniquet Deflation

High dependency of arterial blood pressure (ABP) on enhanced sympathetic activity, which maintains vascular tone, leads to hypotension after hemodynamic insults that blunt the sympathetic activity. Therefore, we hypothesized that sympathovagal balance before tourniquet deflation (TD) determines the extent of a reduction in ABP after TD during total knee arthroplasty (TKA). Fifty-four hypertensive female patients undergoing TKA under spinal anesthesia were analyzed. The sympathovagal balance [low-to-high frequency ratio of heart rate variability (LF/HF)] before TD was defined as (LF/HF during 5 min before TD-preanesthetic LF/HF)/preanesthetic LF/HF (%). An increase in its value represents a shift in sympathovagal balance toward sympathetic predominance. The percent change in the mean ABP (MAP) after TD was defined as (minimum MAP during 10 min after TD-averaged MAP during 5 min before TD)/averaged MAP during 5 min before TD (%). Simple linear regression was performed to assess the correlation between the sympathovagal balance before TD and change in MAP after TD. The correlation was also assessed by multiple linear regression controlling for age, duration of tourniquet inflation, and spinal anesthesia-induced hypotension. Thirty-two minutes (on average) after tourniquet inflation, the MAP was decreased by 12.1 (-3.0 to 47.9) % [mean (range)] upon TD (P<0.001). The sympathovagal balance before TD was negatively proportional to the change in MAP after TD in both simple and multiple linear regression models (R2=0.323 and 0.340, P<0.001). A shift in sympathovagal balance toward sympathetic predominance before TD is associated with a decrease in ABP after TD.

scholarly journals Relationship between early physical activity after total knee arthroplasty and postoperative physical function: are these related?

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Daisuke Takamura ◽  
Kentaro Iwata ◽  
Tatsuya Sueyoshi ◽  
Tadashi Yasuda ◽  
Hideki Moriyama
Keyword(s):  
Physical Activity ◽  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Timed Up And Go ◽  
Total Knee

Abstract Background Physical activity is associated with physical function; however, the relationship between early physical activity after total knee arthroplasty (TKA) and postoperative physical function remains unclear. The purpose of this study was to evaluate the association of early physical activity after TKA with postoperative physical function. Methods Timed Up and Go test (TUG) of 47 patients was assessed preoperatively and at 10 days, 3 months, and 6 months postoperatively. Physical activity from the second to the ninth day after TKA was measured with accelerometer, and the correlation with pre- and postoperative physical function was evaluated . A multiple linear regression was used to predict TUG at 6 months after TKA. Results Postoperative physical activity correlated with preoperative TUG (ρ = −0.485, p < 0.001), TUG at 10 days (ρ = −0.675, p < 0.001), 3 months (ρ = −0.441, p < 0.01), and 6 months (ρ = −0.368, p < 0.05) after surgery. Multiple linear regression indicated that only the preoperative TUG was associated with TUG at 6 months. Postoperative physical activity was not an independent factor predicting TUG at 6 months after TKA. Conclusion Our study demonstrated that patients with better physical function have higher physical activity in the early postoperative period, whereas it does not affect physical function at 6 months after TKA. In the early postoperative period, increasing physical activity may not always be necessary to improve postoperative physical function. We also confirmed that preoperative physical function affects postoperative physical function. These findings may be beneficial in improving rehabilitation programs in the early postoperative period.

Thromboembolism coincident with tourniquet deflation during total knee arthroplasty

The Lancet ◽  
1993 ◽  
Vol 341 (8852) ◽  
pp. 1057-1058 ◽  
Author(s):  
J.L. Parmet ◽  
J.C. Horrow ◽  
H. Rosenberg ◽  
A.T. Berman ◽  
S. Harding
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Total Knee ◽  
Tourniquet Deflation

scholarly journals 1-Year Patient Outcomes for Robotic-Arm Assisted vs. Manual Total Knee Arthroplasty

10.29007/nrl3 ◽  
2019 ◽  
Author(s):  
Robert Marchand ◽  
Nipun Sodhi ◽  
Hiba Anis ◽  
Joseph Ehiorobo ◽  
Jared Newman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Pain Scores ◽  
Patient Reported ◽  
Beta Coefficient ◽  
Total Knee

Introduction:Robotic-arm assisted (RAA) total knee arthroplasty (TKA) has been shown to potentially have certain pre- and intra-operative advantages over manual techniques. Although there are many studies on the alignment advantages when using the robotic-arm assisted (RAA) system for total knee arthroplasty (TKA), there have been questions regarding patient-reported outcomes. Therefore, the purpose of this study was to use this index to compare: 1) total; 2) physical function; and 3) pain scores for manual vs. RAA patients.Methods:We compared 53 consecutive robotic-arm assisted to 53 consecutive manual TKAs. No differences in pre-operative scores were found between the cohorts. Patients were administered a modified WOMAC satisfaction survey pre-operatively, and at 1-year post-operatively. Univariate analyses and multivariate models with stepwise backward linear regression were utilized to evaluate the associations between outcome scores and surgical technique, age, sex, as well as body mass index (BMI).Results:The RAA cohort had significantly improved mean total (6±6 vs. 9±8 points, p=0.03) and physical function scores (4±4 vs. 6±5 points, p=0.02) when compared to the manual cohort. The mean pain score for the RAA cohort [2±3 points (range, 0 to 14 points)], was also lower than that for the manual cohort [3±4 points (range, 0 to 11 points) (p=0.06)].On backward linear regression analyses, RAA was found to be significantly associated with more improved total (beta coefficient [β]-0.208, SE [standard error] 1.401, p&lt;0.05), function (β=0.216, SE=0.829, p&lt;0.05), and pain scores (β-0.181, SE=0.623, p=0.063). The RAA technique was found to have the strongest association with improved scores.Conclusion:With newer surgical technologies constantly being introduced, it is imperative to continue to evaluate these new modalities, particularly in their abilities to improve patient satisfaction outcomes. This study suggests that RAA patients may have short term improvements at minimum 1-year post-operative. However, longer-term follow up with greater sample sizes are needed to further validate these findings.

One-Year Patient Outcomes for Robotic-Arm-Assisted versus Manual Total Knee Arthroplasty

2019 ◽  
Vol 32 (11) ◽  
pp. 1063-1068 ◽  
Author(s):  
Robert C. Marchand ◽  
Nipun Sodhi ◽  
Hiba K. Anis ◽  
Joseph Ehiorobo ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Univariate Analysis ◽  
Robotic Arm ◽  
Pain Scores ◽  
Patient Reported ◽  
Total Knee ◽  
One Year

AbstractAlthough there are many studies on the alignment advantages when using the robotic arm–assisted (RAA) system for total knee arthroplasty (TKA), there have been questions regarding patient-reported outcomes. Therefore, the purpose of this study was to use this index to compare: (1) total, (2) physical function, and (3) pain scores for manual versus RAA patients. We compared 53 consecutive RAA to 53 consecutive manual TKAs. No differences in preoperative scores were found between the cohorts. Patients were administered a modified Western Ontario and McMaster Universities Osteoarthritis Index satisfaction survey preoperatively and at 1-year postoperatively. The results were broken down to: (1) total, (2) physical function, and (3) pain scores. Univariate analysis with independent samples t-tests was used to compare 1-year postoperative scores. Multivariate models with stepwise backward linear regression were utilized to evaluate the associations between scores and surgical technique, age, sex, as well as body mass index (BMI). Statistical analyses were performed with a p < 0.05 to determine significance. The RAA cohort had significantly improved mean total (6 ± 6 vs. 9 ± 8 points, p = 0.03) and physical function scores (4 ± 4 vs. 6 ± 5 points, p = 0.02) when compared with the manual cohort. The mean pain score for the RAA cohort (2 ± 3 points [range, 0–14 points]) was also lower than that for the manual cohort (3 ± 4 points [range, 0–11 points]) (p = 0.06). On backward linear regression analyses, RAA was found to be significantly associated with more improved total (β coefficient [β] −0.208, standard error [SE] 1.401, p < 0.05), function (β = 0.216, SE = 0.829, p < 0.05), and pain scores (β −0.181, SE = 0.623, p = 0.063). The RAA technique was found to have the strongest association with improved scores when compared with age, gender, and BMI. This study suggests that RAA patients may have short-term improvements at minimum 1-year postoperatively. However, longer term follow-up with greater sample sizes is needed to further validate these results.

scholarly journals Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0004
Author(s):  
Prettysia Suvarly ◽  
Nyoman Aditya Sindunata ◽  
Rio Aditya ◽  
Rusli Muljadi ◽  
John Butarbutar
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Knee Arthroplasty ◽  
Femoral Shaft ◽  
Coronal Plane ◽  
Coronal Alignment ◽  
Geriatric Population ◽  
X Ray ◽  
Cutting Angle ◽  
Total Knee

Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis. Methods: Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24. Results: Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa. Conclusion: Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates. References: Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42

A New Tourniquet System that Determines Pressures in Synchrony With Systolic Blood Pressure in Total Knee Arthroplasty

2008 ◽  
Vol 23 (7) ◽  
pp. 1050-1056 ◽  
Author(s):  
Yoshinori Ishii ◽  
Hideo Noguchi ◽  
Yoshikazu Matsuda ◽  
Mitsuhiro Takeda ◽  
To-ichi Higashihara
Keyword(s):  
Blood Pressure ◽  
Total Knee Arthroplasty ◽  
Systolic Blood Pressure ◽  
Knee Arthroplasty ◽  
Total Knee
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