Effects of tourniquet use on clinical outcomes and cement penetration in TKA when tranexamic acid administrated: a randomized controlled trial

Background The role of a tourniquet is still controversial for patients undergoing total knee arthroplasty (TKA). Our current study was performed to determine whether the nonuse of the tourniquet combine with tranexamic acid (TXA) application in TKA patients with end-stage osteoarthritis would accelerate the perioperative recovery rate and provide enough cement mantle thickness for implant fixation. Methods In this prospective, randomized controlled trial, 150 end-stage knee osteoarthritis patients receiving TKA were divided into three groups: group A (tourniquet group), group B (non-tourniquet group), and group C (tourniquet in cementation group). All enrolled patients received 3 g of intravenous TXA and 1 g topical TXA. The primary outcomes included blood loss variables and transfusion values. The secondary outcomes included VAS pain score, inflammatory factors level, range of motion, HSS score, postoperative hospital stay, and complication. Furthermore, by using a digital linear tomosynthesis technique, tibial baseplate bone cement mantle thickness was measured in four zones based on the knee society scoring system. Results No significant difference was found among the three groups with regards to total blood loss, transfusion, and complication. However, patients in group B showed lower inflammatory factors levels, shorter length of hospital stay, better range of motion, and lower postoperative pain. No significant difference was found among the three groups in four zones in terms of bone cement mantle thickness. Conclusions For end-stage knee osteoarthritis patients, the absence of tourniquet did not appear to affect blood loss and cement penetration in TKA patients. Furthermore, less inflammation reaction and better knee function can be achieved without a tourniquet. We recommend no longer use a tourniquet in primary TKA for patients with end-stage osteoarthritis when TXA is administrated. Trial registration ChiCTR-INR-16009026. Level of evidence Therapeutic Level I.

The effect of cement mantle thickness on strain energy density distribution and prediction of bone density changes around cemented acetabular component

Cement mantle thickness is known to be one of the important parameters to reduce the failure of the cemented acetabular component. The thickness of the cement mantle is also often influenced by the positioning of the acetabular cup. The aim of this study is to determine the effect of uniform and non-uniform cement mantle thickness on strain energy density distribution and prediction of the possibility of bone remodelling around the acetabular region. Furthermore, tensile stress distribution in the cement mantle due to non-uniform cement mantle thickness was also investigated. Three-dimensional finite element models of intact and 17 implanted pelvic bone were developed based on computed tomography data sets. Results indicate that implantation with non-uniform cement thickness variation in the anterior–posterior direction has a significant influence on strain energy density distribution around the acetabulum as compared to thickness variation in the superior–inferior direction. Increase in density is predicted at the anterior part of the acetabulum, whereas density decrease is predicted at the posterior, inferior and superior part of the acetabulum. The non-uniform cement mantle thickness affected the tensile stress distribution in the cement mantle, in particularly superiorly placed acetabular cup. This study concludes that uniform cement thickness is desired for the longer success of the cemented acetabular component.

Cement mantle thickness does not influence serum or local gentamicin concentrations in hybrid total hip arthroplasty: a randomised controlled trial

Introduction: We investigated the in vivo gentamicin elution kinetics of Hi-Fatigue Gentamicin Bone Cement (AAP Biomaterials GmbH) in serum and drain fluid after hybrid hip arthroplasty and the relationship with cement mantle thickness. Methods: We compared in a randomised, non-blinded prospective study, the local and systemic gentamicin concentrations in 2 groups. The thin cement mantle group ( n = 16) received a stem implanted line-to-line with the broach, whereas the thick group ( n = 14) had an undersized stem. Gentamicin concentrations were measured in drain fluid and serum at set intervals for 3 days postoperatively. Results: In both groups, local gentamicin concentrations were similar. After a high initial burst above the minimal inhibitory concentration (thin: 57.2 mg/L (SD 34.4), thick: 54.9 mg/L (SD 19.9), p = 0.823) local gentamicin concentrations declined rapidly. In both groups, serum concentrations never exceeded toxic levels (maximum 1.08 mg/L). Conclusion: In hybrid total hip arthroplasty, Hi-Fatigue Gentamicin Bone Cement resulted in effective and safe gentamicin concentrations. Clinical trial protocol number: PMCI 12/02.