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Tourniquet knee surgery

Duan Wang, Hui Zhu, Wei-Kun Meng, Hao-Yang Wang, Ze-Yu Luo, Fu-Xing Pei, Qi Li, Zong-Ke Zhou
BACKGROUND: Although randomized controlled trials have confirmed oral tranexamic acid (TXA) can provide similar blood-sparing efficacy compared with intravenous (IV) TXA in total knee arthroplasty (TKA), some concerns do remain about thromboembolic events after such systemic administration. Many studies have confirmed that intra-articular (IA) application of TXA can show similar blood-saving efficacy with minimal levels of systemic absorption compared with IV TXA. However, it remains unclear whether the efficacy and safety of oral TXA administration is equal to or less than that of IA administration in TKA without the use of a tourniquet and drain...
March 15, 2018: BMC Musculoskeletal Disorders
William Wynell-Mayow, Muhammad Zahid Saeed
BACKGROUND: The WHO includes osteoarthritis as a disease of priority, owing to its significant impact on quality of life, and globally increasing prevalence. Hospital budgets are under pressure to ration knee replacements and shorten inpatient stays. Prolonged tourniquet application has been hypothesised to extend recovery through pain and reduced mobility. PATIENTS AND METHODS: A total of 123 elective total knee replacements meeting inclusion criteria took place from July 2015 to October 2017 at the Royal Free Hospital...
March 14, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Christopher R Abrecht, Marise Cornelius, Albert Wu, Robert N Jamison, David Janfaza, Richard D Urman, Claudia Campbell, Michael Smith, Jennifer Haythornthwaite, Robert R Edwards, Kristin L Schreiber
Objective: To identify factors associated with pain severity and opioid consumption in the early perioperative period. Design: Prospective observational cohort study. Setting: Tertiary academic medical center. Subjects: Patients with osteoarthritis older than age 45 years undergoing primary total knee replacement at Brigham and Women's Hospital. A total of 126 patients enrolled. Methods: Preoperatively, pain questionnaires and quantitative sensory testing were performed on patients to develop a psychosocial and psychophysical profile...
March 7, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Álvaro López-Hualda, Cristina Dauder-Gallego, David Ferreño-Márquez, Javier Martínez-Martín
INTRODUCTION AND OBJECTIVE: Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. MATERIAL AND METHODS: A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study...
February 26, 2018: Medicina Clínica
Fardin Mirzatolooei, Ali Tabrizi, Maryamsadat Mokaram Gargari
Background: The role of wound drainage after total knee arthroplasty is still considered controversial as although closed drainage systems have been believed to be effective in decreasing the post-operative complications, they could also facilitate the bleeding and increase the rate of transfusion and infection. We have conducted the current study to compare the outcomes superficial subcutaneous, one deep, and two deep drain techniques after total knee arthroplasty. Methods: Between 2014 and 2015 sixty consecutive patients were prospectively selected and underwent primary total knee arthroplasty...
January 2018: Archives of Bone and Joint Surgery
Kang Lu, Mingtao Xu, Wei Li, Kai Wang, Dawei Wang
BACKGROUND: Fat embolism is a common complication of orthopedic surgery. However, the exact component and risk factor responsible for this complication remains unelucidated. This study aimed to detect the origin of the pulmonary embolus and identify relevant risk factors of pulmonary embolism in total knee replacement. METHODS: A total of 40 osteoarthritis patients who underwent primary unilateral TKA were recruited into this study. Transesophageal echocardiography (TEE) was utilized to dynamically monitor the embolism...
December 2017: Medicine (Baltimore)
Okan Ozkunt, Kerim Sariyilmaz, Halil Can Gemalmaz, Fatih Dikici
BACKGROUND: It is a randomized study to compare cement penetration on x-rays after total knee arthroplasty (TKA) among 3 different ways to use tourniquets; application during the surgery, application only with implantation prosthesis and with no tourniquet use. METHODS: A total 69 knees of 59 patients were included in the study in a quasirandom manner. Each patient had physical exams and standard radiographic evaluations at 6 weeks after the TKA procedure. Outcome evaluations included visual analog scale (VAS) scores, Knee Society Scores (KSS), blood transfusion, and drainage status after surgery for all groups...
January 2018: Medicine (Baltimore)
Robert J Tamai, Brian T Sullivan, Rushyuan J Lee
BACKGROUND: Peripheral nerve blocks (PNBs) provide excellent pain control and reduce the need for systemic analgesics in orthopaedic surgery. PNBs rarely cause complications; however, a few studies of adults have reported neurological complications during the early postoperative period. We investigated complications associated with the use of PNBs during pediatric knee surgery. METHODS: We reviewed the medical records of all 121 children (aged ≤18 y) who underwent knee surgery by 1 orthopaedic surgeon between October 2014 and September 2016...
March 2018: Journal of Pediatric Orthopedics
Han-Sheng Liang, Yi Feng
OBJECTIVE: To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on hemodynamic fluctuation caused by loosing tourniquet in the elderly patients undergoing knee joint replacement. METHODS: A total of 60 ASA (America Society Anesthesiologist) I or II elderly patients for elective knee joint replacement surgery were randomly divided into control group (30 cases) and TAES group (30 cases). Patients of both groups were treated by intravenous anesthesia, and monitored with bispectral index (BIS, between 45-60) for anesthesia depth, stroke volume variation (SVV) for fluid management, mean arterial pressure (MAP) and cardiac index (CI) for hemodynamic fluctuation evaluation, and with analgesia nociception index (ANI, between 50-70) for remifentanil dosage adjustment...
December 25, 2017: Zhen Ci Yan Jiu, Acupuncture Research
Alexander Franz, Fina Pauline Queitsch, Michael Behringer, Constantin Mayer, Rüdiger Krauspe, Christoph Zilkens
Osteoarthritis of the knee is one of the most commonly diagnosed joint ailments and responsible for increased rates of total knee arthroplasty surgeries worldwide. Whereas the surgical approach is able to diminish the perceived knee pain of concerned patients', the postoperative recovery is often accompanied by persistent skeletal muscle dysfunctions and atrophy, which is responsible for functional deficits for up to several years. Recent findings indicate that surgery induced adverse effects on skeletal muscles are largely associated with the use of pneumatic tourniquets, wherefore several studies try to reduce tourniquet use in orthopedic surgery...
January 2018: Medical Hypotheses
Marco Felipe Francisco Honorato de Barros, Evandro Junior Christovam Ribeiro, Rafael Gomes Dias
Objective: To evaluate the difference between the total blood loss in patients undergoing primary total knee arthroplasty with and without the use of tourniquet. Methods: A retrospective cohort study, with analysis of medical records of patients undergoing primary total knee arthroplasty in 2015, with and without the use of a tourniquet. Comparison was performed of hemoglobin (HB) and hematocrit (HT) variation in the complete blood count (CBC) during the pre- and post-operative period between the two groups...
November 2017: Revista Brasileira de Ortopedia
Ziyu Li, Wendan Cheng, Liangye Sun, Yunfeng Yao, Qiliang Cao, Shuming Ye, Lei Qi, Shenglin Xu, Xiaosan Wu, Juehua Jing
PURPOSE: Whether minimally invasive total knee arthroplasty (MIS-TKA) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial. This prospective and randomized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA. METHODS: Fifty patients, including 50 knees, who required TKA due to osteoarthritis were randomized to the mini-subvastus group (group I) or the medial parapatellar group (group II)...
December 4, 2017: International Orthopaedics
L Sabatini, G Nicolaci, F Atzori, A Oliva, A Aprato, M Terzolo, A Masse'
INTRODUCTION: Even if different surgical approaches for total knee arthroplasty are well known since decades, the standard medial parapatellar incision remains the most common one; general agreement about significant advantages with minimally invasive techniques is lacking. Furthermore, the surgical stress effect on the organism has always been analyzed through blood inflammatory parameters. This study aim was to compare the standard and subvastus approaches, using the salivary cortisol in particular as measure for systemic surgery-related stress...
November 20, 2017: Musculoskeletal Surgery
Edwin P Su, Lauren E Mount, Allina A Nocon, Thomas P Sculco, George Go, Nigel E Sharrock
BACKGROUND: Total knee arthroplasty (TKA) is associated with a risk of thromboembolism requiring routine thromboprophylaxis, but there is debate about the risk with unicondylar knee arthroplasty (UKA) as it is a more minor procedure. We sought to investigate the relative risk of thromboembolism with UKA compared to TKA and one-staged bilateral TKA (BTKA) by measuring the increase in circulating biochemical markers of thrombin generation during the procedures. Degree of surgical trauma was also assessed by measuring interleukin-6, a marker of metabolic injury...
March 2018: Journal of Arthroplasty
Kai Zhou, Tingxian Ling, Haoyang Wang, Zongke Zhou, Bin Shen, Jing Yang, Pengde Kang, Fuxing Pei
BACKGROUND: We aimed to compare the effect of tourniquet use or lack of it on recovery following uncomplicated primary total knee arthroplasty (TKA). METHODS: In a prospective randomised double-blinded study, 150 patients undergoing primary TKA were assigned to either a tourniquet or non-tourniquet group. At the early phase, 3 and 6 months after surgery, an independent observer assessed the primary outcome measure (i.e. total blood loss) and secondary outcome measures (i...
November 14, 2017: Journal of Orthopaedic Surgery and Research
G Balato, S L Di Donato, T Ascione, A D'Addona, F Smeraglia, G Di Vico, D Rosa
Purpose  Septic knee arthritis following arthroscopy is a rare but dreaded complication. Definition and management of knee deep infections are quite discussed in literature. In this review, literature regarding infections after knee arthroscopy is analyzed highlighting the incidence, causative bacteria, risk factors as well as clinical outcomes. Methods  We performed a review of the literature matching the following key words: "septic arthritis" OR "infection" AND "arthroscopy" AND "knee." Knee arthroscopic procedures, such as debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release, were considered...
June 2017: Joints
Jinyan Mu, Dan Liu, Daihong Ji, Borui Li, Zhigang Li, Feng Zhang, William C Lineaweaver
OBJECTIVE: The aim of this study was to investigate the clinical effect of tourniquet inflation pressure setting by ultrasonic Doppler on lower limb operation. METHODS: Ninety-six patients with total knee arthroplasty were selected in this study from January 2015 to December 2015. The patients were randomly divided into the study group and the control group with 48 cases in each group. In the control group, the tourniquet pressure is determined by the doctor's request for the patient's condition, but all the tourniquet pressure values should be 80 KPa or less...
October 31, 2017: Annals of Plastic Surgery
N Ruiz, X Buisson, G Filippi, M Roulet, H Robert
INTRODUCTION: The reduction in length of stay (LOS) in orthopedic surgery has been steady for several years. For the past 3 or 4 years in France, the trend toward outpatient surgery has been growing upwards, as it is a goal for hospital administration. MATERIALS AND METHODS: This is a prospective, continuous, mono-centric, single operator study on 56 UKAs. Included were all UKAs carried out between January 2014 and December 2015, meeting the following criteria: voluntary patients, supportive family environment, absence of comorbidity (oral anticoagulants, diabetes, obesity), ASA score≤3...
October 24, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
Ari Zekcer, Ricardo Del Priori, Clauber Tieppo, Ricardo Soares da Silva, Nilson Roberto Severino
OBJECTIVE: To compare topical vs. intravenous tranexamic acid (TA) in total knee arthroplasty regarding blood loss and transfusion. METHODS: Ninety patients were randomized to receive TA intravenously (20 mg/kg in 100 mL of saline; group IV), topically (1.5 g in 50 mL of saline, sprayed over the operated site, before release of the tourniquet; topical group), or intravenous saline (100 mL with anesthesia; control group). The volume of drained blood in 48 h, the amount of transfused blood, and the serum levels of hemoglobin and hematocrit before and after surgery were evaluated...
September 2017: Revista Brasileira de Ortopedia
Jatin Prakash, Tankeswar Boruah, Anil Mehtani, Suresh Chand, Hitesh Lal
PURPOSE: Medial close wedge Coventry type osteotomy is commonly performed procedure for adoloscent Genu valgum. However this osteotomy has some inherent problems, a wedge resection causes shortening of affected site. An additional plate for stabilization causes increase in soft tissue dissection and surgical time. A cheveron osteotomy is an alternative procedure, not requiring any internal fixation due to its inherent stability. We started this study with aim to analyze the results of Cheveron osteotomy, to see if the osteotomy was stable enough without implants, time required for healing of osteotomy, post-operative range of motion, limb length discrepancy and to evaluate any other complication...
July 2017: Journal of Clinical Orthopaedics and Trauma
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