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https://www.readbyqxmd.com/read/27913565/a-24-year-old-male-with-a-painful-and-cold-lower-extremity
#1
Eric A Robinson, Zain I Khalpey, Rajesh Janardhanan
CLINICAL INTRODUCTION: A 24-year-old male presented to the emergency department with intense pain in his right lower extremity. He has a medical history significant for systemic lupus erythematosus and antiphospholipid syndrome. He also had four prior episodes of deep venous thromboses on rivaroxaban. The patient stated that early in the morning, he started to feel intense pain that started from his knee and progressed to his calf, with associated numbness and paraesthesia. On physical examination, the limb felt cold with absent right popliteal and dorsalis pedis pulses...
December 2, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27913236/effect-of-different-postoperative-limb-positions-on-blood-loss-and-range-of-motion-in-total-knee-arthroplasty-an-updated-meta-analysis-of-randomized-controlled-trials
#2
REVIEW
Yuangang Wu, Timin Yang, Yi Zeng, Haibo Si, Canfeng Li, Bin Shen
BACKGROUND: Postoperative limb positioning has been reported to be an efficient and simple way to reduce blood loss and improve range of motion following total knee arthroplasty (TKA). This meta-analysis was designed to compare the effectiveness of two different limb positions in primary TKA. MATERIALS AND METHODS: A meta-analysis of the PubMed, CENTRAL, Web of Science, EMBASE and Google Search Engine electronic databases was performed. In this meta-analysis, two postoperative limb positions were considered: mild-flexion (flexion less than 60°) and high-flexion (flexion at 60° or more)...
November 29, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/27911916/incidence-of-deep-vein-thrombosis-and-venous-thromboembolism-following-tka-in-rheumatoid-arthritis-versus-osteoarthritis-a-meta-analysis
#3
Do-Kyung Lee, Hyun-Jung Kim, Dae-Hee Lee
This meta-analysis was designed to compare the incidence of deep vein thrombosis (DVT) and venous thromboembolism (VTE) following total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). All studies directly comparing the post-TKA incidence of DVT and/or VTE in patients with RA and OA were included. For all comparisons, odds ratios and 95% confidence intervals (CI) were calculated for binary outcomes. Six studies were included in the meta-analysis. The pooled data showed that the combined rates of asymptomatic and symptomatic DVT did not differ significantly in the RA and OA groups (1065/222,714 [0...
2016: PloS One
https://www.readbyqxmd.com/read/27886686/preoperative-versus-postoperative-initiation-of-warfarin-therapy-in-patients-undergoing-total-hip-and-knee-arthroplasty
#4
REVIEW
Cara Cipriano, Nicholas Erdle, Kai Li, Brian Curtin
The optimal strategy for postoperative deep venous thrombosis prophylaxis remains controversial in hip and knee arthroplasty. Warfarin causes transient hypercoagulability; however, the optimal timing of treatment remains unclear. We evaluated the effects of preoperative versus postoperative warfarin therapy with a primary endpoint of perioperative change in hemoglobin. Warfarin was dosed according to a standard nomogram. No difference in perioperative hemoglobin change was observed. The preoperative group demonstrated higher INRs...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27876235/high-altitude-is-an-independent-risk-factor-for-postoperative-symptomatic-venous-thromboembolism-after-knee-arthroscopy-a-matched-case-control-study-of-medicare-patients
#5
Jourdan M Cancienne, David R Diduch, Brian C Werner
PURPOSE: To use a national database of Medicare patients to evaluate the association of uncomplicated knee arthroscopy performed at high altitude with the incidence of postoperative venous thromboembolism (VTE). METHODS: The 100% Medicare Standard Analytical File database was queried for all patients undergoing isolated arthroscopic partial meniscectomy and/or chondroplasty from 2005-2012. Patients with more complex open or additional arthroscopic knee procedures, a personal history of VTE, or any hypercoagulable state were excluded...
November 18, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27866951/the-incidence-and-economic-burden-of-in-hospital-venous-thromboembolism-in-the-united-states
#6
Alisina Shahi, Antonia F Chen, Timothy L Tan, Mitchell G Maltenfort, Fatih Kucukdurmaz, Javad Parvizi
BACKGROUND: Venous thromboembolism (VTE) is a potentially preventable and costly complication after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The in-hospital incidence and economic burden of VTE following total joint arthroplasty (TJA) in the United States is unknown. The aim of this study was to examine this issue. METHODS: The Nationwide Inpatient Sample was used to estimate the total number of THA, TKA, and VTE events using International Classification of Diseases, Ninth Revision procedure codes from years 2002 to 2011...
October 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27861210/symptomatic-venous-thromboembolism-after-adolescent-knee-arthroscopy
#7
Robert F Murphy, Benton Heyworth, Dennis Kramer, Manahil Naqvi, Patricia E Miller, Yi-Meng Yen, Mininder S Kocher, Benjamin J Shore
BACKGROUND: The frequency of knee arthroscopy procedures is increasing in pediatric and adolescent patients. In general, complications after these procedures in adolescents are uncommon. The purposes of this study are to report the incidence of venous thromboembolism (VTE) in adolescent patients after knee arthroscopy procedures, as well identify risk factors in this patient population. METHODS: Medical records were reviewed in all pediatric and adolescent patients (≤19 y) who underwent an arthroscopic knee procedure from 2010 to 2014 and were diagnosed with a symptomatic VTE in the postoperative period...
November 17, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27843042/low-risk-of-thromboembolic-events-after-routine-administration-of-tranexamic-acid-in-hip-and-knee-arthroplasty
#8
Rune V Madsen, Christian S Nielsen, Thomas Kallemose, Henrik Husted, Anders Troelsen
BACKGROUND: The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retrospective study investigates patient characteristics, occurrences, and predictors of TE events after routine administration of IV TXA in THA and TKA. METHODS: Three thousand one hundred fifty-nine THA or TKA procedures performed from 2007-2013 at our institution were included...
October 20, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27843040/a-phase-iv-study-of-thromboembolic-and-bleeding-events-following-hip-and-knee-arthroplasty-using-oral-factor-xa-inhibitor
#9
David Gomez, Helen Razmjou, Andrea Donovan, Vikas B Bansal, Jeffrey D Gollish, John J Murnaghan
BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012...
October 4, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27837327/topical-versus-intravenous-tranexamic-acid-in-total-knee-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#10
Shangquan Wang, Xinxia Gao, Yan An
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug used widely to prevent bleeding in total knee arthroplasty (TKA). However, there is no consensus regarding the administration routes of TXA. This meta-analysis aimed to investigate the efficacy of topical (intra-articular) versus intravenous TXA in reducing blood loss and transfusion rate in patients who underwent TKA. METHOD: We conducted a Pubmed, EMBASE, Cochrane Library, and Web of Science search for randomized controlled trials (RCTs) comparing topical versus intravenous TXA in TKA...
November 11, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27816099/editorial-commentary-should-the-virchow-triad-have-been-a-quartet-is-high-altitude-a-risk-factor-for-deep-venous-thrombosis-after-knee-arthroscopy
#11
EDITORIAL
Thomas R Hackett, Jonathan A Godin
The Virchow triad includes stasis of blood flow, endothelial injury, and hypercoagulability. It forms the physiological foundation for the development of one of our most dreaded complications: deep venous thrombosis. Although the complication rate after knee arthroscopy remains low, significant morbidity may be associated with thromboembolic events. Tyson et al. report an increased incidence of venous thromboembolism in knee operations performed at higher altitudes versus those conducted closer to sea level...
November 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27789095/deep-venous-thrombosis-prophylaxis-after-unicompartmental-knee-arthroplasty-a-prospective-study-on-the-safety-of-aspirin
#12
Tom Schmidt-Braekling, Andrew D Pearle, David J Mayman, Geoffrey H Westrich, Wenzel Waldstein, Friedrich Boettner
BACKGROUND: Although venous thromboembolism is one of the leading causes of morbidity after knee arthroplasty, little data exist on the risk of deep venous thrombosis (DVT) after unicompartmental knee arthroplasty (UKA). METHODS: We prospectively enrolled 112 patients undergoing UKA to determine the incidence of DVT utilizing aspirin 325 mg twice a day (BID) for 4 weeks postoperatively as DVT prophylaxis. The data were compared with a recent randomized controlled trial of patients undergoing total knee arthroplasty utilizing aspirin and Lovenox in conjunction with pneumatic compression devices...
September 28, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27776904/prevalence-of-venous-thromboembolic-events-is-low-in-asians-after-total-knee-arthroplasty-without-chemoprophylaxis
#13
Hamid Rahmatullah Bin Abd Razak, Noorul Faeyza Binte Abd Razak, Hwee-Chye Andrew Tan
BACKGROUND: This retrospective cohort study was designed to establish the prevalence of clinically significant venous thromboembolic events (VTE) in our patients undergoing total knee arthroplasty (TKA) without chemoprophylaxis. METHODS: A single-surgeon cohort of patients who underwent TKA from 2006 to 2014 were included. All patients had a pneumatic tourniquet applied and a drain inserted postoperatively. Tranexamic acid was not used perioperatively. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE...
September 28, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27760536/a-comparative-retrospective-study-of-peri-articular-and-intra-articular-injection-of-tranexamic-acid-for-the-management-of-postoperative-blood-loss-after-total-knee-arthroplasty
#14
Zhenyang Mao, Bing Yue, You Wang, Mengning Yan, Kerong Dai
BACKGROUND: Intra-articular injection of tranexamic acid (TXA) is known to be effective in controlling blood loss after total knee arthroplasty (TKA). However, this method has some disadvantages, such as TXA leakage due to soft tissue release. Peri-articular injection provides an alternative to intra-articular administration of TXA. This study aimed to evaluate the effects of peri-articular injection of TXA in reducing blood loss after TKA and compare them to those of intra-articular TXA injection...
October 19, 2016: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/27749358/blood-flow-restriction-training-after-knee-arthroscopy-a-randomized-controlled-pilot-study
#15
David J Tennent, Christina M Hylden, Anthony E Johnson, Travis C Burns, Jason M Wilken, Johnny G Owens
INTRODUCTION: Quadriceps strength after arthroscopic knee procedures is frequently diminished several years postoperation. Blood flow restriction (BFR) training uses partial venous occlusion while performing submaximal exercise to induce muscle hypertrophy and strength improvements. The purpose of this study was to evaluate BFR as a postoperative therapeutic intervention after knee arthroscopy. METHODS: A randomized controlled pilot study comparing physical therapy with and without BFR after knee arthroscopy was conducted...
October 5, 2016: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
https://www.readbyqxmd.com/read/27707834/cohort-feasibility-study-of-an-intermittent-pneumatic-compression-device-within-a-below-knee-cast-for-the-prevention-of-venous-thromboembolism
#16
Irene Braithwaite, Bernadette De Ruyter, Alex Semprini, Stefan Ebmeier, Grant Kiddle, Nigel Willis, John Carter, Mark Weatherall, Richard Beasley
OBJECTIVES: To determine the likely enrolment rate of eligible participants into a randomised controlled trial (RCT) in which a within-cast intermittent pneumatic compression device using Jet Impulse Technology (IPC/JIT) is 1 of 3 possible interventions in a RCT for the prevention of venous thromboembolism (VTE) in the clinical setting of isolated lower limb cast immobilisation. DESIGN: A prospective, open-label feasibility study of the IPC/JIT device placed within a lower limb cast...
October 4, 2016: BMJ Open
https://www.readbyqxmd.com/read/27685687/dvt-presentations-to-an-emergency-department-a-study-of-guideline-based-care-and-decision-making
#17
D A Lillis, C Lloyd, S Kelada, P O'Kelly, S Kelly, P Gilligan
Pre-test probability scoring and blood tests for deep venous thrombosis (DVT) assessment are sensitive but not specific leading to increased demands on radiology services. 385 patients presenting to an Emergency Department with suspected DVT were studied to explore our actual work up of patients with possible DVT relating to risk stratification, further investigation and follow up. Of the 205 patients with an initially negative scan, 36 (17.6%) were brought for review to the Emergency Department Consultant clinic...
February 19, 2016: Irish Medical Journal
https://www.readbyqxmd.com/read/27684841/the-effectiveness-and-safety-of-tranexamic-acid-in-bilateral-total-knee-arthroplasty-a-meta-analysis
#18
Kedi Weng, Xingen Zhang, Qing Bi, Chen Zhao
OBJECTIVE: A meta-analysis was performed to investigate the effectiveness and safety of tranexamic acid (TXA) for the treatment of blood loss after a bilateral total knee arthroplasty (TKA). METHODS: Patients prepared for bilateral TKA and intervention including TXA versus placebo were comprehensively retrieved from MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from the time of the establishment of these databases to January 2016...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27627710/efficiency-and-safety-of-intravenous-tranexamic-acid-in-simultaneous-bilateral-total-knee-arthroplasty-a-systematic-review-and-meta-analysis
#19
REVIEW
Xuan Jiang, Xin-Long Ma, Jian-Xiong Ma
The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case-control studies met the inclusion criteria. The current meta-analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0...
August 2016: Orthopaedic Surgery
https://www.readbyqxmd.com/read/27581714/hemodynamics-based-treatment-of-varices-a-therapeutic-concept-counteracting-the-intrinsic-tendency-of-varicose-veins-to-recur
#20
Cestmir Recek
Varicose vein disease is characterized by tenacious tendency to recur. Measures recommended to prevent recurrences (flush ligation at the saphenofemoral junction, removal of incompetent great saphenous vein in the thigh, and insertion of mechanical barriers in the fossa ovalis) did not succeed in preventing recurrence. Reflux recurrence is triggered by the hemodynamic phenomenon called hemodynamic paradox. Abolition of saphenous reflux removes the hemodynamic disturbance of any degree of severity but at the same time it releases the pathological process leading to recurrent reflux...
August 31, 2016: Phlebology
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