J. Pearson, Thomas J Schlierf, Kathy Zhang, Jeffrey T. Hodrick
Keywords Total Knee Arthroplasty, robotic-assisted, opioid use Background With the rise of robotic arm-assisted total knee arthroplasty (TKA) cases, there is a need to determine if there are clinical benefits associated with this technology. The purpose of this study was to further evaluate if robotic-assisted TKAs result in improved inpatient post-operative outcomes compared to conventional TKAs. Materials and Methods After IRB approval, a retrospective chart review of 100 robotic-assisted primary TKAs and 100 matched controls undergoing conventional TKA was performed. Patients underwent primary TKA from 2016 to 2018 with minimum 6-month postoperative follow-up by a single fellowship-trained arthroplasty surgeon at a high-volume joint center. Exclusion criteria included <6 month postoperative follow-up, incomplete chart information, inflammatory arthritis, and BMI >40. Demographics and post-operative outcomes, including length of stay (LOS), opioid consumption, duration of opioid use, and discharge status, were recorded. Results There were no significant differences in pre-operative demographics between the two groups. A decrease in LOS (1.58 vs. 2.18 days, p < 0.001) and morphine equivalents (73.52 vs. 102.50, p = 0.017) was reported for the robotic TKA group compared to the control group. The robotic group also reported fewer patients at six weeks postoperatively requiring opioids compared to the control group (37 vs. 61, p = 0.001). Average KOOS Jr at 6-months postoperatively was 81.73 for the control group and 78.22 in the robotic group (p = 0.039). Conclusion Robotic-assisted TKA patients experienced significantly decreased LOS, morphine equivalents, and opioid usage at 6-week postoperatively, indicating that there are early clinical benefits of robotic-assisted TKA. No significant differences between the robotic and control groups were reported in pre-operative KOOS Jr. Although average 6-month postoperative KOOS Jr was slightly higher for the control group, the difference was clinically insignificant. Our average KOOS Jr for both cohorts was higher than the national 1-year postoperative average, 76.8.
背景随着机械臂辅助全膝关节置换术(TKA)病例的增加，有必要确定该技术是否具有临床益处。本研究的目的是进一步评估与传统tka相比，机器人辅助tka是否能改善住院患者的术后预后。材料和方法经IRB批准后，对100名机器人辅助初级TKA和100名接受常规TKA的匹配对照组进行回顾性图表审查。患者在2016年至2018年期间接受了原发性TKA，术后至少6个月由一名在大容量关节中心接受过培训的关节置换外科医生进行随访。排除标准包括40例。记录人口统计学和术后结果，包括住院时间(LOS)、阿片类药物消耗、阿片类药物使用持续时间和出院状况。结果两组术前人口统计学差异无统计学意义。与对照组相比，机器人TKA组的LOS (1.58 vs. 2.18天，p < 0.001)和吗啡当量(73.52 vs. 102.50, p = 0.017)下降。与对照组相比，机器人组术后6周需要阿片类药物的患者也较少(37对61,p = 0.001)。对照组术后6个月平均KOOS Jr为81.73，机器人组为78.22 (p = 0.039)。结论机器人辅助TKA患者术后6周的LOS、吗啡当量和阿片类药物使用显著降低，表明机器人辅助TKA具有早期临床益处。机器人组与对照组术前KOOS Jr无显著差异。尽管对照组术后6个月平均KOOS Jr略高，但差异无临床意义。两组患者的平均kos Jr均高于全国术后1年平均值76.8。
{"title":"Post-operative outcomes, including opioid utilization and length of stay, following total knee arthroplasty: A retrospective case matched series comparing conventional and robotic-assisted total knee arthroplasty","authors":"J. Pearson, Thomas J Schlierf, Kathy Zhang, Jeffrey T. Hodrick","doi":"10.15438/rr.12.1.302","DOIUrl":"https://doi.org/10.15438/rr.12.1.302","url":null,"abstract":"Keywords Total Knee Arthroplasty, robotic-assisted, opioid use \u0000Background With the rise of robotic arm-assisted total knee arthroplasty (TKA) cases, there is a need to determine if there are clinical benefits associated with this technology. The purpose of this study was to further evaluate if robotic-assisted TKAs result in improved inpatient post-operative outcomes compared to conventional TKAs. \u0000Materials and Methods After IRB approval, a retrospective chart review of 100 robotic-assisted primary TKAs and 100 matched controls undergoing conventional TKA was performed. Patients underwent primary TKA from 2016 to 2018 with minimum 6-month postoperative follow-up by a single fellowship-trained arthroplasty surgeon at a high-volume joint center. Exclusion criteria included <6 month postoperative follow-up, incomplete chart information, inflammatory arthritis, and BMI >40. Demographics and post-operative outcomes, including length of stay (LOS), opioid consumption, duration of opioid use, and discharge status, were recorded. \u0000Results There were no significant differences in pre-operative demographics between the two groups. A decrease in LOS (1.58 vs. 2.18 days, p < 0.001) and morphine equivalents (73.52 vs. 102.50, p = 0.017) was reported for the robotic TKA group compared to the control group. The robotic group also reported fewer patients at six weeks postoperatively requiring opioids compared to the control group (37 vs. 61, p = 0.001). Average KOOS Jr at 6-months postoperatively was 81.73 for the control group and 78.22 in the robotic group (p = 0.039). \u0000Conclusion Robotic-assisted TKA patients experienced significantly decreased LOS, morphine equivalents, and opioid usage at 6-week postoperatively, indicating that there are early clinical benefits of robotic-assisted TKA. No significant differences between the robotic and control groups were reported in pre-operative KOOS Jr. Although average 6-month postoperative KOOS Jr was slightly higher for the control group, the difference was clinically insignificant. Our average KOOS Jr for both cohorts was higher than the national 1-year postoperative average, 76.8.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47253212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Tranexamic acid significantly reduces blood loss and transfusion requirements in arthroplasty patients. However, it is often avoided in patients who have had previous arterial and thromboembolic disease despite the absence of evidence of hazard in this group of patients. We examined the use of tranexamic acid in unselected hip and knee arthroplasty patients including those considered to be ‘high risk’. Methods A 2-year retrospective multicentre study was performed with patients who underwent hip or knee arthroplasty surgery. A blood management protocol included universal tranexamic acid use for all patients. Blood loss, transfusion volumes and complications were analysed. Results A total of 958 patients were included in the study, 130 patients were considered ‘high risk’ of thromboembolic complications and 828 patients were considered ‘low risk’. 879 patients received tranexamic acid with a significant reduction in blood loss (p<0.001) in these patients. Two of 130 (1.5%) ‘high risk’ patients and 14 of 828 (1.7%) ‘low risk’ patients had post-operative VTE. There was no significant difference in rate of VTE between the ‘high risk’ and ‘low risk’ patients (p=0.6) or in the subgroup of ‘high risk’ patients who had received TXA (p=1). Conclusions The efficacy of tranexamic acid is overwhelming and outweighs any potential risks. Tranexamic acid should be considered for use in all arthroplasty patients including those with prior history of venous or arterial thrombosis.
{"title":"Tranexamic Acid Should be Considered for High Risk Arthroplasty Patients","authors":"Andy Ho, D. Campbell, S. Yapa, I. Malek, P. Yates","doi":"10.15438/rr.12.1.299","DOIUrl":"https://doi.org/10.15438/rr.12.1.299","url":null,"abstract":"Background \u0000Tranexamic acid significantly reduces blood loss and transfusion requirements in arthroplasty patients. However, it is often avoided in patients who have had previous arterial and thromboembolic disease despite the absence of evidence of hazard in this group of patients. We examined the use of tranexamic acid in unselected hip and knee arthroplasty patients including those considered to be ‘high risk’. \u0000 \u0000Methods \u0000A 2-year retrospective multicentre study was performed with patients who underwent hip or knee arthroplasty surgery. A blood management protocol included universal tranexamic acid use for all patients. Blood loss, transfusion volumes and complications were analysed. \u0000 \u0000Results \u0000A total of 958 patients were included in the study, 130 patients were considered ‘high risk’ of thromboembolic complications and 828 patients were considered ‘low risk’. 879 patients received tranexamic acid with a significant reduction in blood loss (p<0.001) in these patients. \u0000Two of 130 (1.5%) ‘high risk’ patients and 14 of 828 (1.7%) ‘low risk’ patients had post-operative VTE. There was no significant difference in rate of VTE between the ‘high risk’ and ‘low risk’ patients (p=0.6) or in the subgroup of ‘high risk’ patients who had received TXA (p=1). \u0000 \u0000Conclusions \u0000The efficacy of tranexamic acid is overwhelming and outweighs any potential risks. Tranexamic acid should be considered for use in all arthroplasty patients including those with prior history of venous or arterial thrombosis.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44419791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Bansal, Angad Jolly, Easwar Balasubramaniana, Shamsundar Yalamanchalia
Background: There have been multiple ways to measure outcomes post total knee arthroplasty. Ultimate goal is to replicate a natural joint to allow patients to perform most activities of daily living and give high satisfaction rates. Patient reported outcome measures (PROM) like Forgotten Joint Score (FJS), Oxford Knee Score (OKS)and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) have been validated and used for evaluation of TKA patients. FJS helps to evaluate how natural a prosthesis feels post surgery. Our aim was to study how natural a joint felt or was forgotten 2 year after surgery and how FJS correlates with OKS and WOMAC scores. Materials and Methods : We evaluated 254 total knee replacements with minimum 2 year post TKA. All the patients who were at least 2 year post operative, completed FJS questionnaire where scores are ranged from 0-100; OKS questionnaire where scores are ranged between 0-48; Short – form WOMAC questionnaire where scores are ranged between 0-28. Correlation analysis was performed for FJS with OKS and short - form WOMAC scores. Results: 254 patients with mean age of 65.01 years of which 83 males and 171 females were evaluated with minimum of 24 months follow up and average follow-up of 30.85 months. Average FJS, OKS and SF WOMAC were 77.24, 38.75 & 79.97 respectively. FJS showed good correlation with OKS and SF WOMAC scores. Conclusion : FJS is an easy and equally effective outcome measure, which is valid and reliable like the other common well know measures like OKS and WOMAC. Patients experience a marked improvement in the FJS over the first two years. Patients in our series had good outcomes who had more natural feel of knees or a feeling of “forgotten knees” in their day to day activity after 2 years of surgery.
{"title":"Can Knees be Forgotten 2 Years After Total Knee Arthroplasty?","authors":"R. Bansal, Angad Jolly, Easwar Balasubramaniana, Shamsundar Yalamanchalia","doi":"10.15438/rr.12.1.248","DOIUrl":"https://doi.org/10.15438/rr.12.1.248","url":null,"abstract":"Background:\u0000There have been multiple ways to measure outcomes post total knee arthroplasty. Ultimate goal is to replicate a natural joint to allow patients to perform most activities of daily living and give high satisfaction rates. Patient reported outcome measures (PROM) like Forgotten Joint Score (FJS), Oxford Knee Score (OKS)and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) have been validated and used for evaluation of TKA patients. FJS helps to evaluate how natural a prosthesis feels post surgery. Our aim was to study how natural a joint felt or was forgotten 2 year after surgery and how FJS correlates with OKS and WOMAC scores.\u0000Materials and Methods :\u0000We evaluated 254 total knee replacements with minimum 2 year post TKA. All the patients who were at least 2 year post operative, completed FJS questionnaire where scores are ranged from 0-100; OKS questionnaire where scores are ranged between 0-48; Short – form WOMAC questionnaire where scores are ranged between 0-28. Correlation analysis was performed for FJS with OKS and short - form WOMAC scores. \u0000Results:\u0000254 patients with mean age of 65.01 years of which 83 males and 171 females were evaluated with minimum of 24 months follow up and average follow-up of 30.85 months. Average FJS, OKS and SF WOMAC were 77.24, 38.75 & 79.97 respectively. FJS showed good correlation with OKS and SF WOMAC scores.\u0000Conclusion :\u0000FJS is an easy and equally effective outcome measure, which is valid and reliable like the other common well know measures like OKS and WOMAC. Patients experience a marked improvement in the FJS over the first two years. Patients in our series had good outcomes who had more natural feel of knees or a feeling of “forgotten knees” in their day to day activity after 2 years of surgery. ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41700681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph S. Gondusky, Richard R. Pahapill, Christian Coulson
Total joint arthroplasty (TJA) is moving towards the outpatient setting. Teams must develop patient selection criteria to ensure appropriate candidates are treated at the optimal site of care. Protocols and recommendations have been developed to aid care teams in developing patient selection criteria, but these come from multiple disparate sources. We review the available literature on patient selection criteria and optimization in the outpatient TJA population, and synthesize this information into a workable format for care design. We hope to provide a resource to stakeholders that can be tailored to their unique outpatient facility. Keywords: Total joint arthroplasty, outpatient, same day discharge, selection criteria, patient optimization.
{"title":"A Literature-Based Resource for the Development of Outpatient Arthroplasty Patient Selection Criteria","authors":"Joseph S. Gondusky, Richard R. Pahapill, Christian Coulson","doi":"10.15438/rr.11.1.280","DOIUrl":"https://doi.org/10.15438/rr.11.1.280","url":null,"abstract":"Total joint arthroplasty (TJA) is moving towards the outpatient setting. Teams must develop patient selection criteria to ensure appropriate candidates are treated at the optimal site of care. Protocols and recommendations have been developed to aid care teams in developing patient selection criteria, but these come from multiple disparate sources. We review the available literature on patient selection criteria and optimization in the outpatient TJA population, and synthesize this information into a workable format for care design. We hope to provide a resource to stakeholders that can be tailored to their unique outpatient facility. \u0000 \u0000Keywords: Total joint arthroplasty, outpatient, same day discharge, selection criteria, patient optimization.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Navy Corpsman Maxton “Max” W. Soviak, HM3 (22 years old) of Berlin Heights, Ohio, was one of the 13 U.S. service members killed while supporting non-combatant evacuation operation in Kabul, Afghanistan. Max was advanced to the rank of Hospital Corpsman Third Class “as a result of his brave actions in support of fellow service members,” according to a Navy statement. He was also posthumously awarded the Purple Heart and Fleet Marine Force Corpsman warfare badge.
{"title":"Life Lost Too Soon: Navy Corpsman from Ohio Killed in Afghanistan Attack August 26, 2021","authors":"T. Mctighe","doi":"10.15438/rr.11.1.290","DOIUrl":"https://doi.org/10.15438/rr.11.1.290","url":null,"abstract":"Navy Corpsman Maxton “Max” W. Soviak, HM3 (22 years old) of Berlin Heights, Ohio, was one of the 13 U.S. service members killed while supporting non-combatant evacuation operation in Kabul, Afghanistan. \u0000Max was advanced to the rank of Hospital Corpsman Third Class “as a result of his brave actions in support of fellow service members,” according to a Navy statement. He was also posthumously awarded the Purple Heart and Fleet Marine Force Corpsman warfare badge.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48812789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION: The purpose of this study was to evaluate the two year clinical and radiographic outcomes of patients undergoing a primary total hip arthroplasty (THA) using the Trident Tritanium primary Cup. METHODS: 197 patients who underwent a direct anterior THA using a Tritanium acetabular component between 2011 and 2015 were retrospectively reviewed by two surgeons from a single institution. The investigators, along with an independent physician, separately reviewed radiographs blinded to clinical data looking for radiolucent lines adjacent to the acetabular cup using the Charnley-DeLee zones. Clinical results were measured using acetabular revision surgery as an end point for failure. According to the American Academy of Orthopaedic Surgeons Levels of Evidence, this study was consistent with a Level III Therapeutic study. RESULTS: 101 (48.73%) subjects did not exhibit any radiolucent lines around the acetabular component. 53 (26.90%) subjects displayed radiolucency in only one zone. 27 (13.71%) subjects displayed radiolucency in two zones, and 16 (8.12%) displayed radiolucency in all three zones. Radiolucency was most prevalent in zone 1 at 2 years with 83 (42.13%) subjects displaying radiolucency. There were five (2.54%) acetabular failures within two years of the index surgery. Of those 5 subjects, 3 displayed radiolucency in 1 zone, 2 displayed radiolucency in >1 zone, and 2 displayed radiolucencies >1 mm. CONCLUSION: In our study, the Tritanium Cup demonstrated a 2.54% failure rate for aseptic loosening at 2 year follow-up. In addition, 48.73% of patients displayed a radiolucent line in at least one Charnley-DeLee zone. We also observed a progression of radiolucencies between the 6 month radiographs and the 2 year radiographs.
{"title":"Early Term Radiographic Follow-Up of the Trident Tritanium Acetabular Component","authors":"D. Deboer, Jeffrey T. Hodrick, M. Christie","doi":"10.15438/RR.11.1.273","DOIUrl":"https://doi.org/10.15438/RR.11.1.273","url":null,"abstract":"INTRODUCTION: The purpose of this study was to evaluate the two year clinical and radiographic outcomes of patients undergoing a primary total hip arthroplasty (THA) using the Trident Tritanium primary Cup. \u0000 \u0000METHODS: 197 patients who underwent a direct anterior THA using a Tritanium acetabular component between 2011 and 2015 were retrospectively reviewed by two surgeons from a single institution. The investigators, along with an independent physician, separately reviewed radiographs blinded to clinical data looking for radiolucent lines adjacent to the acetabular cup using the Charnley-DeLee zones. Clinical results were measured using acetabular revision surgery as an end point for failure. According to the American Academy of Orthopaedic Surgeons Levels of Evidence, this study was consistent with a Level III Therapeutic study. \u0000 \u0000RESULTS: 101 (48.73%) subjects did not exhibit any radiolucent lines around the acetabular component. 53 (26.90%) subjects displayed radiolucency in only one zone. 27 (13.71%) subjects displayed radiolucency in two zones, and 16 (8.12%) displayed radiolucency in all three zones. Radiolucency was most prevalent in zone 1 at 2 years with 83 (42.13%) subjects displaying radiolucency. There were five (2.54%) acetabular failures within two years of the index surgery. Of those 5 subjects, 3 displayed radiolucency in 1 zone, 2 displayed radiolucency in >1 zone, and 2 displayed radiolucencies >1 mm. \u0000 \u0000CONCLUSION: In our study, the Tritanium Cup demonstrated a 2.54% failure rate for aseptic loosening at 2 year follow-up. In addition, 48.73% of patients displayed a radiolucent line in at least one Charnley-DeLee zone. We also observed a progression of radiolucencies between the 6 month radiographs and the 2 year radiographs.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46841803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cementless implants were introduced approximately three decades ago in order to address aseptic loosening of cemented hip prostheses with the aim of early mobilisation, better functional result and bone stock preservation. The primary objective of this study is to introduce a new cementless HA coated implant and report its minimum 2 year follow up results. Material & method: This is a prospective, multi-centre, consecutive series, clinical outcomes study with 75 patients. Inclusion criteria for the study were age 21- 85 years, BMI <40, osteoarthritis of the hip. Patients were operated using a standard posterolateral approach. The Paragon stem and the Global cup were implanted in a cementless method. Patients were reviewed at 6 weeks, 6 months and two years postoperative. At each visit AQoL 6D, VAS Pain, Oxford Hip Score were recorded. Post-operative X-Rays were reviewed at immediate post-operative, 6 months and two years. Results: Mean duration of surgery was 63.1 min with range of 40-120 min. AQoL over time changed from pre-op mean 50.51, at 6 weeks and at 2 years mean 35.06. Oxford hip score had upward trend from pre-op to post-op 6wks assessments and a plateau in following assessments. VAS pain trajectories, showing a clear downward trend from pre-op to post-op 6wks and a plateau in the following postoperative assessments. Discussion & conclusion: The combination of Paragon stem and Global cup incorporates proven features of successful implants. The unique feature of lateral tension grooves and progressive neck dimension with dual offset options. This combination has shown promising early results with early follow up of a minimum of 2 years, with a 100% survivorship of the stem and 98.7% survivorship overall for any reason and is a good cementless option in THA.
{"title":"New Cementless Total Hip Arthroplasty. A Multicentre Prospective Minimum 2 Year Follow-up Clinical Outcomes Study.","authors":"Rohit Pandey, S. Coffey, R. Sorial","doi":"10.15438/RR.11.1.251","DOIUrl":"https://doi.org/10.15438/RR.11.1.251","url":null,"abstract":"Background: Cementless implants were introduced approximately three decades ago in order to address aseptic loosening of cemented hip prostheses with the aim of early mobilisation, better functional result and bone stock preservation. The primary objective of this study is to introduce a new cementless HA coated implant and report its minimum 2 year follow up results.\u0000Material & method: This is a prospective, multi-centre, consecutive series, clinical outcomes study with 75 patients. Inclusion criteria for the study were age 21- 85 years, BMI <40, osteoarthritis of the hip.\u0000Patients were operated using a standard posterolateral approach. The Paragon stem and the Global cup were implanted in a cementless method. Patients were reviewed at 6 weeks, 6 months and two years postoperative. At each visit AQoL 6D, VAS Pain, Oxford Hip Score were recorded. Post-operative X-Rays were reviewed at immediate post-operative, 6 months and two years.\u0000Results: Mean duration of surgery was 63.1 min with range of 40-120 min. AQoL over time changed from pre-op mean 50.51, at 6 weeks and at 2 years mean 35.06. Oxford hip score had upward trend from pre-op to post-op 6wks assessments and a plateau in following assessments. VAS pain trajectories, showing a clear downward trend from pre-op to post-op 6wks and a plateau in the following postoperative assessments.\u0000Discussion & conclusion: The combination of Paragon stem and Global cup incorporates proven features of successful implants. The unique feature of lateral tension grooves and progressive neck dimension with dual offset options. This combination has shown promising early results with early follow up of a minimum of 2 years, with a 100% survivorship of the stem and 98.7% survivorship overall for any reason and is a good cementless option in THA.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45466510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction & Aims TKA in more active and young patients has prompted the interest in more durable and biological methods of Osteo-integration with cementless components. With the emergence of improved biomaterials like porous titanium and the success, search for a cementless TKA with long-term durability and survivorship may have ended. This is a retrospective study of 492 consecutive TKAs using Cementless tibial fixation, reporting on the early 4 years clinical and radiological outcomes. Method We studied 492 TKAs performed consecutively by a single surgeon between 1stJan. 2010 and 31stDec. 2015 using a cementless, fixed bearing tibial tray (porous–Regenerex, Vanguard, Zimmer-Biomet) and a cementless femoral component (Vanguard) with no exclusion criteria. Clinical and radiological follow-up was done on these patients and in addition a comprehensive joint registry review was performed on the whole cohort (Level II evidence). Results The average Knee Society Score at final follow-up was 89.33, average pre-op being 42.06. Average post-op WOMAC score was 43.45 and average pre-op was 77.78. On radiological examination, no patients had osteolysis around tibial base plate. In our series 9 patients were revised, out of which only 4 patients had the tibial tray and femoral component revised and 5 patients had patella resurfacing or liner exchange. Overall survivorship of the cementless tibial component is excellent with a survivorship of 99.4% at 5.9 years based on a comprehensive AOANJRR data. Conclusions Cementless tibial fixation using a porous titanium construct can provide stable bone ingrowth fixation on the tibial side with excellent and predictable early 4 to 5 year clinical and radiological outcomes.
{"title":"Cementless Highly Porous Titanium Tibial Base Plate in Total Knee Arthroplasty – Midterm Outcomes.","authors":"Smit N. Shah, N. Coulshed, R. Sorial","doi":"10.15438/RR.11.1.235","DOIUrl":"https://doi.org/10.15438/RR.11.1.235","url":null,"abstract":"Introduction & Aims \u0000TKA in more active and young patients has prompted the interest in more durable and biological methods of Osteo-integration with cementless components. With the emergence of improved biomaterials like porous titanium and the success, search for a cementless TKA with long-term durability and survivorship may have ended. This is a retrospective study of 492 consecutive TKAs using Cementless tibial fixation, reporting on the early 4 years clinical and radiological outcomes. \u0000Method \u0000We studied 492 TKAs performed consecutively by a single surgeon between 1stJan. 2010 and 31stDec. 2015 using a cementless, fixed bearing tibial tray (porous–Regenerex, Vanguard, Zimmer-Biomet) and a cementless femoral component (Vanguard) with no exclusion criteria. Clinical and radiological follow-up was done on these patients and in addition a comprehensive joint registry review was performed on the whole cohort (Level II evidence). \u0000Results \u0000 The average Knee Society Score at final follow-up was 89.33, average pre-op being 42.06. Average post-op WOMAC score was 43.45 and average pre-op was 77.78. On radiological examination, no patients had osteolysis around tibial base plate. In our series 9 patients were revised, out of which only 4 patients had the tibial tray and femoral component revised and 5 patients had patella resurfacing or liner exchange. Overall survivorship of the cementless tibial component is excellent with a survivorship of 99.4% at 5.9 years based on a comprehensive AOANJRR data. \u0000Conclusions \u0000Cementless tibial fixation using a porous titanium construct can provide stable bone ingrowth fixation on the tibial side with excellent and predictable early 4 to 5 year clinical and radiological outcomes.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46273976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Tranexamic acid (TXA) has been shown to be effective in reducing post-operative blood loss after hip replacement surgery. Clinicians can be reluctant to administer intravenous (IV) TXA to high risk patients and intra-articular (IA) administration has been proposed as an alternative mode of delivery. This study was conducted to compare the efficacy of IV versus IA administration of TXA. This prospective, double blinded, randomised non-inferiority trial, compared 69 patients undergoing primary total hip arthroplasty (THA) who received either 3 doses of 15mg/kg of IV TXA or 3 g of IA TXA after capsular closure. The primary outcomes were change in Hb and the rate of blood transfusion. The secondary outcome was the rate of VTE. Results: The mean haemoglobin level change from pre-operative to day 1 post-operative for the IV group was 26.7g/L and for IA group was 27.3g/L. No statistically significant difference was detected between the two groups (p=0.82). No patients required a transfusion or developed a VTE. Conclusions: IA administration of TXA can be equally effective as IV in the reduction of blood loss and the prevention of post-operative anaemia in primary THA. Background
背景：氨甲环酸（TXA）已被证明能有效减少髋关节置换术后的术后失血。临床医生可能不愿意给高危患者静脉注射（IV）TXA，关节内注射（IA）已被提议作为一种替代分娩方式。本研究旨在比较静脉注射与IA给药TXA的疗效。这项前瞻性、双盲、随机非劣效性试验比较了69名接受原发性全髋关节置换术（THA）的患者，这些患者在包膜闭合后接受了3剂15mg/kg静脉注射TXA或3 g IA TXA。主要结果是Hb和输血率的变化。次要结果是VTE的发生率。结果：静脉注射组术前至术后第1天的平均血红蛋白水平变化为26.7g/L，IA组为27.3g/L。两组之间没有统计学显著差异（p=0.82）。没有患者需要输血或发生VTE。结论：TXA的IA给药与IV给药在减少原发性THA患者的失血和预防术后贫血方面同样有效。背景
{"title":"Intravenous versus Intra-Articular Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomised Double Blinded Non-Inferiority Trial","authors":"A. Hasan, D. Campbell, P. Lewis","doi":"10.15438/RR.11.1.245","DOIUrl":"https://doi.org/10.15438/RR.11.1.245","url":null,"abstract":"Background: Tranexamic acid (TXA) has been shown to be effective in reducing post-operative blood loss after hip replacement surgery. Clinicians can be reluctant to administer intravenous (IV) TXA to high risk patients and intra-articular (IA) administration has been proposed as an alternative mode of delivery. This study was conducted to compare the efficacy of IV versus IA administration of TXA. This prospective, double blinded, randomised non-inferiority trial, compared 69 patients undergoing primary total hip arthroplasty (THA) who received either 3 doses of 15mg/kg of IV TXA or 3 g of IA TXA after capsular closure. The primary outcomes were change in Hb and the rate of blood transfusion. The secondary outcome was the rate of VTE. Results: The mean haemoglobin level change from pre-operative to day 1 post-operative for the IV group was 26.7g/L and for IA group was 27.3g/L. No statistically significant difference was detected between the two groups (p=0.82). No patients required a transfusion or developed a VTE. Conclusions: IA administration of TXA can be equally effective as IV in the reduction of blood loss and the prevention of post-operative anaemia in primary THA. Background","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48077431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph S. Gondusky, Benjamin C. Campbell, C. Coulson
Background: Transfusion is a known risk of total hip arthroplasty (THA). It has been associated with a multitude of medical complications and increased cost. Prior studies report transfusion rates associated with THA, with wide variation, but most cannot differentiate the surgical approach utilized. The anterior approach (AA) for THA has been associated with increased operative time, complications, and blood loss, but little data exists regarding the actual transfusion rate associated with the approach. Methods: We performed a retrospective review of 390 consecutive, elective, primary unilateral AA THA procedures. Patient demographic, clinical and perioperative data was analyzed. A modern perioperative pathway, including a simple protocol to limit blood loss, is defined. Results: The group consisted of a typical inpatient arthroplasty population, with wide ranges of age, body mass index (BMI), and health status. The average age was 64.05 years (+ 10.67, range 27-94). BMI averaged 29.76 kg/m2 (+ 5.98, range 16-47). The majority of patients were American Society of Anesthesiologists (ASA) class 2 (45.6%) or 3 (50.3%), with 10 patients ASA 4 (2.6%). Average preoperative hemoglobin was 13.48 g/dL (+ 1.47, range 9.118.2). Operative time averaged 91.22 minutes (+ 14.2). 83.3% of patients received a spinal anesthetic. Most patients were discharged on postoperative day one (93.1%) to home (99%). Estimated blood loss averaged 264mL (+ 95.19, range 100-1000). No patient required perioperative transfusion or readmission for symptomatic anemia within 30 days postoperative. Conclusion: A modern protocol we utilize and define is capable of limiting blood loss and transfusion risk in anterior approach total hip arthroplasty.
{"title":"Low Transfusion Rate Attainable in Anterior Approach Total Hip Arthroplasty Utilizing a Modern Protocol","authors":"Joseph S. Gondusky, Benjamin C. Campbell, C. Coulson","doi":"10.15438/RR.11.1.247","DOIUrl":"https://doi.org/10.15438/RR.11.1.247","url":null,"abstract":"Background: Transfusion is a known risk of total hip arthroplasty (THA). It has been associated with a multitude of medical complications and increased cost. Prior studies report transfusion rates associated with THA, with wide variation, but most cannot differentiate the surgical approach utilized. The anterior approach (AA) for THA has been associated with increased operative time, complications, and blood loss, but little data exists regarding the actual transfusion rate associated with the approach. Methods: We performed a retrospective review of 390 consecutive, elective, primary unilateral AA THA procedures. Patient demographic, clinical and perioperative data was analyzed. A modern perioperative pathway, including a simple protocol to limit blood loss, is defined. Results: The group consisted of a typical inpatient arthroplasty population, with wide ranges of age, body mass index (BMI), and health status. The average age was 64.05 years (+ 10.67, range 27-94). BMI averaged 29.76 kg/m2 (+ 5.98, range 16-47). The majority of patients were American Society of Anesthesiologists (ASA) class 2 (45.6%) or 3 (50.3%), with 10 patients ASA 4 (2.6%). Average preoperative hemoglobin was 13.48 g/dL (+ 1.47, range 9.118.2). Operative time averaged 91.22 minutes (+ 14.2). 83.3% of patients received a spinal anesthetic. Most patients were discharged on postoperative day one (93.1%) to home (99%). Estimated blood loss averaged 264mL (+ 95.19, range 100-1000). No patient required perioperative transfusion or readmission for symptomatic anemia within 30 days postoperative. Conclusion: A modern protocol we utilize and define is capable of limiting blood loss and transfusion risk in anterior approach total hip arthroplasty.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41567925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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