Anis Tebourbi, A. Elloumi, K. Hadhri, M. Salah, Mouadh Nefiss, R. Bouzidi, M. Kooli
Context: Prosthetic joint infection due to Mycobacterium tuberculosis with no previous history of pulmonary or extra pulmonary tuberculosis is an extremely rare complication. Aim s To report the case of a patient with tuberculous mycobacterial prosthetic hip infection, 14 years after surgery for post traumatic osteoarthritis, with no previous history of tuberculosis . Methods A 46-year-old male presented an acetabular loosening of a cemented total hip arthroplasty with subnormal biologic parameters. A one stage revision surgery was planned. Intraoperative findings suggested mycobacterial tuberculous infection with presence of periacetabular yellowish rice-shaped granules. Results A one-stage prosthesis exchange was performed; Culture on Lowenstein-Jensen medium grew MTB days after inoculation and histological examination confirmed tuberculous infection. Patient was treated by antituberculous agents for 12 months with optimal clinical and biological response and no prosthetic loosening signs at eighteen months follow up. Conclusions Total hip arthroplasty loosening due to mycobacterium tuberculosis is a rare entity, which should be evoked even when no inflammatory signs are shown. Discovery of yellowish rice-shaped granules is an indicator to investigate for tuberculosis. Management of prosthetic joint infection due to M.tuberculosis must involve both medical and surgical approach.
{"title":"Total Hip Arthroplasty Loosening Due to Mycobacterium Tuberculosis: A Case Report and Review of the Literature","authors":"Anis Tebourbi, A. Elloumi, K. Hadhri, M. Salah, Mouadh Nefiss, R. Bouzidi, M. Kooli","doi":"10.15438/RR.7.1.160","DOIUrl":"https://doi.org/10.15438/RR.7.1.160","url":null,"abstract":"Context: Prosthetic joint infection due to Mycobacterium tuberculosis with no previous history of pulmonary or extra pulmonary tuberculosis is an extremely rare complication. Aim s To report the case of a patient with tuberculous mycobacterial prosthetic hip infection, 14 years after surgery for post traumatic osteoarthritis, with no previous history of tuberculosis . Methods A 46-year-old male presented an acetabular loosening of a cemented total hip arthroplasty with subnormal biologic parameters. A one stage revision surgery was planned. Intraoperative findings suggested mycobacterial tuberculous infection with presence of periacetabular yellowish rice-shaped granules. Results A one-stage prosthesis exchange was performed; Culture on Lowenstein-Jensen medium grew MTB days after inoculation and histological examination confirmed tuberculous infection. Patient was treated by antituberculous agents for 12 months with optimal clinical and biological response and no prosthetic loosening signs at eighteen months follow up. Conclusions Total hip arthroplasty loosening due to mycobacterium tuberculosis is a rare entity, which should be evoked even when no inflammatory signs are shown. Discovery of yellowish rice-shaped granules is an indicator to investigate for tuberculosis. Management of prosthetic joint infection due to M.tuberculosis must involve both medical and surgical approach.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48435799","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}
Medical terminology is an important tool for communication among medical practitioners, researchers, and scientists. The precise use of terms ensures a successful orientation in the field of medical practice contributing to the adequate treatment of patients. The subject of this commentary is the misuse of the terms “osteoarthritis” and “osteoarthrosis” in the specialty of orthopedic surgery. Contemporary literature, journals, media, etc., especially those in English language, are dominated by the use of the term “osteoarthritis” for the most common pathological condition, namely the degenerative joint disease.
{"title":"Osteoarthritis or Osteoarthrosis: Commentary on Misuse of Terms","authors":"Panayot P. Tanchev","doi":"10.15438/RR.7.1.178","DOIUrl":"https://doi.org/10.15438/RR.7.1.178","url":null,"abstract":"Medical terminology is an important tool for communication among medical practitioners, researchers, and scientists. The precise use of terms ensures a successful orientation in the field of medical practice contributing to the adequate treatment of patients. The subject of this commentary is the misuse of the terms “osteoarthritis” and “osteoarthrosis” in the specialty of orthopedic surgery. Contemporary literature, journals, media, etc., especially those in English language, are dominated by the use of the term “osteoarthritis” for the most common pathological condition, namely the degenerative joint disease.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45348772","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}
We present a single case of fracture of an Exeter femoral prosthesis at the neck, occurring after a fall from standing height, in a lean 70yr lady at 6 years post implantation. The fracture propagated from the insertion dimple on the superior aspect of the prosthesis shoulder. Materials analysis suggested variance in composition of the alloy, particularly with grain size heterogeneity. Whilst Exeter femoral prosthesis fracture is extremely rare, when it does occur the literature suggests it is often in the context of excessive mechanical stresses (obesity, high offset, falls). However, this case may represent a failure of materials rather than mechanical stresses alone.
{"title":"Prosthetic Fracture of a Cemented Exeter Femoral Stem (Case Report)","authors":"M. Facek, Y. Khatib, E. Swarts","doi":"10.15438/RR.6.4.159","DOIUrl":"https://doi.org/10.15438/RR.6.4.159","url":null,"abstract":"We present a single case of fracture of an Exeter femoral prosthesis at the neck, occurring after a fall from standing height, in a lean 70yr lady at 6 years post implantation. The fracture propagated from the insertion dimple on the superior aspect of the prosthesis shoulder. Materials analysis suggested variance in composition of the alloy, particularly with grain size heterogeneity. Whilst Exeter femoral prosthesis fracture is extremely rare, when it does occur the literature suggests it is often in the context of excessive mechanical stresses (obesity, high offset, falls). However, this case may represent a failure of materials rather than mechanical stresses alone.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683927","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}
Anis Tebourbi, K. Hadhri, M. Salah, R. Bouzidi, M. Kooli
Context: Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging. Aim s To report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature . Methods We report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapy Results At two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic loosening Conclusions Brucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.
{"title":"Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review","authors":"Anis Tebourbi, K. Hadhri, M. Salah, R. Bouzidi, M. Kooli","doi":"10.15438/RR.6.4.164","DOIUrl":"https://doi.org/10.15438/RR.6.4.164","url":null,"abstract":"Context: Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging. Aim s To report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature . Methods We report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapy Results At two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic loosening Conclusions Brucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683982","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}
Thermal plasma sprayed coatings are designed to improve both the biocompatibility and durability of implantable medical devices, and include pure titanium, cobalt/chrome alloy and hydroxyapatite. Coated joint replacements have now been in continuous clinical use for thirty years and are applied to products manufactured or used in Europe, North America, South America, Africa, Asia and Australasia. Prostheses incorporating such coatings have been successfully implanted into several million of patients worldwide and to date there have been very few reports of any failure of an implant which could be attributed to problems with, or failure of, the coating. This paper summarises the early history of cementless prostheses and subsequent development, specification, validation, regulatory requirements and clinical performance of thermal plasma spray coatings provided by Accentus Medical.
{"title":"The History, Technical Specifications and Efficacy of Plasma Spray Coatings Applied to Joint Replacement Prostheses","authors":"A. Mccabe, M. Pickford, J. Shawcross","doi":"10.15438/RR.6.4.136","DOIUrl":"https://doi.org/10.15438/RR.6.4.136","url":null,"abstract":"Thermal plasma sprayed coatings are designed to improve both the biocompatibility and durability of implantable medical devices, and include pure titanium, cobalt/chrome alloy and hydroxyapatite. Coated joint replacements have now been in continuous clinical use for thirty years and are applied to products manufactured or used in Europe, North America, South America, Africa, Asia and Australasia. Prostheses incorporating such coatings have been successfully implanted into several million of patients worldwide and to date there have been very few reports of any failure of an implant which could be attributed to problems with, or failure of, the coating. This paper summarises the early history of cementless prostheses and subsequent development, specification, validation, regulatory requirements and clinical performance of thermal plasma spray coatings provided by Accentus Medical.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683391","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}
J. Pierrepont, C. Stambouzou, B. Miles, P. O'Connor, L. Walter, A. Ellis, R. Molnar, J. Baré, M. Solomon, S. McMahon, A. Shimmin, E. Marel
Appropriate component alignment is critical for reducing instability, maximising bearing performance and restoring native anatomy after Total Hip Replacement (THR). Due to the large variation in patient kinematics between functional activities, current technologies lack definition of what constitutes correct target alignment. Analysis of a large series of symptomatic THR patients confirm that apparently well-orientated components on standard radiographs can still fail due to functional component malalignment. Evidently, previously defined “safe zones” are not appropriate for all patients as they don’t consider the dynamic behaviour of the hip joint. The Optimized Positioning System TM (OPS TM ) comprises preoperative planning based on a patient-specific dynamic analysis, and patient-specific instrumentation for delivery of the target component alignment. This paper presents the application of OPS TM in three case studies.
{"title":"Patient Specific Component Alignment in Total Hip Arthroplasty","authors":"J. Pierrepont, C. Stambouzou, B. Miles, P. O'Connor, L. Walter, A. Ellis, R. Molnar, J. Baré, M. Solomon, S. McMahon, A. Shimmin, E. Marel","doi":"10.15438/RR.6.4.148","DOIUrl":"https://doi.org/10.15438/RR.6.4.148","url":null,"abstract":"Appropriate component alignment is critical for reducing instability, maximising bearing performance and restoring native anatomy after Total Hip Replacement (THR). Due to the large variation in patient kinematics between functional activities, current technologies lack definition of what constitutes correct target alignment. Analysis of a large series of symptomatic THR patients confirm that apparently well-orientated components on standard radiographs can still fail due to functional component malalignment. Evidently, previously defined “safe zones” are not appropriate for all patients as they don’t consider the dynamic behaviour of the hip joint. The Optimized Positioning System TM (OPS TM ) comprises preoperative planning based on a patient-specific dynamic analysis, and patient-specific instrumentation for delivery of the target component alignment. This paper presents the application of OPS TM in three case studies.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683488","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}
We present the first UK single surgeon case series for the iDuo knee. This is a CT based custom fit monolithic bi-compartmental design that resurfaces both trochlea and condyle. Perceived benefits include maintenance of normal kinematics and preservation of bone stock on the unaffected side. The femoral component is tailored to the patient with no compromise of either the trochlea or femoral geometry. Method Patients were selected based on functional ability and physiological age who had an intact symptom free lateral compartment. Knee Society scoring (KSS) was performed pre-operatively and at regular intervals. Patients were asked whether they would undergo the same operation at the one-year mark. Results Seven patients have undergone this procedure from 2013 until present. Average age is 60 (Range 55- 82). Average pre-op KSS was 108. All patients consistently scored higher at each interval follow up with excellent results at one year (Av KSS 194). This benefit was seen past two years in all but one in those reaching this point. Conclusion Our early results suggest that the iDuo knee is a good option for those with isolated bi-compartmental disease and outcome scores are comparable with those reported for the BKA. This bi-compartmental design may bridge the gap between the uni-compartmental and total knee replacement. The choice between monolithic or modular designs remains in debate. We will continue to use this prosthesis for a carefully selected group of patients.
{"title":"The iDuo Bi-compartmental Knee Replacement: Our Early Experience.","authors":"P. Jemmett, Stuart Roy","doi":"10.15438/RR.6.4.149","DOIUrl":"https://doi.org/10.15438/RR.6.4.149","url":null,"abstract":"We present the first UK single surgeon case series for the iDuo knee. This is a CT based custom fit monolithic bi-compartmental design that resurfaces both trochlea and condyle. Perceived benefits include maintenance of normal kinematics and preservation of bone stock on the unaffected side. The femoral component is tailored to the patient with no compromise of either the trochlea or femoral geometry. Method Patients were selected based on functional ability and physiological age who had an intact symptom free lateral compartment. Knee Society scoring (KSS) was performed pre-operatively and at regular intervals. Patients were asked whether they would undergo the same operation at the one-year mark. Results Seven patients have undergone this procedure from 2013 until present. Average age is 60 (Range 55- 82). Average pre-op KSS was 108. All patients consistently scored higher at each interval follow up with excellent results at one year (Av KSS 194). This benefit was seen past two years in all but one in those reaching this point. Conclusion Our early results suggest that the iDuo knee is a good option for those with isolated bi-compartmental disease and outcome scores are comparable with those reported for the BKA. This bi-compartmental design may bridge the gap between the uni-compartmental and total knee replacement. The choice between monolithic or modular designs remains in debate. We will continue to use this prosthesis for a carefully selected group of patients.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683782","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}
The Oxford Partial Knee Replacement was approved for implantation in the US in 2004 after the surgeon completed an educational training requirement. Since then my knee practiced has expanded to over 50% partial knee. This experience coupled with refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated the transformation to same day discharge for partial knee cases and has quickly transitioned to total hip, total knee, and selected revision surgeries. Patient selection has also expanded for outpatient joints and is now based on medical screening criteria and insurance access. Over a two-year period we have performed over 1,000 outpatient arthroplasty procedures with no readmissions for pain control. Overall readmission rate for all reasons was 2%. Patient satisfaction scores were 98% Great-Good for 2014-15. The combination of a partial knee replacement practice and an outpatient joint program brings the best VALUE to the patients, surgeons, and the arthroplasty system and represents the future of arthroplasty care.
{"title":"Oxford Partial Knee Replacement as a Gateway to Outpatient Arthroplasty “Lessons Learned along the Journey”","authors":"M. Berend","doi":"10.15438/RR.6.3.147","DOIUrl":"https://doi.org/10.15438/RR.6.3.147","url":null,"abstract":"The Oxford Partial Knee Replacement was approved for implantation in the US in 2004 after the surgeon completed an educational training requirement. Since then my knee practiced has expanded to over 50% partial knee. This experience coupled with refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated the transformation to same day discharge for partial knee cases and has quickly transitioned to total hip, total knee, and selected revision surgeries. Patient selection has also expanded for outpatient joints and is now based on medical screening criteria and insurance access. Over a two-year period we have performed over 1,000 outpatient arthroplasty procedures with no readmissions for pain control. Overall readmission rate for all reasons was 2%. Patient satisfaction scores were 98% Great-Good for 2014-15. The combination of a partial knee replacement practice and an outpatient joint program brings the best VALUE to the patients, surgeons, and the arthroplasty system and represents the future of arthroplasty care.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683197","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}
Congenital hip dysplasia often requires surgical interventions in younger adults. 3D-navigated, robotic-assisted surgery for total hip arthroplasty may be beneficial in cases of pseudo-acetabulum and preceding treatments (Chiari Pelvic osteotomy) due to better pre-surgical planning and higher levels of precision associated with the technology, which may be associated with positive effects regarding short-term and long-term clinical outcomes. Here, we report the case of a 26-year-old Caucasian woman with a Crowe-IV dysplastic hip and pseudo-acetabulum. Earlier interventions included Chiari pelvic osteotomy, femoral osteotomy and femoral lengthening, which did not improve pain and function in the longer term. The surgical approach via robot-assisted surgery lead to positive outcomes in the short-term (four months post-surgery) and medium-term (17 months post-surgery) in this specific case.
{"title":"Robot-assisted Total Hip Arthroplasty after Chiari Pelvic Osteotomy: A Case Report","authors":"M. Dettmer, A. Pourmoghaddam, S. Kreuzer","doi":"10.15438/RR.6.3.130","DOIUrl":"https://doi.org/10.15438/RR.6.3.130","url":null,"abstract":"Congenital hip dysplasia often requires surgical interventions in younger adults. 3D-navigated, robotic-assisted surgery for total hip arthroplasty may be beneficial in cases of pseudo-acetabulum and preceding treatments (Chiari Pelvic osteotomy) due to better pre-surgical planning and higher levels of precision associated with the technology, which may be associated with positive effects regarding short-term and long-term clinical outcomes. Here, we report the case of a 26-year-old Caucasian woman with a Crowe-IV dysplastic hip and pseudo-acetabulum. Earlier interventions included Chiari pelvic osteotomy, femoral osteotomy and femoral lengthening, which did not improve pain and function in the longer term. The surgical approach via robot-assisted surgery lead to positive outcomes in the short-term (four months post-surgery) and medium-term (17 months post-surgery) in this specific case.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682789","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}
T. Watters, Dan L Levy, R. Kim, T. Miner, D. Dennis, J. Jennings
Abstract Background : The use of a tourniquet during total knee arthroplasty (TKA) continues to be a matter of debate. Advantages of tourniquet use include improved visualization, decreased intraoperative and total blood loss, and possibly decreased transfusion requirement. However, the recent widespread adoption of antifibrinolytic therapy with tranexamic acid (TXA), may negate these benefits. The purpose of this study was to evaluate perioperative blood loss and transfusion requirement with two different tourniquet application strategies, and surgery without the use of a tourniquet during routine, primary cemented TKA. Methods : A retrospective cohort study was performed of 300 patients undergoing TKA at a single institution after the implementation of a routine intravenous TXA administration protocol and consisted of three groups based on tourniquet usage: tourniquet inflation before incision and deflation following cement hardening (TQ), tourniquet inflation prior to cement application and deflation following hardening (Partial TQ), and no tourniquet usage (No TQ). Each group consisted of 100 consecutive patients. Perioperative blood loss, change in hematocrit and transfusion requirement were compared between groups. Results : Total blood loss (estimated blood loss and drain output) was lowest in the TQ group, however this was only due a slight decrease in intraoperative estimated blood loss. There was no difference in post-operative drain output, or change in hematocrit levels from preoperative values. There were no transfusions in the Partial TQ and No TQ groups, whereas there were 5 transfusions in the TQ group. Conclusions : In the era of routine TXA administration during TKA, tourniquet usage does not appear to have a benefit in regards to perioperative blood loss or transfusion requirement.
{"title":"Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid","authors":"T. Watters, Dan L Levy, R. Kim, T. Miner, D. Dennis, J. Jennings","doi":"10.15438/RR.6.3.151","DOIUrl":"https://doi.org/10.15438/RR.6.3.151","url":null,"abstract":"Abstract Background : The use of a tourniquet during total knee arthroplasty (TKA) continues to be a matter of debate. Advantages of tourniquet use include improved visualization, decreased intraoperative and total blood loss, and possibly decreased transfusion requirement. However, the recent widespread adoption of antifibrinolytic therapy with tranexamic acid (TXA), may negate these benefits. The purpose of this study was to evaluate perioperative blood loss and transfusion requirement with two different tourniquet application strategies, and surgery without the use of a tourniquet during routine, primary cemented TKA. Methods : A retrospective cohort study was performed of 300 patients undergoing TKA at a single institution after the implementation of a routine intravenous TXA administration protocol and consisted of three groups based on tourniquet usage: tourniquet inflation before incision and deflation following cement hardening (TQ), tourniquet inflation prior to cement application and deflation following hardening (Partial TQ), and no tourniquet usage (No TQ). Each group consisted of 100 consecutive patients. Perioperative blood loss, change in hematocrit and transfusion requirement were compared between groups. Results : Total blood loss (estimated blood loss and drain output) was lowest in the TQ group, however this was only due a slight decrease in intraoperative estimated blood loss. There was no difference in post-operative drain output, or change in hematocrit levels from preoperative values. There were no transfusions in the Partial TQ and No TQ groups, whereas there were 5 transfusions in the TQ group. Conclusions : In the era of routine TXA administration during TKA, tourniquet usage does not appear to have a benefit in regards to perioperative blood loss or transfusion requirement.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67683330","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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