P. Walker, D. Campbell, P. Torre, D. Brazil, T. Mctighe
We describe four patients who were treated with primary total hip arthroplasty (THA) at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe or TMZF O Stryker Osteonics, Mahwah NJ, USA) TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92) following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.
{"title":"Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series","authors":"P. Walker, D. Campbell, P. Torre, D. Brazil, T. Mctighe","doi":"10.15438/RR.6.3.161","DOIUrl":"https://doi.org/10.15438/RR.6.3.161","url":null,"abstract":"We describe four patients who were treated with primary total hip arthroplasty (THA) at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe or TMZF O Stryker Osteonics, Mahwah NJ, USA) TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92) following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.","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":"67683162","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}
This report updates previous articles and commentary presented on Modular Necks from our Tissue Sparing Implant Study Group. In July 2012 we reported that at two years post-op we had encountered no modular neck taper failures or any signs of fretting corrosion, or pseudo tumors associated with the ARC™ Stem. Today we describe five patients out of five hundred and forty-two who had total hip arthroplasty revision [titanium alloy stem, cobalt-chromium modular neck (c.c.) and c.c. modular head (32 mm or 36 mm), highly-cross-linked polyethylene liner, metal titanium plasma sprayed cementless metal cup]. All patients’ were female and all demonstrated progressive hip pain or late instability. All had debridement of the periarticular soft tissue, stem extraction with new primary length cementless stem replacement. At revision and early follow up all patients are doing well, however, we recommend heighten awareness in all active female patients with modular neck stem junctions.
{"title":"Modular Necks and Corrosion - Review of Five Cases","authors":"T. Mctighe, D. Brazil","doi":"10.15438/RR.6.3.163","DOIUrl":"https://doi.org/10.15438/RR.6.3.163","url":null,"abstract":"This report updates previous articles and commentary presented on Modular Necks from our Tissue Sparing Implant Study Group. In July 2012 we reported that at two years post-op we had encountered no modular neck taper failures or any signs of fretting corrosion, or pseudo tumors associated with the ARC™ Stem. Today we describe five patients out of five hundred and forty-two who had total hip arthroplasty revision [titanium alloy stem, cobalt-chromium modular neck (c.c.) and c.c. modular head (32 mm or 36 mm), highly-cross-linked polyethylene liner, metal titanium plasma sprayed cementless metal cup]. All patients’ were female and all demonstrated progressive hip pain or late instability. All had debridement of the periarticular soft tissue, stem extraction with new primary length cementless stem replacement. At revision and early follow up all patients are doing well, however, we recommend heighten awareness in all active female patients with modular neck stem junctions.","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":"67683297","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: Precise bone resection and appropriate soft tissue balancing are considered indispensable in total knee arthroplasty (TKA). However, in most TKAs, only the experienced-based subjective physical “feel” of the surgeon, or either a computer-based navigation system or a soft tissue balancing system are applied to improve the results. In the present study, a combination of both an accelerometer-based navigation system and an electronic knee balancing force sensor were applied to attempt to obtain optimal outcomes. Materials and Methods: An accelerometer-based navigation system and an electronic knee balancing force sensor were applied in combination in 5 TKAs. Thereafter, the incidence of radiographical outliers of the lower-extremity mechanical axis and the alignments of femoral and tibial components, and the incidence of intraoperative lateral retinacular release were evaluated and compared against those of 5 TKAs performed with the force sensor alone as a control. Results: The posterior slope of the tibia was significantly improved in the TKAs performed with the combination of both devices (P=0.004). No lateral release was performed in any TKAs of either group. Conclusion: TKAs performed under the combination of an accelerometer-based navigation system and an electronic knee balancing force sensor can obtain greater the accuracy of bone resection and appropriate soft tissue balancing.
{"title":"Combination of Accelerometer-Based Navigation and Force Sensor for Precise Bone Resection and Appropriate Soft Tissue Balancing in Total Knee Arthroplasty","authors":"Y. Oshima, J. Fetto","doi":"10.15438/RR.6.3.155","DOIUrl":"https://doi.org/10.15438/RR.6.3.155","url":null,"abstract":"Background: Precise bone resection and appropriate soft tissue balancing are considered indispensable in total knee arthroplasty (TKA). However, in most TKAs, only the experienced-based subjective physical “feel” of the surgeon, or either a computer-based navigation system or a soft tissue balancing system are applied to improve the results. In the present study, a combination of both an accelerometer-based navigation system and an electronic knee balancing force sensor were applied to attempt to obtain optimal outcomes. Materials and Methods: An accelerometer-based navigation system and an electronic knee balancing force sensor were applied in combination in 5 TKAs. Thereafter, the incidence of radiographical outliers of the lower-extremity mechanical axis and the alignments of femoral and tibial components, and the incidence of intraoperative lateral retinacular release were evaluated and compared against those of 5 TKAs performed with the force sensor alone as a control. Results: The posterior slope of the tibia was significantly improved in the TKAs performed with the combination of both devices (P=0.004). No lateral release was performed in any TKAs of either group. Conclusion: TKAs performed under the combination of an accelerometer-based navigation system and an electronic knee balancing force sensor can obtain greater the accuracy of bone resection and appropriate soft tissue balancing.","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":"67683463","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 : Many total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient morphology and normal activities of daily living, for that patient population. Femoral component sizing in primary total knee arthroplasty is of paramount importance for optimizing complication free post-operative function across all patients. The purpose of this study was to report the early results of a primary TKA system in support of the component design characteristics for achievement of increased functional expectations. METHODS : A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of two-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender. RESULTS : There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 3.8 years). In addition, there was an average significant increase in change of HSS score (p<0.01) and ROM (P<0.01) when compared to pre-operative baseline. CONCLUSIONS : The design characteristic for component sizing and functional expectations were confirmed in the reported Western population cohort series. Further continued use and study of this primary TKA system is warranted across all ethnic cultures.
{"title":"Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Component Design and Early Results","authors":"Sridhar M. Durbhakula, Laura F. Rego","doi":"10.15438/RR.6.3.156","DOIUrl":"https://doi.org/10.15438/RR.6.3.156","url":null,"abstract":"BACKGROUND : Many total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient morphology and normal activities of daily living, for that patient population. Femoral component sizing in primary total knee arthroplasty is of paramount importance for optimizing complication free post-operative function across all patients. The purpose of this study was to report the early results of a primary TKA system in support of the component design characteristics for achievement of increased functional expectations. METHODS : A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of two-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender. RESULTS : There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 3.8 years). In addition, there was an average significant increase in change of HSS score (p<0.01) and ROM (P<0.01) when compared to pre-operative baseline. CONCLUSIONS : The design characteristic for component sizing and functional expectations were confirmed in the reported Western population cohort series. Further continued use and study of this primary TKA system is warranted across all ethnic cultures.","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":"67683129","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}
Context- A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips. Materials and methods- 50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009). Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw) with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter. Statiscal analysis used- VAS and Harris hip score formed the basis of evaluation Results- These patients were followed up for a mean period of 49 months (Range 36-72 months). The average incision size was 14.38 cm (10-18 cm) and blood loss was 269 ml (175-450 ml). There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 %) had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41) patients had an excellent outcome at last follow-up. Conclusion- We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit initially followed by bone in-growth and was ideally suited to satisfy the requirements of a conservative hip implant. Unfortunately, due to unknown reasons, the implant has been recently withdrawn from the market by DePuy and is no longer available for use. Key Message Conservative hip stems that preserve bone and soft tissue at the time of surgery, prevent femoral stress shielding by circumferential loading, promote positive bone remodeling and help to make revision surgeries easier are ideally suited as hip implants for young active adults with end stage hip disease requiring hip replacement surgery.
背景-短解剖型干骺端股骨是年轻关节炎患者髋关节置换术中保留骨和软组织的理想髋关节植入物。股骨近端生理负荷防止应力屏蔽，长期保存股骨的骨存量。因此，它是一种理想的髋关节植入物，适合于保守的髋关节手术，活跃的年轻成年人有髋关节关节炎。材料和方法:在3年期间(2006年7月至2009年9月)，对41例平均年龄45岁的患者进行了50例近端髋关节置换术。髋关节病变的诊断从继发于缺血性坏死的骨关节炎、类风湿关节炎、结核后关节炎到髋关节发育不良不等。其中9例患者有双侧髋关节受累症状，并在一次坐位中接受了双侧髋关节置换术。所有患者均行近端干骺端植入(DePuy, Warsaw)，采用大直径金属对金属或尖顶关节。分别在3个月、6个月、1年及以后每年进行临床和放射学评估。采用统计学分析- VAS评分和Harris髋关节评分构成评估的基础结果-这些患者的平均随访时间为49个月(范围36-72个月)。平均切口大小为14.38 cm (10-18 cm)，出血量为269 ml (175-450 ml)。所有患者无围手术期死亡或严重发病率。一名患者术中外侧皮质破裂，只需要延迟康复。41例患者中有5例(12.1%)出现并发症，其中3例完全恢复，1例需要翻修股骨干进行无菌性松动。随访中丢失1例。Harris髋关节评分由52分提高至89.3分。最后随访时，95.1%(39/41)患者预后良好。结论-我们得出结论，通过最初的紧密配合和骨生长，近端干干提供了临床和放射学上稳定的固定，非常适合满足保守髋关节植入物的要求。不幸的是，由于未知的原因，植入物最近被DePuy从市场上撤回，不再可用。保守性髋关节柄在手术时保护骨骼和软组织，防止通过周向负荷屏蔽股骨应力，促进骨正向重塑，并有助于使翻修手术更容易，是理想的髋关节植入物，适用于需要髋关节置换术的终末期髋关节疾病的年轻活跃成年人。
{"title":"Our Experience with Short Stem Hip Replacement Surgery","authors":"S. Rastogi, S. Marya","doi":"10.15438/RR.6.2.140","DOIUrl":"https://doi.org/10.15438/RR.6.2.140","url":null,"abstract":"Context- A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips. Materials and methods- 50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009). Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw) with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter. Statiscal analysis used- VAS and Harris hip score formed the basis of evaluation Results- These patients were followed up for a mean period of 49 months (Range 36-72 months). The average incision size was 14.38 cm (10-18 cm) and blood loss was 269 ml (175-450 ml). There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 %) had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41) patients had an excellent outcome at last follow-up. Conclusion- We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit initially followed by bone in-growth and was ideally suited to satisfy the requirements of a conservative hip implant. Unfortunately, due to unknown reasons, the implant has been recently withdrawn from the market by DePuy and is no longer available for use. Key Message Conservative hip stems that preserve bone and soft tissue at the time of surgery, prevent femoral stress shielding by circumferential loading, promote positive bone remodeling and help to make revision surgeries easier are ideally suited as hip implants for young active adults with end stage hip disease requiring hip replacement surgery.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682659","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}
G. Sharma, V. Bagaria, Shyam Nadange, Chaitanya Waghchoure, Smit N. Shah, Ravishanker Tangirala, F. Wadia
Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.
{"title":"Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report","authors":"G. Sharma, V. Bagaria, Shyam Nadange, Chaitanya Waghchoure, Smit N. Shah, Ravishanker Tangirala, F. Wadia","doi":"10.15438/RR.6.2.145","DOIUrl":"https://doi.org/10.15438/RR.6.2.145","url":null,"abstract":"Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682732","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}
Sickle cell disease (SCD) is a hemoglobinopathy characterized by abnormal morphology of blood cells causing transient interruption of blood supply to various body parts. Femoral Head avascular necrosis is one of the commonest skeletal sequeale of SCD. Total Hip arthroplasty (THA) in SCD has evolved through different stages with a spectrum of results and technical challenges. This article reviews the pathologic basis of sickle cell disease , the various challenges perioperatively associated with THA in SCD.
{"title":"Total Hip Arthroplasty in Sickle Cell Disease","authors":"M. Manzary","doi":"10.15438/RR.6.2.137","DOIUrl":"https://doi.org/10.15438/RR.6.2.137","url":null,"abstract":"Sickle cell disease (SCD) is a hemoglobinopathy characterized by abnormal morphology of blood cells causing transient interruption of blood supply to various body parts. Femoral Head avascular necrosis is one of the commonest skeletal sequeale of SCD. Total Hip arthroplasty (THA) in SCD has evolved through different stages with a spectrum of results and technical challenges. This article reviews the pathologic basis of sickle cell disease , the various challenges perioperatively associated with THA in SCD.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682826","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 Excessive perioperative bleeding requiring transfusion remains a potential complication of Total Knee Arthroplasty (TKA). There is overwhelming evidence supporting the efficacy of intravenous Tranexamic acid to reduce bleeding and the need for transfusion in TKA. There is still some question regarding the efficacy of other methods of Tranexamic acid administration. This case series study evaluated the effects of the use of intravenous Tranexamic acid administered alone, or in combination with intra-articular tranexamic acid on transfusion rate and other clinical outcomes; and compared this to a group of patients who received neither treatment. Method We conducted a case review of 150 patients who had undergone TKA from 2012-2015. 50 patients underwent TKA with IV Tranexamic acid (Group A). A further 50 patients underwent TKA with IV Tranexamic acid in combination with intra-articular administration of 2grams of Tranexamic acid in 20ml saline (Group B). A final 50 patients underwent TKA without the use of Tranexamic acid (non-treatment group). Outcome measures were transfusion rate, change in haemoglobin and haematocrit, medical review events, patient mortality and changes in knee flexion and extension measurements at six weeks after surgery. Results There were no significant differences in red blood cell transfusion rates between the non-treatment group and the two treatment groups, however an absolute reduction in transfusion rate from 8% to 0% (p=0.134) was observed. The mean change of haemoglobin level in the non-treatment group was 29 while in treatment groups A and B, this was 23 and 19 respectively (p=0.0001). No significant difference was observed between treatment group A and B. There was a significant difference in post-operative haemoglobin level, where mean haemoglobin concentrations in non-treatment, Group A and B were 110 vs 115 vs 123 respectively (P= 0.0001). Pairwise comparison showed that Group B was significantly different when compared to both non treatment (p=0.0001) and treatment group A (p=0.020). There were no significant differences observed in other outcomes. Conclusion This study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence). Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone
{"title":"Combination Intravenous and Intra-Articular Tranexamic Acid Compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study","authors":"C. Buntting, R. Sorial, S. Coffey, G. Eslick","doi":"10.15438/RR.6.2.138","DOIUrl":"https://doi.org/10.15438/RR.6.2.138","url":null,"abstract":"Introduction Excessive perioperative bleeding requiring transfusion remains a potential complication of Total Knee Arthroplasty (TKA). There is overwhelming evidence supporting the efficacy of intravenous Tranexamic acid to reduce bleeding and the need for transfusion in TKA. There is still some question regarding the efficacy of other methods of Tranexamic acid administration. This case series study evaluated the effects of the use of intravenous Tranexamic acid administered alone, or in combination with intra-articular tranexamic acid on transfusion rate and other clinical outcomes; and compared this to a group of patients who received neither treatment. Method We conducted a case review of 150 patients who had undergone TKA from 2012-2015. 50 patients underwent TKA with IV Tranexamic acid (Group A). A further 50 patients underwent TKA with IV Tranexamic acid in combination with intra-articular administration of 2grams of Tranexamic acid in 20ml saline (Group B). A final 50 patients underwent TKA without the use of Tranexamic acid (non-treatment group). Outcome measures were transfusion rate, change in haemoglobin and haematocrit, medical review events, patient mortality and changes in knee flexion and extension measurements at six weeks after surgery. Results There were no significant differences in red blood cell transfusion rates between the non-treatment group and the two treatment groups, however an absolute reduction in transfusion rate from 8% to 0% (p=0.134) was observed. The mean change of haemoglobin level in the non-treatment group was 29 while in treatment groups A and B, this was 23 and 19 respectively (p=0.0001). No significant difference was observed between treatment group A and B. There was a significant difference in post-operative haemoglobin level, where mean haemoglobin concentrations in non-treatment, Group A and B were 110 vs 115 vs 123 respectively (P= 0.0001). Pairwise comparison showed that Group B was significantly different when compared to both non treatment (p=0.0001) and treatment group A (p=0.020). There were no significant differences observed in other outcomes. Conclusion This study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence). Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682953","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}
S. Qurashi, Jason Chinnappa, Pasquale Rositano, S. Asha
Normal.dotm 0 0 1 187 1067 8 2 1310 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} Introduction: SuperPATH is a new minimally invasive technique for hip replacement surgery that was introduced in Australia in 2013. The aim of this study was to assess short-term patient outcomes and surgical results of SuperPATH hip replacements in Australia. Methods: A retrospective cohort analysis of the first 100 SuperPATH hip replacements by a single surgeon was performed. Surgical outcomes were reviewed with a minimum follow-up of 1 year post operation. A functional and patient satisfaction questionnaire was administered at a minimum of 6 weeks post operation. Results: There were 3 major complications with 1 revision operation in this series. There were no dislocations. By 2 weeks post operation, 86% of patients were ambulant without walking aids, 84% of patients were able to dress themselves independently and 91% of patients did not need opioid analgesia. 81% of patients were driving within 4 weeks of surgery. Of patients who were working full-time prior to surgery, 33% of them were back at work or functional baseline within 1 week post surgery, and 52% by 2 weeks. 100% of patients were extremely satisfied with the operation. Conclusion: We conclude that SuperPATH is a safe technique of hip arthroplasty with excellent functional recovery and patient satisfaction.
{"title":"SuperPATH® Minimally Invasive Total Hip Arthroplasty - An Australian Experience","authors":"S. Qurashi, Jason Chinnappa, Pasquale Rositano, S. Asha","doi":"10.15438/RR.6.2.139","DOIUrl":"https://doi.org/10.15438/RR.6.2.139","url":null,"abstract":"Normal.dotm 0 0 1 187 1067 8 2 1310 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ \u0000table.MsoNormalTable \u0000 {mso-style-name:\"Table Normal\"; \u0000 mso-tstyle-rowband-size:0; \u0000 mso-tstyle-colband-size:0; \u0000 mso-style-noshow:yes; \u0000 mso-style-parent:\"\"; \u0000 mso-padding-alt:0in 5.4pt 0in 5.4pt; \u0000 mso-para-margin:0in; \u0000 mso-para-margin-bottom:.0001pt; \u0000 mso-pagination:widow-orphan; \u0000 font-size:12.0pt; \u0000 font-family:\"Times New Roman\"; \u0000 mso-ascii-font-family:Cambria; \u0000 mso-ascii-theme-font:minor-latin; \u0000 mso-hansi-font-family:Cambria; \u0000 mso-hansi-theme-font:minor-latin;} \u0000 Introduction: SuperPATH is a new minimally invasive technique for hip replacement surgery that was introduced in Australia in 2013. The aim of this study was to assess short-term patient outcomes and surgical results of SuperPATH hip replacements in Australia. Methods: A retrospective cohort analysis of the first 100 SuperPATH hip replacements by a single surgeon was performed. Surgical outcomes were reviewed with a minimum follow-up of 1 year post operation. A functional and patient satisfaction questionnaire was administered at a minimum of 6 weeks post operation. Results: There were 3 major complications with 1 revision operation in this series. There were no dislocations. By 2 weeks post operation, 86% of patients were ambulant without walking aids, 84% of patients were able to dress themselves independently and 91% of patients did not need opioid analgesia. 81% of patients were driving within 4 weeks of surgery. Of patients who were working full-time prior to surgery, 33% of them were back at work or functional baseline within 1 week post surgery, and 52% by 2 weeks. 100% of patients were extremely satisfied with the operation. Conclusion: We conclude that SuperPATH is a safe technique of hip arthroplasty with excellent functional recovery and patient satisfaction.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682998","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: The volume of total knee arthroplasty procedures is growing rapidly and, correspondingly, it is expected that the volume of revision procedures will grow rapidly as well. Revision surgery is most successful when adequate bone remains on both the tibia and femur to allow for the least invasive revision. We hypothesized that total knee arthroplasty with a patient-specific implant would result in significant bone preservation as compared to standard total knee arthroplasty with “off-the-shelf” implants. Methods: We evaluated 100 total knee arthroplasties which utilized patient-specific implants, versus 37 standard posterior stabilized and 32 standard posterior cruciate retaining total knee arthroplasties. Bone resection was quantified utilizing intra-operative measurements of actual resected bone. Additionally we performed a virtual, CAD-based analysis of resections via CT imaging on 15 knees. Findings: We found that patients had significantly less bone resected in all zones measured, on both the femur and tibia, when patient-specific implants with patient-specific jigs were used. When assessed volumetrically with CAD imaging, standard implants resected 12-49% more bone than did patient-specific implants, depending on the size of the implant utilized. Interpretations: Utilizing patient-specific implants in total knee arthroplasty results in significant bone sparing as compared to standard total knee arthroplasty. This has the potential for less invasive revision surgery in the future, possibly obviating the need for dedicated revision implants or augments and other bone substituting devices.
{"title":"Bone Preservation in a Novel Patient Specific Total Knee Replacement.","authors":"W. Kurtz, John E. Slamin, Scott W. Doody","doi":"10.15438/RR.6.1.133","DOIUrl":"https://doi.org/10.15438/RR.6.1.133","url":null,"abstract":"Background: The volume of total knee arthroplasty procedures is growing rapidly and, correspondingly, it is expected that the volume of revision procedures will grow rapidly as well. Revision surgery is most successful when adequate bone remains on both the tibia and femur to allow for the least invasive revision. We hypothesized that total knee arthroplasty with a patient-specific implant would result in significant bone preservation as compared to standard total knee arthroplasty with “off-the-shelf” implants. Methods: We evaluated 100 total knee arthroplasties which utilized patient-specific implants, versus 37 standard posterior stabilized and 32 standard posterior cruciate retaining total knee arthroplasties. Bone resection was quantified utilizing intra-operative measurements of actual resected bone. Additionally we performed a virtual, CAD-based analysis of resections via CT imaging on 15 knees. Findings: We found that patients had significantly less bone resected in all zones measured, on both the femur and tibia, when patient-specific implants with patient-specific jigs were used. When assessed volumetrically with CAD imaging, standard implants resected 12-49% more bone than did patient-specific implants, depending on the size of the implant utilized. Interpretations: Utilizing patient-specific implants in total knee arthroplasty results in significant bone sparing as compared to standard total knee arthroplasty. This has the potential for less invasive revision surgery in the future, possibly obviating the need for dedicated revision implants or augments and other bone substituting devices.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682265","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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