Gholam Hossain Shahcheraghi, MD, FRCS(C); Mahzad Javid, MD; Mohammad Arasteh, MD xArasteh, MD
Abstract
Background: Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis.Methods: In a prospective case series study from ...
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Background: Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis.Methods: In a prospective case series study from January to December 2012, 100 consecutive total knee arthroplasty (TKA) candidates were evaluated for TED by clinical evaluation and doppler sonography preoperatively and 2 months postoperatively and by clinical evaluation one year after surgery. The patients in this study randomly received either warfarin or enoxaparin prophylactically.Results: A total of 77 women and 23 men with mean age of 67 years (52-82 years) entered the study. The average hemoglobin drop of 2.7 g with warfarin and 3.3 with enoxaparin was observed. No case of TED, pulmonary embolus (PE), major bleeding, post-thrombotic syndrome, or hemarthrosis was observed.Conclusions: No clinically significant DVT was found using either enoxaparin or warfarin prophylaxis after TKA in Southern Iran. Relatively excessive postoperative bleeding was observed, particularly with enoxaparin.The article is published online in Journal of Orthopaedics, 01/2014: 12(2):86-91 and is available online at www.sciencedirect.comjournal homepage: www.elsevier.com/locate/jorCopyright 2014 by Professor P K Surendran Memorial Education Foundation. Publishing Services by Reed Elsevier India Pvt. Ltd. All rights reserved.
Fardin Mirzatolouei, MD; Majid Mohseni Kabir, MD
Abstract
Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning ...
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Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning of femoral component. The aim of this study was to compare the accuracy of femoral component rotation after TKA, using either PCL or TEA reference points. Methods: In a retrospective study, 42 consecutive TKA candidates with severe varus knees were divided into two groups: In group I posterior condylar line, and in group II transepicondylar axis was considered as the primary landmark for rotational positioning. Erosion of medical femoral condylar was recorded in millimeters. One year after operation all the patients underwent CT scan and the angles between TEA and PCL of the prosthesis was meausured. The degree of knee flexion and also WOMAC scores were recorded. Results : The female gender was prominent in both groups (81% in group 1, 85.7% in group II). There was no significant femoral condylar erosion in either group. The mean Womac score in group 1 was 71.4±17.51 and 72.07±15.48 in group II (p < /i>=.9). The degree of external rotation according to condylar twisting angle was 3.35±1.74 in group 1 and 1.9±1.7 in group 2 (p < /i>=.009). Conclusions: In severe Knee-varus deformity, TEA landmark gives more external rotation position for femoral component, despite of lack of significant erosion in femoral condyle.
Mohammad Mahdi Sarzaeem; Gholamhossein Kazemian; Gholamhossein Kazemian; Mohammad Emami; Alireza Manafi Rasi,; Mohammad Emami; Arash Ghaffari; Salim Khani
Abstract
Background: One of the common complications following total knee arthroplasty (TKA) is excessive post operative blood loss. Tranexamic acid (TXA), an antifibrinolytic drug, is commonly used to control post-operative blood loss. However, the ideal route of administration is not yet quite clear. In this ...
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Background: One of the common complications following total knee arthroplasty (TKA) is excessive post operative blood loss. Tranexamic acid (TXA), an antifibrinolytic drug, is commonly used to control post-operative blood loss. However, the ideal route of administration is not yet quite clear. In this study, the different administration routes of TXA for blood loss control after TKA will be evaluated. Methods: In a clinical trial study, 200 patients who were scheduled for knee arthroplasty were randomly divided into 4 groups. In group 1, TXA (500 mg mixed in 100 cc of saline) was administered intravenously at the time of wound closure. In group 2, the knee joint cavity was irrigated and soaked for 5 minutes with 3 g of TXA in 100 cc of saline just before wound suturing. In group 3, immediately after wound closure, 1.5 g of TXA in 100 cc of saline was injected into the knee through the drain. Group 4 (control group) received no TXA , but the drain was clamped completely for an hour. The amount of blood loss and transfusion, and changes in hemoglobin levels were documented accordingly. Results: The mean post-operative blood loss in the groups 1 to 4 were respectively 476.8±114.8, 743.2±116.5, 173.9±60.5, and 860.5±152.2 ml (p < /i>
Seyyed Morteza Kazemi, MD; Reza Minaei, MD; Ramin Zanganeh, MD; Mohammad Reza Miniator Sajadi, MD; Mohammad Ali Okhovatpoor, MD
Abstract
Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence ...
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Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence of patella baja and pseudo-patella baja after total knee arthroplasty. Methods: In a retrospective study, 60 patients (49 women, 11 men) who had knee arthroplasty between 1992 and 2002 at Akhtar teaching Hospital in Tehran were studied for patellar problem. At the time of the study, patients were at least one year and at most eleven years from their operation. All measurements were made by a single person. All the patients received posterior cruciate ligament retaining prosthesis knees through a medial parapatellar arthrotomy. The average age at the time of the study was 62.5 years and the average follow-up was 27.5 months. The Knee Society Scoring System was used to score the knees. Patients' radiographs were examined using the Insall Salvati and Blackburne Peel methods. Results: Pseudo-patella baja was found in 15 (25%) patients while simultaneous baja and Pseudo-patella baja in 2 (3%) patients. While patella baja or Pseudo-patella baja were associated with more incidence of knee pain or limitation of motion, no relation was seen with final knee society scores.Conclusion: Patella baja or Pseudo-patella baja after knee arthroplasty may cause pain or limitation in knee range of motion. Attention to proper bone cuts and patellar tracking during surgery is suggested.
