Total knee arthroplasty (TKA) is one of the most successful surgeries to relieve pain and dysfunction caused by severe arthritis. However, it is a still big problem that there is a possibility of death in pulmonary embolism (PE) after TKA. We previously reported that there was more incidence of asymptomatic PE than estimated in general by detail examinations. But it was difficult to whom we decided to perform additional examinations except the patients with some doubtful symptoms. Therefore, we investigated detail of PE patients after primary TKA to find out anything key point in PE. Consecutive ninety-nine patients who underwent primary TKA from January 2015 to March 2018 were applied. There were 23 male and 76 females included, and the mean age was 73.7 years old. There were 96 cases of osteoarthritis, 2 cases of osteonecrosis and one of rheumatoid arthritis. A single knee surgery team performed all operations with cemented type prostheses and air tourniquet during operation. There were 35 cases of one-staged bilateral TKA and 64 of unilateral TKA. Detail examinations with contrast enhanced CT (CE-CT) and venous ultrasonography (US) were performed at the 3rd day after surgery. Next, we applied ultra sound cardiogram (UCG) to the patients diagnosed as PE by CE-CT, we checked right ventricular overload (RVO) to treat PE. These images were read by a single senior radiologist team.Introduction
Methods
The purpose of this study was to evaluate the efficacy and safety of the drained-clamped method with intra-articular infusion of tranexamic acid (TA) for reducing blood loss in total knee arthroplasty (TKA). From November 2011 to July 2014 inclusive, 72 patients with a diagnosis of osteoarthritis underwent unilateral primary TKA using a computed tomography (CT) free navigation system. Patients were randomly divided into two groups: group T (n=40) was given 2000 mg (40 ml) of TA and group W (n=32) was given 40 ml sterile saline only. All operations were performed under total anaesthesia through the medial mid-vastus approach. Cemented posterior stabilised or cruciate retaining prostheses were used. The patella was resurfaced. After tourniquet release and wound suture, TA or saline was infused into the knee joint in addition to the drained-clamped method for 2 hours. For VTE prophylaxis, all patients received bilateral intermittent pneumatic calf compressors, thromboembolic deterrent stockings, and subcutaneous injection of enoxaparin (4000IU daily). We evaluated the hematocrit, hemoglobin and the postoperative estimate of bleeding. At postoperative days 4, extremity venous ultrasonography was performed for the investigation of venous thromboembolism in the latest 40 patients and contrast-enhanced CT was performed in the latest 34 patients without a previous history of asthma and diminished renal function. The present study received institutional review board approval, and informed consent was obtained from all patients.Objective
Material and Methods
Large variations in knee kinematics existed after conventional TKA. Different design of TKA showed different intra-operative kinematics with navigation system. The purpose of this study was to compare the kinematics of the three different types of prosthesis in navigation-based in vivo simulation. (Material and Method) Studies were carried out on 15 osteoarthritis Knees using the CT-free navigation system (Kolibri Knee, Brain LAB). Fourteen patients were female and one patient was male with mean age of 72 years. Five knees were implanted with the CR knee, 5 knees were implanted with the PS knee and 5 knees were implanted with PS mobile knee by navigated measured resection technique (PFC-sigma knee system, DePuy, Warsaw, IN). Intra-operative knee kinematics during passive range of motion from full extension to 130 degrees of knee flexion was measured after implantation while patella reduced and tourniquet released. While supporting the foot with one hand, the surgeon used his opposite hand to gently lift the thigh, flexing the hip and knee. Three types of prosthesis were compared for following factors: Presence of condylar lift-off (the gap difference greater than 1mm between medial gap and lateral gap) and anterior-posterior (AP) displacement of the center of femur relative to the tibia.Introduction
Purpose
Total knee arthroplasty (TKA) is one of the most successful surgeries to relieve pain and dysfunction caused by severe arthritis of the knee. Despite developments in prophylactic methods, deep venous thrombosis (DVT) and pulmonary embolism (PE) continue to be a serious complication following TKA. Otherwise DVT/PE is known to be a relatively low incidence in Asian patients, its accurate incidence is still controversial. Therefore, we prospectively investigated the incidence of DVT/PE after primary TKA by contrast enhanced computed tomography (CE-CT) and venous ultrasonography (US) in Japanese Patients. We prospectively investigated 51 patients who underwent primary TKA at the hospital from July 2013 to December 2013. All were of Japanese ethnicity. The mean age at the surgery was 74.9 years and average BMI was 26.0. There were 45 (88.2%) cases of osteoarthritis and 5 (9.8%) of rheumatoid arthritis. A single knee surgery team performed all operations with cemented type prostheses by utilizing pneumatic tourniquet. There were 21 cases of one-staged bilateral TKA and 30 of unilateral TKA. All patients were applied intermittent pneumatic compression (IPC) until 24 hours and graduated compression stockings for 3[高木1] weeks after the operation. Beginning from the day after the surgery, the patients were allowed walking with walker, along with the gradual range of motion exercise for physical thromboprophylaxis. Low-dose unfractionated heparin (LDUH) as a chemical thromboprophylaxis was administered subcutaneously for 3 days after the surgery. Informed consent was obtained regarding this thromboprophylaxis protocol. CE-CT and venous US were performed at the 4th day after surgery and images were read by a single senior radiologist team. The patients without DVT/PE by examination, they did not take additional chemical thromboprophylaxis. In cases of existence of DVT, continuous heparin administration and oral warfarin were applied and adjusted in appropriate dose for treatment. Warfarin was continued to be applied for at least three months until the patients had no symptoms and normal D-dimer level. In cases of PE, additional ultrasonic echocardiography (UCG) was performed, and then we consulted cardiologist to treat for PE. CE-CT was performed in 42 patients (82.3%), otherwise nine patients (17.7%) could not take the examination because of exclusion criteria. There was no side-effect regard to contrast medium. The incidence of DVT and/or PE was 32 patients (62.7%), including two PE (3.9%), 21 DVT (41.1%) and nine both PE and DVT (17.6%). Six-teen patients were used LDUH routinely for 3 days after surgery. Five patients were used continuous heparin administration and oral warfarin instead of using LDUH because of medical co-morbidities. Additional continuous heparin administration and oral warfarin after LDUH use was needed in 26 patients. Three patients who had duodenal ulcer with chronic pancreatitis, massive PE with right heart strain and multiple DVT/PE with HIT antibody were needed another treatment.Methods
Results
The aim of the study was to evaluate THA using Robodoc system for osteoarthritis of the hip joint. The Robodoc system consists of: 1. the Orthodoc computer workstation that simultaneously displays computerised tomography images of patient’s femur and a selected prosthesis, 2.a five-axis robot, 3.the operating room display, 4. the control cabinet. Follow up were 3months and 1 year on 27cases (Male 5, Female 22). Selected stems: Zimmer anatomic, 13, Versis 14(VSS,7, VSL,7). Mean age 57.9. Among 27 cases of osteoarthritis, one is after osteotomy and two are after osteonecrosis. Pain, ROM, Radiographs and ADL were evaluated using JOA hip score system. Sockets were fixed with cementless conventional technique. Mean operating time, 2 hours and 40min.; Mean bleeding, 455 ml; Mean Ant. Version, 29.26 degree (22.0–39.7); Level of osteotomy of the femur neck, Mean, 9.19 mm from the trochanter minor. JOA hip score after THA, 82.20. In one case, 5 mm sinking occurred 5 days after the operation. No intraoperative femoral fractures and varus or valgus insertion of stems occurred in 27cases. The thigh pains were nothing. The patients were discharged at 4weeks after the operation with one crutch. The results showed statistically better fit and fill of the femoral component in the Robodoc system. The Robodoc system is thought to be safe and effective in producing radiographically superior implant fit and positioning without fractures and other complication. Precise fit of the implant may be increase bone-to-implant contact, providing stress transfer from prosthesis to bone and more bone growth into prosthesis.
Our purpose was to evaluate the incidence of anterior knee pain after ACL reconstruction and the associated affecting factors. The study assessed 50 ACL reconstructed knees: 29 males and 21 females. The age at surgery was from 14 to 39 years old, with 23.7 years old on the average. The ACL injury was unilateral in all cases, and the normal side was defined as the control. We treated chronic ACL-deficient knees by reconstruction of the ligament through a limited arthrotomy using one-third of the patellar tendon (BTB) with the Kennedy LAD as a graft. Anterior knee pain was classified into 4 group: absent, trace-mild, moderate, and severe. We evaluated the height of the patella, knee extension strength, anterior laxity, leg rotation, Lysholm score, and loss of extension. Anterior laxity and leg rotation were measured by a three-dimensional analyzer. Ten of the fifty knees (20%) had anterior knee pain. Knee extension strength (reconstructed side/control side) was 71.1% in the cases with anterior knee pain and 84.2% in the cases without anterior knee pain. A significant difference was found between these values. Regarding leg rotation, 4 knees showed normal leg rotation (physiological screw home movement) in the cases with anterior knee pain, compared to 31 knees in the cases without anterior knee pain. There was a significant difference in the incidence of anterior knee pain between the cases with normal leg rotation and the cases without. Other factors failed to show any significant correlation. In this study, knee extension strength and leg rotation had a correlation with anterior knee pain.
