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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 18 - 18
1 Jul 2022
Thompson R Cassidy R Hill J Bryce L Beverland D
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Abstract. Aims. The association between body mass index (BMI) and venous thromboembolism (VTE) is well studied, but remains unclear in the literature. We aimed to determine whether morbid obesity (BMI≥40) was associated with increased risk of VTE following total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA), compared to those of BMI<40. Methods. Between January 2016 and December 2020, our institution performed 4506 TKAs and 449 UKAs. 450 (9.1%) patients had a BMI≥40. CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE) and ultrasound scan for suspected proximal deep vein thrombosis (DVT) were recorded up to 90 days post-operatively. Results. When comparing those of BMI<40 to those with BMI≥40, there was no difference in incidence of PE (1.0% vs 1.1%, p=0.803) or proximal DVT (0.4% vs 0.2%, p=0.645). There was no difference in number of ultrasound scans ordered (p=0.668), or number of CTPAs ordered for those with a BMI≥40 (p=0.176). The percentage of patients with a confirmed PE or proximal DVT were 24.2% and 3.9% respectively in the BMI<40 group, compared to 20.0% (p=0.804) and 2.3% (p=0.598) in the BMI≥40 group. Conclusion. Morbid obesity was not associated with increased risk of PE or proximal DVT within 90 days of TKA or UKA. Overall, 76.3% of CTPAs and 96.2% of ultrasound scans were negative. Increasing the threshold for VTE investigation would reduce the rate of negative investigations. Establishing more effective risk stratification protocols, to guide investigation, would likely reduce unnecessary imaging


The Bone & Joint Journal
Vol. 106-B, Issue 8 | Pages 817 - 825
1 Aug 2024
Borukhov I Ismailidis P Esposito CI LiArno S Lyon J McEwen PJ

Aims

This study aimed to evaluate if total knee arthroplasty (TKA) femoral components aligned in either mechanical alignment (MA) or kinematic alignment (KA) are more biomimetic concerning trochlear sulcus orientation and restoration of trochlear height.

Methods

Bone surfaces from 1,012 CT scans of non-arthritic femora were segmented using a modelling and analytics system. TKA femoral components (Triathlon; Stryker) were virtually implanted in both MA and KA. Trochlear sulcus orientation was assessed by measuring the distal trochlear sulcus angle (DTSA) in native femora and in KA and MA prosthetic femoral components. Trochlear anatomy restoration was evaluated by measuring the differences in medial, lateral, and sulcus trochlear height between native femora and KA and MA prosthetic femoral components.


The Bone & Joint Journal
Vol. 99-B, Issue 4 | Pages 483 - 488
1 Apr 2017
Pinsornsak P Nangnual S Boontanapibul K

Aims

Multimodal infiltration of local anaesthetic provides effective control of pain in patients undergoing total knee arthroplasty (TKA). There is little information about the added benefits of posterior capsular infiltration (PCI) using different combinations of local anaesthetic agents. Our aim was to investigate the effectiveness of the control of pain using multimodal infiltration with and without infiltration of the posterior capsule of the knee.

Patients and Methods

In a double-blind, randomised controlled trial of patients scheduled for unilateral primary TKA, 86 were assigned to be treated with multimodal infiltration with (Group I) or without (Group II) PCI. Routine associated analgesia included the use of bupivacaine, morphine, ketorolac and epinephrine. All patients had spinal anaesthesia and patient-controlled analgesia (PCA) post-operatively. A visual analogue scale (VAS) for pain and the use of morphine were recorded 24 hours post-operatively. Side effects of the infiltration, blood loss, and length of stay in hospital were recorded.