To assess the impact of two oral thromboprophylaxis agents against Clexane with regard to range of movement (ROM) following TKR with or without haemostasis following tourniquet release. Thromboprophylaxis choice following total knee replacement (TKR) has become of interest with the introduction of oral anticoagulants and support for these by NICE. Specific concerns with oral agents include a perceived elevated level of anti-coagulation and soft tissue complications. The population (n=264) was subclassified into cohorts regarding thromboprophylaxis cover: Clexane, Rivaroxaban and Dabigatran. Each subgroup was subdivided into whether surgery was performed with or without haemostasis following tourniquet release. This study demonstrates Clexane is associated with a better and earlier return of ROM post-operatively as compared to oral the thromboprophylaxis agents. This effect was more obvious when combined with haemostasis following early tourniquet release (p< 0.05). The oral thromboprophylaxis agents Rivaroxaban and Dabigatran had a relative negative effect on ROM as compared against Clexane. This was independent of whether the surgery was performed with or without haemostasis following tourniquet release. There was no different between the subgroups with repect to change of serum haemoglobin, symptomatic venous thromboembolism or rate of return to theatre.Study Aim
Methods & Results
Osteochondral defects of the knee may occur following patella dislocation or following direct trauma or twisting injuries to the knee in adolescents. Often a diagnostic and therapeutic challenge, if these lesions are left, posttraumatic osteoarthritis may occur. This retrospective single centre study presents the short-term results following operative fixation of osteochondral fragments of the knee using Omnitech ® screws. All skeletally immature patients presenting with an osteochondral fracture of their femur or patella confirmed on xray and MRI were identified. Arthroscopic evaluation of the osteochondral defect was performed followed by open reduction and internal fixation of the osteochondral fragment using Omnitech ® screws. A standard postoperative rehabilitation protocol was followed. Patients were evaluated at follow-up using a Knee Injury and Osteoarthritis Outcome Score (KOOS).Introduction
Method
This study investigates the effect of early tourniquet release on range of flexion following total knee replacement, and the influence of anticoagulation with Rivaroxaban and Clexane (Enoxaparin). 78 patients were included in the study, who underwent unilateral primary total knee replacement (TKR) in our department under the care of two specialist knee surgeons over a 12 month period. 27 patients underwent TKR with early release of the tourniquet and haemostasis, prior to closure of quadriceps layer: 22 were anticoagulated with Rivaroxaban (GROUP ER), 15 with the low molecular weight heparin Clexane (GROUP EC). Over the same time period, 41 patients TKR with late release of the tourniquet, following closure and bandaging: 13 were anticoagulated with Rivaroxaban (GROUP LR), 28 with Clexane (GROUP LC). A standardised operative technique was employed, and all patients received an AGC (Biomet) PCL-retaining prostheses. Outcome was assessed with range of flexion at 12 weeks postoperatively.Purpose
Method
This study investigates the effect of Rivaroxaban (Bayer HealthCare) on early post-operative stiffness in primary total knee replacement. The anticoagulant of choice for total knee arthroplasty in our Department was changed from Enoxaparin to Rivaroxaban in September 2009. We reviewed a consecutive, multi-surgeon, multi-implant series of primary total knee replacements for a 6 month period prior to (group A) and after (group B) the treatment change. All patients were reviewed by an independent Clinical Specialist Physiotherapist at 6 weeks post-surgery, where the range of movement was recorded prospectively using a goniometer. A stiff knee replacement was defined as one with 15 degrees of extension deficit or flexion to less than 75 degrees at 6 week follow up. All data was analysed on an intention to treat basis.Introduction
Methods
The remaining 144 patients were separated in to two groups. Group I (n=54) consisted of those patients that received one or more recorded I/A steroid injections in their operated knee in an orthopaedic clinic, rheumatology clinic or general practice setting prior to surgery. Group II (n=90) consisted of those patients with no record of receiving an I/A steroid injection prior to surgery.
In addition to those patients with confirmed deep infections, five patients underwent post-operative investigations for suspected deep infection, due to symptoms of persistent swelling or pain. All had received an I/A steroid injection pre-operatively. The length of time between injection and subsequent post-operative infection leads us to speculate that the steroid agent might not fully dissolve, becoming trapped within the soft tissues or cystic areas of degeneration in the knee joint. Such steroids may become re-activated during operation, leading to catastrophic results. Indeed, there is experimental evidence to suggest an increased risk of infection with the intra-operative administration of steroids.
We reviewed 231 patients who had undergone total knee replacement with an AGC (Biomet) implant over a period of 2.5 years. After applying exclusion criteria and with some loss to follow-up, there were 144 patients available for study. These were divided into two groups; those who had received intra-articular steroid in the 11 months before surgery and those who had not. There were three deep infections, all of which occurred in patients who had received a steroid injection. The incidence of superficial infection was not significantly different in the two groups. Five patients had undergone investigation for suspected deep infection because of persistent swelling or pain and all of these had received an intra-articular injection pre-operatively. We conclude that the decision to administer intra-articular steroids to a patient who may be a candidate for total knee replacement should not be taken lightly because of a risk of post-operative deep infection.
