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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 60 - 60
1 Jul 2012
EARLY TOURNIQUET RELEASE IN TOTAL KNEE REPLACEMENT: THE INFLUENCE OF RIVAROXABAN
Colaço H Davidson J Pekicten B Ahmed S Skyrme A Armitage A Rajaratnam S
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Purpose

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).

Method

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.

Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 414 - 414
1 Jul 2010
ATTITUDES TO SPORT AND REHABILITATION: INFLUENCE ON OUTCOME FOLLOWING ACL RECONSTRUCTION
Colaço H Oussedik S Paton B Haddad F
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Introduction: The aim of this study is to investigate the relationship between patient psychological characteristics, adherence to rehabilitation physiotherapy and outcome at one year following anterior cruciate ligament reconstruction.

Methods: A group of 57 patients undergoing ACL reconstruction received a pre-operative psychological assessment comprising of five questionnaires; Athletic Identity Measurement Scale (AIMS), Recovery Locus of Control Scale (RLCS), Self-Motivation Inventory (SMI), Hospital Anxiety and Depression Scale (HADS), and Short Form Social Support Questionnaire (SSQ6). Four functional questionnaires were completed pre-operatively by the patient; Subjective Knee Evaluation Form (IKDC 2000), Tegner Activity Scale (TAS), Lysholm Score (LS), and Lower Extremity Functional Score (LEFS). Final outcome was assessed by repeating the functional questionnaires at 1-year post-operatively following rehabilitation. Anterior displacement of the tibia was recorded using a KT1000 arthrometer pre-operatively and at 1 year postoperatively. Adherence to rehabilitation was recorded using the Sport Injury Rehabilitation Adherence Scale (SIRAS) and attendance to physiotherapy appointments.

Results: The data were analysed using regression analysis. Self motivation, a higher athletic identity, good social support and an internal locus of control are all positive predictors of final outcome. Poor self motivation and an external locus of control are associated with less successful final outcome. Rehabilitation adherence is also a positive predictor of final outcome, although psychological factors were not found to be predictive of adherence to rehabilitation.

Discussion and Conclusion: Self motivation and an internal locus of control are positive predictors of adherence to physiotherapy and final outcome. These aspects can be reinforced during rehabilitation. Patients with an external locus of control and poor self-motivation can be identified and their pre- and post-operative management adapted to achieve optimal outcome.