Intravenous dexamethasone has been shown to reduce immediate postoperative pain after total hip arthroplasty (THA), though the effects are short-lived. We aimed to assess whether two equivalent perioperative split doses were more effective than a single preoperative dose. A total of 165 patients were randomly assigned into three groups: two perioperative saline injections (Group A, placebo), a single preoperative dose of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative doses of 10 mg dexamethasone (Group C). Patients, surgeons, and staff collecting outcome data were blinded to allocation. The primary outcome was postoperative pain level reported on a ten-point Numerical Rating Scale (NRS) at rest and during activity. The use of analgesic and antiemetic rescue, incidence of postoperative nausea and vomiting (PONV), CRP and interleukin-6 (IL-6) levels, range of motion (ROM), length of stay (LOS), patient satisfaction, and the incidence of surgical site infection (SSI) and gastrointestinal bleeding (GIB) in the three months postoperatively, were also compared.Aims
Methods
The efficacy and safety of intrawound vancomycin for preventing surgical site infection in primary hip and knee arthroplasty is uncertain. A systematic review of the literature was conducted, indexed from inception to March 2020 in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases. All studies evaluating the efficacy and/or safety of intrawound vancomycin in patients who underwent primary hip and knee arthroplasty were included. Incidence of periprosthetic joint infection (PJI), superficial infection, aseptic wound complications, acute kidney injury, anaphylactic reaction, and ototoxicity were meta-analyzed. Results were reported as odds ratios (ORs) and 95% confidence intervals (CIs). The quality of included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) assessment tool.Aims
Methods
Although single-radius designs have theoretical advantages in some aspects, there has been a paucity of evaluation studies. The purpose of this study was to compare 10-year clinical, radiological, survivorship outcomes of single radius and multi radius posterior stabilized prosthesis in total knee arthroplasty(TKA) with Rheumatoid Arthritis (RA). In this retrospective observational study, we reviewed 240 patients (240 knees) with RA who underwent TKA between Oct 2005 and Dec 2007: SR group (120 patients, 120 knees, Stryker Scorpio NRG) and MR group (120 patients, 120 knees, Depuy sigma RP). A 1 : 1 matched case control study was conducted in two groups which were similar in terms of age, gender, BMI, ASA classification and operation team. Mean follow-up periods were 10.73±1.13 (range: 8–13) years and 10.82±1.09 (range: 7–13) years.Object
Method
The aim of this study was to identify the most effective regimen
of multiple doses of oral tranexamic acid (TXA) in achieving maximum
reduction of blood loss in total knee arthroplasty (TKA). In this randomized controlled trial, 200 patients were randomized
to receive a single dose of 2.0 g of TXA orally two hours preoperatively
(group A), a single dose of TXA followed by 1.0 g orally three hours
postoperatively (group B), a single dose of TXA followed by 1.0 g
three and nine hours postoperatively (group C), or a single dose
of TXA followed by 1.0 g orally three, nine, and 15 hours postoperatively
(group D). All patients followed a routine enhanced-recovery protocol.
The primary outcome measure was the total blood loss. Secondary
outcome measures were hidden blood loss (HBL), reduction in the
level of haemoglobin, the rate of transfusion and adverse events.Aims
Patients and Methods
The efficacy and safety of tranexamic acid (TXA) on reducing blood loss and transfusion has been confirmed in primary total hip arthroplasty (THA). The main methods of administration includes intravenous, topical alone or combined use, and the most appropriated methods remains undecided. This study was aimed to compare the efficacy and safety of different methods of TXA following primary THA. We prospectively collected patients' data through National Health Database from January 2013 to December 2016. The patients were divided into control group, intravenous group, topical group and combined group according to the different methods of TXA. The primary outcome was the incidence of transfusion and venous thromboembolism. Secondary outcomes were total blood loss, hemoglobin level on postoperative day 3 and decrease in hemoglobin, incidence of wound complications and other adverse events.Objective
Methods
The optimal dosage and timing of tranexamic acid in total hip arthroplasty (THA) still is undetermined. Previous studies showed the hyper-fibrinolysis would last for 18 hours after surgery. The study aimed to examine the efficacy and safety of multiple bolus of intravenous TXA on hidden blood loss and inflammation response following primary THA. 150 patients were randomly divided into three groups to receive single bolus of 20 mg/kg IV-TXA before skin incision (Group A), or another bolus of 1 g IV-TXA 3 hours later (Group B), or another two boluses of 1g IV-TXA 3 hours and 6 hours later (Group C). All patients received a standard perioperative enhanced recovery protocol. The primary outcomes was hidden blood loss. Other outcome measurements such as hemoglobin level, total blood loss, transfusion rate, inflammation markers (CRP, IL-6), VAS pain score, length of hospital stay (LOH) and venous thromboembolism (VTE) were also compared.Objective
Methods
The hip fracture has been increasing as the aging population continues to grow. Hip fracture patients are more susceptible to blood loss and venous thromboembolism (VTE). The objective of this study was to assess the efficacy and safety of tranexamic acid (TXA) in fracture patients undergoing fast-track hemiarthroplasty. 609 hip fracture patients undergoing hemiarthropalsty from January 2013 to September 2016 were prospectively selected. 289 patients received 15 mg/kg TXA prior to surgery, and the remaining 320 patients received no TXA. All the patients received a fast-track program including nutrition management, blood management, pain management, VTE prophylaxis and early mobilization and early intake. The primary outcome was transfusion requirement, other parameters such as blood loss, hemoglobin (Hb) level, VTE, adverse events and length of hospital stay were also compared. Multivariate logistic regression analysis and meta-analysis were also performed to identify the risk factors of transfusion and confirm the results of current study.Purpose
Methods
The aim of this study was to examine the efficacy and safety
of multiple boluses of intravenous (IV) tranexamic acid (TXA) on
the hidden blood loss (HBL) and inflammatory response following
primary total hip arthroplasty (THA). A total of 150 patients were allocated randomly to receive a
single bolus of 20 mg/kg IV TXA before the incision (group A), a
single bolus followed by a second bolus of 1 g IV-TXA three hours
later (group B) or a single bolus followed by two boluses of 1 g
IV-TXA three and six hours later (group C). All patients were treated
using a standard peri-operative enhanced recovery protocol. Primary
outcomes were HBL and the level of haemoglobin (Hb) as well as the
levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers
of inflammation. Secondary outcomes included the length of stay
in hospital and the incidence of venous thromboembolism (VTE).Aims
Patients and Methods
The aim of this study was to compare the accuracy of limb alignment and component positioning after total knee arthroplasty(TKA) performed using fixed or individual distal femoral valgus correction angle(VCA)in valgus knees. One hundred and twenty-four patients were randomised to undergo TKA with either of the clinical baseline, radiological outcomes and subsequent outcome such as knee HSS scores, knee range of motion (ROM) and visual analogue scale (VAS) scores were assessed. Knees in the individual group (n=62) were performed with a tailored VCA. Knees in the fixed group (n=62) were performed utilizing a 4°VCA.Purpose
Materials and Methods
Recently many authors have questioned the role of tourniquets in primary knee arthroplasty (TKA). Meanwhile, whether the use of an intra-articular wound drainage is an advance over the lack of a drain in TKA is controversial in the literature. This study aimed to investigate the efficacy and safety of drainage or not in TKA without a tourniquet. Eighty participants who underwent primary unilateral TKA were prospectively enrolled and were randomized to one of two techniques during surgery without a tourniquet: drainage (Group A) or non-drainage (Group B). Blood loss was monitored perioperatively. The operating time, allogeneic blood transfusion rate, thigh pain, knee pain, limb swelling, clinical outcome as measured by the hospital for special surgery (HSS) score, the ability to straight-leg raise, visual analog scale (VAS) in pain, length of stay and knee active range of motion (ROM) were also recorded. The digital radiographs taken at 6 months postoperatively were assessed for cement mantle thickness and radiolucency using the Knee Society radiographic zones.Purpose
Methods
Compare the safety and effectiveness of different anesthetic technique used in the simultaneous bilateral total knee arthroplasty (BTKA). Medical records of patients admitted for simultaneous BTKA between January 1, 2014 and September 1, 2015 in ‘The safety and effect evaluation of joint arthroplasty’ database were analyzed. The general anesthesia (GA) and neuraxial anesthesia (NA) group were identified. Patient preoperative characteristics were compared. Perioperative outcomes measured included operating time, blood loss, transfusion requirement, length of hospitalization, joint range of motion at discharge, complications.Objective
Methods
To investigate the effectiveness of applying fast track surgery concept in primary total hip arthroplasty. The data of patients with primary total hip arthroplasty in our department from January 1, 2013 to October 1, 2015 were retrospectively analyzed. The patients were divided into traditional recovery group, enhanced recoverygroup and update enhanced recovery group according to different interventions. The blood loss, transfusion rate, complications rate, postoperative function, length of stay, hospitalization expense and readmission rate were compared between three groups.Objective
Methods
To explore whether good postoperative alignment could be obtained through simple individual valgus resection angle using common instruments in total knee arthroplasty with lateral bowing femur. Data of 46 TKAs with lateral bowing femur were collected prospectively, the center of the femoral intercondylar notch was the fixed drilling hole whether preoperative planning or intraoperative implementing. The intramedullary rod was put into the femur as deep as possible, until completely entrance or the distal point of the rod contact with the lateral cortical bone of the femur, which prevent the further entrance of the rod. Individual valgus resection angle ranging from 7°to 9°was performed according to preoperative planning, followed by meticulous assessment of matching between cutting surface and valgus resection angle. Postoperative hip-knee-ankle (HKA) angle?medial tibial plate angle and position of lower extremity alignment passing through the tibial plate were measured.Objective
Methods
Recent anthropometric studies have suggested that current design of total knee arthroplasty (TKA) does not cater to racial anthropometric differences. The purpose of this study was to investigate the exact sizing and rotational landmarks of the distal femur collected and its gender differences from a large group of healthy Southern Chinese using 3D-CT measurements, and then compare these measurements to the five total knee prostheses conventionally used in China. This study evaluated distal femoral geometry in 85 healthy Southern Chinese, included 39 females (78 knees) and 46 males (92 knees) with a mean age of 33.9 years，a mean height of 164.7 cm and a mean weight of 59.9 kg. The width of the articular surface as projected onto the transepicondylar line(ML), anteroposterior dimension (AP), the dimensions from medial/lateral epicondyle to posterior condylar (MEP/LEP) were measured. A characterization of the aspect ratio (ML/AP) was made for distal femur. The angles between the tangent line of the posterior condylar surfaces, the Whiteside line, the transepicondylar line, and the trochlear line were measured. The sulcus angle and hip center-femoral shaft angle were also measured [Fig. 1]. The data were compared with the five total knee prostheses conventionally used in China. In analyzing the data, best-fit lines were calculated with use of least-squares regression. The dimensions are summarized as the mean and standard deviation. Comparisons of dimensions between males and females were made with use of the two-sample t test. A p value of <0.05 indicated a significant effect.Background
Methods
Recent anthropometric studies have suggested that current design of total knee arthroplasty (TKA) does not cater to racial anthropometric differences. The purpose of this study was to investigate the exact sizing and rotational landmarks of the distal femur collected from a large group of healthy Southern Chinese using three dimensional computer tomographic measurements, and then compare these measurements to the known dimensions from Caucasian populations. This study evaluated distal femoral geometry in 125 healthy Southern Chinese, included 58 women (106 knees) and 67 men (134 knees) with a mean age of 35.2±8.11 years, a mean height of 165.5±7.94 cm, and a mean weight of 61.7±9.56 kg. The width of the articular surface as projected onto the transepicondylar line(ML), anteroposterior dimension (AP), the dimensions from medial/lateral epicondyle to posterior condylar (MEP/LEP)were measured. A characterization of the aspect ratio (ML/AP) was made for distal femur[Fig. 1]. The angles between the tangent line of the posterior condylar surfaces, the Whiteside line, the transepicondylar line, and the trochlear line were measured. The sulcus angle and hip center-femoral shaft angle were also measured. Known dimensions from Caucasian populations were compared with the morphologic data collected in this study[Fig. 2]. In analyzing the data, best-fit lines were calculated with use of least-squares regression. The dimensions are summarized as the mean and standard deviation. The differences of rotational landmarks and sizing between the Southern Chinese and Caucasians were assessed with use of the Student t test. A p value of <0.05 indicated a significant effect.Background
Methods
Total hip arthroplasty (THA) has been applied to treat pain and disability in patients with post-traumatic arthritis after acetabular fracture for many years. However, the midterm and long-term results of THA for this unique population are still controversial. According to previous studies, we found that uncemented acetabular reconstructions were usually performed in patients who were most likely to have the best results and an abnormal acetabular structure was usually the reason for THA failure. In this study, we evaluated the midterm results of using uncement acetabular components to treat posttraumatic arthritis after acetabular fracture. In addition, we investigated the effects of different acetabular fracture treatments and fracture patterns on THA. Between January 2000 to December 2003, 34 uncemented acetabular reconstructions were performed in 34 patients for posttraumatic arthritis after acetabular fractures. Among them, 31 patients underwent complete clinical and radiographic follow-up for an average of 6.3 years (range, 3.1–8.4 years). There were 22 men and 9 women. The patients' average age was 51 ± 12 years (range, 27–74 years) at the time of arthroplasty. The average interval from fracture to THA was 5.58 ± 4.42 years (range, 0.75–17.5 years). Of the 31 patients, 19 had undergone ORIF (open-reduction group) and 12 had received conservative treatment for the acetabular fractures (conservative-treatment group). Then, 14 had simple pattern fractures (simple group) and 17 had complex pattern fractures (complex group). After midterm follow-up, the radiographic and clinic results of the different groups were compared.Background and Objective
Materials and Methods
We performed 52 total hip replacements in 52 patients using a cementless acetabular component combined with a circumferential osteotomy of the medial acetabular wall for the late sequelae of childhood septic arthritis of the hip. The mean age of the patients at operation was 44.5 years (22 to 66) and the mean follow-up was 7.8 years (5 to 11.8). The mean improvement in the Harris Hip Score was 29.6 points (19 to 51) at final follow-up. The mean cover of the acetabular component was 98.5% (87.8% to 100%). The medial acetabular wall was preserved with a mean thickness of 8.3 mm (1.7 to 17.4) and the mean length of abductor lever arm increased from 43.4 mm (19.1 to 62) to 54.2 mm (36.5 to 68.6). One acetabular component was revised for loosening and osteolysis 4.5 years postoperatively, and one had radiolucent lines in all acetabular zones at final review. Kaplan-Meier survival was 94.2% (95% confidence interval 85.8% to 100%) at 7.3 years, with revision or radiological loosening as an end-point when two hips were at risk. A cementless acetabular component combined with circumferential medial acetabular wall osteotomy provides favourable results for acetabular reconstruction in patients who present with late sequelae of childhood septic hip arthritis.
