Blood Loss of Image-free Navigation Assisted Minimal Invasive total Knee Arthroplasty

PURPOSE: To assess blood loss and transfusion between Navigation assisted minimally invasive total knee arthroplasty (TKA) performed with immediate release of drain and 1-hour - delayed release of drain. MATERIALS AND METHODS: We carried out a prospective randomised study to evaluate the blood loss in 100 knees having a Navigation-assisted minimally invasive TKA by dividing into two groups, one having a immediate release of drain (group A) and the other having a 1 hour-delayed release of drain(group B). All patients had a unilateral primary TKA using cemented type. RESULTS: The mean drainage of blood was 464.9 ml in a immediate release of drain group and 409.1ml in 1 hour-delayed release of drain group. This difference was not statistically significant (p=0.117). The pre- and postoperative hemoglobin were mean 13.36g/dl and 10.77 g/dl in group A, mean 12.8 g/dl and 10.37 g/dl in group B. All patients were not transfused in intra- and post operation. CONCLUSION: There was no significant difference in total blood loss of drain and pre- and postoperative hemoglobin between the two groups by the Navigation-assisted minimally invasive TKA. All patients were not transfused in intra- and post operation.

Comparative Analysis of Image-free Navigation System-Assisted TKA and Conventional TKA

PURPOSE: To compare the roentgenographic results between Image-free navigation system-assisted total knee arthroplasty (TKA) using the OrthoPilot(R) and conventional TKA. MATERIALS AND METHODS: Of 120 primary TKA that operated by one surgeon, 60 cases were operated with a Image-free navigation system (OrthoPilot(R) 4.0, Aesculap, Tuttlingen, Germany) (group A) and 60 cases were operated with conventional method (manual alignment system) (group B). The alignment of the lower extremity and the position of the components were determined on postoperative long-leg standing anteroposterior radiogram and lateral radiogram. RESULTS: Mechanical axis was significantly more accurate in group A than group B(95% compared with 80%). The coronal inclination of femoral component to mechanical axis (theta) was significantly more accurate in group A than group B(96.7% compared with 80%). There were no significant differences between two groups in the sagittal inclination of femoral component(gamma), the coronal inclination of tibial component (beta) and the sagittal inclination of tibial component(delta). In all five measurements being excellently implanted, a significantly higher number was in group A(60% compared with 40%). CONCLUSION: Image-free navigation system-assisted TKA using the OrthoPilot(R) led to significantly increased precision of restoration of the alignment of the lower extremity and the position of the components compared with the conventional method. Potential benefits in long-term outcome and functional improvement require further investigation.

Autogenous Bone Graft for Medial Tibial Bone Defect in Total Knee Arthroplasty

PURPOSE: To evaluate clinical and radiographic results associated with the use of autogenous bone graft with preservation of cortical bone in the patients with severe bone defect of the proximal medial tibia in total knee arthroplasty. MATERIALS AND METHODS: From January 2000 to June 2003, thirty three primary total knee arthroplasty were performed with autogenous bone graft for severe peripheral defect of the proximal medial tibia. After sclerotic bone of defect site was removed by the burr, reconstruction of medial wall was done by use of resected bone, which was fixed by wedge-shaped bone. Autogenous cancellous bone was grafted in the central type bone defect area. We reviewed the result using the HSS knee rating scores and observed the radiographic changes. RESULTS: The mean HSS knee rating score was 43.5 preoperatively and was 91.3 at last follow-up. Radiologically, union of the tibial bone grafts were impossible to determine, but there were no evidence of the displacement of grafted bone, osteolysis and loosening of the inserted implants. CONCLUSION: The method of autogenous bone graft applied with preservation of cortical bone and wedge bone graft could be supposed as useful in the reconstruction of the tibial bone defects as well as in the stability of the tibial component.

Comparison Between TKR with Tourniqeut and Injected Diluted Adrenaline without Tourniqeut

PURPOSE: To assess clinical difference between total knee replacement (TKR) performed with tourniquet and diluted adrenine infiltration without tourniquet. MATERIALS AND METHODS: We analyzed the postoperative transfusion amount, intraoperative blood loss, operation time, range of motion and postoperative thigh pain in 60 cases. 30 cases (group I) were performed TKR with tourniquet and the others (group II) were performed TKR using diluted adrenaline (2.5mg of 1:1000 epinephrine diluted in 500 ml of normal saline) infiltration without tourniquet. Closed suction drainage was not used in all patients. RESULTS: In gruop I, the intraoperative blood loss was average 407.6 ml, pre- and postoperative hemoglobin average 12.6 and 9.4 g/dl, postoperative transfusion average 1.83 unit, operative time average 116.5 minutes and range of motion (at preoperative, at 7days and 6 weeks after the operation) average 116.3 degrees, 90.7degrees and 103.4degrees. In group II, the intraoperative blood loss was average 398.2 ml, pre- and postoperative hemoglobin average 13.1 and 9.7 g/dl, postoperative transfusion amount average 1.76 unit, operative time average 118.3 minutes and range of motion average 113.6 degrees, 89.2 degrees, and 105.7degrees. But average postoperative thigh pain score was significantly higher in group I (average 3.7) than group II (average 0.9). CONCLUSION: There was no significant difference in intraoperative blood loss, pre- and postoperative hemoglobin, postoperative transfusion amount, operative time and range of motion between the two groups. But we could decrease the thigh pain after TKR, not using the tourniquet.