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In order to respond to the call of the National Health Commission to implement day surgery, this study elaborated the work process and the efficiency improvement strategies of hip and knee joint replacement in ambulatory surgery centre in foreign countries. It summarized the good points in process, summarized the management experience, combined with domestic conditions. It explored the key steps and matters needing attention related to the ambulatory surgery center of hip and knee joint replacement to provide reference for operating efficiency and speeding up the process of Enhanced Rehabilitation After Surgery in orthopedic field.
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Objective To explore curative effect of bilateral total knee replacement (TKA) under different operative strategies of one stage,several stages in a single hospitalization and several hospitalizations.Methods Two hundred and thirty-two patients with bilateral total knee arthroplasty (TKA) were divided into same stage group (98 cases),stage 1 group (85 cases) and stage 2 group (49 cases) according to operative strategies,all the patients were given bilateral TKA.Patients in the same stage group were given bilateral TKA in the same stage,patients in stage 1 group were given one side operation,and the other side were given operation after 7 to 14 days,while the operation time interval were 15 days to one year in stage 2 group.The total operation time,blood transfusion and total hospital stay and postoperative complications were compared among the three groups.The knee joint function after one year of operation was evaluated by the score of the hospital for special surgery (HSS).Results Blood transfusion of stage 1 and 2 group was lower than that of the same stage group significantly (P ＜ 0.01),and total hospital stay was higher than that of the same stage group significantly (P ＜0.01).There was no significant difference in blood transfusion between stage 1 group and stage 2 group(P ＞ 0.05).There was no significant difference in total operation time among the three groups(P ＞ 0.05).There was no significant difference in the incidence of postoperative complications including wound infection,pulmonary embolism,deep venous thrombosis of lower limb and cardiovascular system complications among the three groups(P ＞ 0.05).One year after operation,the HSS scores of the three groups were significantly higher than those before operation (P ＜ 0.05),there was no significant difference in the and HSS score at one year after operation among the three groups (P ＞ 0.05).Conclusion Although the blood transfusion of patients in several stages operation is lower and the hosptital stay is longer than those in the one stage operation,both one stage and several stages operation can achieve better clinical effect in improving the function of knee joint,and the operation safety are consistent.
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OBJECTIVE: To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on hemodynamic fluctuation caused by loosing tourniquet in the elderly patients undergoing knee joint replacement. METHODS: A total of 60 ASA (America Society Anesthesiologist) I or II elderly patients for elective knee joint replacement surgery were randomly divided into control group (30 cases) and TAES group (30 cases). Patients of both groups were treated by intravenous anesthesia, and monitored with bispectral index (BIS, between 45－60) for anesthesia depth, stroke volume variation (SVV) for fluid management, mean arterial pressure (MAP) and cardiac index (CI) for hemodynamic fluctuation evaluation, and with analgesia nociception index (ANI, between 50－70) for remifentanil dosage adjustment. TAES (2 Hz/100 Hz, 8－20 mA) was applied to bilateral Xinshu (BL 15), Feishu (BL 13), Neiguan (PC 6) and Hegu (LI 4) acupoints for 30 min first (followed by anesthesia induction and operation), and given continuously until 15 min after tourniquet loosing. Patients of the control group were only given with electrodes attachment without electrical stimulation. The levels of MAP, CI, and arterial blood pH, PaCO2, PaO2, base excess (BE) and lactic acid (Lac) 1 min before, and 5 and 15 min after tourniquet loosing, and the dosages of remifentanil and ephedrine after tourniquet loosing were recorded. RESULTS: The changed levels of MAP, CI and blood Lac at 5 min after tourniquet loosing (relevant to the baseline levels), and blood Lac content at 15 min after tourniquet loosing (relevant to 5 min after tourniquet loosing) were significantly lower in the TAES group than in the control group (P0.05). CONCLUSIONS: TAES has a positive effect on hemodynamics fluctuation caused by loosing tourniquet in the aged patients undergoing knee joint replacement.
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Objective To evaluate the effect of asymptomatic hyperuricemia on the postoperative functional recovery in osteoarthritis (OA)patients with knee joint replacement.Methods Among the 294 patients who recieved knee joint replacement in our hospital from Feb-ruary 2013 to September 2015,a total of 187 patients were included in this study with 79 cases in the hyperuricemia group and the other 108 cases in the control group.The WOMAC index of the two groups were analyzed before the surgery,2 weeks,3 months,and 6 months after the knee joint replacement surgery.Multivariable linear regression was performed to test the effect of impact factors on the variation of WOMAC index.Results The WOMAC index of the two groups significantly increased 2 weeks after surgery,and the difference was statistically signifi-cant(P <0.05).And the WOMAC index of the control group was higher than that in the hyperuricemia group 2 weeks and 3 months after sur-gery with statistically significant difference(P <0.05).Conclusion The uric acid level before surgery was a influence factor of WOMAC index, and high uric acid level before knee joint replacement has negatively impact for the postoperative functional recovery in the osteoarthritis patients.
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[Objective]To investigate the indications,complications and mid-term results of total knee arthroplasties using rotating hinge knee prosthesis. [Methods]Thirty total knee arthroplasties using rotating hinge prosthesis were performed in twenty-eight patients from July 1998 to July 2008.Seven patients were male and twenty-one patients were female.The average age was 62 years(42-75 years).The diagnosis included osteoarthritis in 8 patients,rheumatoid arthritis in 2 patients,traumatic arthritis in 3 patients,Paget's disease patient,serious genu valgum in 7 patients and 10 failure TKAs.All patients were followed up for 12 to 120 months.The patients were evaluated according to knee score system and the complications were observed.[Results]The pain was relieved and function was improved in all knees.The average knee pain score increased from 19.5 to 77.9,and knee function score from 22.5 to 50.5.Range of motion of knees increased from 58.4?to 72.8?.No revision was needed in all patients,The complications included anterior knee pain(8 cases),extension lag(5 cases),prosthesis broken(1 case) and patella tendon rupture(1 case).[Conclusion]The mid-term results of total knee arthroplasty using rotating hinge knee for severe knee deformity are satisfactory.Complications should be prevented carefully.