Changes in the Body Mass Index after Total Knee Arthroplasty in Asians / 대한정형외과학회잡지

Purpose@#This study examined the changes in the body mass index (BMI) and the effects of BMI on the knee function and risk factors for an increase in BMI after total knee arthroplasty (TKA) in Asians. @*Materials and Methods@#A prospective observational study was conducted on 100 cases of TKA performed by one surgeon. Obesity was defined as BMI ≥25 kg/m 2 . The BMI and Knee Society Score, consisting of the Knee Score and Function Score, were measured on the day before surgery and one year after surgery. @*Results@#The BMI decreased or was maintained in 34 cases (34%) and increased in 66 cases (66%) one year after surgery. An increase in BMI of 5% or more was considered a clinically significant increase in BMI and occurred in 28 cases (28%). The patients with an increased BMI by more than 5% showed a significantly lower knee function score. The age and preoperative function score were significantly associated with an increased BMI by more than 5%. As the age increased by one year, the odds ratio at which the BMI would increase by more than 5% one year after surgery was 0.905. Moreover, as the preoperative function score increased by one point, the odds ratio that the BMI would increase by 5% one year after surgery was 0.902. In other words, a younger preoperative age and a lower preoperative function score mean a higher risk of a more than 5% postoperative increase in BMI. @*Conclusion@#The BMI increased by more than 5% one year after surgery in 28% of the TKA patients examined. They had a lower functional score. The risk factors for a more than 5% increase in BMI after TKA were young age and a low preoperative function score. Therefore, surgeons should educate patients, particularly those who are young or have a low preoperative function score, so that the patient’s BMI would not increase after surgery.

Synergistic Effect of Intraarticular Tranexamic Acid Injection and the Use of Navigation in Total Knee Arthroplasty for Reducing Blood Loss / 대한정형외과학회잡지

Purpose@#This study investigated the synergistic effects of an injection of tranexamic acid and using navigation to reduce the need for blood transfusion and postoperative bleeding after total knee arthroplasty (TKA). @*Materials and Methods@#Patients were divided into three groups and compared. Group 1 (58 cases) included those who had manual TKA with the injection of tranexamic acid in the joint. Group 2 (30 cases) was comprised of those who had navigated TKA without tranexamic acid. Group 3 (32 cases) consisted of patients who had navigated TKA with tranexamic acid. The frequency of transfusion after the operation was measured. To compare bleeding after surgery, drainage volume during 24 hours after surgery was compared and analyzed. @*Results@#Group 1 had five cases of transfusion (8.6%), while there were 9 cases in group 2 (30%) and three cases in group 3 (9.4%). The Chi-squared test revealed a significant difference (p=0.016). An average of 343.67±165.20 ml, 452.10±197.91 ml, and 311.00±129.32 ml was drained in the 24 hours after surgery in groups 1, 2, and group 3, respectively. This difference was analyzed using ANOVA test, which showed a significant difference (p=0.003). The need for transfusion in group 2 was 3.71 times higher than that in group 1. The need for transfusion in group 2 was 4.14 times higher than that of group 3. @*Conclusion@#The combination of navigation use and injection of tranexamic acid has no synergistic effect in reducing the need for blood transfusion and post TKA bleeding. In addition, an injection of tranexamic acid in the joint is more effective in reducing blood transfusions and blood loss after TKA than navigation.

A Comparative Study on Internal Fixation Using Long Proximal Intramedullary Nail for the Treatment of Humeral Shaft Fracture according to Fracture Types

BACKGROUND@#This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types.@*METHODS@#From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed.@*RESULTS@#Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352).@*CONCLUSIONS@#Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

Preoperative Temporary Discontinuation of Aspirin Medication Does Not Increase the Allogeneic Transfusion Rate and Blood Loss in Primary Total Hip Arthroplasty / 대한고관절학회지

PURPOSE: This study aims to determine whether preoperative temporary discontinuation of aspirin (100 mg/d) use is a safe procedure does not increase blood loss and the need for transfusion after total hip arthroplasty (THA). MATERIALS AND METHODS: This study retrospectively reviewed 219 patients who underwent consecutive primary THA from January 2012 to December 2018. They were divided into the experimental group (42 cases) that discontinued aspirin intake 7 days before surgery and the control group (150 cases) that had no history of use of antiplatelet agents. To compare initial blood loss between the two groups, we analyzed the changes hemoglobin (Hb) levels and hematocrit values measured preoperatively and in lowest values measured during three days after surgery. In addition, transfusion rate was compared within the first two postoperative weeks between the two groups. A multiple logistic regression was performed to assess the association of transfusion with age, gender, use of antiplatelet agents, preoperative anesthetic risk, body weight and preoperative Hb. RESULTS: No statistically significant difference was found in the changes in lowest Hb level (P=0.30) and hematocrit value (P=0.14) measured preoperatively and for three days after surgery between the experimental group and the control group. There was no statistically significant association between transfusion and the use of antiplatelet agents, and preoperative Hb level was identified as a factor that affected the need for transfusion (odds ratio, 0.427; P=0.001). CONCLUSION: Preoperative temporary discontinuation of aspirin use for 7 days before surgery did not increase initial blood loss after THA and the need for transfusion in the first two postoperative weeks compared to patients with no history of use of antiplatelet agents.

A Comparative Study on Internal Fixation Using Long Proximal Intramedullary Nail for the Treatment of Humeral Shaft Fracture according to Fracture Types

BACKGROUND: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. METHODS: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. RESULTS: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). CONCLUSIONS: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.