The effect of the tourniquet on cement mantle thickness in total knee arthroplasty / 重庆医学

Objective To research the tourniquet effect on cement mantle thickness in total knee arthroplasty.Methods From June 2013 to June 2014,112 cases of patients were received total knee arthroplasty in the First People's Hospital of Foshan and 94 cases of which received primary operation,82 cases were recruited of the research and randomly divided into experimental group(n=41) without tourniquet and control group(n =41)with tourniquet.The radiological cement mantle thickness was evaluated postoperatively in 2 zones (tibia) on anteroposterior and 4 zones (tibia 2;femur 2) on lateral radiographs,and values were cumulated.Additionally,the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were recorded.Results The study showed that (3.57± 0.62) mm on without tourniquet group and(3.74 ±0.71)mm on tourniquet group in tibia (P=0.240).However,the cement mantle thickness of mm on without tourniquet group(2.00±0.43) mm on tourniquet group(2.19±0.48) in femur (P=0.053),there was no statistically significant difference between two groups.The tourniquet group were reduced on the calculated blood loss,haemoglobin loss,blood transfusion rate and average transfusion volume compared with without tourniquet group(P＜0.05).But VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were slightly increased in tourniquet group compared with without tourniquet group (P＜0.05).Conclusion The use of a tourniquet in total knee arthroplasty can reduce the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,but without using a tourniquet has a better clinical results.

Roles of Distal Centralizer in Cemented Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study was performed to find out the influencing factors on cement mantle thickness in cemented total hip arthroplasty. MATERIALS AND METHODS: Eighty patients were randomly enrolled who received total hip arthroplasty with the third generation cementing technique. Four types of femoral prosthesis (20 patients in each type) were used: Centralign (Zimmer, Warsaw, IN), Precision (Howmedica, Rutherford, NJ), Omnifit (Osteonics, Allendale, NJ), and Elite Plus (Depuy, Warsaw, IN). Size of femoral prosthesis, diameter of stem tip, shape and size of centralizer, and the condition of cement mantle on the radiograph were analyzed. RESULTS: Between the two groups of same or above C1 (> or =C1; A, B, and C1, n=69) and C2 (n=11) by Barrack classification, there was no difference in age, sex, underlying disease, size of applied stem, Dorr ratio, and the distance between stem tip and plug. The difference of distal diameter between centralizer and stem was less than 2 mm in 18 patients, and same or above 2 mm in 62 patients. C2 was more frequently observed in patients with the diameter difference or =2 mm (22.2% vs. 11.3%). However, C2 developed in all types of femoral stems, irrespective of their shapes, even the diameter difference was > or =2 mm. CONCLUSION: The diameter of distal centralizing device should be at least 2 mm larger than that of stem tip for an optimal cement mantle thickness. In addition, centralizers investigated in this study should be carefully used, and more improved shape of centralizer is required for the successful cement mantle formation.

Cemented Femoral Component with Centralizing Device : Is it Effective for Centralization and for Attainment of Optimal Cement Mantle Thickness ? / 대한정형외과학회잡지

To evaluate the effectiveness of centralizing device, three groups of patients on whom cemented total hip arthroplasty with three types of implant was performed respectively were analyzed and compared; SL stems without centralizing device were used in Group I, Interlok stems with central sleeve in Group II, and MS-30 stems with distal centralizer in Group III .The size of each group was 20. Cement mantle thickness, the amount of displacement of stem tip, and axis alignment of femoral stem on A-P radiograph checked at 2 weeks after operation were assessed. More optimal cement mantle thickness (3~6mm) was achieved in Group II (P=0.046) and Group III (P=0.01) than in Group I. Centralizing effect of the distal femoral stem in the intramedullary canal was significantly better (P<0.05) in Group III ( 4.55% ) than in Group I (11.60%) and Group II (12.35%). Neutral alignment of femoral stem was achieved in 15% of Group I, in 90% of Group II, and in 95% of Group III. Compared to stem without centralizing device, cemented femoral stem with distal centralizer resulted in 1) significantly more centralized distal femoral stem, 2) significantly more neutrally aligned femoral stem,and 3) significantly more optimal cement mantle thickness at zone V. Compared to stem without centralizing device, cemented femoral stem with central sleeve resulted in 1) significantly more neutrally aligned femoral stem, and 2) significantly more optimal cement mantle thickness at zone VI.