Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty / 中国医学科学杂志(英文版)

Objective Total knee arthroplasty is one of the most common orthopedic surgeries. Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons. In this study, we evaluated the risk factors for severe complications after primary total knee arthroplasty. Methods We retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital. Postoperative complication ≥ grade Ⅲ was defined as severe complication according to Clavien-Dindo classification system. Binary logistic regression was used to identify the predictive risk factors for severe complications. Results The complication rate after primary total knee arthroplasty was 6.8% and severe complication rate was 2.5%. Male (OR = 2.178, 95%CI: 1.324-3.585, P= 0.002), individuals above 75 years old (OR = 1.936, 95%CI: 1.155-3.244, P= 0.012), arrhythmia (OR = 2.913, 95%CI: 1.350-6.285, P= 0.006) and cerebrovascular disease (OR = 2.804, 95%CI: 1.432-5.489, P= 0.003) were predictive risk factors for severe complications after primary total knee arthroplasty. Conclusion Advanced age, male, arrhythmia, and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty. Special attention should be paid to patients with risk factors.

Application of Modified Pie-crusting Technique in Releasing Medial Tightness During Primary Total Knee Arthroplasty / 中国微创外科杂志

Objective To analyze and evaluate the safety and efficacy of modified Pie-crusting ( PC) technique for releasing medial tightness during primary total knee arthroplasty ( TKA) . Methods We completed primary TKA by the same performer with modified PC technique in 30 patients (34 knees) with genu varus from March 2014 to June 2016.By using a special curved scalpel with width limit of 3 mm and depth limit of 5 mm to poke the tension parts , we released the anterion bondle of superficial medial collateral ligament ( sMCL) and posteromedial corner structures ( PMCS) during tension happened in extension , and we released the posterior bondle of sMCL during tension happened in flexion .According to the gap value measured intraoperatively , we divided these cases into three groups: extension with flexion tension group ( 10 knees ) , extension tension group ( 13 knees ) , and flexion tension group (11 knees).The difference between medial and lateral gap value no more than 1 mm was defined as gap balance.We calculated the gap balance rate of each group .Series of weighted frontal X-ray were conducted at fixed period to evaluate the varus angle of the knee postoperatively.The range of motion (ROM), HSS scores and WOMAC scores were also recorded at the same time . Results Among the 34 knees , 31 knees reached the medial and lateral gap balance at both extension and flexion .There was a difference of 2 mm in medial and lateral gap value at extension in 1 knee and the same difference at flexion in the other 2 knees.The total postoperative gap balance rate was 91.2%( 31/34 ).The constrained inserts were implanted in 3 cases.No technical-related complications happened after the surgery.After the releasing procedure, the flexion gap value had an increase of 1 mm (range, 1-3mm) in the extension tension group , and the extension gap value had an increase of 1 mm ( range, 1-2 mm) in the flexion tension group, without significant difference (Z=-1.118, P=0.264).The ROM was 83.3°±14.7°preoperatively and 100.7°±14.2° postoperatively (t=-7.714, P=0.000).The median alignment of the knee was 11.5°(range, 7°-32°) preoperatively and 1° (range, 0°-4°) postoperatively (Z=-5.092,P=0.000).The HSS scores were (42.7 ±16.3) points preoperatively and (88.1 ± 9.9) points postoperatively (t=-21.868, P=0.000).The WOMAC scores were (76.2 ±8.2) points preoperatively and (11.4 ± 9.7) points postoperatively (t=31.726, P=0.000).All of them were significantly improved in comparison with those before the surgery. Conclusions Using modified PC technique is safe and effective in medial releasing during primary TKA .Both extension and flexion gap value will be affected by releasing tensed fiber at extension or flexion position .

Lateral Retinacular Release in Primary Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine the effect of lateral retinacular release on patellofemoral alignment in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From June 1990 to December 1998, 351 cases of TKA, which were followed up more than 3 years, were divided into two groups, 147 cases (group I) with lateral retinacular release and 204 cases (group II) were without release. We compared the two groups in terms of the range of motion, patellofemoral alignment and clinical results using a Hospital for Special Surgery score. RESULTS: Average range of motion in group I (112 degrees preoperatively and 113 degrees on final follow-up) and group II (114 degrees preoperatively and 113 degrees on final follow-up) showed no statistical difference. The average functional knee score in group I (58 preoperatively and 88 on final follow-up) and group II (59 and 85 respectively) also showed no statistical difference. Patellar maltracking occurred in 4 cases (2.7%) in group I and 31 cases (15.2%) in group II. Patellar tilting (4.5 degrees in group I and 7.7 degrees in group II) and patellar translation (3.7 mm in group I and 7.8 mm in group II) showed significant statistical difference between the two groups at the final follow-up. CONCLUSION: Patellar tracking was better in the lateral retinacular release group, although there was no clinically significant difference at the short term follow-up period.

Auto-Transfusion in Total Knee Arthroplasty

PURPOSE: The purposes of this study are to see how much the auto-transfusion reduce the need for allo- genic blood transfusion and to ascertain whether transfusion affects the incidence of deep vein thrombo- sis(DVT) in primary total knee arthroplasty(TKA). MATERIALS AND METHODS: A retrospective analysis of 263 consecutive patients who had had a primary TKA was performed. The operations included 165 unilateral and 98 one-stage bilateral cases. The predeposit autologous blood donated 1pint for the unilateral cases and 2pints for bilateral cases preoperatively. Intraoperative salvage of blood was performed using the cell saver system. The collected data from the patients charts(the estimated blood loss and the amount of transfusion) were statistically analysed to examine relationships between development of DVT and the loss of blood or transfusion. RESULTS: We excluded the data of the patients who needed to be transfused over 6pints. For the unilateral cases, the average estimated loss of blood was 307+/-150cc(50~1000), the average amount of transfusion was 1.5+/-0.8 pint(0~5), and the average amount of blood that was salvaged through cell saver system was 210+/-141 cc(0~660). Adding the autologous donation(400cc), auto-transfusion was up to 100% of the average amount of transfusion. For the one-stage bilateral cases, the average estimated loss of blood was 678+/-267cc(100~1400), the average amount of transfusion was 3.0+/-0.9 pint(1~5), and the average amount of blood that was salvaged through cell saver system was 524+/-279cc(125~1125), Adding the autologous donation(800cc), auto-transfusion was up to 100% of the average amount of transfusion. There were no statistical associations between DYT and the loss of blood or transfusion(p>0.05). CONCLUSION: Combining preoperative autologous blood donation with intraoperative salvage effectively reduces the need for allogenic blood transfusion in primary TKA.