Comparison of functional performance after total knee arthroplasty using rotating platform and fixed-bearing prostheses with or without patellar resurfacing.

OBJECTIVE: To retrospectively compare the functional performances of rotating platform and fixed-bearing total knee arthroplasties with or without patellar resurfacing. METHODS: One hundred and ninety-seven patients (205 knees) of mean age 66.4 years were randomly assigned to receive different prostheses. One hundred ninety-five patients, including 97 fixed-bearing prostheses with 37 patellae resurfaced and 106 rotating platform prostheses with 76 patellae resurfaced, were followed up for a mean duration of 32 months. RESULTS: Outcomes in the rotating platform with patellar resurfacing and fixed-bearing with patellar resurfacing groups did not differ significantly according to Hospital for Special Surgery (HSS) scores and flexion and extension angles. For total knee arthroplasties without patellar resurfacing, there were no significant differences in HSS score and flexion angle between the rotating platform and fixed-bearing subgroups. Although the extension angle of rotating platform prostheses was slightly better than that of the fixed-bearing in the patellar non-resurfacing group, this difference was not clinically significant. CONCLUSIONS: Rotating platform and fixed-bearing prostheses have similar overall postoperative outcomes with regard to postoperative HSS scores and extension and flexion angles. Rotating platform prostheses are not superior to fixed bearing prostheses.

[Effects of postoperative restrictive fluid management on recovery of gastrointestinal function after elective colonic resection].

OBJECTIVE: To investigate the effect of postoperative restrictive fluid management by ensuring adequate tissue perfusion on the recovery of gastrointestinal function after elective colonic resection. METHODS: Thirty patients suffered with elective colonic resection, after 6 hours of anesthesia recovery, were randomly divided into restrictive fluid management group (restrictive group, n=15) and traditional fluid management group (control group, n=15). From the surgery day to the 4th postoperative day, patients in restrictive group and control group received the total fluids of 25-35 ml×kg(-1)×d(-1) or 40-50 ml×kg(-1)×d(-1) respectively. Fluid balance, tissue perfusion, gastrointestinal function recovery time and the imbalance of fluid and electrolyte were recorded. RESULTS: The total fluid input and net fluid balance in restrictive group were significantly fewer than those in control group (total fluid input: 1782.56±258.38 ml/d vs. 2707.50±294.64 ml/d, net fluid balance: 316.67±202.86 ml/d vs. 623.33±244.38 ml/d, both P<0.05), and central venous pressure (CVP) was significantly lower than that in control group (4.03±1.81 mm Hg vs. 6.47±3.09 mm Hg, P<0.05). There were no differences in heart rate (HR) and mean arterial pressure (MAP) between two groups (HR: 85.03±13.49 bpm vs. 81.44±12.49 bpm, MAP: 80.65±11.39 mm Hg vs. 82.38±8.28 mm Hg, both P>0.05). The lactate clearance rate of the first postoperative 24 hours in restrictive group was higher than that in control group [35 (17, 53)% vs. 17 (-6, 33)%, P<0.05]. The times of bowel sounds recovery, the first flatus and stool passed in restrictive group were shorter than those in control group (bowel sounds: 37.43±24.97 hours vs. 46.36±19.34 hours, flatus: 53.63±12.78 hours vs. 75.43±20.07 hours, stool: 78.73±46.48 hours vs. 93.40±41.08 hours, all P<0.05). Vomiting was reduced in the restrictive group compared with control group (2 vs. 7, P<0.05). There were no differences in the occurrences of electrolyte imbalance (5 vs. 3), fluid insufficient (2 vs. 0) and fluid overload (0 vs. 1) between the two groups. CONCLUSION: The postoperative restrictive fluid management by ensuring tissue perfusion can shorten the gastrointestinal function recovery time after elective colonic resection, and may not increase the incidence of water and electrolyte disorders.