ABSTRACT
Introduction: Although the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA. Methods: This cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay. Results: Of the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001). Conclusions: The topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.
ABSTRACT
INTRODUCTION: Many physicians recommend annual or biennial visits after total hip and knee arthroplasty (THA and TKA). This study sought to establish the cost of a post-operative visit to both the health care system and patient and identify if these visits altered patient management. METHODS: A prospective cohort study was conducted using patients presenting for follow-up after THA or TKA from April through December 2016. All surgeries were performed by a single orthopaedic surgeon in Wichita, Kansas. All eligible subjects that met the inclusion criteria received and completed a questionnaire about the personal cost of the visit and their assessment of their function and outcome after total joint arthroplasty. The physician also completed a questionnaire that examined the cost of the visit to the health care system and whether the clinical or radiographic findings altered patient management. RESULTS: Fifty-six patients participated with an average length of follow- up of 4.5 ± 4.1 years since surgery. The average patient cost was $135.20 ± $190.53 (range, $1.65 - $995.88), and the average visit time for the patient was 3.9 ± 2.9 hours. Eighty percent of patients reported no pain during the clinic encounter, and 11% reported loss of function. Eighty-four percent thought the visit was necessary. Physician time for each visit lasted 12.9 ± 3.7 minutes (range, 10 - 20 minutes). Only 9% of patient encounters resulted in an alteration in patient management. This occurred at an average follow-up time of 3.6 ± 1.8 years after the index procedure. The average cost of each visit to the health care system at large was $117.31 ± 60.53 (range, $93.90 - $428.28). CONCLUSIONS: The findings of this study advise total joint patients and orthopaedic surgeons regarding the cost of routine post-operative appointments and whether these visits alter patient management. The majority of the routine follow-up visits after THA and TKA did not result in an alteration in patient management, but added substantial cost to the health care system.
ABSTRACT
BACKGROUND: With the advent of new bone cements with different viscosities, it is important to understand how they respond to different cementing techniques. The purpose of this study was to evaluate the high viscosity (HV) bone cement intrusion characteristics comparing negative pressure intrusion technique (NPI) and finger-packing technique in a cadaveric proximal tibial bone. METHODS: Soft tissues were removed from twenty- four fresh frozen cadaver proximal tibiae, and standard arthroplasty tibial cuts were performed. Palacos-R (Zimmer, Warsaw, IN) and Simplex-HV (Stryker Howmedica Osteonics, Mahwah, NJ) bone cement were used. Each tibia was randomly assigned to receive one of the two bone cements with finger-packing technique and NPI technique. Forty-five Newton weight was applied along the long axis of the tibia during cement-setting phase. Once the cement had cured, sagittal sections were prepared and analyzed for cement penetration depth using digital photography and stereoscopic micrographs. Area of interest (AOI) for each specimen was also used to quantitatively evaluate the area of cement penetration. RESULTS: When using Palacos-R, significant dif ferences were detected in cement penetration between the two cementing techniques. On the other hand, when using Simplex-HV, cement penetration was not significantly increased with finger-packing technique when compared to NPI technique. When comparing the two high-viscosity bone cements when using NPI cementing technique, significant differences were detected at Zone 4, where Simplex-HV penetrated deeper than the Palacos-R. When finger-packing technique was used with Simplex-HV, significant differences were detected in bone cement penetration at Zones 3-5. When looking at AOI, no significant differences were found between the Palacos-R and Simplex-HV bone cements in terms of penetration depths with NPI technique. Higher penetration depths were achieved with Simplex-HV bone cement compared to Palacos-R cement in finger packing technique. CONCLUSION: The data demonstrated that the combination of different bone cement formulations and the cementing technique has a significant effect on cement penetration into the cut bone surface.
