Total knee arthroplasty in carefully selected patients aged 80 years or older.

BACKGROUND: The patients aged ≥ 80 years have been considered to have a higher risk of mortality, postoperative complications, and longer hospital stay following total knee arthroplasty (TKA) than younger patients. The purposes of this retrospective study were to review the results of TKA in patients aged ≥ 80 years after a preoperative consultation. METHODS: Seventy-five patients aged ≥ 80 years underwent TKA from January 2006 and June 2010. A control group of younger patients (65-74 years) was matched in a 1:1 ratio with the ≥ 80 years group for sex, diagnosis of the disease, body mass index, the American Society of Anesthesiologists' type of anesthesia, and comorbidities. Cardiologists and neurologists carefully evaluated the risk of patients for both groups before surgery. The groups were compared with regard to Knee Society Scores, Knee Society Function Score, Western Ontario and McMaster Universities Osteoarthritis Index scores, length of stay, postoperative complications, and 90-day mortality rate. RESULTS: The mean follow-up was 2.3 years (range 1-5 years). We found no difference in the functional outcomes and length of stay between the two groups. The ≥ 80 years group had a higher rate of blood transfusion (29.3% versus 10.7%, p = 0.006) after Bonferroni correction. There were no cardiovascular or cerebrovascular complications in the ≥ 80 years group. There were no mortalities within 90 days in either group. CONCLUSIONS: Despite similar functional results and pain relief of the TKA compared with the young patient group, the ≥ 80 years group had a higher complication rate of blood transfusion. With a preoperative consultation by cardiologists and neurologists, patients aged ≥ 80 years have a low cardiovascular or cerebrovascular complications and 90-day mortality after TKA.

Ceramic-on-ceramic total hip arthroplasty: incidence and risk factors of bearing surface-related noises in 125 patients.

The ceramic-on-ceramic bearing surface has high wear resistance and good biocompatibility in total hip arthroplasty (THA). However, the postoperative noise problem has been an important issue. The purpose of this retrospective study was to determine the incidence and risk factors of bearing surface-related noises in patients with third-generation ceramic-on-ceramic THAs. One hundred twenty-five patients (143 hips) with ceramic-on-ceramic THAs were included in the study and followed to obtain noise and functional results. Patient factors, including sex, age, height, weight, body mass index, diagnosis, and postoperative range of motion, and surgical factors, including cup inclination, ceramic head size and length, and size of cup related to noises, were recorded. Mean follow-up was 4.2 years (range, 2-10 years). Mean Harris Hip Score was 94 points (range, 68-100 points) at latest follow-up. One (0.8%) patient had radiological evidence of osteolysis, and 4 (3.2%) patients had hip dislocation. No hip sustained a fracture of the ceramic component. Eight (6.4%) patients developed noise at their hips, including clicking in 4, grinding in 2, and snapping in 2. No patient developed squeaking hips or underwent revision surgery because of noisy hips. Younger patients (P=.01), a diagnosis of osteonecrosis (P=.014), a 28-mm ceramic head (P=.042), and a higher hip range of motion postoperatively (P=.001) were related to noise in ceramic-on-ceramic THAs. The study showed third-generation ceramic-on-ceramic THAs had a low incidence of noise problems. However, long-term follow-up is necessary to determine the clinical relevance.

Total knee arthroplasty in patients with stiff knees.

The purpose of this study was to evaluate the clinical outcome of total knee arthroplasty and analyze the prognostic factors in patients with stiff knees. Thirty-two patients (39 knees) with severe knee arthritis and an arc of motion of 50° or less were treated by total knee arthroplasty. The mean follow-up period was 58 months (range, 24-123 months). The mean arc of motion improved from 35° before the operation to 94° at the time of the latest follow-up (P<.05). Improvement in knee motion after postoperative 3 months was insignificant. The most important factor related to the final arc of knee motion was preoperative arc of knee motion. The V-Y quadricepsplasty was associated with an inferior clinical outcome. Total knee arthroplasty in patients with stiff knees has substantially improved in the clinical outcome and the arc of motion.

Does tranexamic acid save blood in minimally invasive total knee arthroplasty?

BACKGROUND: Tranexamic acid (TEA) reportedly reduces perioperative blood loss in TKA. However, whether it does so in minimally invasive TKA is not clear. QUESTIONS/PURPOSES: We asked whether TEA would reduce blood loss and blood transfusion requirements after minimally invasive TKA. PATIENTS AND METHODS: We prospectively enrolled 100 patients who underwent minimally invasive TKAs: 50 received one intravenous injection of TEA before deflation of the tourniquet and a control group of 50 patients received an equivalent volume of placebo. We compared changes in hemoglobin, postoperative drainage, total blood loss, and transfusion rates between the two groups. RESULTS: The total blood loss was less for patients in the TEA group than for the control group: 833 mL (374-1014 mL) versus 1453 mL (733-2537 mL), respectively. The rate of blood transfusion also was less for patients in the TEA group than in the control group (4% versus 20%). The hemoglobin levels on the second and fourth postoperative days were greater for patients in the TEA group than in the control group. CONCLUSIONS: Our data suggest one intraoperative injection of TEA decreased the total blood loss and need for transfusion after minimally invasive TKA. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Two-stage reimplantation of infected hip arthroplasties.

BACKGROUND: Although two-stage reimplantation for infected hip arthroplasty has a high success rate, the protocols of the antibiotic therapy after resection arthroplasty have varied in different reports. The purpose of this study was to evaluate the clinical outcomes of two-stage reimplantation for infected hip arthroplasty using our protocol of combined parenteral and oral antibiotic therapy and the criterion for reimplantation. METHODS: Forty-seven patients (48 hips) with infected hip arthroplasty were treated with two-stage reimplantation using interim antibiotic-impregnated cement beads with an average 2.6 weeks of parenteral antibiotic and 6 weeks of oral antibiotic therapy. The timing for reimplantation was determined using the values of erythrocyte-sedimentation rate (ESR) and C-reactive protein (CRP) with no clinical signs of infection. The average follow-up period was 5.6 years. RESULTS: Forty-six (96%) hips were free of recurrent infection according to clinical examination and laboratory tests at the latest follow up. All 48 hips had negative tissue culture results obtained at the second-stage reimplantation except one which resulted in a recurrent infection. The average interim period of time from the first-stage procedure to reimplantation was 5.4 months (range, 2-24 months). Two hips had recurrent infections after reimplantation. The mean Harris hip score improved from 26 points preoperatively to 83 points at the latest follow up. Thirty-five patients (74%) achieved excellent or good results. CONCLUSIONS: Two-stage reimplantation of an infected hip arthroplasty can achieve a high success rate using the protocol of aggressive surgical debridement, local antibiotic-loaded cement beads, combined parenteral and oral antibiotic therapy and reimplantation after normalization of ESR and CRP levels.