PURPOSE OF THE STUDY To compare topical and intravenous (IV) administration of tranexamic acid (TXA) 2 g in patients undergoing total hip arthroplasty (THA), or total knee arthroplasty (TKA). MATERIAL AND METHODS In total, 452 patients undergoing THA or TKA were randomised to 3 groups: 1) the IV TXA group received 2 doses of TXA 1 g intravenously 3 hours apart; 2) the topical TXA group received TXA 2 g topically, and 3) the NO TXA - control group. Furthermore, each group was divided in two subgroups by performed surgery (THA versus TKA). The following endpoints were used for final analysis: postoperative blood loss, transfusion requirement, haemoglobin drop and postoperative complications (haematoma, surgical site infection, thromboembolism, early surgical revision). RESULTS Both topical and IV administration of TXA significantly reduced postoperative bleeding (mean ± standard deviation) after THA and TKA (topical 504.4±281.0 ml, IV 497.3±251.7 ml, NO 863.1±326.4 ml, p<0.001). Topical use was superior to IV in reducing postoperative drainage output in THA (topical 377±213.3 ml, IV 518.1±259.0 ml, p<0.01). On the opposite, IV use was superior to topical in drainage output in TKA (topical 646.1±281.3 ml, IV 457.8±235.8 ml, p<0.01). The differences in transfusion requirement and Hb drop between these administration methods were not statistically significant (p≥0.05), but any TXA administration was significantly better than no TXA in all endpoints of efficacy (p<0.001). The lowest complication rate was observed in the topical group (NO 24%, IV 19%, topical 7.5%). DISCUSSION Consensus on optimal TXA dosing regime in primary hip and knee arthroplasties is still missing. Use of TXA therapy in routine clinical practice is highly individualized in accordance with the current approach of personalized medicine. Topical application seems to be the safest route of TXA administration. However, precise application technique is essential. IV TXA is beneficial especially in patients with some bleeding coagulopathies undergoing TKA with a tourniquet. Repeat doses of TXA are not usually necessary after completed primary arthroplasties. CONCLUSIONS IV and topical TXA 2 g have similar effect on reduction of transfusion requirements and haemoglobin drop in THA and TKA. The IV route is superior to topical in TKA while topical TXA reduces complications in both THA and TKA. Key words: tranexamic acid, total hip arthroplasty, total knee arthroplasty, topical administration, intravenous administration.
- MeSH
- antifibrinolytika * MeSH
- aplikace lokální MeSH
- hemoglobiny MeSH
- intravenózní podání MeSH
- krvácení při operaci prevence a kontrola MeSH
- kyselina tranexamová * MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky metody MeSH
- totální endoprotéza kolene * škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Úvod: Totálna náhrada kolenného kĺbu je jednou z najčastejších a najúspešnejších operačných metód v ortopédii u pacientov s diagnózou pokročilej artrózy. V tejto retrospektívnej analýze sa zameriavame na porovnanie funkčných a klinických výsledkov u pacientov podstupujúcich unilaterálnu výmenu a u pacientov s bilaterálnou výmenou v rámci jedného operačného zákroku. Metódy: Do štúdie bolo zaradených celkovo 54 pacientov (bilaterálna 19, unilaterálna 35), ktorí na našom pracovisku podstúpili totálnu náhradu kolenného kĺbu. U pacientov bola sledovaná dĺžka hospitalizácie. Na objektívne zhodnotenie sme použili štandardizované dotazníky WOMAC a KSS 1, KSS 2, rozsah pohybu v operovanom kolennom kĺbe a výskyt pooperačných komplikácii. Výsledky: Obe skupiny pacientov boli vekom, body mass index a zastúpením pohlaví pomerne homogénne. Dĺžka hospitalizácie bola v unilaterálnej skupine 4,7±1,3 nesignifikantne kratšia ako v bilaterálnej skupine 5,6±2,0. Pacienti operovaní unilaterálne dosahovali rok po operácii flexiu 114,9±9,3, bilaterálna skupina dosahovala flexiu 112,6±8,6. Tak v unilaterálnej skupine u WOMAC, KSS1 a KSS2, ako aj v bilaterálnej skupine dochádza pri porovnaní s predoperačnými hodnotami k signifikantnému zlepšeniu jeden rok pooperačne. Pri porovnaní výsledkov WOMAC, KSS1 a KSS2 unilaterálnej a bilaterálnej skupiny 3, 6 a 12 mesiacov pooperačne, sú rozdiely hodnôt nesignifikantné. Revidovanosť implantátov v dvojročnom sledovaní dosahovala v unilaterálnej skupine 1,5 % a 1,4 % v bilaterálnej skupine. Záver: Unilaterálna aj bilaterálna implantácia endoprotézy kolenného kĺbu ako úspešné operačné metódy majú svoje zastúpenie v každodennej ortopedickej praxi. Pri dôslednej indikácii pacientov môže byť bilaterálna implantácia výhodnejšou alternatívou liečby, nakoľko pacient podstupuje len jeden operačný zákrok a riziká s ním spojené.
Introduction: Total knee replacement is one of the most common surgical methods in diagnosis of end staged osteoarthritis. In this retrospective analysis, we focus on comparison of functional and clinical outcome in patients undergoing unilateral and bilateral replacement within a single surgical procedure. Methods: 54 patients (bilateral 19, unilateral 35) underwent total knee replacement in our clinic participated in the current study. The length of hospital stay was monitored in all patients. Assessment of functional results was based on the WOMAC score, KSS 1, KSS2, range of motion and presence of complications in both groups. Results: Both groups of patients were homogeneous with age, body mass index and sex. The length of hospital stay in the unilateral group was 4.7±1.3 and 5.6±2.0 in the bilateral group. Patients operated on unilaterally achieved flexion of 114.9±9.3 after one year, bilateral group 112.6±8.6, the difference was insignificant. In both groups, there is a significant improvement one year postoperatively at WOMAC, KSS1 and KSS2. Comparing WOMAC, KSS1 and KSS2 between the unilateral and bilateral groups 3, 6, 12 months postoperatively, the differences are insignificant. The revision of implants in two-year follow-up reached 1.5% in unilateral group and 1.4% in bilateral group. Conclusion: Unilateral and bilateral knee joint endoprosthesis implantation is a successful surgical method in orthopedic practice. With conscious selection of patients, bilateral implantation may be more advantageous alternative, as the patient undergoes one operation and the associated risks.
The majority of adults with mild osteogenesis imperfecta report significant functional impairment due to musculoskeletal concerns. Knee osteoarthritis is common in these patients. Although total knee arthroplasty has become a highly efficient surgical technique for osteoarthritis, this procedure remains uncommon in patients with osteogenesis imperfecta. This current case report describes the important clinical aspects of osteogenesis imperfecta that must be considered during the planning and performance of a total knee replacement. A 62-year-old female patient with a history of osteogenesis imperfecta suffered from severe osteoarthritis of the knee with valgus deformity. Two years after posterior stabilized total knee arthroplasty, her Hospital for Special Surgery knee score had improved from preoperative 53 points to 85 points at the final follow-up. The current case report describes the crucial technical aspects of a successful total knee replacement in this uncommon scenario. Underlying deformities and concomitant pathologies constitute specific surgical challenges. Special care should be taken to protect the patient from potential complications.
- MeSH
- artróza kolenních kloubů * komplikace diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- koleno MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteogenesis imperfecta * komplikace chirurgie MeSH
- totální endoprotéza kolene * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- lidé MeSH
- perioperační období metody rehabilitace MeSH
- primární zdravotní péče MeSH
- totální endoprotéza kolene * metody přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND AND OBJECTIVE: Total knee arthroplasty (TKA) with modern all-polyethylene tibial (APT) components has shown high long-term survival rates and comparable results to those with metal-backed tibial components. Nevertheless, APT components are primarily recommended for older and low-demand patients. There are no evidence-based biomechanical guidelines for orthopaedic surgeons to determine the appropriate lower age limit for implantation of APT components. A biomechanical analysis was assumed to be suitable to evaluate the clinical results in patients under 70 years. The scope of this study was to determine biomechanically the appropriate lower age limit for implantation of APT components. METHODS: To generate data of the highest possible quality, the geometry of the computational models was created based on computed tomography (CT) images of a representative patient. The cortical bone tissue model distinguishes the change in mechanical properties described in three parts from the tibial cut. The cancellous bone material model has a heterogeneous distribution of mechanical properties. The values used to determine the material properties of the tissues were obtained from measurements of a CT dataset comprising 45 patients. RESULTS: Computational modeling showed that in the majority of the periprosthetic volume, the von Mises strain equivalent ranges from 200 to 2700 με; these strain values induce bone modeling and remodeling. The highest measured deformation value was 2910 με. There was no significant difference in the induced mechanical response between bone models of the 60-year and 70-year age groups, and there was <3% difference from the 65-year age group. CONCLUSIONS: Considering in silico limitations, we suggest that APT components could be conveniently used on a bone with mechanical properties of the examined age categories. Under defined loading conditions, implantation of TKA with APT components is expected to induce modeling and remodeling of the periprosthetic tibia. Following clinical validation, the results of our study could modify the indication criteria of the procedure, and lead to more frequent implantation of all-polyethylene TKA in younger patients.
- MeSH
- analýza metodou konečných prvků MeSH
- biomechanika MeSH
- kovy MeSH
- lidé MeSH
- mechanický stres MeSH
- polyethylen MeSH
- protézy - design MeSH
- protézy kolene * MeSH
- tibie diagnostické zobrazování chirurgie MeSH
- totální endoprotéza kolene * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The research aims to analyze the tibial component rotation using the finite element method by resecting the tibia in a transverse plane at an angle between 1.5° (external rotation) and -1.5° (internal rotation). We used a three-dimensional scanner to obtain the tibia's geometrical model of a cadaveric specimen. We then exported the surfaces of the tibial geometrical model through the Computer-Aided Three-dimensional Interactive Application (CATIA), which is a Computer-Aided Design (CAD) program. The CAD program three-dimensionally shaped the tibial component, polyethylene, and cement. Our analysis determined that the maximum equivalent stress is obtained in the case of proximal tibial resection at -1.5° angle in a transverse plane (internal rotation) with a value of 12.75 MPa, which is also obtained for the polyethylene (7.693 MPa) and cement (6.6 MPa). The results have shown that detrimental effects begin to occur at -1.5°. We propose the use of this finite element method to simulate the positioning of the tibial component at different tibial resection angles to appreciate the optimal rotation.
x
x
- Klíčová slova
- referenční body,
- MeSH
- chirurgie s pomocí počítače MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- totální endoprotéza kolene * metody MeSH
- Check Tag
- lidé MeSH
AIM: We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. METHODS: In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). RESULTS: Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). CONCLUSION: The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.
- MeSH
- antifibrinolytika aplikace a dávkování MeSH
- aplikace lokální MeSH
- artróza kolenních kloubů chirurgie MeSH
- fibrin-fibrinogen - produkty degradace metabolismus MeSH
- hematokrit MeSH
- hemoglobiny metabolismus MeSH
- intravenózní podání MeSH
- krvácení při operaci * MeSH
- kyselina tranexamová aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- plazminogen metabolismus MeSH
- pooperační krvácení epidemiologie MeSH
- senioři MeSH
- totální endoprotéza kolene metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Úvod: Cílem naší práce bylo sledování růstu BMI (index tělesné hmotnosti) u pacientů podrobujících se implantaci totální náhrady nosného kloubu. Soubor pacientů a metodika: Soubor tvořilo 1286 pacientů, kterým byla v letech 2010-2016 implantována náhrada kyčelního kloubu, v letech 2015-2016 náhrada kolenního kloubu. Na základě anamnézy, věku, BMI pacientů a roku implantace byla zaznamenaná data rozdělena v kontingenčních tabulkách. Výsledky: U pacientů podrobujících se implantaci kyčelního kloubu z důvodu primární koxartrózy byl BMI v roce 2010 u mužů 30,29 a u žen 29,86, v roce 2016 u mužů 30,93 a u žen 30,47. Pacienti se sekundární koxartrózou se pohybovali v hodnotách nadváhy. V roce 2016 byl průměrný BMI u pacientů s gonartrózou, kteří se podrobili implantaci totální endoprotézy kolenního kloubu, u mužů 31,81, u žen dokonce 32,40. Diskuse: Z výsledků je patrný celkově postupný nárůst BMI u odoperovaných pacientů. Dále bylo potvrzeno, že vyšší BMI má větší vliv na vznik gonartrózy. V diskusi jsme na základě lineární regrese odhadli další vývoj BMI v nadcházejících letech. Závěr: Na základě našich výsledků a vzhledem k růstu BMI v české populaci je jisté, že se s obézními pacienty budeme setkávat mnohem více. Musíme hledat nové postupy a zajistit technické zabezpečení k ošetření takových pacientů. Obezita by neměla být odrazujícím faktorem od výkonu, který vede k odstranění bolestí artroticky postiženým kloubem.
Introduction: The aim of the study was to monitor the growth of BMI in patients undergoing implantation of total replacement of the bearing joint. Methods: The set consisted of 1286 patients who underwent THA (total hip arthroplasty) between 2010 and 2016 or TKA (total knee arthroplasty) between 2015 and 2016. We evaluated patients' history, age, BMI and the year of surgery, using pivot tables. Results: In those patients, who underwent hip implantation, due to primary hip OA (osteoarthritis), BMI increased from 30,29 in 2010 to 30,93 in 2016 in male and from 29,86 in 2010 to 30,47 in 2016 in a female group. In cases of secondary hip OA, the results showed a tendency towards overweight patients. In 2016 the average BMI in patients with knee OA, who underwent total knee arthroplasty, was 31,81 in men and 32,40 in women. Discussion: Our data shows a gradual increase of patients' BMI in recent years. Also, it has been confirmed that higher BMI has a greater effect on knee OA. In the discussion, based on linear regression, we have estimated further development in BMI, over the coming years. Conclusion: Based on our results and the growth of BMI in the Czech population, it is certain that we will have to deal with obese patient much more often. We need to look for new modalities and provide technical provisions to treat this kind of patients. Obesity should not be a deterrent factor in surgery that leads to the removal of a pain causing arthritic joint.
- MeSH
- artróza kolenních kloubů diagnóza etiologie chirurgie MeSH
- artróza kyčelních kloubů * diagnóza etiologie chirurgie MeSH
- epidemiologické studie MeSH
- index tělesné hmotnosti MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody normy trendy MeSH
- obezita * prevence a kontrola MeSH
- pooperační komplikace MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- statistika jako téma MeSH
- totální endoprotéza kolene metody trendy MeSH
- věkové faktory MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- dítě MeSH
- kosti stehna a bérce růst a vývoj MeSH
- lidé MeSH
- nádory femuru farmakoterapie chirurgie patologie MeSH
- osteosarkom * chirurgie MeSH
- protézy kolene trendy MeSH
- totální endoprotéza kolene metody přístrojové vybavení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- novinové články MeSH
