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Chen Y, Qin L, Yang J, Wang J, Huang J, Gong X, Hu N. Changes in Thromboelastography to Predict Ecchymosis After Knee Arthroplasty: A Promising Guide for the Use of Anticoagulants. Front Surg 2022; 9:871776. [PMID: 35495763 PMCID: PMC9039049 DOI: 10.3389/fsurg.2022.871776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEcchymosis is one of the worrisome complications after total knee arthroplasty (TKA) and interferes with functional rehabilitation. Current clinical guidelines do not provide individualized approaches for patients with ecchymoses.MethodsIn this study, we used thromboelastography (TEG) to determine the coagulation state after TKA and to then explore markers that predict the occurrence of ecchymosis events after TKA. In our cohort, patients were divided into ecchymosis (n = 55) and non-ecchymosis (n = 137) groups according to whether ecchymosis events occurred after TKA. Rivaroxaban 10 mg/d was taken orally for thromboprophylaxis after surgery. All patients completed TEG testing. Correlation analysis was used to determine the risk factors for ecchymosis after TKA, and receiver operating characteristic (ROC) curves for variables with significant correlation were plotted.ResultsIn all, 55 of the 192 patients (28.65%) developed ecchymosis surrounding the surgical site. Multivariate analysis showed that hidden blood loss (OR = 1.003 and p = 0.005) and changes in the coagulation index (ΔCI) values (OR = 0.351 and p = 0.001) were risk factors for ecchymosis after TKA. Using the Youden index, 0.1805 was determined as the optimal threshold value of ΔCI for predicting the occurrence of ecchymosis, with a sensitivity of 74.55% and specificity of 72.99%. ΔCI is a promising marker as an alarm for the occurrence of ecchymosis after TKA.Trial RegistrationThe study was registered in the Chinese Clinical Trial Registry (ChiCTR1800017245). Registered name: The role of thrombelastography in monitoring the changes of coagulation function during perioperative period of arthroplasty. Registered 19 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29220
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Affiliation(s)
- Yuelong Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Leilei Qin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianye Yang
- Department of Orthopaedics, Fuling Central Hospital, Chongqing, China
| | - Jiawei Wang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaxing Huang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Gong
- Department of Outpatient Care, Chongqing General Hospital, Chongqing, China
- *Correspondence: Xuan Gong
| | - Ning Hu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Ning Hu
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De Tromboprofilaxis En Cirugía Ginecológica GDDC, de Obstetricia Y Ginecología Fecolsog FC. Consensus on thromboprophylaxis in gynecological surgery. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2021; 72:53-68. [PMID: 33878814 PMCID: PMC8372767 DOI: 10.18597/rcog.3666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023]
Abstract
Objective: To draw a synthesis of the available evidence regarding interventions for the prevention of venous thromboembolic events during the perioperative care of women with benign gynecological pathology, with the aim of reducing the associated morbidity and mortality. Materials and methods: The development group included healthcare professionals, decision-makers and one patient representative. All the participants stated their disclosures. Answerable clinical questions were built and outcomes were graded. The search for information was conducted in Medline, Embase, Epistemonikos and LILACS, but it also included grey literature and was updated on September 22, 2020, with no date or language restrictions. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to determine the quality of the evidence and the strength of the recommendations. Formal consensus was developed in accordance with the RAND/UCLA methodology. The document was submitted to peer review before publication. Results: The abbreviated version of the “consensus on the prevention of venous thromboembolic events during the perioperative care of women with benign gynecological pathology” is presented together with the supporting evidence and respective recommendations. Conclusions: The key recommendations for implementation include the use of the Caprini scale and of interventions consistent with the individual perioperative risk level.
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Buttacavoli FA. Gravity-Assisted Passive Flexion in Total Knee Arthroplasty Recovery. Orthopedics 2020; 43:e431-e437. [PMID: 32745229 DOI: 10.3928/01477447-20200721-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/22/2019] [Indexed: 02/03/2023]
Abstract
This study examined the use of gravity-assisted passive flexion (GAP-FLEX) for perioperative total knee arthroplasty (TKA) recovery. The main questions associated with this technique were: (1) Can GAP-FLEX improve patient recovery of range of motion after TKA? (2) Does GAP-FLEX reduce patient time and effort associated with therapy compared with continuous passive motion (CPM)? (3) Does GAP-FLEX reduce overall episodic care cost? A prospective, randomized multicenter study was conducted. Two senior surgeons used identical surgical approach, prosthesis, and postoperative management protocols. Patients consenting to the study were randomly assigned to either standard of care (CPM) or GAP-FLEX groups. Active flexion range of motion (ROM) was measured via goniometer with a primary endpoint established at 4 weeks after surgery. Secondary endpoints included pain and functional mobility. A total of 27 patients completed the study. Average ROM in the GAP-FLEX sample was 8.4° greater than the CPM sample (P=.009) at study endpoint. The GAP-FLEX patients achieved greater postoperative ROM within 2 days and maintained an improvement over CPM to study endpoint. Eighty-five percent (11 of 13) of GAP-FLEX patients achieved or surpassed their baseline ROM by study endpoint, compared with 50% (7 of 14) of CPM patients. These improvements occurred while requiring 90% less therapy time on device compared with the CPM patients. Patients did not report any statistically different pain levels but did exhibit higher functional mobility at endpoint (P=.026). [Orthopedics. 2020;43(5):e431-e437.].
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Abstract
The authors report an update of the main methods for preventing deep vein thrombosis after total knee replacement, which are divided into mechanical and pharmacological methods. The current principal used drugs, their dosages, and the comparative risks and benefits are also reported.
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Liu N, Luo S, Hang C, Zha Z, Li J, Wu W, Hou D. Changes in coagulation functions and hemorheological parameters may predict hematoma formation after total knee arthroplasty. J Orthop Surg Res 2016; 11:35. [PMID: 27013496 PMCID: PMC4806485 DOI: 10.1186/s13018-016-0370-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/16/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hematoma formation around the knee is commonly seen after total knee arthroplasty (TKA) and may cause patient discomfort and worry regarding the success of the surgery. This study aimed to evaluate the coagulation functions and hemorheological parameters in patients undergoing TKA and investigate their associations with hematoma formation. METHODS This study prospectively included 146 patients treated for knee osteoarthritis by unilateral TKA between August 2013 and August 2014. Apixaban was administered twice during the 12-24-h period after surgery. Blood coagulation functions were evaluated according to activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time, and fibrinogen preoperatively and on postoperative days 1, 3, 7, and 14. Hemorheological parameters were also measured. Patients were divided into a hematoma group and a non-hematoma group for comparison. RESULTS On postoperative day 1, the hematoma group showed significantly prolonged APTT and PT and significantly decreased hematocrit relative to baseline values (P < 0.05). The whole blood high shear rate, whole blood low shear rate, plasma viscosity, and hematocrit did not differ significantly between the two groups at baseline or from postoperative days 1-14 in (P > 0.05). CONCLUSIONS Prolonged APTT and PT on the first day after TKA as well as decreased hematocrit may indicate an increased risk of hematoma formation. Postoperative use of apixaban may promote the formation of ecchymoses but is not a major contributing factor.
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Affiliation(s)
- Ning Liu
- The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China.,Institute of Orthopaedic Disease Research, Jinan University, Guangzhou, 510632, China
| | - Simin Luo
- The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China.,Institute of Orthopaedic Disease Research, Jinan University, Guangzhou, 510632, China
| | - Cheanglek Hang
- Macau Medical Science & Technology Research Association, Macau, China
| | - Zhengang Zha
- The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China. .,Institute of Orthopaedic Disease Research, Jinan University, Guangzhou, 510632, China.
| | - Jieruo Li
- The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China.,Institute of Orthopaedic Disease Research, Jinan University, Guangzhou, 510632, China
| | - Wenrui Wu
- The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China.,Institute of Orthopaedic Disease Research, Jinan University, Guangzhou, 510632, China
| | - Dabiao Hou
- The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China.,Institute of Orthopaedic Disease Research, Jinan University, Guangzhou, 510632, China
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Hughes KE, Nickel D, Gurney-Dunlop T, Knox KB. Total knee arthroplasty in multiple sclerosis. Arthroplast Today 2016; 2:117-122. [PMID: 28326412 PMCID: PMC5045468 DOI: 10.1016/j.artd.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
We present a case report of total knee arthroplasty complicated by spasticity and contractures in a patient with multiple sclerosis (MS). Four previous case reports in the literature describe adverse outcomes after total knee arthroplasty in persons with MS secondary to severe spasticity. Preoperative, intraoperative, and postoperative considerations for persons with MS, which may help to improve functional outcomes, are discussed. Prospective research is needed among persons with MS to help determine the timing and selection of persons for arthroplasty and to minimize complications related to spasticity.
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Affiliation(s)
| | - Darren Nickel
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tanner Gurney-Dunlop
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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