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Lee HW, Park CH, Bae DK, Song SJ. How much preoperative flexion contracture is a predictor for residual flexion contracture after total knee arthroplasty in hemophilic arthropathy and rheumatoid arthritis? Knee Surg Relat Res 2022; 34:20. [PMID: 35395934 PMCID: PMC8994339 DOI: 10.1186/s43019-022-00146-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Although total knee arthroplasty (TKA) in hemophilic arthropathy (HA) or rheumatoid arthritis (RA) can improve functional ability, the postoperative range of motion (ROM) and prosthesis durability are reduced compared with those in osteoarthritic patients. Aim We aimed to compare (1) the pre- and postoperative flexion contracture after TKA in HA and RA, (2) the threshold of preoperative flexion contracture as a predictor of residual contracture > 15° after TKA, and (3) the survival rate. Methods Data from a consecutive cohort comprising 48 TKAs in HA and 92 TKAs in RA were retrospectively reviewed. The degree of flexion contracture was analyzed. Through receiver operating characteristics analysis, we aimed to determine the cutoff value of preoperative flexion contracture that increases the risk of residual contracture > 15° after TKA and compare the cutoff value in HA and RA. The survival rate was evaluated based on life table analysis and the Kaplan–Meier method. Results The degree of preoperative flexion contracture was not significantly different. The degree of postoperative residual flexion contracture was 5.6° in the HA group and 1.4° in the RA group, respectively (p < 0.001). The cutoff value of preoperative flexion contracture for residual contracture of > 15° at last-follow up was 25.0° in the HA group and 32.5° in the RA group. The 5- and 12-year survival rates were 96% and 87% in the HA and 99% and 95% in the RA group, respectively (n.s.). Conclusions The postoperative residual flexion contracture was greater and the cutoff value of preoperative flexion contracture for residual contracture was smaller in the HA group than the RA group. Appropriate intra- and postoperative care to avoid postoperative residual contracture is required in HA patients. Level of evidence III.
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Affiliation(s)
- Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea.
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Li S, Qu B, Ma W, Li Y. Perioperative anaesthesia and coagulation management of haemophilia patients receiving total hip and knee replacement arthroplasty: Experience from a case series. J Orthop Surg (Hong Kong) 2020; 27:2309499019874931. [PMID: 31554469 DOI: 10.1177/2309499019874931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report 13 consecutive cases of successful triad of anaesthesia, blood and coagulation management (ABC protocol) in haemophilic total joint arthroplasty (TJA) and its feasibility and safety on haemophilic TJA. METHODS All the clinical data of 13 consecutive cases were descend from electronic medical record. Patients who suffered from haemophilia A, undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) with ABC protocol at the academic hospital from December 2014 to November 2018 were included, and demographic, perioperative characteristics according to the classified method were further analysed. RESULTS All 13 haemophilic patients had undergone successful surgery with ABC protocol. No massive blood loss was observed in perioperative period. The mean external blood loss was 876.92 ± 592.86 mL. The mean change in haemoglobin was 5.42 ± 2.43 g dL-1 at 5 days post-operatively. The mean allogeneic transfusion volume was 1.23 ± 1.35 units, and the mean volume of autotransfusion was 237.5 ± 76.93 mL. The average clotting factor consumption for per operated joint was 458.26 ± 226.45 IU kg-1 in all cases. No severe perioperative complications were occurred. CONCLUSION ABC-related series of measures were appropriate management mode for patients received THA and/or TKA with mild or moderate haemophilia. However, more robust evidence came from larger samples is needed.
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Affiliation(s)
- Sibei Li
- Guangzhou University of Chinese Medicine, Guangdong, China
| | - Bo Qu
- Guangzhou University of Chinese Medicine, Guangdong, China
| | - Wuhua Ma
- Department of Anaesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yuhui Li
- Department of Anaesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
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Oyarzun A, Barrientos C, Barahona M, Martinez Á, Soto-Arellano V, Courtin C, Cruz-Montecinos C. Knee haemophilic arthropathy care in Chile: Midterm outcomes and complications after total knee arthroplasty. Haemophilia 2020; 26:e179-e186. [PMID: 32311196 DOI: 10.1111/hae.14004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) can improve knee function in the general population, but challenges arise for TKA use in haemophilic patients (HPs). AIM This study aimed to evaluate the midterm clinical experience of a single medical centre in TKA in HPs. METHODS We performed a case series of consecutive TKAs from 2007 to 2013 in HPs. All patients received coagulation factor supplementation according to the institutional protocol. Surgery was performed without a tourniquet by a standard midline medial parapatellar approach. We compared the range of motion (ROM) and flexion contracture before surgery and 1-year postoperative using paired Wilcoxon-non-parametric test (P < .05 was considered significant). The need for revision surgery was considered TKA survival failure. RESULTS Forty-one HP/60 TKAs were reviewed (19 cases were bilateral). Preoperative median ROM and flexion contracture was 75° (range, 0°-95°) and 20° (range, 5°-80°), respectively. The postoperative median ROM increased to 83° (range, 45°-110°), and median flexion contracture decrease to 0° (range, 0°-40°) a statistically significant difference (P < .01). Postoperative median clinical Knee Society Score (KSS) and functional KSS were 88 (range, 59-97) and 100 (range, 30-100), respectively. Six patients required revision (6.66%) due to infection. TKA survival at 5 years was 92% (range, 82%-96%). CONCLUSION This study supports that TKA improves function and ROM in haemophilic knee arthropathy. The protocol of coagulation factors used in this cohort is valid as no related complications were reported. A higher incidence of complications, especially infections, must be expected compared with a TKA in non-HPs.
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Affiliation(s)
- Andrés Oyarzun
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile
| | - Cristian Barrientos
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile.,Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Álvaro Martinez
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile
| | - Verónica Soto-Arellano
- Centre of Haemophilia and Studies of Congenital Coagulopathies, Roberto del Rio Children's Hospital, Santiago, Chile
| | - Carolina Courtin
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Biomechanics and Kinesiology Laboratory, Service of Physical Therapy, San José Hospital, Santiago, Chile
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Song SJ, Bae JK, Park CH, Yoo MC, Bae DK, Kim KI. Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy: A review of consecutive 131 knees between 2006 and 2015 in a single institute. Haemophilia 2017; 24:299-306. [PMID: 29193440 DOI: 10.1111/hae.13383] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Although total knee arthroplasty (TKA) in haemophilic arthropathy can reduce severe joint pain and improve functional disability, it is technically demanding. AIM To evaluate mid-term outcomes and complications of TKA in haemophilic arthropathy. METHODS This study retrospectively reviewed 131 consecutive primary TKAs in a single institute. The mean age was 41.0 years old, and the mean follow-up period was 6.8 years. Clinical and radiographic results were evaluated. Complications were categorized according to the classification system of the Knee Society for TKA complications. RESULTS The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score improved from 66.0 to 24.2. The average flexion contracture significantly decreased from 17.3° to 4.7°, but the average pre- and postoperative maximum flexion did not differ (80.9° vs 85.6°, respectively). The average mechanical axis was varus 5.2° preoperatively and valgus 0.3° postoperatively. The coronal positions of the femoral and tibial components and the sagittal positions of these components were within ±3° in 83.2%, 89.3%, 63.4% and 73.3% of cases, respectively. Complications occurred in 17 knees (13.0%): hemarthrosis (n = 7), medial collateral ligament injury (n = 1), stiffness (n = 2), deep periprosthetic joint infection (PJI) (n = 3) and periprosthetic fracture (n = 4). CONCLUSIONS The mid-term results of TKA in haemophilic arthropathy were satisfactory in pain relief, improved function and decreased flexion contracture. Bleeding and PJI continue to be major concerns for TKA in haemophilic arthropathy, and risk of periprosthetic fracture must be taken into account for patient education and appropriate prevention.
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Affiliation(s)
- S J Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - J K Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - C H Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - M C Yoo
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - D K Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - K I Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Pan JK, Hong KH, Xie H, Luo MH, Guo D, Liu J. The efficacy and safety of autologous blood transfusion drainage in patients undergoing total knee arthroplasty: a meta-analysis of 16 randomized controlled trials. BMC Musculoskelet Disord 2016; 17:452. [PMID: 27806693 PMCID: PMC5094026 DOI: 10.1186/s12891-016-1301-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Autologous blood transfusion drainage (ABTD) has been used for many years to reduce blood loss in total knee arthroplasty (TKA). We evaluate the current evidence concerning the efficiency and safety of ABTD used in TKA compared with conventional suction drainage (CSD). Methods We performed a systematic literature search of the PubMed, Embase, Cochrane Library and four Chinese databases. All randomized controlled trials (RCTs) that compared the effects of ABTD versus CSD in TKA were included in the meta-analysis. Results Sixteen RCTs involving 1534 patients who compared the effects of ABTD versus CSD were included. Five of the RCTs were performed in Asia, ten in Europe, and one in North America. Patients in the ABTD group had a lower blood transfusion rate (OR: 0.25 [0.13, 0.47]; Z = 4.27, P < 0.0001) and fewer units transfused per patient (WMD: −0.68 [−0.98, −0.39]; Z = 4. 52, P < 0.00001) than did patients in the CSD group. Wound complications, deep vein thrombosis, febrile complications, post-operative hemoglobin days 5–8, drainage volume, and length of hospital stay did not differ significantly between the two types of drainage systems. Conclusion This meta-analysis suggests that ABTD is a safe and effective method that yields a lower blood transfusion rate and fewer units transfused per patient in TKA compared with CSD. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1301-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian-Ke Pan
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Kun-Hao Hong
- Department of Orthopedics, Guangdong Second Traditional Chinese Medicine Hospital, No. 60 Hengfu Road, Guangzhou, Guangdong, 510095, China
| | - Hui Xie
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Ming-Hui Luo
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Da Guo
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Jun Liu
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
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Does Hemophilia Increase the Risk of Postoperative Blood Transfusion After Lower Extremity Total Joint Arthroplasty? J Arthroplasty 2016; 31:1578-82. [PMID: 26869059 DOI: 10.1016/j.arth.2016.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/31/2015] [Accepted: 01/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemophilia can lead to the development of arthropathies secondary to recurrent hemarthroses. However, given these patients' bleeding tendencies, postoperative complications associated with blood loss are a considerable concern. METHODS We identified men in the Nationwide Inpatient Sample who underwent total hip or knee arthroplasty between January 1998 and December 2010. We used propensity scores to match 332 hemophiliacs (267 hemophilia A, 65 hemophilia B) to a comparison cohort of 996 patients in a 1:3 ratio, according to the site of arthroplasty, year of admission, age, race, and Charlson and Deyo score. RESULTS The incidence of any postoperative transfusion was 15.06% for hemophiliacs, compared with 9.84% for the matched comparison cohort (P = .012). For hemophiliacs, the odds ratio was 1.60 (95% confidence interval [CI] = 1.11-2.31; P = .013) for any transfusion, 1.90 (95% CI = 1.24-2.92; P = .003) for allogenic transfusion, and 1.05 (95% CI = 0.56-1.95; P = .888) for autogenic transfusion. CONCLUSION Hemophilia is associated with an increased risk of blood transfusion after lower extremity total joint arthroplasty. Patients and providers should discuss these risks before surgery, and insurers should consider incorporating this comorbidity into bundled payments for total hip and knee arthroplasty.
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Modern Patient Blood Management in Arthroplasty. PERIOPERATIVE MEDICAL MANAGEMENT FOR TOTAL JOINT ARTHROPLASTY 2015. [PMCID: PMC7123738 DOI: 10.1007/978-3-319-07203-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
One of the oldest and still commonest procedures in clinical practice, allogeneic blood transfusion (ABT), is not fully supported by available evidence. In the last few decades, increasing concerns about unfavorable outcomes associated with ABT, anticipation of future insufficient blood supply, and awareness of the cost (direct and indirect) of transfusion have led to the promotion of patient blood management (PBM) as a cost-effective strategy, beneficial for patients as well as for society (Shander et al. 2010). PBM programs utilize a series of measures with a proven ability to reduce ABT and to be cost-effective. Despite that the impact of PBM on patient clinical outcomes needs to be fully defined and future studies are needed, PBM should be adopted as a new standard of care.
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