A strong and reliable indicator for early postoperative major cardiac events after elective orthopedic surgery: Aortic arch calcification

BACKGROUND

Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required.

AIM

The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery.

METHODS

Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray.

RESULTS

A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery.

CONCLUSIONS

Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery.

Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture

OBJECTIVE

The purpose of this study was to evaluate the visibility of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with chronic anterior cruciate ligament (ACL) rupture.

MATERIALS AND METHODS

This retrospective case - control study compared 1.5 - T MRI scans for 50 patients with a chronic ACL rupture with those of a control group of 50 patients with an intact ACL. The ALL was evaluated in three portions: femoral, meniscal, and tibial. The status of each portion was classified as visualized or non-visualized. Two radiologists separately reviewed all the MRI scans to evaluate interobserver reliability.

RESULTS

At least one portion of the ALL was visualized in 100% of the control group and 72% of the chronic ACL rupture group. All three portions of the ALL were identified in 72% of the control group but only 10% of the chronic ACL rupture group. In both groups, the most commonly visualized portion was the meniscal portion and the least visualized was the tibial portion. In 18% of the chronic ACL rupture group, no portion of the ALL was visualized.

CONCLUSIONS

The visibility of the ALL of the knee was significantly lower in patients with a chronic ACL rupture than in those with an intact one.

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

AIMS

The combined (IV (intravenous) + topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral + topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral + topical use is as safe and efficient as the IV + topical use, in addition to the main advantage of relatively low cost.

METHODS

In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral + topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded.

RESULTS

There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 ( p < 0.05) in favour of the combined group. The post-operative drainage amounts ( p = 0.0001), measured blood loss volume ( p = 0.003) and transfusion rates ( p = 0.03) were lower in the combined (oral + topical) group compared to the topical group.

CONCLUSIONS

Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.

Microfracture technique versus carbon fibre rod implantation for treatment of knee articular cartilage lesions

PURPOSE

To compare the microfracture technique with carbon fibre rod implantation for treatment of knee articular cartilage lesions.

METHODS

10 men and 30 women aged 22 to 56 (mean, 37.4) years underwent microfracture (n=20) or carbon fibre rod implantation (n=20) for International Cartilage Repair Society grade 3 to 4 knee articular cartilage lesions after a mean of 12.2 months of viscosupplementation and physiotherapy. Clinical outcome at 6 and 12 months was assessed using the Tegner-Lysholm score and modified Cincinnati score. Magnetic resonance imaging (MRI) outcome at 12 months was assessed by a radiologist. The modified magnetic resonance observation of cartilage repair tissue (MOCART) score was evaluated.

RESULTS

The 2 groups were comparable in terms of age, body mass index, lesion location, lesion size, duration of symptoms, and coexisting pathology. The microfracture group had a higher preoperative Tegner-Lysholm score (39.4±7.3 vs. 34.4±4.9, p=0.015) and modified Cincinnati score (36.4±7.2 vs. 30.4±4.0, p=0.002) than the carbon fibre rod group. At 12 months, change in both scores was significant within each group (p<0.001) and was higher in the microfracture than carbon fibre rod group (p<0.001). MRI showed minimal regenerative tissue. Lobulation, oedema, and hypertrophy were more commonly found in the regeneration tissue after carbon fibre rod implantation than microfracture. At 12 months, the MOCART score was higher in the microfracture than carbon fibre rod group (59 vs. 47, p<0.001).

CONCLUSION

Microfracture is superior to carbon fibre rod implantation in terms of clinical and radiological outcome.