The Journal of arthroplasty
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Multicenter Study
Revision of unicompartmental arthroplasty to total knee arthroplasty: not always a slam dunk!
As the number of UKA performed in the world continues to increase, so will the number of failures. A better understanding of the outcomes after revision UKAto TKA is warranted. The objective of this study is to report the outcomes of modern UKA revised to TKA in three US centers. ⋯ In the present series, the re-revision rate after revision TKA from UKA was 4.5 % at an average of 75 months or 1.2 revisions per 100 observed component years. Compared to published individual institution and national registry data, re-revision of a failed UKA is equivalent to revision rates of primary TKA and substantially better than re-revision rates of revision TKA. These data should be used to counsel patients undergoing revision UKA to TKA.
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Revision total knee arthroplasty (TKA) has been associated with an increased risk of perioperative blood loss. Tranexamic acid (TXA) has been proven to be safe and effective in preventing blood loss in primary TKA. The purpose of this study was to evaluate the effect of TXA on blood loss and transfusion rates in revision TKA. ⋯ A total of 178 patients did not receive TXA while 246 patients received one intraoperative dose of 20mg/kg of TXA given prior to tourniquet release. There was a significant reduction in hemoglobin loss (42±16g/L vs 38±15g/L, P=0.005), transfusion rates (30.3% vs 16.7%, P=0.001) and average amount transfused (1.1±1.9units vs 0.5±1.1units, P=0.001) in the TXA group. There was no significant difference in recorded major adverse events with the administration of TXA.
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Staphylococcus decolonization prior to surgery is used to prevent surgical site infections (SSIs) after total joint arthroplasty (TJA). To determine if current treatment protocols result in successful decolonization of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA), 106 consecutive patients were screened for nasal MSSA/MRSA colonization pre-operatively and on the day of surgery. Colonized patients used intranasal mupirocin twice a day and chlorhexidine showers daily 5 days prior to surgery. ⋯ On the day of surgery, 3 joints (2.8%) who underwent decolonization were positive for MSSA colonization and 0 joints were positive for MRSA colonization. The reduction in MSSA colonization was significant (P<0.001), while the eradication of MRSA colonization approached statistical significance (P=0.063). Current decolonization protocols using intranasal mupirocin and chlorhexidine washes are effective for reducing MRSA/MSSA colonization.
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Randomized Controlled Trial
Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study.
Pain control is necessary for successful rehabilitation and outcome after total knee arthroplasty. Our goal was to compare the clinical efficacy of periarticular injections consisting of a long-acting local anesthetic (ropivacaine) and epinephrine with and without combinations of an α2-adrenergic agonist (clonidine) and/or a nonsteroidal anti-inflammatory agent (ketorolac). ⋯ Compared with Group D, Group A and B patients had significantly lower postoperative visual analog pain scores and nurse pain assessment and Group C patients had a significantly greater reduction in physical therapist pain assessment. We found no differences in other parameters analyzed.
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Randomized Controlled Trial
Use of bovine thrombin to reduce blood loss in primary total knee arthroplasty: a controlled randomized trial.
Reducing blood loss during primary total knee arthroplasty (TKA) can improve outcomes by reducing transfusion requirements and wound complications. We examined the use of bovine thrombin to augment hemostasis during primary TKA. A double-blinded randomized trial was performed with 80 primary TKA patients. ⋯ Hemoglobin levels in the study group did decline less than the control group, but no statistically significant difference was found in rates of transfusion, drain outputs, length of stay, or Knee Society scores. This agent does appear to slightly reduce blood loss, but routine use is not cost effective. Thrombin may be considered for patients who would benefit more from greater blood conservation.