The Knee
-
Randomized Controlled Trial
A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures.
The present investigation is a prospective study comparing the use of locked plates and classic double plates for the repair of bicondylar tibial plateau fractures. Eighty-four patients with bicondylar tibial plateau fractures were treated with plate fixation by either a locked plate (Less Invasive Stabilization System, LISS) or classic double plates (DP). All patients were followed for a minimum of 24 months. ⋯ Wound size and blood loss were significantly less in the LISS group than in the DP group (both P<0.05). A significantly higher incidence of post-operative malalignment of the proximal tibia (P=0.041) and a trend toward significance of a higher incidence of symptomatic hardware irritation (P=0.057) were observed in the LISS group compared to the DP group. In conclusion, LISS provides an alternative treatment for bicondylar tibial plateau fractures, but it may not replace the conventional two-incision double plating technique as the standard of care.
-
Randomized Controlled Trial Comparative Study
A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered.
The results for autologous chondrocyte implantation (ACI) in the treatment of full thickness chondral defects in the knee are encouraging. At present two techniques have been described to retain the chondrocyte suspension within the defect. The first involves using a periosteal cover (ACI-P) and the second involves using a type I/III collagen membrane (ACI-C). To the authors knowledge there are no comparative studies of these two techniques in the current literature. We have therefore undertaken such a study to establish if there is a difference between the 2 techniques based on a clinical and arthroscopic assessment. ⋯ This study has shown no statistical difference between the clinical outcome of ACI-C versus ACI-P at 2 years. A significant number of patients who had the ACI-P required shaving of a hypertrophied graft. We conclude that there is no advantage in using periosteum as a cover for retaining chondrocytes within an osteochondral defect; as a result we advocate the use of an alternative cover such as a manufactured type I/III collagen membrane.
-
Randomized Controlled Trial
Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients.
Extensive blood loss related to knee arthroplasty is quite normal and many patients require blood transfusions. Surgery and the use of pneumatic tourniquets lead to an increase in the activity of the fibrinolytic system, which in turn may accentuate the blood loss. Drugs that inhibit the fibrinolytic system may thus be used to reduce blood loss. Tranexamic acid (TA) acts by binding to one of the enzymes at the start of the coagulation cascade, so inhibiting the fibrinolytic system. A concern is that this inhibition may have the side effect of increasing thromboembolic disease, a common complication of joint replacement surgery. We aimed to confirm the reductions in blood loss and to assess the impact of TA usage on clinical and sub-clinical DVT. ⋯ One injection of 15 mg/kg of tranexamic given at the time of cementing the prosthesis in total knee arthroplasty, before deflation of the tourniquet, significantly decreases the amount of blood loss in the early post-operative period. The treatment was not associated with an increase in thromboembolic complications.
-
Randomized Controlled Trial Clinical Trial
The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement.
The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. ⋯ Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Neutrophil activity in total knee replacement: implications in preventing post-arthroplasty infection.