[Show abstract][Hide abstract] ABSTRACT: Because of controversy regarding timing of tourniquet release during total knee arthroplasty (TKA), a closed arthrotomy as a tamponade for effective hemostasis was used to save ischemia time. The study was to verify the safety and efficacy on clinical issues.
A prospective cohort study was conducted on 72 consecutive unilateral primary TKAs. They were divided into two groups according to different timing of tourniquet release. The study group was composed of 36 index procedures with an intra-operative release after a tight arthrotomy closure; while the remaining 36 TKAs with a tourniquet application throughout the procedure comprised the comparative group. In all operations, no drain was used to augment the intra-articular tamponade.
In the study group, the tourniquet time was significantly shorter (p<0.001), and thus ischemic duration and perioperative blood loss were reduced. The postoperative course was similar on the basis of analgesics consumption and inpatient stay, but better earlier functional recovery as well as subjective performance was observed at early postoperative follow-ups.
The results suggest that a closed tamponade with arthrotomy closure and drainage avoidance is an effective hemostasis to reduce ischemia time during TKAs.
No preview · Article · Jan 2012 · Journal of the Formosan Medical Association
[Show abstract][Hide abstract] ABSTRACT: Purpose: To report the result of cemented cups and cementless stems (reverse hybrid) in 17 total hip arthroplasties (THAs). Methods: From January 2003 to January 2008, 17 hips (17 patients) received reverse hybrid THAs and were included in this study. The mean patient age was 70 years (range, 52-81 years). The reasons for a reverse hybrid THA were an acetabulum too small to accommodate a metal shell, a severely osteoporotic acetabulum with thin subchondral bone, in which press-fit and screw fixation of the metal shell was deemed unstable, irradiation arthritis, and sequelae of sepsis, while the proximal femoral canal is normally shaped for a press-fit stem. Demographic data, surgical techniques, reasons for surgery, Harris hip score, and complications were reported. Results: The average Harris hip score was 84.4 (range, 48-100) points at an average follow-up of 40.1 months (range, 24-73 months). One patient had a Vancouver type 2B fracture and received reoperation with open reduction. The patient had a 3-cm subsidence of the stem and thigh pain at follow-up. Another patient had an asymptomatic 1.5-cm subsidence of the stem. No loosening, migration, or progressive radiolucent lines around the cup were noted in any patient. Conclusion: Reverse hybrid THA was associated with good clinical and radiographic results of the cemented cups in patients with the four selection criteria. It is noteworthy that one periprosthetic femoral fracture and one asymptomatic stem subsidence occurred. The lower average hip score with reverse hybrid THA than with ordinary THA is attributable to major comorbidities in the patients.