The journal of knee surgery
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The treatment of hematologic malignancies has advanced over the years, resulting in an improved survival of patients. As a result, these patients may be a part of the increasing population requiring total knee arthroplasty (TKA); however, they might be at a higher risk of adverse perioperative outcomes. The purpose of this study was to determine the perioperative outcomes (complications, length of stay [LOS], and costs) of patients with hematologic malignancies following TKA. ⋯ Hematologic malignancies were associated with an increased incremental LOS (0.13 d, p < 0.0001) and an increased incremental cost ($788, p < 0.0001). Thus, we conclude that following TKA, patients with hematologic malignancies are at an increased risk of perioperative complications, longer LOS, and higher costs. The risk quantification for adverse perioperative outcomes in association with an increased cost may help design different risk stratification and reimbursement methods in such patients when undergoing TKA.
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Comparative Study
Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma to Enhance Osseous Integration Potential for Osteochondral Allografts.
Fresh osteochondral allograft (OCA) transplantation is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Since a lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. This study sought to determine and compare the potential of bone marrow aspirate concentrate (BMC) and leukoreduced platelet rich plasma (PRP) to repopulate the osseous portion of an OCA with cells and deliver osteogenic proteins. ⋯ BMC samples had a significantly higher (p = 0.029) CFU/mL compared with PRP samples. At day 3 and/or 7 of culture, the concentration of several osteogenic proteins was significantly higher in both BMC and PRP samples. Autogenous BMC can be used to deliver both a cell population and osteogenic proteins that may improve healing of the osseous portion of the OCA clinically.
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Tranexamic acid (TXA) can reduce blood loss and decrease transfusion rates after total knee arthroplasty (TKA). The purpose of our study was to evaluate the efficacy of TXA in a homogenous, consecutive cohort of patients undergoing simultaneous bilateral primary TKA. This was a retrospective study of 50 consecutive patients who underwent bilateral simultaneous primary TKA between 2011 and 2015. ⋯ No thromboembolic events occurred. TXA in bilateral simultaneous TKA effectively reduces blood loss, maintains postoperative Hb and Hct levels, and significantly decreases blood transfusion rates. The level of evidence is level III (therapeutic study).
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Comparative Study
Gap-Balancing versus Measured Resection Technique in Total Knee Arthroplasty: A Comparison Study.
Proper femoral component alignment in the axial plane during total knee arthroplasty (TKA) depends on accurate bone cuts and soft tissue balancing. Two methods that are used to achieve this are "measured resection" and "gap balancing." However, a controversy exists as to which method is more accurate and leads to better outcomes. Therefore, the purpose of this study was to evaluate: (1) implant survivorship, (2) patient outcomes, (3) complications, and (4) radiographic analysis comparing patients who underwent TKA with either gap-balancing or measured resection techniques. ⋯ Otherwise, the radiographic evaluation at latest follow-up did not demonstrate any evidence of progressive radiolucencies or loosening, of any prosthesis. The results of this study found that at a mean follow-up of 3 years, both the measured resection and gap-balancing techniques achieved excellent survivorship and postoperative outcomes. This demonstrates that both methods can be used to achieve accurate femoral component alignment with similar short-term outcomes.
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Comparative Study
Comparative Study for Alignment of Extramedullary Guides versus Portable, Accelerometer-Based Navigation in Total Knee Arthroplasty.
The use of portable, accelerometer-based navigation (PN) devices for positioning of the components of total knee arthroplasty (TKA) is emerging as an alternative to standard extramedullary (EM) systems, which was needed to the image intensifier. The aim of our study was to compare the accuracy of component positioning in TKA using an EM and PN systems. Data from 100 consecutive primary TKAs, performed by multiple surgeons in 87 patients between October 2010 and June 2015, were analyzed. ⋯ In conclusion, the coronal and sagittal alignments for the femoral components was less accurate compared with tibial component alignment, especially in the PN group, and the sagittal alignment of the femoral component was less accurate than coronal alignment for both groups. Both the PN and EM systems provide satisfactory coronal and sagittal component alignments in TKA. Further technical improvement of the PN system could further improve its application for accurate component implantation in TKAs.