The journal of knee surgery
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Multicenter Study Comparative Study Observational Study
Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty.
Multiple studies have shown tranexamic acid (TXA) to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA). Accordingly, TXA has become a routine blood conservation agent for TKA. In contrast, ε-aminocaproic acid (EACA), a similar acting antifibrinolytic to TXA, has been less frequently used. ⋯ Administration of EACA or TXA significantly decreased postoperative transfusion rates compared with no antifibrinolytic therapy. Utilization of EACA for unilateral TKA proved to be comparable to TXA in all studied aspects at a lower cost. The level of evidence for the study is Level 3.
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Multicenter Study Comparative Study
Outcomes of total knee replacement after patellofemoral arthroplasty.
There is increasing interest in the use of patellofemoral joint replacements and the cohort receiving them are the youngest of any of the groups of patients undergoing a knee arthroplasty. With more contemporary prostheses, progression of arthritis in other parts of the knee joint is becoming the predominant mechanism of failure. We conducted a multicenter retrospective comparative cohort study to discover whether the outcome of total knee replacement is compromised by prior patellofemoral joint arthroplasty. ⋯ At a mean follow-up of 2.4 years, the primary total knee replacement cohort had significantly better Oxford Knee Scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scores, pain visual analog scores, and EQ-5D scores. There was no significant difference in patient satisfaction or EQ-5D visual analog scale. Our results indicate that although the revision of a patellofemoral joint replacement to a total knee replacement is a technically straightforward procedure, the eventual outcome may be less satisfactory when compared with a primary total knee replacement.
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Multicenter Study
Adverse effects of increased body mass index and weight on survivorship of total knee arthroplasty and subsequent outcomes of revision TKA.
To investigate the effects of increased weight and body mass index (BMI) on total knee arthroplasty (TKA) survivorship and on functional outcomes and quality of life following revision TKA, a prospective cohort study of 291 consecutive revision TKA patients was performed. Average patient BMI was 32.3 +/- 7.7, and 57% of patients were obese (BMI > or = 30). The obese group was not significantly different from the nonobese group regarding reasons for prosthesis failure; however, they were more likely to experience certain comorbidities. ⋯ In regression analysis, BMI was a significant predictor of Short Form-36, WOMAC difficulty of function, and KSS. Weight and BMI have deleterious effects on the longevity of primary TKA and functional and quality of life outcomes following revision TKA. These findings indicate a need for more effective management of these patients.