The Knee
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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.
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The clinical survival of joint arthroplasties is related to the quality of the surrounding bone environment. Bone mineral density (BMD) is an important measure of bone strength and quality. The aim of this prospective study was to measure the quantitative changes in BMD in the distal femur after cemented total knee arthroplasty (TKA) in osteoarthrotic knee joints. ⋯ The clinical status and function parameters of the knee joint, evaluated by the American Knee Society (AKS) score, had improved significantly on the preoperative values at the three- and 12-month follow-ups (P<0.0005). However, improvement in the AKS score was not associated with periprosthetic BMD change (P=0.204), whereas age (P=0.067) and body mass index (P=0.019) correlated with BMD loss for the total metaphyseal region of interest (ROI), by repeated measures ANOVA. We suggest that the observed periprosthetic bone loss was mainly the result of prosthesis-related stress-shielding.