The Knee
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Control of perioperative blood loss is important in total knee arthroplasty (TKA), especially cementless or hybrid TKA. There is increasing interest in the use of tranexamic acid (TXA) for this purpose, however, studies to date have mainly evaluated the effects of various TXA administration regimens on patients who have undergone cemented TKA. We sought to determine (1) whether administration of TXA reduces blood loss after hybrid TKA, and (2) whether an autologous blood reinfusion system is necessary in TKA patients who are treated with TXA. ⋯ Level II.
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Randomized Controlled Trial
Reducing blood loss in simultaneous bilateral total knee arthroplasty: combined intravenous-intra-articular tranexamic acid administration. A prospective randomized controlled trial.
We asked whether tranexamic acid (TXA) administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of a novel method of TXA administration in TKA. ⋯ This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss with negligible side effects.
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Review Meta Analysis
A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction.
There is a lack of comprehensive studies comparing the clinical outcome of anterior cruciate ligament (ACL) reconstruction with either a bone-patellar tendon-bone (BPTB) or four-strand hamstring tendon (4SHT) autografts. The optimal choice of graft for anterior cruciate ligament reconstruction remains controversial. ⋯ Based on the results above, ACL reconstruction with BPTB autografts might be superior in resuming rotation stability of the knee joint and allow patients to return to higher levels of activity in comparison with 4SHT autografts. Whereas, postoperative complications of the knee joint were lower for 4SHT autografts than for BPTB autografts. There was insufficient evidence to identify which of the two types of grafts was significantly better for ACL reconstruction considering the limitations of this study. More high-quality randomized controlled trials with strictly specified inclusion criteria are highly required before drawing a reliable conclusion.
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Randomized Controlled Trial
Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial.
Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff. ⋯ Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48 h after fast-track TKA, compared to using a tourniquet.
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The arthroplasty registries report the survivorship of knee arthroplasties and the reasons for revisions. The various registries report similar implant survivorships. However, the reasons for the knee revisions have not been compared. The aims of this study were to assess the reasons for knee arthroplasty revisions from the five valid arthroplasty registries and to evaluate whether the reasons for revisions in each registry were similar. ⋯ The reasons for knee arthroplasty revisions are categorized differently in various arthroplasty registries, and there is a wide range of percentages presented. The differences in percentages may not be fully explained by the different outcome results in the different countries. The heterogeneity of the registries may guide the recording of the reasons behind the revisions. There is a definite need to standardize the structure of the arthroplasty registries, and to validate the data therein. A larger collaboration between the registries is essential.