Tourniquet-free minimally invasive total knee arthroplasty is associated with early aseptic loosening.

Autor: Kunes JA; Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA., El-Othmani MM; Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA., LaVelle M; Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA., Santos WM; Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA., Geller JA; Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA., Shah RP; Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA. Electronic address: roshan.shah.pub@gmail.com.
Jazyk: angličtina
Zdroj: The Knee [Knee] 2024 Jan; Vol. 46, pp. 19-26. Date of Electronic Publication: 2023 Nov 21.
DOI: 10.1016/j.knee.2023.11.001
Abstrakt: Background: While tourniquet-free (T-) total knee arthroplasty (TKA) has gained popularity, tourniquet-use during minimally-invasive (MIS)-TKA has not been adequately studied. Traditional techniques employ knee hyper-flexion, compressing vasculature and reducing impact of bleeding, while MIS-TKA embraces the semi-extended knee position, which does not restrict the effects of bleeding on cementation and visualization. We compared the risk of aseptic loosening between patients undergoing T- MIS-TKA compared to T + MIS-TKA.
Methods: This single-surgeon cohort study included 329 consecutive MIS-TKA (226 T+,103 T-) patients with minimum 3-year follow-up. Aseptic loosening, radiolucent lines (RLL), health related quality of life scores, and complications were recorded. T-test and chi-square test were used to compare continuous and categorical variables, and logistic regression included BMI, age, ASA, patellar-resurfacing, and tourniquet-use.
Results: There were no differences in baseline demographics. One (0.4 %) aseptic loosening occurred with T+, versus 7 (6.8 %) with T- (p = 0.002). No T + and 3 T- patients (2.9 %, p = 0.01) had revision for aseptic loosening. The incidence of RLLs was 16.8 % in T + and 30.1 % in T- (p = 0.008). Logistic regression revealed T + was significantly associated with decreased aseptic loosening and risk of RLL (odds ratio = 16.4, odds ratio = 2.8).
Conclusion: In this consecutive series, T- MIS-TKA was associated with increased rates of revision for aseptic loosening as compared to the T + MIS-TKA, even controlling for BMI, age, ASA level, and patellar resurfacing. Radiolucent lines were increased with T- MIS-TKA compared to T + MIS-TKA. Complications, all-cause revision, ROM, and HRQoL scores were similar between tourniquet-use and tourniquet-free cohorts.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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