Both chemical and mechanical methods of prophylaxis have reduced the incidence of thromboembolic complications following total knee replacement (TKR). Only a few studies have shown that mobilization on the first post-operative day further reduces the incidence of thromboembolic phenomena. We conducted a prospective study to verify not only if early mobilization but also whether the distance mobilized on the first post-operative day after TKR reduced the incidence of thromboembolic complications. The incidence of deep venous thrombosis and pulmonary embolism were compared in 50 consecutive patients who underwent TKR from July 2006 following a change in the mobilization protocol with 50 consecutive patients who underwent TKR before the protocol was instigated. The mobilization protocol changed from strict bed rest the first post-operative day to mobilization on the first post-operative day. Mobilization was defined as sitting out of bed or walking for at least 15-30 min twice a day. The distance mobilized was accurately recorded by the physiotherapists. All patients underwent duplex scans of both lower limbs on the fourth post-operative day. There was a significant reduction in the incidence of thromboembolic complications in the mobilization group (seven in total) compared with the control group (16 in total) (P= 0.03). Furthermore, in the mobilization group the odds of developing a thromboemobloic complication was significantly reduced the greater the distance the patient mobilized (Chi-squared linear trend = 8.009, P= 0.0047). Early mobilization in the first 24 h after TKR is a cheap and effective way to reduce the incidence of post-operative deep venous thrombosis.
IntroductionTotal knee arthroplasty (TKA) has a success rate of 80–90%, but despite this encouraging figure a painful TKA can be a source of dismay for patients and surgeons. Computed tomography (CT) scan has been developed as a tool to collect data in the analysis of TKA component placement. Protocols used to collect such data exist in orthopaedic and radiology practice with little standardization and significant variation. The aim of this review article was to evaluate such variability by sampling a series of protocols from a range of different radiology practices within NSW, Australia in a case‐based manner and to then compare them against any literature standards.MethodsThe literature was surveyed for existing CT scan protocols used in TKA assessment. These were then compared with a series of metropolitan and rural radiology firms across the public and private sectors in NSW, Australia.ResultsConsiderable variability exists between current protocols across NSW, Australia, which differ with proposed literature standards.ConclusionVariabilities encountered when comparing the different scanning protocols in use for the assessment of TKA constitute a large potential source of error in the analysis of TKA component positioning. The reliance surgeons place on such analyses suggests the need for an established scanning protocol with an incorporated grading system and standardized values to allow reproducible data to help assess and predict TKA function.
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