The blood loss that accompanies total knee arthroplasty (TKA) can be substantial. Many patients need perioperative blood transfusions. To avoid anemia and transfusion-related complications, the amount of blood loss and need for blood transfusions must be reduced. If standard jig instruments are used, an opening of the femoral medullary canal is required. This operative step has been recognized as a reason for elevated blood loss; it is not required if computer navigation is used. Hence, the purpose of this study was to investigate the effect of computer navigation on blood loss and transfusion rate in TKA. The data of 500 consecutive patients undergoing TKA were analyzed, and patient- and operation-related data and blood loss and transfusion rates were recorded. The total blood loss was calculated by use of the Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula. The average blood loss in the drainages (standard procedures, 880 mL; navigated procedures, 761 mL; P=.001) and the calculated total blood loss (standard procedures, 1375 mL; navigated procedures, 1242 mL; P=.036) were significantly reduced in the navigation group. The transfusion rate of navigated procedures was almost halved (standard procedures, 0.23 transfusions/patient; navigated procedures, 0.12 transfusions/patient; P=.035). Our study demonstrated a reduced blood loss if TKAs were implanted by use of computer navigation. The diminished blood loss resulted in a 50% reduction of allogenic blood transfusions. Hence, computer navigation may be attractive for patients with a high risk of transfusions or uncommon blood groups. Prospective studies are required to verify this potential benefit of computer navigation.
Prophylactic use of antibiotics to prevent postoperative infections is a routine method in neurosurgery. Little is known about the period of effectiveness of antibiotics applied only for the purposes of operation. The actual concentration of cefazolin was determined in the serum, in the contents of wound drains, and in the cerebrospinal fluid in a 24-hour postoperative period after the administration of 1 g of cefazolin just prior to skin incision in 8 patients undergoing lumbar discectomy and 11 patients undergoing craniectomy. The concentration of the antibiotic was then compared with the minimal inhibitory concentration values of cefazolin for 10 different bacterial species. For evaluating the concentration of cefazolin, capillary electrophoresis was used, which is a new clinical application of this separation technique. Results showed that the antibiotic was effective against bacterial breeding in the serum and in the drainage up to 12 hours. The drug concentration in the cerebrospinal fluid remained less than the value of the serum, and it exceeded the minimal inhibitory concentration values only for approximately 5 hours.
The purpose of our study was to calculate the optimal tibial resection depth in total knee arthroplasty. The data from 464 navigated total knee arthroplasties were analysed.
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