With increasing average life expectancy and the physical activeness of the population aged 60 and older, major orthopedic arthroplasty is becoming more common. In particular, total knee arthroplasty (TKA) has become a major orthopedic procedure in the aging population in Korea; additionally, venous thromboembolism (VTE) is one of the major compliThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Substantial variation exists in the reported rates of postoperative venous thromboembolism (VTE) following total knee arthroplasty (TKA) in the Asian population. This retrospective study aimed to compare the early postoperative VTE incidence between patients managed with epidural anesthesia and those managed by general anesthesia at the time of TKA. Methods:We reviewed 589 cases of unilateral primary TKA performed between January 2011 and June 2014. We selected epidural versus general anesthesia groups as the main anesthetic choices, with postoperative patient-controlled analgesia. All the patients underwent deep vein thrombosis (DVT) computed tomography angiography on postoperative day 7. The incidence of DVT and pulmonary thromboembolism (PTE) was evaluated and compared between epidural and general anesthesia.Results: The overall incidence of VTE was 8.0% in the two groups together. The incidence did not differ between the groups. The odds ratio in the generalized estimation equations analysis showed a higher incidence of DVT and PTE in the epidural group; however, this result was not statistically significant. Although, the odds ratio for age showed that the risk of developing DVT and PTE increased 1.12 times per year.Conclusions: Total VTE incidence was not significantly different between patients who underwent general anesthesia and those who underwent epidural anesthesia for TKA. A prospective multicenter study is required to evaluate the nature of the Korean VTE status in major orthopedic surgeries, and to prepare guidelines and protocols for medical prophylaxis for DVT and PTE in Korea.
Percutaneous vertebroplasty (PVP) is widely performed on patients suffering from painful vertebral compression fractures due to osteoporosis, as well as spinal metastasis of cancer [1,2]. Although it is regarded as a safe and simple minimally invasive procedure, leakage of bone cement (polymethyl methacrylate, PMMA) into the spinal canal occurs more frequently than practitioners may expect [3,4].Rare but serious neurological complications can result from thermal injury due to bone cement leakage [5,6]. However, even though serious complications are expected, there is no known specific treatment to date. We present a case in which we initially failed to detect bone cement leakage into the spinal canal, and the patient suddenly complained of right lower quadrant (RLQ) abdominal pain that began a few minutes later as the bone cement began to heat. We diagnosed this as a preceding sign of neurological complication by thermal injury due to leakage of bone cement. We immediately administered an epidural steroid injection, followed by cooled normal saline irrigation through an epidural catheter to treat and minimize thermal injury due to bone cement leakage. CASE REPORTA 72-year-old female complained of lower back pain lasting longer than 2 weeks. Except when lying still, her lower A 72-year-old woman was diagnosed with Kümmell's disease of the T12 and L3 vertebrae. During bone cement injection under continuous fluoroscopic guidance, bone cement spread beyond the posterior border of the T12 vertebral body. We halted the injection immediately. A few minutes later, the patient complained of increasing right lower quadrant abdominal pain. This was diagnosed as a preceding sign of neurological complication due to thermal injury. Consequently, we administered an epidural steroid injection, followed by cooled normal saline irrigation through an epidural catheter to minimize and treat the thermal injury. The pain gradually decreased after saline irrigation and completely disappeared after approximately 10 minutes. After completing the percutaneous vertebroplasty, the patient's lower back pain improved without neurological complications. In conclusion, immediate epidural steroid injection followed by cooled normal saline irrigation through epidural catheterization can be used to treat thermal injury due to bone cement leakage.
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