Bleeding after total knee arthroplasty increases the risk of pain, delayed rehabilitation, blood transfusion, and transfusion-associated complications. The authors compared pre- and postoperative decreases in hemoglobin as a surrogate for blood loss in consecutive patients treated at a single institution by the same surgeon (J.L.C.) using conventional hemostatic methods (electrocautery, suturing, or manual compression) or a gelatin and thrombin-based hemostatic matrix during total knee arthroplasty. Data were collected retrospectively by chart review. The population comprised 165 controls and 184 patients treated with hemostatic matrix. Median age was 66 years (range, 28–89 years); 66% were women. The arithmetic mean±SD for the maximal postoperative decrease in hemoglobin was 3.18±0.94 g/dL for controls and 2.19±0.83 g/dL for the hemostatic matrix group. Least squares means estimates of the group difference (controls–hemostatic matrix) in the maximal decrease in hemoglobin was 0.96 g/dL (95% confidence interval, 0.77–1.14 mg/dL;
P
<.0001). Statistically significant covariate effects were observed for preoperative hemoglobin level (
P
<.0001) and body mass index (
P
=.0029). Transfusions were infrequent in both groups. The frequency of acceptable range of motion was high (control, 88%; hemostatic matrix, 84%). In both groups, overall mean tourniquet time was approximately 1 hour, and the most common length of stay was 3 to 5 days. No serious complications related to the hemostatic agent were observed. These data demonstrate that the use of a flowable hemostatic matrix results in less reduction in hemoglobin than the use of conventional hemostatic methods in patient undergoing total knee arthroplasty.
Fifty-six consecutive revised total knee arthroplasties (TKA) were followed for an average of 8.3 years (range: 3 to 15 years). The purpose of this study was to evaluate the results of revision TKA to determine any trend's in either the good outcomes or the failures. We found that the success rate for revision TKA was comparable to that for primary TKA. Eighty-nine percent of the knees rated at least fair, with 73% of these rating good or excellent, and 4% poor result. Moreover, the findings suggest that if prostheses are aligned correctly at implantation, there is only slight deterioration in their performance over time. Outcome was not affected by the type of prosthesis used in either the previous surgery or the revision. There is a correlation between the number of revisions and the functional knee rating; the more revisions, the less chance for success. There was also a direct correlation between varus knee alignment and significant increased incidence of failure. No appreciable difference was found between degenerative arthritis patients and rheumatoid patients, except that the rheumatoid patients had a higher incidence of delayed infections.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.