BackgroundWhether cementless fixation on femoral and tibial components increases blood loss during total knee arthroplasty (TKA) is unclear. The purpose of this randomized controlled trial was to compare blood loss and early functional recovery between patients who underwent cementless or cemented TKA.MethodsBetween November 2021 and April 2022, sixty-one eligible patients at our medical center were randomized to cementless and cemented group. The primary outcome was total blood loss (TBL). Secondary outcomes were drainage, knee swelling, anemia, transfusion, hematological indicators, early functional recovery, and postoperative complications. The early functional recovery included range of motion (ROM), Hospital for Special Surgery (HSS) score, walking distance.ResultsA total of 61 patients were analyzed, of whom 30 underwent cementless fixation. On postoperative day 1, the mean TBL was 394.39 ml (SD 182.97 ml) in the cementless group and 382.41 ml (SD 208.67 ml) in the cemented group (P = 0.863). By postoperative day 3, the corresponding mean TBL was higher at 593.48 ml (SD 230.04 ml) and 603.80 ml (SD 213.16 ml) (P = 0.751). The two groups did not differ significantly in drainage, knee swelling, anemia, levels of hemoglobin or hematocrit or platelets, ROM, HSS score, walking distance, or rates of transfusion or postoperative complications.ConclusionsCementless fixation on femoral and tibial components during TKA does not increase blood loss or impede early functional recovery, which suggests that clinicians need not worry about blood loss and early functional recovery when deciding what type of fixation to perform during TKA.Trial registrationNumber: ChiCTR2100052857; Date: November 6, 2021.

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Background: Many methods have been proposed to increase cup coverage by host bone during primary total hip arthroplasty (THA) in hip osteoarthritis secondary to developmental dysplasia of hip (DDH). However, there was no study comparing results of controlled fracture of medial wall with structural autograft with bulk femoral head. Methods: 67 hips classified as Crowe II/III were retrospectively included in this cohort study, which consisted of 33 controlled fracture (group A) and 34 structural autograft (group B). The Harris Hip Scores (HHS) was recorded. The radiological assessments were analyzed. Also, complications are assessed. The paired sample t test was used for data analysis before and after operation, while independent sample T test was used for the comparison between the two groups.Results: All patients were reconstructed acetabulum at anatomical location. HHS increased greatly for both groups (P=0.18). No statistic difference was observed for two groups in postoperative leg-length discrepancy ((0.51±0.29) cm for group A and (0.46±0.39) cm for group B, P=0.64 ), postoperative height of hip center ((2.25±0.42) cm for group A and (2.09±0.31) cm for group B, P=0.13), inclination of cup ((39±4)°for group A and (38±3)°for group B, P=0.65 ). The rate of cup coverage for group B ((94±2)% ) was better than group A ((91±5)%), ( P=.009). Rate of cup protrusio was (48±4)% for group A. For both two groups, no complications were observed at the latest follow-up. Conclusion: Controlled fracture of medial wall to increase cup coverage by host bone at anatomical location can act as an alternative technique for DDH Crowe II/III with advantage of shorter operation time and less technically demanding.

Background The aim of the present study is to analyze the hospital length of stay (LOS), total hospital expense (THE), reasons, and subsequent fate of patients who had a total joint arthroplasty (TJA) cancelled.Methods In December 2020, we retrospectively reviewed a consecutive series of 18,508 patients who underwent primary total hip arthroplasty or knee arthroplasty between January 2009 and December 2018. Patients with unexpected cancellations of scheduled TJA surgeries were identified. LOS, THE, reasons for cancellations, and the number of patients who eventually performed arthroplasty were recorded.Results A total of 1,003 (5.4%) participants had scheduled TJA surgeries cancelled, which included 23 (2.3%) with two cancellations and 980 (97.7%) with one cancellation. The median LOS and THE of cancellations were 4 days (interquartile range [IQR] 3–7) and 4139 RMB (IQR 2611-6583.5), respectively. There were 720 patients (71.8%) who were cancelled due to medical-related reasons. Compared to non-medically related cancellation, medical-related cancellation had a higher age (60.9 vs 54.2, p < 0.001), LOS (5 vs 3, p < 0.001), and THE (4862 vs 2661, p < 0.001); meanwhile, the latter had a higher percentage of two cancellations (3.2% vs 0.0%, p = 0.002). During the follow-up, three hundred and twenty-three (32.3%) patients finally performed joint replacement in our institution, and the median time interval between the originally scheduled date of surgery and the actual date of surgery was 94 days (IQR 46-275.5).Conclusions This study suggests that the cancellation rate is relatively high in TJA practice, and medical-related cancellations are the most common. On the other hand, cancelling the operation will result in huge additional costs for patients and increased length of non-surgical hospital stay. Given that many of the reasons for cancellation are modifiable, a physician-guided pre-admission assessment is necessary to erase the concerns before the patient is admitted. Meanwhile, to prevent further delays, attention should be paid to patients whose TJA procedures have been cancelled and help them get their procedures rescheduled in a timely manner.

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