Background: Whole leg radiograph (WLR) is the gold standard in assessing lower limb alignment before total knee arthroplasty (TKA) although in practice, non-weight-bearing short knee radiographs (NWB SKRs) are used by most medical institutions. The objective of this study was to determine whether the femorotibial angle (FTA) could be used to evaluate lower limb alignment on limited NWB SKRs. We also investigated whether FTA alignment measurements on NWB SKRs and WLRs differed depending on the direction of knee deformity.Methods: In all, 105 knees which underwent both NWB SKR and WLR were included. Measurement of hip-knee-ankle angle (HKA) was obtained through WLR, while the FTA was found using NWB SKR (FTA SKR ) and WLR (FTA WLR ). All knees were divided into three groups based on the HKA. The Kappa statistic was used to compare the agreement of categorical alignment variables between the HKA and FTA SKR . The agreement of the measurements obtained from the two radiographs was made using Bland-Altman plots and intraclass correlation coefficient (ICC). Pearson correlation coefficient and simple linear regression analysis were also conducted to evaluate the correlation between different angles. Results:The agreement for categories of lower limb deformity was rated excellent (kappa =0.804, P<0.001). The Bland-Altman plot showed that the mean difference for the FTA SKR and FTA WLR was 4.4°.There was an excellent correlation (r=0.861, P<0.001) and good reliability (ICC, 0.607) between the FTA SKR and HKA. For the varus group, there was a good correlation between the FTA SKR and HKA (r=0.650, P<0.001); however, there were no significant correlations between the FTAS KR and HKA in the neutral (r=0.106, P=0.543) and valgus groups (r=0.322, P=0.102).Conclusions: For outpatient follow-up, we found that the FTA on NWB SKRs is an acceptable means for classifying knee alignment (varus, neutral, or valgus). The measurement on NWB SKR also showed excellent correlation and good agreement with the HKA. For varus knees, NWB SKR measurements showed the best correlation with the HKA. However, for neutral and valgus knees, NWB SKR measurements were insufficient for conducting a reliable calculation and quantification of coronal alignment of the lower limb.
Purpose: The purpose of this study was to compare the coagulation difference in patients with either rivaroxaban or enoxaparin as thromboprophylaxis after total hip arthroplasty (THA) regarding thromboelastography (TEG) and routine coagulation tests. Patients and methods: Two hundred and twenty-eight patients undergoing primary THA were recruited in this study. They were divided into two groups according to a computer-generated random sequence. Patients in the rivaroxaban group received 10 mg of rivaroxaban orally once daily. Patients in the enoxaparin group received 4000 AxaIU (0.4 mL) of enoxaparin subcutaneously once daily. Rivaroxaban and enoxaparin were started 6–8 h after surgery. The administration of the anticoagulant prophylaxis was lasted for a minimum of 14 days. TEG and routine coagulation tests were performed on the day before the operation and 1 day and 7 days after the operation. Results: No difference was observed in the incidence of deep vein thrombosis (DVT) or pulmonary embolism (PE) between the two groups. There was no significant difference with regard to prothrombin time (PT), activated partial thromboplastin time (PTT), international normalized ratio (INR), and thrombin time (TT) between the two groups. However, while considering TEG, R time of the rivaroxaban group was significantly higher than that of the enoxaparin group ( p = 0.003), whereas the maximum amplitude (MA) ( p = 0.036) value and coagulation index (CI) ( p = 0.002) value were significantly lower than those of the enoxaparin group. Conclusion: With regard to TEG analysis, there was coagulation difference in patients with rivaroxaban and those with enoxaparin as thromboprophylaxis after THA. Under recommended dose of rivaroxaban and enoxaparin, patients undergoing THA were in hypercoagulability on 7days postoperative.
Background Anemia is one of severe complications in the perioperative period of total hip arthroplasty (THA). Erythropoietin (EPO) has been considered to improve patients’ anemia state, but its efficiency and safety remains controversial. Methods A total of 152 patients who underwent total hip arthroplasty from January 2017 to March 2019 were randomized to 2 groups. Recombinant human erythropoietin (rHu-EPO) group was treated with rHu-EPO subcutaneous injection 10000 IU after operation and once daily in the next week, while control group was treated with none extra treatment. Routine hematologic examination and thrombelastography (TEG) performed at different time point respectively. Doppler ultrasound for bilateral lower limbs was performed 1 day before surgery and 7 days after surgery. Auxiliary examination outcomes, blood transfusions outcomes, and postoperative complications were recorded as assessment indicators. Results The difference in the relevant indexes of traditional coagulation and TEG values between two groups were not significantly. No significant difference was observed in the incidence of thromboembolism events and other complications between two groups during postoperative period. The amount of intraoperative blood loss was similar between the two groups. However, the postoperative use and dosage of allogeneic blood in the rHu-EPO group were lower than those in the control group. The hemoglobin and hematocrit level in the rHu-EPO group were higher than that in the control group after surgery. Conclusion Postoperative subcutaneous injection of rHu-EPO can improve hematological anemia-related parameters, reduce the use and dosage of allogeneic blood transfusions (ABTs), and has no significant influence on the formation of thrombosis and other complications in patients undergoing total hip arthroplasty in short term.
Background: Knee osteoarthritis (KOA) is a crippling disease and affects many people around the world. Total knee arthroplasty (TKA) is an effective way to treat this disease. The objectaives of this study to compare the weight of the total knee arthroplasty implants and the weight of the natural knee in different groups and also to analyze facts which may affect the weight of surgical host excision. Methods: In total, 105 consecutive TKAs were enrolled in this prospective cohort study with three different brands of knee prostheses. Patients meeting the criterion were divided into the normal bone mass group, the osteopenia group or the osteoporosis group according to the results of preoperative bone density examination. The removal of bone and soft tissues that were collected during TKA operations of each group were weighed and compared with the total weight of the knee prosthesis (including implanted bone cement). Multivariate logistic stepwise regression analysis was conducted to identify indicators affecting host removal weight.Results: The average host removal weight was (132.56±36.88)g for normal bone mass group, (112.86±23.65)g for osteopenia group and (103.74±20.66)g for osteoporosis group. There were statically differences among the three groups. There was a significant difference between the normal bone mass group and the osteopenia group (P=0.003), while no difference between the osteopenia group and the osteoporosis group (P=0.154). No differences were found in the TKA components weight, bone cement weight and knee joint weight gained after TKA among all groups. Stepwise multiple regression analysis using the weight of excised host tissues as a dependent variable and BMD level, gender, age and other available indicators as independent variables revealed that BMD level(B=9.057, p=0.008), gender(B=21.692, p<0.001), Kellgren-Lawrence grade(B=13.790, p=0.003) are significant factors affecting excised host tissues weight. Conclusion: There is a positive correlation between the weight of the host removals of TKA and the patient's bone density. BMD level, gender and K-L stage of KOA were the main factors affecting the weight of the host removal.
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