Effects of Computer Navigation versus Conventional Total Knee Arthroplasty on Endothelial Damage Marker Levels: A Prospective Comparative Study

Abstract

Total knee arthroplasty (TKA) inevitably perturbs the femoral medullary canal, which increases blood loss or morbidities associated with marrow embolization postoperatively. Computer navigation TKA reportedly minimizes medullary disturbance to alleviate perioperative blood loss. We performed a prospective comparative study, enrolling 87 patients with osteoarthritic knees from March 2011 to December 2011 in our hospital. The patients were separated into two groups, according to the surgeon they visited. Fifty-four patients underwent computer navigation TKAs and 33 had conventional TKAs. Levels of cell adhesion molecules (CAMs), including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and platelet endothelial cellular adhesion molecule-1 (PECAM-1) in sera and hemovac drainage were measured by ELISA before and 24 hours after the surgery. We showed that patients receiving computer navigation TKAs had less blood loss and lower CAMs in serum and hemovac drainage after the operation. Less postoperative elevation of serum ICAM-1 (p=0.022) and PECAM-1 (p=0.003) from the preoperative baseline after the surgery was also noted. This study provides molecular evidence for the differential extent in vascular injury between conventional and navigation TKAs and sheds light on the possible benefits of computer navigation TKAs.Trial RegistrationClinicalTrials.gov NCT02206321

Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study

“…The study design is similar to our previous work [ 3 ]. Patients requiring TKA for advanced knee OA presented to the outpatient department and were scheduled for TKA surgery.…”

“…The minimum sample size required for each group was calculated because of the pilot nature of the study. The priori power calculation (G*Power 3.1.9.2 software: http://www.gpower.hhu.de/en.html ) used a 2-tailed Wilcoxon signed-rank test to calculate the sample size of at least 27 for each group (calculated effect size: 0.8; α level: 0.05; power: 80%; allocation ratio: 1).We finally planned to enroll at least 40 patients for each group after referencing the pertinent publications[ 3 , 8 ].…”

“…Any anticoagulation regimen was discontinued prior to surgery. Procedural differences between the navigation and conventional techniques are described below[ 3 ].…”

“…Importantly, navigation TKA mitigates blood loss and the dissipation of systemic emboli associated with conventional TKA. Our previous publication showed that navigation TKA can lead to lower levels of surgery-stimulated endothelial injury markers as compared with conventional TKA[ 3 ].…”

Hepatitis B Virus Infection Is a Risk Factor for Periprosthetic Joint Infection Among Males After Total Knee Arthroplasty

“…Total knee arthroplasty (TKA) is a well-established modality with a high satisfaction rate for treating various knee disorders. 1 , 2 Despite the undisputed general success of this procedure, periprosthetic joint infection (PJI) is a grave complication that can affect patients undergoing TKA. In addition to its major adverse effects on the quality of life, PJI can also result in a higher incidence of mortality.…”