The Application of Thromboelastography in Understanding and Management of Ecchymosis After Total Knee Arthroplasty

Wang, Jian; Zhu, Hailun; Shi, Zhanjun; Zhang, Yang

doi:10.1016/j.arth.2018.08.024

Cited by 13 publications

(23 citation statements)

References 22 publications

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“…Total knee arthroplasty (TKA) is an effective procedure for advanced disorders of the knee joint, such as osteoarthritis [ 1 ]. It is important to reconstruct anatomical alignment of the operative limb during TKA procedures, to obtain maximum range of motion (ROM) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

Bao

Rong

Shi

et al. 2021

BMC Musculoskelet Disord

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Background Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. Methods Eighty healthy volunteers were recruited. CT scans were performed followed by three-dimensional reconstruction. PCO and PTS were measured and analyzed, as well as the correlation between them. Results PTS averaged 6.78° and 6.11°, on the medial and lateral side respectively (P = 0.002). Medial PCO was greater than lateral (29.2 vs. 23.8 mm, P < 0.001). Both medial and lateral PCO of male were larger than female. On the contrary, male medial PTS was smaller than female, while there was no significant difference of lateral PTS between genders. There was an inverse correlation between medial PCO and PTS, but not lateral. Conclusions Significant differences exhibited between medial and lateral compartments, genders, and among individuals. An inverse correlation exists between PCO and PTS in the medial compartment. These results improve our understanding of the morphology and biomechanics of normal knees, and subsequently for optimising prosthetic design and surgical techniques.

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Section: Introductionmentioning

confidence: 99%

Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

Bao

Rong

Shi

et al. 2021

BMC Musculoskelet Disord

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“…Ecchymosis of the limb occurs commonly with anticoagulation therapy after TKA. 5 In our study, ecchymosis was associated with decreased haemoglobin level, more EPO and iron sucrose consumption, longer hospital stays and increased total medical cost. Moreover, the It is known that obesity can have profound effects on the drug distribution and clearance based on changes in the volume of distribution, body composition and regional blood flow.…”

Section: Discussionmentioning

confidence: 46%

“…However, conflicting results exist. 5,[7][8][9] These conflicts may be explained by differences in anticoagulants administrated, indications for anticoagulation or types of bleeding events used as observational endpoints. In this study, we identified higher BMI increased the risk of ecchymosis in the limb with rivaroxaban administration after TKA.…”

Section: Discussionmentioning

confidence: 99%

“…4 Subcutaneous ecchymosis of the limb is one of the most commonly seen bleeding-related complications after TKA, with an incidence of up to 33.3%. 5 In our clinical work, we observed that with the administration of rivaroxaban for thromboprophylaxis after TKA, many patients have experienced various degrees of limb ecchymosis. It has been previously reported by other authors even with intravenous tranexamic acid (TXA) followed by the oral tablets, and the incidence of subcutaneous ecchymosis during rivaroxaban anticoagulation after TKA could still reach as high as 11.6%.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 97%

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Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

et al. 2021

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What is known and objective: Ecchymosis of the limb is commonly seen after total knee arthroplasty (TKA) when using anticoagulants for thromboprophylaxis, but it is unknown which factors may predispose patients to an increased risk. The aim of this study was to evaluate risk factors for ecchymosis in patients receiving rivaroxaban after TKA. Methods: A retrospective, single-centre cohort analysis was conducted. The electronic medical records of patients admitted to the Department of Orthopedics during January 2018 to December 2019 and who received rivaroxaban 10 mg daily after TKA were reviewed for documentation of ecchymosis. Baseline demographics, laboratory values and surgical information were included for analysing their relationship with ecchymosis. Results and discussion: A total of 227 patients were included in the study. Among them, 54 patients (23.8%) developed ecchymosis, and 173 did not. The ecchymosis group had a higher proportion of patients with a body weight >60 kg [83.33% vs. 50.00%, p = 0.0004] and hypertension [61.11% vs 41.46%, p = 0.0304]. The ecchymosis group also had a higher BMI [26.04 ± 2.71 kg/m 2 vs 24.52 ± 3.18 kg/m 2 , p = 0.0066] mean arterial pressure (MAP) recorded from post-operation day 1 to day 3 [105.21 mmHg vs 91.52 mmHg, p = 0.0003]. However, serum albumin concentrations before surgery [3.85 g/dL vs. 4.20 g/dL, p = 0.0225] and on post-operation day 3 [3.50 g/dL vs. 3.91 g/dL, p = 0.0370] were lower in the ecchymosis group. Serum haemoglobin on post-operation day 3 was also lower [10.07 g/dL vs. 11.57 g/dL, p = 0.0459]. Five risk factors for ecchymosis were identified by binary logistic regression: mean MAP (from POD1 to POD3) (OR=2.

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“…Ecchymosis, a local bleeding complication, is mainly caused by vascular wall damage and coagulation dysfunction caused by local bleeding complications. (35) The revision THA inevitably damages the vessel walls and it is more severe than primary THA. Despite there are so many advantages of Rivaroxaban, there was research showing that its application was associated with a higher risk for bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

Changes in coagulation status as measured by thromboelastography in patients undergoing revision total hip arthroplasty

Yang

Zhu

Qin

et al. 2020

Preprint

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Background: Venous thromboembolism events (VTEs) continue to be of the most widespread severe complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are no optimal accurate monitoring methods to assess the changes in coagulability after anticoagulation and anti-fibrinolysis during the perioperative period. Therefore, the objective of this study is to determine changes in coagulability as measured by thromboelastography (TEG) following revision total hip arthroplasty when the patients received rivaroxaban and tranexamic acid in perioperative period during enhanced recovery after surgery (ERAS). Methods: We retrospectively reviewed 70 revision TKA patients (mean age 63.69±10.17 years). Perioperative management of each patient was conducted in accordance with ERAS. The patients received tranexamic (TXA) to control perioperative bleeding. TEG was performed pre-operatively and on post-operative days (POD) 1, 3, 5 and 7. TEG-hypercoagulability was classified into three types: enzymatic hypercoagulability, platelet hypercoagulability and mixed hypercoagulability. Screening for coagulation-related complications at three months of follow-up. Results: The mean duration of surgery was 2.91±0.99 h. the mean intraoperative blood loss of patients was 486.43±346.92 ml. And 55.71% (39) patients received transfusion, the mean blood transfusion volume was 482.86 ± 458.79 ml. There only were 4 (5.71%) patients who suffered postoperative coagulation-related complications. 1 patient with hypercoagulable on preoperative developed intramuscular venous thrombosis at 1 month postoperatively. 1 patient with hypercoagulability at POD5 and POD7 suffered melena at POD5. 2 patients with hypocoagulability developed ecchymosis at POD3. The proportion of postoperative hypercoagulable state is gradually increasing. The distribution of different hypercoagulable states on the postoperative day (POD) 5 and 7 were significantly different from that pre-operation (Pre) and POD1 (POD5 vs Pre: p=0.011; POD5 vs POD1: p=0.001; POD7 vs Pre: p=0.001; POD7 vs POD5: p<0.001). We found 32.86%(23) revision THA with hypercoagulable state on POD7.For 78.26%(18) of these patients there was mixed hypercoagulability. Conclusions: In ERAS, thromboelastography was an effective way to identify hypercoagulable state in patients undergoing revision hip arthroplasty, and mixed hypercoagulability is the predominant hypercoagulable state following revision hip arthroplasty. In addition, it is very important to develop an individualized coagulation management program.

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The Application of Thromboelastography in Understanding and Management of Ecchymosis After Total Knee Arthroplasty

Cited by 13 publications

References 22 publications

Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

Changes in coagulation status as measured by thromboelastography in patients undergoing revision total hip arthroplasty

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