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Total knee arthroplasty is a true success story in orthopaedics, showing great clinical effectiveness for the treatment of many knee conditions, mainly knee osteoarthritis. But surgeons differ in approach: in particular, the use of the tourniquet is widely debated. Whether the reduced blood loss and improved field visualization is worth the possible drawbacks of pain and complications is unclear. But what if the truth is somewhere in between – what if we just use it for a shorter time?
62 patients undergoing total knee arthroplasty were randomized to receive full tourniquet application (from pre-incision to closure) or limited tourniquet application (from cementation to completion of component placement). The primary outcomes of interest were intra-op, post-op, total and hidden blood loss.
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Intra-operative blood loss was significantly higher in the limited application group compared to the full application group (p=0.001). No differences in post-operative, hidden, or total blood loss were observed (p>0.05 for all).
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The proportion of cases that had clear surgical field visualization was significantly lower in the limited application group (64.5% vs. 100%, p=0.001). However, operative time was similar in both groups (p=0.099).
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No differences in the rate of peri-operative complications were observed.
Bottom line. Limited tourniquet application led to significantly greater intra-operative blood loss and a possible reduction in surgical field clarity, but resulted in similar overall blood loss and complication rate compared to full tourniquet application.
Read the full ACE Report on this study here. |
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One of the greatest barriers to post-operative mobilization and recovery after total hip arthroplasty? Pain. Nerve blocks, such as the femoral nerve block, have shown great efficacy in reducing post-operative pain, but have been associated with muscle inhibition, placing patients at risk of falls. Could the anterior quadratus lumborum block (AQL) provide an advantage over the femoral nerve block?
110 patients scheduled for a total hip arthroplasty were randomized to receive either a femoral nerve block (n=56) or a AQL block (n=54). The primary outcome of interest was total opioid consumption in the initial 24 hours post-operation.
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Both cumulative, intraoperative, and post-operative morphine consumption was not statistically different between the two groups (p>0.05 for all).
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Pain during active motion was significantly lower in the femoral nerve block group (p=0.04).
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The proportion of patients with post-operative muscle weakness was similar in both groups at both 24- and 48-hours post-operation (p>0.05 for both).
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The incidence of post-operative complications was similar between the two groups.
Bottom line. Both blocks provided similar levels of post-operative pain management, with a small benefit in pain during active motion in favour of femoral nerve blockade. With similar rates of muscle weakness and complications, both blocks are viable options in THA.
Read the full ACE Report on this RCT here. |
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Increasingly, new robotic devices are entering the market, with the aim of improving implant component placement and subsequently improving outcomes for patients. But what does the evidence say for TKA – is it better than manual TKA? This randomized trial aimed to find out.
100 patients scheduled for a total knee arthroplasty were randomized to receive a standard-care, manual TKA procedure (n=50) or a robotic-assisted TKA procedure (n=50) using the MAKO robot (Stryker). The primary outcome of interest was knee function, measured with the WOMAC scale.
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The change in WOMAC function scores were not significantly different between the robotic and manual TKA groups at both 2- and 6-months post-operation (p>0.05 for both).
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No differences in the change in quality of life or joint-specific scores (OKS; FJS) were observed between groups at either time-point (p>0.05 for all).
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The change WOMAC pain scores at 2 months were significantly better in the robotics group (p=0.037). Moreover, the proportion of patients who experienced a clinically meaningful improvement in WOMAC pain score was significantly higher in the robotics group at both 2- and 6-months post-operation.
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Patient expectations and satisfaction was similar in both groups (p>0.05 for both).
Bottom line. Robotic TKA does not appear to provide any advantage in functional improvement compared to manual TKA. However, this RCT found that a significantly greater proportion of patients who received robotic TKA experienced clinically meaningful improvements in pain – a finding which should be explored in future large RCTs!
Read the full ACE Report on this RCT here. |
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EDITOR’S PICKS |
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The History of the ABOS – In this OrthoJoe podcast, Mo Bhandari and Marc Swiontkowski sit down with ABOS board members Dr. David Martin, Dr. Fred Azar, and Dr. David Elstein for a discussion on the history of the ABOS, and its key role in the orthopaedic community. (Watch) |
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Women in Orthopaedics: A Cultural Perspective – In this OE World Tour event, Dr. Bhandari sat down with 3 female orthopaedic physicians to discuss the importance of female representation in the specialty, the value of female role models, and how we can all help to improve the diversity of orthopaedics, to the benefit of both patients and surgeons. (Read) |
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