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Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Recently, new custom-fit pin guides in total knee arthroplasty (TKA) have been introduced. Use of these guides may reduce operating time. Use of the guides combined with the absence of intramedullary alignment jigs may lead to reduced blood loss and improved early outcomes. Our aim was to evaluate blood loss and early clinical outcomes in patients undergoing minimally invasive TKA using custom-fit magnetic resonance imaging (MRI)–based pin guides.

Methods

A prospective study in 80 patients was carried out. Patients were divided randomly into 2 equal groups. In one group, intramedullary alignment jigs were used. In the second group, custom-fit MRI-based pin guides were used. All patients received the same cemented posterior-stabilized implant through a mini-midvastus approach. The volume in the drain bottles was recorded after 48 h. Hb loss was estimated by subtracting the postoperative from the preoperative Hb level. Transfusion requirements and surgical time were recorded. Outcome measures were Knee Society Scores (KSS), knee flexion, knee swelling and pain.

Results

There was lower mean drainage of blood in the custom-fit group (391 ml vs. 603 ml; p < 0.0001). There was no difference in estimated loss of Hb (3.6 g/dl vs. 4.1 g/dl; n.s.) and in transfusion requirements (7.5 % vs. 10 %; n.s.). Surgical time was reduced in the custom-fit group (12 min less; p = 0.001). KSS measured at week 2, 6 and 12 showed no significant difference between groups. Knee flexion measured on days 7, 10 and at week 6, 12 and knee swelling and pain measured on days 1, 3, 10 and at week 6, 12 showed no significant difference between groups.

Conclusions

Using custom-fit pin guides reduces blood drainage, but not the estimated Hb loss in minimally invasive TKA and does not affect transfusion rate. Surgical time is reduced. There is no effect on the early clinical outcomes.

Level of evidence

Therapeutic study, Level I.

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References

  1. Alfonso DT, Toussaint RJ, Alfonso BD et al (2006) Nonsurgical complications after total hip and knee arthroplasty. Am J Orthop (Belle Mead NJ) 35:503–510

    Google Scholar 

  2. American Society of Anesthesiologists Task Force (2006) Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American society of Anesthesiologists task force on perioperative blood transfusion and adjuvant therapies. Anesthesiology 105:198–208

    Article  Google Scholar 

  3. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (Germany) (2003) Stationäre und ambulante Thromboembolieprophylaxe in der Chirurgie und der perioperativen Medizin. http://www.awmf.org

  4. Bali K, Walker P, Bruce W (2012) Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplast 27:1149–1154

    Article  Google Scholar 

  5. Bertsch C, Holz U, Konrad G et al (2007) Early clinical outcome after navigated total knee arthroplasty. Comparison with conventional implantation in TKA: a controlled and prospective analysis. Orthopade 36:739–745

    Article  PubMed  CAS  Google Scholar 

  6. Bierbaum BE, Callaghan JJ, Galante JO et al (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Jt Surg Am 81:2–10

    CAS  Google Scholar 

  7. Bonutti PM, Dethmers DA, McGrath MS et al (2008) Navigation did not improve the precision of minimally invasive knee arthroplasty. Clin Orthop Relat Res 466:2730–2735

    Article  PubMed  Google Scholar 

  8. Brunson ME, Alexander JW (1990) Mechanisms of transfusion-induced immunosuppression. Transfusion 30:651–658

    Article  PubMed  CAS  Google Scholar 

  9. Chang CW, Wu PT, Yang CY (2010) Blood loss after minimally invasive total knee arthroplasty: effects of imageless navigation. Kaohsiung J Med Sci 26:237–243

    Article  PubMed  Google Scholar 

  10. Charrois O, Kahwaji A, Vastel L et al (2001) Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis. Int Orthop 25:22–24

    Article  PubMed  CAS  Google Scholar 

  11. Cheng T, Pan XY, Mao X et al (2012) Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up. Knee 19:237–245

    Article  PubMed  CAS  Google Scholar 

  12. Chotanaphuti T, Ongnamthip P, Karnchanalerk K et al (2008) Comparative study between 2 cm limited quadriceps exposure minimal invasive surgery and conventional total knee arthroplasty in quadriceps function: prospective randomized controlled trial. J Med Assoc Thail 91:203–207

    Google Scholar 

  13. Hasegawa M, Yoshida K, Wakabayashi H et al (2011) Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome. Knee Surg Sports Traumatol Arthrosc 19:904–910

    Article  PubMed  Google Scholar 

  14. Hinarejos P, Corrales M, Matamalas A et al (2009) Computer-assisted surgery can reduce blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:356–360

    Article  PubMed  Google Scholar 

  15. Hitt K, Shurman JR, Greene K et al (2003) Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Jt Surg Am 85(Suppl 4):115–122

    Google Scholar 

  16. Holm B, Kristensen MT, Bencke J et al (2010) Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil 91:1770–1776

    Article  PubMed  Google Scholar 

  17. Howell SM, Kuznik K, Hull ML et al (2008) Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 31:857–863

    Article  PubMed  Google Scholar 

  18. Huang HT, Su JY, Chang JK et al (2007) The early clinical outcome of minimally invasive quadriceps-sparing total knee arthroplasty: report of a 2-year follow-up. J Arthroplast 22:1007–1012

    Article  Google Scholar 

  19. Insall JN, Dorr LD, Scott RD et al (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  20. Kalairajah Y, Simpson D, Cossey AJ et al (2005) Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Jt Surg Br 87:1480–1482

    CAS  Google Scholar 

  21. Kerr DR, Kohan L (2008) Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 79:174–183

    Article  PubMed  Google Scholar 

  22. Laskin RS, Beksac B, Phongjunakorn A et al (2004) Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 428:74–81

    Article  PubMed  Google Scholar 

  23. Macfarlane AJ, Prasad GA, Chan VW et al (2009) Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res 467:2379–2402

    Article  PubMed  Google Scholar 

  24. Martin A, Sheinkop MB, Langhenry MM et al (2010) Comparison of two minimally invasive implantation instrument-sets for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:359–366

    Article  PubMed  Google Scholar 

  25. Munk S, Jensen NJ, Andersen I et al (2012) Effect of compression therapy on knee swelling and pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1963-0

    PubMed  Google Scholar 

  26. Ng VY, Declaire JH, Berend KR et al (2011) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470:99–107

    Article  Google Scholar 

  27. Noble JW Jr, Moore CA, Liu N (2012) The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplast 27:153–155

    Article  Google Scholar 

  28. Nunley RM, Ellison BS, Ruh EL et al (2012) Are patient-specific cutting blocks cost-effective for total knee arthroplasty? Clin Orthop Relat Res 470:889–894

    Article  PubMed  Google Scholar 

  29. Pietsch M, Djahani O, Hofmann S (2007) Minimally invasive mini-midvastus approach as standard in total knee arthroplasty. Orthopade 36:1120–1128

    Article  PubMed  CAS  Google Scholar 

  30. Rashiq S, Finegan BA (2006) The effect of spinal anesthesia on blood transfusion rate in total joint arthroplasty. Can J Surg 49:391–396

    PubMed  Google Scholar 

  31. Rosencher N, Kerkkamp HE, Macheras G et al (2003) Orthopedic surgery transfusion hemoglobin European overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43:459–469

    Article  PubMed  Google Scholar 

  32. Ross M, Worrell TW (1998) Thigh and calf girth following knee injury and surgery. J Orthop Sports Phys Ther 27:9–15

    Article  PubMed  CAS  Google Scholar 

  33. Schnurr C, Csecsei G, Eysel P et al (2010) The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics 33:474

    PubMed  Google Scholar 

  34. Smith TO, Hing CB (2010) Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee 17:141–147

    Article  PubMed  Google Scholar 

  35. Spencer BA, Mont MA, McGrath MS et al (2009) Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop 33:1571–1575

    Article  PubMed  Google Scholar 

  36. Thiengwittayaporn S, Junsee D, Tanavalee A (2009) A comparison of blood loss in minimally invasive surgery with and without electromagnetic computer navigation in total knee arthroplasty. J Med Assoc Thail 92(Suppl 6):27–32

    Google Scholar 

  37. Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190

    Article  PubMed  Google Scholar 

  38. Walker RH (1987) Special report: transfusion risks. Am J Clin Pathol 88:374–378

    PubMed  CAS  Google Scholar 

  39. Yue B, Varadarajan KM, Ai S et al (2011) Differences of knee anthropometry between Chinese and white men and women. J Arthroplast 26:124–130

    Article  Google Scholar 

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Acknowledgments

The authors thank Dr. Peter Schmidt and his team at the MRI department and Mr. Kurt Lercher and his team at the radiology department of the LKH Stolzalpe hospital for management and performance of scans and images.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, General and Orthopaedic Hospital Stolzalpe, 8852, Stolzalpe, Austria

    M. Pietsch, O. Djahani, Ch. Zweiger, F. Plattner, R. Radl, Ch. Tschauner & S. Hofmann

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  1. M. Pietsch
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  2. O. Djahani
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  3. Ch. Zweiger
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  4. F. Plattner
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  6. Ch. Tschauner
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  7. S. Hofmann
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Correspondence to M. Pietsch.

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Pietsch, M., Djahani, O., Zweiger, C. et al. Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes. Knee Surg Sports Traumatol Arthrosc 21, 2234–2240 (2013). https://doi.org/10.1007/s00167-012-2284-z

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  • DOI: https://doi.org/10.1007/s00167-012-2284-z

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