ObjectiveTo explore the feasibility and short-term effectiveness of lateral unicompartmental knee arthroplasty (LUKA) through a lateral parapatellar approach for lateral compartmental osteoarthritis (LCOA). MethodsBetween November 2010 and August 2012, 15 consecutive patients (15 knees) with LCOA were treated with LUKA. There were 7 men and 8 women with a mean age of 67.3 years (range, 51-82 years). The mean duration of disease was 5.4 years (range, 3-15 years). The left knee was involved in 6 cases and the right knee in 9 cases. According to Ahlback rating, there were 2 cases (2 knees) of grade I, 8 cases (8 knees) of grade Ⅱ, and 5 cases (5 knees) of grade Ⅲ. The incision length, operation time, blood loss, drainage, and complication were recorded. The pre- and post-operative knee function was evaluated by Hospital for Special Surgery (HSS) score system. The pre- and post-operative range of motion (ROM) and alignment of the lower limbs (hip-knee-ankle angle) were measured and compared. ResultsACL rupture or medial compartmental osteoarthritis occurred in 2 patients (2 knees) who changed to total knee arthroplasty (TKA); 1 case (1 knee) failed to follow up. The other 12 cases (12 knees) were followed up 32.5 months on average (range, 26- 45 months). The mean length of incision was 6.9 cm (range, 6-8 cm); the mean operation time was 115.8 minutes (range,90-155 minutes); the mean blood loss volume during operation was 152.2 mL (range, 105-250 mL); and mean drainage was 145.6 mL (range, 50-300 mL). At last follow-up, the average HSS score was significantly improved from 73.4±4.6 preoperatively to 94.6±2.1 postoperatively (t=14.240, P=0.000). The results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%. The hip-knee-ankle angle was significantly decreased from valgus angle of (10.08±1.38)° preoperatively to valgus angle of (5.17±0.94)° postoperatively (t=14.626, P=0.000). Postoperative ROM was significantly improved to (123.75±4.09)° from (108.67±5.10)° preoperatively (t=8.998, P=0.000). Two patients developed superficial skin infection, which was managed with anti-inflammatory therapy and dressing. No patient had complication of deep vein thrombosis, prosthesis dislocation and loosing, or development of medial osteoarthritis. ConclusionLUKA through a lateral approach has the advantages of rapid recovery of joint function, less complication, and small trauma in the treatment of LCOA. Correct patient selection and further mid- and long-term studies, however, are essential.
ObjectiveTo clarify the effects of tourniquet use on pain, early rehabilitation, blood loss, incidence rate of thrombosis in primary total knee arthroplasty (TKA) through a randomized controlled trial. MethodBetween Janurary 2014 and August 2015, 168 patients with knee osteoarthritis undergoing primary TKA were randomly allocated to tourniquet group (n=84) or non-tourniquet group (n=82) . There was no significant difference in gender, age, body mass index, affected side, osteoarthritis grading, disease duration, preoperative range of motion (ROM), visual analogue scale (VAS), Hospital for Special Surgery (HSS) score, and hemoglobin (Hb) between 2 groups (P>0.05) . The operation time, hospitalization time, 90°knee flexion time, straight leg lifting time, and ambulation time were compared between 2 groups. Intraoperative blood loss, Hb decrease, postoperative VAS score, HSS score, ROM, and postoperative complications were recorded and compared. ResultsThere was no significant difference in operation time (t=-1.353, P=0.178) . The patients were followed up 3-20 months (mean, 12 months) in tourniquet group, and 3-22 months (mean, 13 months) in non-tourniquet group. No significant difference was found in Hb decrease (t=-1.855, P=0.066) and transfusion rate (23.81% of tourniquest group vs. 25.61% of non-tourniquest group) (χ2=0.072, P=0.788) between 2 groups. Significant difference was found in the incidence rate of thrombosis between tourniquet and non-tourniquet groups (10.71% vs. 2.44%) (χ2=4.592, P=0.032) , and the intraoperative blood loss of tourniquet group was significantly less than that of non-tourniquet group (t=-16.066, P=0.000) . The 90°knee flexion time, straight leg lifting time, ambulation time, and hospitalization time of tourniquet group were significantly later than those of non-tourniquet group (P<0.05) . The tourniquet group had significantly higher VAS score at 3, 5, 7, and 14 days after operation (P<0.05) and lower HSS score at 28 days after operation (t=-4.192, P=0.000) than non-tourniquet group, but there was no significant difference in the ROM between 2 groups (t=0.676, P=0.500) . ConclusionsThe use of a tourniquet during TKA will increase knee pain and thrombotic events, but can not decrease total blood loss and transfusion rate. A tourniquet use during TKA is unfavorable for early rehabilitation progress.