【Abstract】 Objective To compare the two different techniques determining tibial rotational al ignment in total kneearthroplasty(TKA) to enhance postoperative effect and reduce compl ications. Methods From May 2006 to April 2007, 60 patients(27 males, 33 females, aged 55-78 years ) received TKA and randomly divided into 2 groups(n =30): tibial rotational al ignmentin TKA was determined by medical 1/3 of tibial tubercle in Group A, by medial border of tibial tubercle at 0-9°varus inGroup B, by medical 1/3 of tibial tubercle at 20°or greater varus or by the mean l ine between medial border of tibial tubercle andmedical 1/3 of tibial tubercle at 10-19°varus. The angle of rotation of polyethylene cushion was calculated. Results The angleof rotation of polyethylene cushion in Group A was (8.4±3.8)° at 0-9°varus, (3.5±2.7)° at 10-19°varus and (0 ±2.4)° at 20°varusor over, respectively, and there was significant difference (P lt; 0.05). The angle of rotation of polyethylene cushion in Group Bwas (0 ±2.1)° at 0-9° varus, (0 ±2.0)° at 10-19°varus and (0 ±1.7)° at 20°varus or over, respectively, and there was no significantdifference (P gt; 0.05). The angle of rotation of polyethylene cushion averaged (5.6±2.8)°in Group A and (0±1.9)° in Group B,showing significant difference (P lt; 0.05). Conclusion The range of ideal tibial rotational al ignment in TKA was from medialborder of the tibial tubercle to medical 1/3 of the tibial tubercle, and is decided by the degree of varus deformities and valgus deformities.
To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).Methods From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis.The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation; there was no significant difference between the two groups（P＞0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1.208±243 ml in Group B; there were significant differences between the two groups (P＜0.05). The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024± 278 ml in Group B; there was a significant difference between the two groups (P＜0.05). The postoperative hemoglobin concentration was higher in GroupA than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The ostoperative follow-up for 612 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92±0.56 mg/L vs. 0.35±0.13 mg/L in Group A; 1.32±0.79 mg/L vs. 0.37± 0.21 mg/L in Group B) (P＜0.05). The D-dimeride level 3 hours after operation was significantly higher n Group B than in Group A（P＜0.05）. There were no significant differencesin the levels of fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups（P＞0.05）.Conclusion During and after the TKA operation, a shortterm use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
Objective To review the advance in the researchand clinical application of the tibial rotational alignment technique in the total knee arthroplasty in China and abroad. Methods The recent literature concerned with the tibial rotational alignment technique in the totalknee arthroplasty was extensively reviewed and briefly summarized. Results According to the literature reviewed, the traditional tibial rotational references for the total knee arthroplasty were affected by many factors, so that the references were not accurate enough. There have been no unified references.ConclusionChoosing the range from the medial border of the tibial tubercle to the medial 1/3 of the tibial tubercle, decided by the degrees of the varus deformities and the valgus deformities, to determine the rotaional alignment of the tibial component will create an optimal tibiofemoral rotational alignment.