Alfredas Smailys

Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial

Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding. In a prospective, randomised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis. We compared blood loss, number of transfusions, postoperative complications and knee function and found significantly less postoperative blood loss through the drains (p < 0.001), and fewer blood transfusions (p = 0.09) were needed in the clamped group. We conclude that clamping drainage after total knee arthroplasty in severe osteoarthritis reduces blood loss through the drains and the need for blood transfusions.RésuméLa prothèse totale du genou dans les gonarthroses sévères nécessite souvent une résection tissulaire importante, celle-ci étant souvent associée à un saignement important. Nous avons réalisé une étude prospective randomisée comparant le drainage conventionnel post-opératoire versus clampage du drain durant 4 heures chez 60 patients ayant bénéficié d’une prothèse totale du genou pour une gonarthrose importante. Nous avons comparé les pertes sanguines, le nombre de transfusion, les complications post-opératoires, la fonction du genou. Nous avons observé qu’il y avait beaucoup moins de pertes sanguines dans les drains (p < 0.001) et beaucoup moins de transfusions (p = 0.009) dans le groupe des patients dont le drain avait été clampé pendant 4 heures. Nous pouvons conclure que le clampage du drain après prothèse totale du genou dans les gonarthroses sévères permet de réduire les pertes sanguines et le nombre de transfusions.

Short rotator tendons do not increase intracapsular pressure in severe osteoarthritic hips.

BackgroundWhile a relation between pain and intracapsular pressure in the hip joint has previously been reported by some of the present authors, a newly published study including patients with severe osteoarthritis was not able to confirm this finding. This stimulated us to investigate the role of short rotators in relation to intracapsular pressure and pain in osteoarthritic hips.MethodsWe measured the intracapsular hydrostatic pressure peroperatively in 25 total hip arthroplasty patients with severe osteoarthritis in various positions of the hip joint before and after short rotator release, and correlated these pressures to pain.ResultsRelease of the short rotators did not change the intracapsular pressure in any position except in 45° flexion, in which the pressure increased (p = 0.002). We found no correlation between intracapsular pressure and pain before or after short rotator release.ConclusionWe could not show that the rotators directly affected the pressure nor could we find a relation between pressure and pain.

Introduction of total hip arthroplasty in Lithuania: Results from the first 10 years

Background Hip replacement as a routine procedure was introduced in Lithuania in 1991. At Klaipeda Hospital, one of the 2 hospitals at which this was begun, the arthroplasties were followed prospectively from the start. This study concerns the 10-year results from a country with no previous experience of hip replacement. The results are compared with those from a hospital with considerable experience of total hip replacement. Methods We compared the revision rate for the first 658 primary ScanHip arthroplasties inserted at Klaipeda to that for the first 939 ScanHip primary arthroplasties inserted at Lund University Hospital, Sweden. Only patients with osteoarthritis were included, and the endpoint was revision for aseptic loosening with exchange of one or both components. Results We found that patients operated at Klaipeda Hospital had a significantly higher risk of revision (12%) than those operated in Lund (6%). Interpretation Although we could not identify any specific reason for the Swedish results being better than the Lithuanian results, it is probable that previous surgical inexperience of hip replacement in Lithuania played a role. We believe that the findings will stimulate surgeons in Lithuania to analyze their failures and improve the results.

Short-term outcome after total hip arthroplasty using dual-mobility cup : report from Lithuanian Arthroplasty Register

PurposeThe purpose of the study was to investigate how the use of dual-mobility cups (DMCs) affected the risk of revision due to dislocation as well as overall risk of revision compared with a conventional total hip arthroplasty (THA) system in the short term.MethodsA total of 12,657 primary THAs were registered from the start of 2011 to the end of 2014. 620 THAs were with DMCs. For comparison, we included all registered THAs with Exeter cup and a cemented Exeter stem combined with 28-mm femoral head. Patients were followed up with respect to revision and/or death until 1 January 2016. For survival analysis, we used revision as an endpoint. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, surgical approach, THA model and pre-operative diagnosis).ResultsOf the 620 dual-mobility THAs and 2170 Exeter THAs, 100 had been revised. The overall unadjusted cumulative revision rate (CRR) for any reason of revision at five years after surgery was 3.9% in the dual-mobility group and 5.2% in the Exeter group. Cox regression analysis, adjusting for age, gender, THA type, surgical approach and pre-operative diagnosis, showed that the risk of revision was less in patients operated with DMCs and in patients having their operation for osteoarthritis.ConclusionThe DM implant had a lower short-term complication rate than a conventional well defined THA. Low dislocation rate suggests that it is a good choice for high risk patients.

Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations : five year results from Lithuanian arthroplasty register

PurposeRecently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations.MethodsThe data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept).ResultsA total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs.ConclusionIn revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup.

Calcium Sulphate/Hydroxyapatite Carrier for Bone Formation in the Femoral Neck of Osteoporotic Rats

This study investigated bone regeneration in the femoral neck canal of osteoporotic rats using a novel animal model. A calcium sulphate (CS)/hydroxyapatite (HA) carrier was used to deliver a bisphosphonate, zoledronic acid (ZA), locally, with or without added recombinant human bone morphogenic protein-2 (rhBMP-2). Twenty-eight-week-old ovariectomized Sprague–Dawley rats were used. A 1 mm diameter and 8 mm long defect was created in the femoral neck by drilling from the lateral cortex in the axis of the femoral neck, leaving the surrounding cortex intact. Three treatment groups and one control group were used: (1) CS/HA alone, (2) CS/HA + ZA (10 μg) (3) CS/HA + ZA (10 μg) + rhBMP-2 (4 μg), and (4) empty defect (control). The bone formation was assessed at 4 weeks post surgery using in vivo micro computed tomography (micro-CT). At 8 weeks post surgery, the animals were sacrificed, and both defect and contralateral femurs were subjected to micro-CT, mechanical testing, and histology. Micro-CT results showed that the combination of CS/HA with ZA or ZA + rhBMP-2 increased the bone formation in the defect when compared to the other groups and to the contralateral hips. Evidence of new dense bone formation in CS/HA + ZA and CS/HA + ZA + rhBMP-2 groups was seen histologically. Mechanical testing results showed no differences in the load to fracture between the treatments in either of the treated or contralateral legs. The CS/HA biomaterial can be used as a carrier for ZA and rhBMP-2 to regenerate bone in the femoral neck canal of osteoporotic rats.

The Patello-Femoral Joint Degeneration and the Shape of the Patella in the Population Needing an Arthroscopic Procedure

Background: the main goal of the study was to investigate the prevalence of the articular cartilage defects (ACD) in the patellofemoral (PF) region of the knee joint based on the anatomical shapes of patella and its impact on the level of physical activity in the population needing arthroscopic procedures for all types of pathologies in the knee. Methods: The articular cartilage status of the PF region was obtained from 1098 arthroscopic procedures of the knee joint. The ACD were correlated to Wiberg’s shape of the patella and classified according to the degree, size and depth of the ACD in the PF region using the ICRS (International Cartilage Repair Society) system: group I consisting of patients with Wiberg type I shape (W1), group II—patients with Wiberg type II shape (W2) and group III—patients with Wiberg type III shape (W3). The Tegner physical activity scale was used to evaluate the physical activity of the patients. Results: The mean of ACD size (PF region) in the W3 group was 3.10 ± 0.99 cm2, which was a statistically significantly larger area in comparison with the W1 (1.90 ± 0.63 cm2; p < 0.0000) and W2 (1.95 ± 0.71 cm2; p < 0.0000). The patients from the W3 group (mean 3.10 ± 0.99) were less physically active (<4 Tegner) compared to the W2 group (mean of 4.48 ± 0.88; p = 0.004) and W1 group (mean of 4.55 ± 0.72; p = 0.002). Conclusions: The patients with the Wiberg type III patella shape had a higher incidence and larger size of ACD in the PF of the knee compared to the groups of Wiberg type I and II. Wiberg III patients with a lower level of physical activity had a larger size of ACD in the PF joint.

Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.

Outcomes and mortality after hip fractures treated in Kazakhstan

INTRODUCTION Patients with hip fractures are usually treated operatively in Western Europe. However, in Mid-Asia different indications are used to decide whether this patient is suitable for operative treatment and those are related to specific traditions and rules in hospital. Thus, traditions and surgeon/patient fears seem to affect treatment choices in hip fractures and subsequent outcomes. The aim of our study was to investigate patients with hip fractures and compare outcome at 1-year follow-up in the operated and nonoperated patient groups. METHODS All patients over 50 years old who sustained a hip fracture, between January 2014 and December 2014, were included. Patients were assessed preoperatively and at 1-year follow-up, using questionnaires from National Swedish Hip Fracture Register and quality of life (Euroqol EQ-5D). RESULTS Out of 398 included patients, 299 were operated on and 99 were not. 344 patients remained for our analysis before the end of 1-year follow-up. 51 patients (65%) deceased in the nonoperated group as compared to 55 (21%) in the operated group, p<0.001. Out of 27 patients in the nonoperated group hip function was evaluated at 1-year follow-up, 11 (41%) were walking independently or using 1 stick, as compared to 192 (91%) in the operated group. CONCLUSIONS We conclude that nonoperative treatment of hip fracture patients is associated with higher mortality and worse functional outcome as compared to those who were treated operatively. We therefore advocate operative treatment of the hip fracture in the vast majority of cases.