Patient specific instrumentation affects peri-operative blood loss in total knee arthroplasty.
Author(s):
Cucchi D. (Germany)
,
Cucchi D. (Germany)
Affiliations:
Menon Alessandra
,
Menon Alessandra
Affiliations:
Zanini Beatrice
,
Zanini Beatrice
Affiliations:
Compagnoni R.
,
Compagnoni R.
Affiliations:
Ferrua P.
,
Ferrua P.
Affiliations:
Fossati Chiara
,
Fossati Chiara
Affiliations:
Randelli P.
Randelli P.
Affiliations:
ESSKA Academy. Cucchi D. 05/09/18; 209642; P11-1378 Topic: Joint Replacement
Dr. Davide Cucchi
Dr. Davide Cucchi
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Abstract
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Objectives: Patient Specific Instrumentation (PSI) may contribute to reduce blood loss related to total knee arthroplasty (TKA) by avoiding violation of the medullary canal. The purpose of the study was to compare the estimated haemoglobin (Hb) and red blood cell volume (RBC) losses in two groups of patients undergoing TKA with PSI and conventional instrumentation.

Methods: Pre- and post-operative blood samples were collected form 22 patients randomly assigned to receive a PSI-assisted or conventional TKA. Post- to pre-operative Hb difference was calculated and RBC loss was estimated according to Sehat et al. Normality of data distribution was tested with a Shapiro-Wilk test. The differences between the two groups of patients for continuous variables was proved with an unpaired Student's t-test or Mann-Whitney test according to the characteristics of the data distribution. The differences for categorical variables were tested with the chi-square test or Fisher's exact test. Analysis of variance was performed in order to investigate the influence of dependent factors on the blood loss.

Results: A significant difference in Hb reduction in favour of the PSI group was registered on the last day of stay (p=0.0084), but not on the previous post-operative days. No significant differences were found in mean RBC loss at any of the post-operative measurements. A significant treatment effect (p=0.027) on Hb reduction after intervention was found with a regression model for longitudinal measurements.

Conclusions: PSI leads to a significant trend in earlier Hb re-gain, although this does not reflect a significant RBC loss. These promising results suggest a beneficial effect of PSI in blood loss reduction. PSI may be considered a valid strategy to control and reduce Hb loss related to TKA.

Keywords:
Patient-specific instrumentation; Total knee arthroplasty; Haemoglobin loss; Blood loss; transfusions; Outcomes
Objectives: Patient Specific Instrumentation (PSI) may contribute to reduce blood loss related to total knee arthroplasty (TKA) by avoiding violation of the medullary canal. The purpose of the study was to compare the estimated haemoglobin (Hb) and red blood cell volume (RBC) losses in two groups of patients undergoing TKA with PSI and conventional instrumentation.

Methods: Pre- and post-operative blood samples were collected form 22 patients randomly assigned to receive a PSI-assisted or conventional TKA. Post- to pre-operative Hb difference was calculated and RBC loss was estimated according to Sehat et al. Normality of data distribution was tested with a Shapiro-Wilk test. The differences between the two groups of patients for continuous variables was proved with an unpaired Student's t-test or Mann-Whitney test according to the characteristics of the data distribution. The differences for categorical variables were tested with the chi-square test or Fisher's exact test. Analysis of variance was performed in order to investigate the influence of dependent factors on the blood loss.

Results: A significant difference in Hb reduction in favour of the PSI group was registered on the last day of stay (p=0.0084), but not on the previous post-operative days. No significant differences were found in mean RBC loss at any of the post-operative measurements. A significant treatment effect (p=0.027) on Hb reduction after intervention was found with a regression model for longitudinal measurements.

Conclusions: PSI leads to a significant trend in earlier Hb re-gain, although this does not reflect a significant RBC loss. These promising results suggest a beneficial effect of PSI in blood loss reduction. PSI may be considered a valid strategy to control and reduce Hb loss related to TKA.

Keywords:
Patient-specific instrumentation; Total knee arthroplasty; Haemoglobin loss; Blood loss; transfusions; Outcomes
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