This study aims to analyze the effect of intravenous administration of tranexamic acid (TA) on reducing the risk of revision for acute and delayed periprosthetic joint infection (PJI) after primary total knee replacement (TKR). Patients and methods: This prospective observational cohort study included 1,529 TKRs (396 males, 1,133 females; mean age 67.8 years; range, 44 to 85.1 years) performed between January 2003 and October 2017. We analyzed the revision rate for acute and delayed PJI in a group of 787 TKRs with preoperatively intravenously administered TA (TA group) in comparison with a group of 742 TKRs without administration of TA (non-TA group). Multiple logistic regression analysis was used to evaluate significant predictors of TKR revision for acute and delayed PJI. Results: Revision surgery due to PJI was recorded in one patient in the TA group and eight patients in the non-TA group. Cumulative revision rate of TKR was significantly lower in the TA group (0.13% vs. 1.08%, hazard ratio 0.113; 95% confidence interval [CI] 0.0147-0.937; p=0.043). Multivariate logistic regression analysis confirmed two predictors of revision: being aged over 75 years at the time of primary surgery (odds ratio [OR] 8.464; 95% CI: 2.016-35.54; p=0.004) and male gender (OR: 7.9; 95% CI: 1.879-33.26; p=0.005). The use of TA was shown as the significant protective factor (OR: 0.109; 95% CI: 0.0128-0.929; p=0.043). Conclusion: We have found a lower cumulative revision rate of TKR for acute and delayed PJI when TA was used. We think that the preoperative intravenous use of TA may be an effective, safe and inexpensive method for the prevention of PJI.

ÖZAmaç: Bu çalışmada hareketli polietilen (HP)'e kıyasla sabit polietilen (SP) total diz replasmanı (TDR)'nda sağkalım oranı ve revizyon riskinde farklılık olup olmadığı belirlendi.Hastalar ve yöntemler: Bu prospektif gözlemsel çalışmaya 63 hastada (23 erkek, 40 kadın; ort. yaş 69.7 yıl; dağılım, 46.5-85.5 yıl) takip eden revizyon cerrahisi olan, patella eklem yüzeyi değiştirilmeyen 1571 çimentolu posterior olmayan stabilize TDR dahil edildi. SP TDR grubu 756 revize olmayan ve 31 revize implanttan oluştu. HP TDR grubu 752 revize olmayan ve 32 revize diz içerdi. TDR'nin sağkalım oranı Kaplan-Meier yöntemi ile belirlendi ve revizyonun insert tipine ilişkin göreli risk (GR)'i belirlendi. Göreli riskin analizi revizyon zamanı ve revizyon nedenine dayanılarak alt gruplara ayrıldı. Bulgular: Sabit polietilen ve HP TDR'ler arasında kümülatif sağkalım oranı ve herhangi bir nedenle total revizyonun GR'si açısından anlamlı farklılık bulunmadı. Herhangi bir nedenle erken revizyon alt grubunda, HP'de 2.22 kat artmış revizyon riski bulundu (p= 0.02). HP'de herhangi bir nedenle geç revizyon riski SP'deki riskten daha düşüktü (GR 0.27; p= 0.009). HP'de erken revizyon alt grubunda instabilite için daha yüksek revizyon riski bulundu (GR 23.8; p= 0.03). HP aseptik gevşeme için anlamlı şekilde daha düşük total (GR 0.46; p= 0.049) ve geç (GR 0.14; p= 0.008) revizyon riski ile ilişkiliydi. Sonuç: Hareketli polietilen ve SP TDR'ler arasında kümülatif sağkalım oranlarında farklılık bulunmadı. SP TDR'lere kıyasla HP TDR'ler aseptik gevşemeye bağlı daha düşük revizyon riski ile ilişkiliydi. HP insertler sadece instabiliteye bağlı erken revizyonlar için anlamlı bir risk faktörü oluşturdu.Anahtar sözcükler: Sabit polietilen, hareketli polietilen, revizyon, sağkalım, total diz replasmanı. ABSTRACTObjectives: This study aims to determine whether there is a difference in the rate of survival and risk of revision for mobilebearing (MB) compared with fixed-bearing (FB) total knee replacements (TKRs). Patients and methods: This prospective observational study included 1,571 cemented non-posterior-stabilized TKRs without patellar resurfacing with the subsequent revision surgery in 63 patients (23 males, 40 females; mean age 69.7 years; range, 46.5 to 85.5 years). The group of FB TKRs consisted of 756 non-revised and 31 revised implants. The group of MB TKRs included 752 non-revised and 32 revised knees. We determined the survival rate of TKR with Kaplan-Meier method and the relative risk (RR) of the revision in relation to the type of the insert. The analysis of the RR was divided into subgroups based on the time to revision and the reason for revision. Results: No significant difference was found between FB and MB TKRs regarding the cumulative survival rate and the RR of total revision for any reasons. In the subgroup of early revisions for any reason, 2.22-fold increased risk of revision was found in the MB (p= 0.02). The risk of late revisions for any reason in MB was lower than the risk in FB (RR 0.27; p= 0.009). Higher risk of revision for i...

PURPOSE OF THE STUDYThe study aims to evaluate the long-term results of computer-navigated total knee arthroplasties performed by less experienced surgeon performing a small number of procedures per year. MATERIAL AND METHODSIn the prospective randomised study functional and radiological results, rate of revision and probability of clinical and radiological survival were compared in 30 computer-navigated (in 28 patients: 19 women, 9 men, with the mean age of 66.9 years) and 31 conventionally implanted (in 30 patients: 27 women, 3 men, with the mean age of 66.5 years) cemented total knee replacements without patellar resurfacing. The group was composed of patients who underwent surgery performed by the same surgeon who at the time of enrolment of patient in the study had no previous experience with the total knee replacement surgery and performed up to 30 such procedures annually. The mean follow-up of patients was 11 years. RESULTSNo statistically significant differences were detected regarding the mean age, sex, body mass index and etiology of osteoarthritis of the operated knee. The mean duration of computer-navigated surgeries (101±14.1; 80-140 min) was considerably longer than the duration of conventional joint replacements (94±8.2; 80-100 min; p = 0.01). When evaluating the radiological results, a statistically significant difference was found between the groups only with respect to the mean value of dorsal inclination of the tibial component (88.2˚±2.1 vs 86.2˚±3, p = 0.02). The mean values of other monitored angles did not show any significant differences. The number of correct implants (with a deviation of 3 degrees from the target values) was statistically significantly higher in the group of computer-navigated joint replacement surgeries in all the monitored parameters

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PURPOSE OF THE STUDYThe aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. MATERIAL AnD METHODSThe group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., first, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence clasification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. RESULTSOsteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the first time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSIOnOsteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent findings of osteopenia and osteoporosis in this study show that patients with osteoarthritis may not be protected from the development of generalised osteoporosis. Our results are compared with the relevant literature data and potential effects of osteoporosis and vitamin D deficiency on total hip arthroplasty are discussed. COnCLUSIOnSHip osteoarthritis does not reduce the risk of generalised osteoporosis. We found a relative high incidence of osteopenia and osteoporosis as well as vitamin D deficiency in patient with advanced form of hip osteoarthritis.