Embolic phenomena during computer-assisted and conventional total knee replacement

Abstract

Systemic emboli released during total knee replacement have been implicated as a cause of peri-operative morbidity and neurological dysfunction. We undertook a prospective, double-blind, randomised study to compare the cardiac embolic load sustained during computer-assisted and conventional, intramedullary-aligned, total knee replacement, as measured by transoesophageal echocardiography. There were 26 consecutive procedures performed by a single surgeon at a single hospital. The embolic load was scored using the modified Mayo grading system for echogenic emboli. Fourteen patients undergoing computer-assisted total knee replacement had a mean embolic score of 4.89 (3 to 7) and 12 undergoing conventional total knee replacement had a mean embolic score of 6.15 (4 to 8) on release of the tourniquet. Comparison of the groups using a two-tailed t-test confirmed a highly significant difference (p = 0.004). This study demonstrates that computer-assisted knee replacement results in the release of significantly fewer systemic emboli than the conventional procedure using intramedullary alignment.

Coagulation and Fibrinolysis Markers and Their Use for the Prediction of High Risk Patients with Venous Thromboembolism Following Total Hip Arthroplasty

“…First, VTE could be initiated during the operation [35,36], in the postoperative period without mobilization [37], or 1-2 months after surgery [38,39]. Thus, evaluations of VTE occurrence may vary depending on the timing of imaging tests, duration of follow-up, or the duration of postoperative thromboprophylaxis.…”

Computer navigated total knee arthroplasty: Aspects of a single unit's experience of 777 cases

“…Studies do exist which show reduced blood loss [14,28,29], fewer systemic emboli [24,30,31] and fewer clinically detectable thromboembolic events [32] in navigated TKA compared with conventional TKA, and this is thought to be directly related to the avoidance of femoral and/or tibial intramedullary instrumentation. Cohorts in all these studies were, however, very small and offer low levels of evidence, and contradictory evidence does exist showing no difference in blood loss [25,33] and thromboembolic phenomena [13] between the two groups.…”

Navigation knee replacement

“…The risk of fat embolism during knee replacement has been shown to be significantly reduced when an extramedullary femoral alignment guide [27] or computerassisted surgery is used [7,15]. Studies using non-invasive [15] and invasive monitoring [7] have shown that significantly fewer emboli are detected in the systemic circulation during computer-assisted TKR compared with conventional TKR.…”

“…Studies using non-invasive [15] and invasive monitoring [7] have shown that significantly fewer emboli are detected in the systemic circulation during computer-assisted TKR compared with conventional TKR. However, most studies comparing these two methods have not shown any significant difference in post-operative thromboembolic events [2].…”