Unikondiler diz artroplastisi ile kombine ön çapraz bağ rekonstrüksiyonu ameliyat sonrası dönemde kanamayı arttırır mı?

Yıl 2017, Cilt: 24 Sayı: 4, 146 - 152, 01.12.2017

Emrah Kovalak A. Meriç Ünal

https://doi.org/10.17343/sdutfd.297732

Öz

Amaç:
Unikondiler diz artroplastisi ile beraber ön çapraz bağ rekonstrüksiyonu
yapılan hastalarda kanama miktarı ve kullanılan greft tipinin kanama miktarı
üzerine olan etkisinin belirlenmesi.

Hastalar
ve yöntem: Primer medial kompartman osteoartriti tanısı ile  unikondiler diz artroplastisi (UKA) yapılan
hastalar- Grup A ve UKA ile beraber ön çapraz bağ (ÖÇB) rekonstrüksiyonu
yapılan hastalar- Grup B olmak üzere iki gruba ayrıldılar. Grup B’ yi oluşturan
hastalar kendi içerisinde allogreft ve hamstring tendon grefti (HTG) kullanılan
hastalar olmak üzere iki gruba ayrıldılar. Her iki grupta 24 saatte drenden
gelen kanama miktarı kayıt altına alındı.

Bulgular:
Grup A 28, Grup B ise 18 hastadan oluşmakta idi. Gruplar;
yaş, cinsiyet, kilo ve boy açısından karşılaştırılabilir idi. Her iki grup
arasında hemovak drenden ölçülen kanama miktarları arasında istatiksel bir fark
saptanmadı (p=0.86). Grup B’de hemovac drenden ölçülen kanama miktarı HTG
kullanılan grupta allogreft kullanılan hastalara göre daha fazla idi (p=0.043).Grup
A ile HTG ve allogreft kullanılan hastaların drenden ölçülen kanama miktarları
karşılaştırıldığında istatiksel olarak bir fark saptanmadı (p= 0.058 ve p = 0.65).

Sonuç: ÖÇB ile kombine yapılan UKA de, ön
çapraz bağ rekonstrüksiyonun oluşturduğu kanama miktarı özellikle allogreft
kullanıldığında ihmal edilebilir düzeyde olup, kanama miktarı üzerine olumsuz
etkisi yoktur.

Anahtar Kelimeler

Replasman artroplastisi, diz; Kanama

Does unicondylar knee arthroplasty combined with anterior cruciate ligament reconstruction increase post-operative bleeding?

Öz

Aim: To evaluate the post-operative bleeding in patients
who had unicondylar knee arthroplasty (UKA) combined with anterior cruciate
ligament (ACL) reconstruction and the affect of graft type on bleeding.

Patients and methods: The patients who had UKA comprised in Group A and the
patients who had UKA combined ACL reconstruction comprised in Group B.  The patients, who participated in Group B,
are also evaluated in 2 groups according to the used grafts such as allograft
and hamstring tendon graft (HTG). The drainage was recorded for 24 hours in
groups.

Results:

Group A was
comprised of 28 and group B was comprised of 18 patients. Groups were
comparable according to the age, sex, weight and  height. There was no statistical significance
between the groups according to the measured bleeding (p=0.86). In Group B, the
measured bleeding was more in allograft used patients with a statistical
significance (p=0.043). But, there was no statistical significance in measured
bleeding with Group A and HTG, allograft used patients (p= 0.058
and
p = 0.65).

Conclusion:  The bleeding is negligible and no additive affect on bleeding when UKA
is combined with ACL reconstruction, especially when allograft is used.

Anahtar Kelimeler

Replacement Arthroplasty, Knee; Hemorrhage

Kaynakça

• 1. Asanuma K, Ito H, Ogawa A, Asanuma Y, Yoshikawa T, Hasegawa M, Sudo A. Recurrent hemarthrosis after unicompartmental knee arthroplasty. Orthopedics. 2011;34(9):578-80.
• 2. Berend KR, Morris MJ, Lombardi AV.Unicompartmental knee arthroplasty: incidence of transfusion and symptomatic thromboembolic disease. Orthopedics.2011;33(9Suppl):8-10.
• 3. Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Zhu G. No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial. Arch Orthop Trauma Surg. 2015;135(5):709-13.
• 4. Schwab PE, Lavand'homme P, Yombi JC, Thienpont E. Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3494-500.
• 5. Tinius M, Hepp P, Becker R. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):81-7.
• 6. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39(12):1338-44.
• 7. Ventura A, Legnani C, Terzaghi C, Iori S, Borgo E. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):675-80.
• 8. White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73: 582-6.
• 9. Deschamps G, Lapeyre B,. Rupture of the anterior cruciate ligament: a frequency unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years. Rev Chir Orthop Reparactice Appar Mot. 1987;73:544-51.
• 10. Boissonneault A, Pandit H, Pegg E, Jenkins C, Gill SH, Dodd CAF, et al. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2013;21:2480-6.
• 11. Mancuso F, Hamilton TW, Kumar V, Murray DW, Pandit H. Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24:112-22.
• 12. Bahl V, Goyal A, Jain V, Joshi D, Chaudhary D. Effect of hemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction- single bundle versus double bundle. J Orthop Surg Res. 2013; 19;8:5.
• 13. Reilly TJ, Gradisar IJ, Pakan W, Reilly M. The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop Relat Res. 1986;208:238-42.
• 14. Li C, Nijat A, Askar M. No clear advantage to use of wound drains after unilateral total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2011;26(4):519-22.
• 15. Ares O, Seijas R, Hernandez A, Castellet E, Sallent A. Knee arthroplasty and bleeding: when to remove drainages. Knee Surg Sports Traumatol Arthrosc. 2013;21:393-7.
• 16. Zhang QD, Guo WS, Zhang Q, Liu ZH, Cheng LM, Li ZR. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis. J Arthroplasty. 2011; 26(8):1265–72.
• 17. 
Jenny JY, Boeri C, Lafare S. No drainage does not increase complication risk after total knee prosthesis implantation: a prospective, comparative, randomized study. Knee Surg Sports Traumatol Arthrosc . 2001;9(5):299–301.
• 18. 
Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res. 1998; 347:188–93.
• 19. 
Fan Y, Liu Y, Lin J, Chang X, Wang W, Weng XS. Drainage does not promote post-operative rehabilitation after bilateral total knee arthroplasties compared with nondrainage. Chin Med Sci J. 2013;28(4):206–10.
• 20. Camillieri G, Margheritimi F, Maresca G, Mariani PP. Postoperative bleeding following notchplasty in anterior cruciate ligament reconstruction: thermal radio frequency versus powered instrumentation. Knee Surg Sports Traumatol Arthrosc. 2001;9:12-14.
• 21. Ruffilli A, Buda R, Castagnini F, Di Nicolantonio D, Evangelisti G, Giannini S et al. Temperature- controlled continuous cold flow device versus traditional icing regimen following anterior cruciate ligament reconstruction: a prospective randomized comparative trial. Arc Orthop Trauma Surg. 2015; 135: 1405-10.
• 22. Lombardi AV Jr., Berend KR, Walter CA, Aziz- Jocobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty. Clin Orthop Relat Res. 2009;467:1450-7.
• 23. Yang KY, Wang MC, Yeo SJ, Lo NN. Minimally invasive unicondylar versus total condylar knee arthroplasty- early results of a matched- pair comparison. Singap Med J. 2003; 44: 559-62.
• 24. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty.2004; 19:281-7.
• 25. Jeer PJS, Cossey AJ, Keene GCR. Haemoglobin levels following unicompartmental knee arthroplasty: Influence of transfusion practice and surgical approach. The Knee. 2005;12:358-61.
• 26. Karaaslan F, Karaoğlu S, Yurdakul E. Reducing intra-articular hemarthrosis after arthroscopic anterior cruciate ligament reconstruction by the administration of intravenous tranexamic acid. Am J Sports Med. 2015;43(11):2720-6.
• 27. Wu H, Chen LX, Li YL, Wu Q,Wu QL, Ning GZ et al. Tourniquet used in anterior cruciate ligament reconstruction: a system review. Eur J OrthopSurg Traumatol. 2014;24:999-1003.
• 28. Pape D, Seil R, Adam F, Gödde S, Georg T, Rupp S, et al. Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome? Arch Orthop Trauma Surg. 2001;121:574-7.