Saratov JOURNAL of Medical and Scientific Research

knee replacement

Thrombinogenesis in patients with aseptic instability of knee endoprosthesis and periprosthetic infection

Year: 2020, volume 16 Issue: №2 Pages: 478-484
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
Organization: Saratov State Medical University
Summary:

Objective: To evaluate thrombinogenesis in patients with periprosthetic infection and aseptic loosening of endoprosthesis after primary knee arthroplasty. Material and Methods: 28 of 52 examined patients who suffered from the loosening of knee endoprosthesis components and 24 from periprosthetic infection; 18 healthy individuals were also engaged into the study. Thrombinogenesis was analyzed with thrombin generation assay in an automated Ceveron alpha coagulometer (Technoclone, Austria) using RB and RC-low activators containing 2 and 5 pmol/ml of tissue factor respectively. Each of the main groups of patients was divided into two subgroups: in patients of the 1st subgroups RC-low activator aggravate thrombinogenesis while in the 2nd subgroups it inhibited the process as compared to the effects of RB activator. Results: In the 1st subgroup of patients with aseptic loosening RC-low activator caused chronometric hyperthrombinogenesis, and in the 2nd — both chronometric and structural ones. In patients with periprosthetic infection the effects of RB and RC-low activators were comparable. Conclusion: In patients with aseptic loosening of the implant and stopped periprosthetic infection that developed after primary knee replacement, the thrombin generation test reveals normal, paradoxical and inert types of thrombinogenesis.

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Modern surgical aspects in blood loss management in total knee arthroplasty

Summary:

The frequency of knee arthroplasty in knee arthritis is forcing the orthopedic community to take measures to optimize this surgical intervention. Despite the fact that this is a routine operation, it is often accompanied by significant blood loss. Large intraoperative blood loss leads to the development of postoperative post-hemorrhagic anemia which is an extremely unfavorable effect in the course of wound healing, moreover, it affects the length of stay of a patient in clinic and the cost of treatment. The analysis of the literature on the issue of patient blood loss management tells of divergent efforts of experts in related fields of medicine and complex multi-disciplinary research on this topic, often — with contradictory conclusions. It can be noted that nowadays there is no accurate, reliable and scientifically proven sound algorithm of blood loss management in primary total knee arthroplasty in modern Russian and foreign literature.

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