Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty

Abstract Background The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. Material and Methods This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words “tourniquet”, “total knee arthroplasty”, “TKA” and “knee endoprosthesis” up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. Results 18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. Conclusion The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.

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Pulmonary embolism following total knee arthroplasty in Taiwanese patients

Journal of the Chinese Medical Association ◽

10.1016/j.jcma.2013.11.005 ◽

2014 ◽

Vol 77 (3) ◽

pp. 155-159 ◽

Cited By ~ 3

Author(s):

Po-Kuei Wu ◽

Cheng-Fong Chen ◽

Lien-Hsiang Chung ◽

Chien-Lin Liu ◽

Wei-Ming Chen

Keyword(s):

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Total Knee

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One Versus Two Doses of Intravenous Tranexamic Acid in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1700805 ◽

2019 ◽

Author(s):

Ryan S. Charette ◽

Jenna A. Bernstein ◽

Matthew Sloan ◽

Corbyn M. Nchako ◽

Atul F. Kamath ◽

...

Keyword(s):

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Deep Vein Thrombosis ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Transfusion Rate ◽

Vein Thrombosis ◽

Total Knee ◽

Deep Vein

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.

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Fatal Pulmonary Embolism during Manipulation after Total Knee Arthroplasty. A Case Report*

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199601000-00016 ◽

1996 ◽

Vol 78 (1) ◽

pp. 111-3 ◽

Cited By ~ 13

Author(s):

MICHAEL S. STECKER ◽

MICHAEL D. RIES

Keyword(s):

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Case Report ◽

Knee Arthroplasty ◽

Fatal Pulmonary Embolism ◽

Total Knee

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Previous History of Breast Cancer Increases Rates of Pulmonary Embolism and Costs after Total Knee Arthroplasty: An Evaluation of 185,114 Matched Patients

The Journal of Knee Surgery ◽

10.1055/s-0038-1641155 ◽

2018 ◽

Vol 32 (04) ◽

pp. 337-343 ◽

Cited By ~ 1

Author(s):

Samuel Rosas ◽

T. Luo ◽

Alexander Jinnah ◽

Alejandro Marquez-Lara ◽

Martin Roche ◽

...

Keyword(s):

Breast Cancer ◽

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Previous History ◽

Increased Risk ◽

Comorbidity Burden ◽

History Of ◽

Total Knee

AbstractRisk factors for adverse events after total knee arthroplasty (TKA) relating to malignancy have not been well studied. Thus, the purpose of this study was to conduct a retrospective case–control outcome and cost analysis after TKA in this population. Patients with a history of breast cancer (BrCa) were identified based on the International Classification of Disease 9th revision codes. An age- and sex-matched cohort was also identified of patients without a history of BrCa. Complications, length of stay, comorbidity burden, and reimbursements were tracked at 90 days. Each cohort comprised 92,557 patients. Length of stay was similar between cohorts (p = 0.627). Comorbidity status and incidence of pulmonary embolism (PE), lower extremity ultrasound, and chest computed tomography (CT) use were higher in patients with a history of BrCa (p < 0.05 for all). Control patients had a lower incidence of acute myocardial infarction (0.14 vs. 0.21%; p < 0.001). Surgical complications were similar. The 90-day reimbursements were greater in patients with a history of BrCa (US$13,990 vs. US$13,033 for controls; p = 0.021). Surgeons should be aware of the increased risk of PE after TKA in patients with a history of BrCa as well as increased 90-day costs, which warrant great attention.

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