Efficacy of intra-operative administration of iron isomaltoside for preventing postoperative anaemia after total knee arthroplasty: A randomised controlled trial.

BACKGROUND: Postoperative anaemia is common after total knee arthroplasty (TKA). Emerging evidence shows the beneficial effects of peri-operative iron supplementation in patients at risk of postoperative anaemia. OBJECTIVE: To evaluate the efficacy of intra-operative administration of iron isomaltoside for the prevention of postoperative anaemia in patients undergoing TKA. DESIGN: Randomised, controlled, double-blind, parallel-group study. SETTING: A tertiary care teaching hospital; between 29 March 2018 and 16 April 2019. PATIENTS: Eighty-nine patients scheduled for unilateral TKA were included. INTERVENTION: Iron isomaltoside or placebo were administered intravenously over 30 min during surgical wound closure. MAIN OUTCOME MEASURES: The primary outcome measure was the incidence of anaemia at 30 days after TKA: anaemia was defined as haemoglobin less than 12 g dl-1 for female and less than 13 g dl-1 for male. RESULTS: In total, 89 patients were included in the final analysis (44 in the treatment group; 45 in the control group). The administered dose of iron isomaltoside in the treatment group was 1136 ±â€Š225 mg. The incidence of anaemia at 30 days after TKA was significantly lower in the treatment group (34.1%, 15/44) than that in the control group (62.2%, 28/45): relative risk 0.55 (95% confidence interval, 0.34 to 0.88), P = 0.008. Haemoglobin concentration, serum ferritin concentrations, and transferrin saturation were also significantly higher in the treatment group at 30 days after TKA. CONCLUSION: The intra-operative administration of iron isomaltoside effectively prevents postoperative anaemia in patients undergoing TKA, and thus it can be included in patient blood management protocols for reducing postoperative anaemia in these population. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03470649.

The use of medial joint opening rather than mechanical axis deviation to determine the clinical outcomes after high tibial osteotomy.

Aims: The aim of this study was to evaluate whether achieving medial joint opening, as measured by the change in the joint line convergence angle (∆JLCA), is a better predictor of clinical outcomes after high tibial osteotomy (HTO) compared with the mechanical axis deviation, and to find individualized targets for the redistribution of load that reflect bony alignment, joint laxity, and surgical technique. Methods: This retrospective study analyzed 121 knees in 101 patients. Patient-reported outcome measures (PROMs) were collected preoperatively and one year postoperatively, and were analyzed according to the surgical technique (opening or closing wedge), postoperative mechanical axis deviation (deviations above and below 10% from the target), and achievement of medial joint opening (∆JLCA > 1°). Radiological parameters, including JLCA, mechanical axis deviation, and the difference in JLCA between preoperative standing and supine radiographs (JLCAPD), an indicator of medial soft-tissue laxity, were measured. Cut-off points for parameters related to achieving medial joint opening were calculated from receiver operating characteristic (ROC) curves. Results: Patients in whom the medial joint opening was achieved had significantly better postoperative PROMs compared with those without medial opening (all p < 0.05). Patients who were outliers with deviation of > 10% from the target mechanical axis deviation had significantly similar PROMs compared with patients with an acceptable axis deviation (all p > 0.05). Medial joint opening was affected by postoperative mechanical axis deviation and JLCAPD. The influence of JLCAPD on postoperative axis deviation was more pronounced in a closing wedge than in an opening wedge HTO. Conclusion: Medial joint opening rather than the mechanical axis deviation determined the clinical outcome in patients who underwent HTO. The JLCAPD identified the optimal postoperative axis deviation necessary to achieve medial joint opening. For patients with increased laxity, lowering the target axis deviation is recommended to achieve medial joint opening. The target axis deviation should also differ according to the technique of undergoing HTO.

Influence of the apolipoprotein E type 4 allele on cerebral glucose metabolism in Alzheimer's disease patients.

It is still unclear whether apolipoprotein E epsilon 4 (APOE E4) influences the cerebral glucose metabolism abnormalities found in Alzheimer's disease (AD), although APOE E4 is a well-known risk factor for AD. [(18)F]Fluorodeoxyglucose PET was conducted in patients with very mild (n=17), mild (n=27), and moderate-to-severe (n=19) AD. The presence of APOE E4 was associated with greater reduction of glucose metabolism in the left inferior temporal region in very mild AD but neither in mild nor in moderate-to-severe AD. These findings favor the hypothesis that APOE E4 is related mainly to the development of AD, not to its progression.