Survivorship of Extensor Mechanism Allograft Reconstruction After Total Knee Arthroplasty.

BACKGROUND: Extensor mechanism disruption remains a devastating complication after total knee arthroplasty. The purpose of this study is to describe the outcomes of extensor mechanism allograft (EMA) reconstruction in a large single-center case series. METHODS: Consecutive patients with a previous total knee arthroplasty undergoing extensor mechanism reconstruction using a fresh-frozen EMA tensioned in full extension were identified retrospectively from single-center institutional database (N = 25 patients, 26 knees; mean follow-up 68 months [range 22-113 months]). The primary outcome was initial allograft failure, defined as removal of the allograft or extensor lag >30 degrees at most recent follow-up. RESULTS: Sixty-nine percent (18/26) of knees had retained their initial allograft reconstruction at their latest follow-up despite reoperation rates of 58% (15/26). A younger age was significantly associated with failure of the initial allograft reconstruction. Knee Society Scores increased from 101 (38 standard deviation [SD]) to 116 (40 SD) at most recent follow-up for the group as a whole (P = .4). Patients undergoing a reoperation for any cause had lower Knee Society Scores (101 [SD 38] vs 138 [SD 32], respectively; P = .04) at most recent follow-up. CONCLUSION: EMA reconstruction shows adequate overall intermediate-term survival; however, reoperation rates were high and associated with worse functional outcomes.

The safety and efficacy of intraoperative heparin in total hip arthroplasty.

A single dose of unfractionated heparin (15 U/kg), administered intravenously before surgery on the femur suppresses thrombogenesis during total hip replacement. Nine hundred eighty-nine patients (1021 hips) who received one dose of intraoperative heparin with hypotensive epidural anesthesia were followed up prospectively for 3 months. Asymptomatic deep vein thrombosis assessed by ultrasound in the first 198 consecutive patients showed an incidence of 7.1% (14 of 198). The incidence of clinical deep vein thrombosis in the subsequent 791 patients was 0.88% (seven of 791). Symptomatic pulmonary embolism occurred in 0.5% (five of 989). No patients died and there was one major bleeding episode. Based on this favorable experience, intraoperative heparin appears safe and efficacious as thromboembolic prophylaxis.