Paper 187: Does Femoral Cementing Influence Perioperative Blood Loss in Total Knee Arthroplasty? A Prospective Randomized Study

ABSTRACTS cluded between March 2004 and February 2008. The arthroscope was inserted to anterolateral portal and then advanced to see the posteromedial compartment through the space between PCL and medial femoral condyle. There were 3 types of the posteromedial joint capsule whether the presence of capsular fold and opening. The type I joint capsule have both capsular fold and opening, type II has only capsular fold, whereas type III has no capsular fold and opening. The posteromedial portal was made around the junction of the posterior horn of the medial meniscus and posterior aspect of medial femoral condyle. In the group without Baker’s cyst, 3 cases of type II posteromedial joint capsule and 5 cases of type III was dissected by arthroscopic intra-articullary dissection using posteromedial portal. The distance between posteromedial portal and fold, medial head of gastrocnemius was measured using probe. Results: The type I of posteromedial joint capsule were observed at 9(9%) cases, the type II were 52(52%) cases and the type III were 39(39%) cases in the group without Baker’s cyst. In the Baker’s cyst group, 13(93%) cases, 0 case, 1(7%) case was observed respectively. The shapes of capsular fold were crescent in type I and II. The average distance from posteromedial portal to lateral border of medial head of gastrocnemius was 15(1416)mm, from posteromedial portal to lateral border of capsular fold was 12(10-13)mm, from posteromedial portal to medial border of fold was 26(22-30)mm and the average height of capsular fold from the bottom of posteromedila joint capsule was 17(15-20)mm. With these data, we designed the internal window technique(Ahn and Cho’s procedure) with which we can easily approach to the potential space of Baker’s cyst between medial head of gastrocnemius and semimembranosus using arthroscopic intra-articular dissection of posteromedial joint capsule, even though the surgical landmark was somewhat vague such as type II and III, especially type III Conclusions: The comprehensive understanding and knowledge about the arthroscopic anatomy of posteromedial joint capsule of the knee will made the surgeon perform arthroscopic decompression and cystectomy for Baker’s cyst successfully. And with internal window technique, simple and universal arthroscopic approach for Baker’s cyst will be allowed. Key Words: anatomy, posteromedial joint capsule, knee, Baker’s cyst, arthroscopy, internal window technique Paper 187: Does Femoral Cementing Influence Perioperative Blood Loss in Total Knee Arthroplasty? A Prospective Randomized Study GUILLAUME DEMEY, MD, FRANCE, PRESENTING AUTHOR

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ELVIRE SERVIEN, MD, FRANCE ALBAN PINAROLI, MD, FRANCE SEBASTIEN LUSTIG, FRANCE TARIK SELMI AÏT SI, FRANCE PHILIPPE NEYRET, MD, FRANCE ABSTRACT Introduction: In 2004 and 2005, we conducted a prospective randomized study of 130 consecutive primary total knee arthroplasty (TKA) to assess the influence of femoral cement on TKA results. In this report, we analyse on a subset of these patients to compare the perioperative blood loss of those patients with a cemented femoral component, to those receiving a cementless femoral component with hydroxyapatite. Material and Methods: The TKA used was the HLS Noetos. A cemented tibial component with mobile insert and a patellar resurfacing arthroplasty were performed in all cases. All patients were preoperatively randomly assigned treatment in either the cement group (group 1) or uncemented group (group 2). We selected the 107 TKA performed by medial parapatellar approach. Group 1 consisted of 42 women and 12 men (n⫽54). Group 2 consisted of 37 women and 16 men (n⫽53). There were no significant differences between the groups concerning anthropometric or demographic data. The surgical procedures were performed by the same surgical team using a standardized technique. At the time of surgery, two suction drains were inserted inside the joint, and the tourniquet time (TQ) was recorded. The haemoglobin and haematocrit levels were recorded preoperatively and 5 days postoperatively for each patient. The volumes of postoperative suction drainage and incidence of blood transfusion were recorded. The calculated blood losses were evaluated as described Mercuriali using preoperative and postoperative haematocrit, patients’ weight and volume of blood transfusion. A statistical analysis was carried out using Student’s t test. P value less than 0.05 was considered significant. Results: The mean TQ was 63.8 min for group 1 and 65.5 min for group 2 (p⫽0.5). No difference was recorded in the patients’ initial haemoglobin and haematocrit levels. Postoperatively, the haemoglobin level was 9.7 g/dl for both groups; the haematocrit level was 29.4% for group 1 and 29.9% for group 2 (p⫽0.4). The total measured blood loss amounted to 1758.9 ml for group 1 and 1759 ml for group 2 (p⫽0.9). The average postoperative drainage was 1077 ml for group 1 and 1181 ml for group 2 (p⫽0.3). Following TKA, 18 patients from group 1 and 17 patients from group 2 received a blood transfusion.

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Conclusions: In our study, the use of femoral cement did not influence perioperiative blood loss, or the need for subsequent transfusion. Some previous authors have found a relation between using cement and decreasing blood loss. However, many of them analyzed the use of tibia and femur cement at the same time. Furthermore, the comparison with other studies is difficult because several different methods have been used to evaluate the amount of blood loss. Paper 188: Medio-lateral Laxity Before and After Total Knee Replacement YANN DIESINGER, MD, FRANCE, PRESENTING AUTHOR JEAN-YVES JENNY, MD, FRANCE CYRIL BOERI, MD, FRANCE EUGÈNE CIOBANU, MD, FRANCE ABSTRACT Introduction: Navigation systems are able to measure very accurately the movement of bones, and consequently the knee laxity, which is a movement of the tibia under the femur. These systems might help measuring the knee laxity during the implantation of a TKR or a UKR. Material and Methods: 20 patients operated on for TKR (13 cases) or UKR (7 cases) because of primary varus osteoarthritis have been analyzed. Pre-operative examination involved varus and valgus stress X-rays at 0 and 90° of knee flexion. The intra-operative medial and lateral laxity was measured with the navigation system at the beginning of the procedure and after prosthetic implantation. Varus and valgus stress X-rays were repeated after 6 weeks. X-ray and navigated measurements before and after TKR were compared with a paired Wilcoxon test at a 0.05 level of significance. Results: The mean pre-operative medial laxity in extension was 2.3° (SD 2.3°). The mean pre-operative lateral laxity in extension was 5.6° (SD 5.1°). The mean preoperative medial laxity in flexion was 2.2° (SD 1.9°). The mean pre-operative lateral laxity in flexion was 6.7° (SD 6.0°). The mean intra-operative medial laxity in extension at the beginning of the procedure was 3.6° (SD 1.7°). The mean intra-operative lateral laxity in extension at the beginning of the procedure was 3.0° (SD 1.3°). The mean intra-operative medial laxity in flexion at the beginning of the procedure was 1.9° (SD 2.6°). The mean intra-operative lateral laxity in flexion at the beginning of the procedure was 3.5° (SD 2.7°). The mean intra-operative medial laxity in extension after implantation was 2.1° (SD 0.9°). The mean intraoperative lateral laxity in extension after implantation was 1.9° (SD 1.1°). The mean intra-operative medial

laxity in flexion after implantation was 1.9° (SD 2.5°). The mean intra-operative lateral laxity in flexion after implantation was 3.0° (SD 2.8°). The mean post-operative medial laxity in extension was 2.4° (SD 1.1°). The mean post-operative lateral laxity in extension was 2.0° (SD 1.7°). The mean postoperative medial laxity in flexion was 4.4° (SD 3.3°). The mean post-operative lateral laxity in flexion was 4.7° (SD 3.2°). There was a significant difference between navigated and radiographic measurements for the pre-operative medial laxity in extension (mean ⫽ 1.4° ⫺ p ⫽ 0.005), the pre-operative lateral laxity in extension (mean ⫽ 2.6° ⫺ p ⫽ 0.01), the pre-operative lateral laxity in flexion (mean ⫽ 3.3° ⫺ p ⫽ 0.005). There was no significant difference between navigated and radiographic measurements for the pre-operative medial laxity in flexion (mean ⫽ 0.3° ⫺ p ⫽ 0.63). There was a significant difference between navigated and radiographic measurements for the post-operative medial laxity in flexion (mean ⫽ 2.5° ⫺ p ⫽ 0.004). There was no significant difference between navigated and radiographic measurements for the post-operative medial laxity in extension (mean ⫽ 0.3° ⫺ p ⫽ 0.30), the post-operative lateral laxity in extension (mean ⫽ 0.2° ⫺ p ⫽ 0.76), the post-operative lateral laxity in flexion (mean ⫽ 1.7° ⫺ p ⫽ 0.06). These differences were less than 2 degrees in most of the cases, and then considered as clinically irrelevant. Discussion: The navigation system used allowed measuring the medial and lateral laxity before and after TKR. This measurement was significantly different from the radiographic measurement by stress X-rays for pre-operative laxity, but not statistically different from the radiographic measurement by stress X-rays for postoperative laxity. The differences were mostly considered as clinically irrelevant. The navigated measurement of the knee laxity can be considered as accurate. The navigated measurement is valuable information for balancing the knee during TKR. The reproducibility of this balancing might be improved due to a more objective assessment. Conclusion: The navigation system used allows measuring accurately and objectively the knee laxity during TKR. Paper 189: Knee Range of Motion Depending on Different Femoral Component Designs: Evaluated In Vivo by a Navigation System EUN KYOO SONG, MD, KOREA, PRESENTING AUTHOR TAEK RIM YOON, MD, SOUTH KOREA YOUNG JIN KIM, MD, SOUTH KOREA