The Effect of Systolic Blood Pressure on Cement Penetration Depth in Primary Total Knee Arthroplasty

M. Shen
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Abstract

Background: Cement Penetration Depth (CPD) into bone is an important factor for successful Total Knee Arthroplasties (TKA). Our study investigated the effect of Systolic Blood Pressure (SBP) on average tibial, femoral and total CPD in primary TKA. Methods and Findings: In this retrospective cohort study, patients who had a primary TKA between November 2018 and February 2020 at four, academic medical centers were included. CPD was evaluated according to the Knee Society Radiographic Evaluation System on radiographs one month post-operatively. Two independent evaluators measured four zones of tibial penetration and three zones of femoral penetration and averaged their results. The measurements were combined to create an average tibial, average femoral and average total CPD. SBP was collected at the 3/4 time of surgery length- the estimated time of cementation. 1221 primary TKA cases were included in the study – 1128 in the tourniquet group and 93 in the tourniquet-less group. There were no significant differences between the age, sex, BMI, or LOS between the two cohorts. A multiple, multivariate analysis was performed. In the tourniquet-less group, SBP did not significantly affect average tibial CPD (p=0.98), average femoral CPD (p=0.45), or average total CPD (p=0.23). However, tourniquet use was found to significantly increase average femoral (p<0.001) and total penetration (p=0.001). Conclusion: SBP did not significantly affect tibial, femoral, or total CPD in patients undergoing tourniquet-less, primary TKA. However, the use of a tourniquet significantly aids in average femoral and total CPD. The clinical significance of this difference needs further investigation.
初次全膝关节置换术中收缩压对骨水泥穿透深度的影响
背景:骨水泥入骨深度(CPD)是全膝关节置换术(TKA)成功的重要因素。我们的研究探讨了收缩压(SBP)对原发性TKA患者平均胫骨、股骨和总CPD的影响。方法和发现:在这项回顾性队列研究中,纳入了2018年11月至2020年2月期间在4个学术医疗中心进行原发性TKA的患者。术后1个月根据膝关节学会放射学评估系统对CPD进行评估。两名独立的评估人员测量了胫骨穿透的四个区域和股骨穿透的三个区域,并平均了他们的结果。这些测量结果结合起来得到平均胫骨、平均股骨和平均总CPD。收缩压采集于手术时间的3/4,即预计的骨水泥时间。1221例原发性TKA纳入研究,其中止血带组1128例,无止血带组93例。两组患者的年龄、性别、BMI或LOS无显著差异。进行了多变量分析。在无止血带组中,收缩压对胫骨平均CPD (p=0.98)、股骨平均CPD (p=0.45)或平均总CPD (p=0.23)无显著影响。然而,止血带的使用显著增加了平均股动脉穿透力(p<0.001)和总穿透力(p=0.001)。结论:收缩压对不带止血带的原发性TKA患者的胫骨、股骨或总CPD没有显著影响。然而,止血带的使用明显有助于平均股动脉和总CPD。这种差异的临床意义有待进一步探讨。
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