The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient’s tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

https://epub.ub.uni-muenchen.de/24023/1/oa_24023.pdf

Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology

Review on titanium and titanium based alloys as biomaterials for orthopaedic applications.

Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis.

/pdf/3d-printing-techniques-in-a-medical-setting-a-systematic-53jv953e7s.pdf

3D-printing techniques in a medical setting: a systematic literature review

The American College of Surgeons

The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to

/pdf/management-of-severe-perioperative-bleeding-guidelines-from-2wdggnur4g.pdf

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016.

Successful total knee arthroplasty (TKA) has often been based on the restoration of the knee to neutral alignment postoperatively. Numerous reports have linked malaligned TKA components to increased wear, poor functional outcomes, and failure. There have been many different alignment philosophies and surgical techniques that have been established to attain the goal of proper alignment, which includes such techniques as computerized navigation, and custom cutting guides. In addition, these methods could potentially have the added benefit of leading to improved functional outcomes following total knee arthroplasty. In this report, we have reviewed and analyzed recent reports concerning mechanical, anatomic, and kinematic axis/alignment schemes used in total knee arthroplasty.

/pdf/mechanical-anatomical-and-kinematic-axis-in-tka-concepts-and-3lxwfv2lkv.pdf

Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications

The purpose of this study was to measure the impact of periprosthetic joint infections (PJIs) on the length of hospitalization, readmissions, and the associated costs. Between 2007 and 2011, our prospectively collected infection database was reviewed to identify PJIs that occurred following primary total knee arthroplasty (TKA), which required a two-stage revision. We identified 21 consecutive patients and matched them to 21 non-infected patients who underwent uncomplicated primary TKA. The patients who had PJIs had significantly longer hospitalizations (5.3 vs. 3.0 days), more readmissions (3.6 vs. 0.1), and more clinic visits (6.5 vs. 1.3) when compared to the matched group, respectively. The mean annual cost was significantly higher in the infected cohort ($116,383; range, $44,416 to $269,914) when compared to the matched group ($28,249; range, $20,454 to $47,957). Periprosthetic infections following TKA represent a tremendous economic burden for tertiary-care centers and to patients.

The Economic Impact of Periprosthetic Infections Following Total Knee Arthroplasty at a Specialized Tertiary-Care Center

Purpose
The purpose of this study was to compare the clinical outcomes of patients undergoing total hip arthroplasty (THA) who had been using narcotic medications prior to surgery to those who had not used them.

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

The negative effects of obesity following total joint arthroplasty, such as increased morbidity and mortality, have been well documented in literature. However, little is known about whether specific body mass indices can be used as cutoffs to determine which patients are most at risk for having a poor postoperative outcome. We evaluated the effects of differing levels of obesity as measured by body mass index (BMI) on implant survivorship, Knee Society scores, complications, and radiographic outcomes. A systematic review of the literature was performed to identify all studies reporting outcomes of total knee arthroplasty in obese (30 ≤ BMI < 40 kg/m2) and morbidly obese patients (40 ≤ BMI < 50 kg/m2). Twenty-four studies were identified in our literature search. At a mean 5-year follow-up, morbidly obese patients (88%) had significantly lower implant survivorship than obese patients (95%) and nonobese patients (97%). Significantly, lower postoperative mean Knee Society objective and function scores (71 and 60 points) were observed for morbidly obese patients than for nonobese patients (75 and 90 points), but obese patients did not have significantly lower Knee Society objective and function scores than nonobese patients (78 and 84 points). Complication rates for nonobese, obese, and morbidly obese patients were 9, 15, and 22%, respectively, all of which were significantly different. However, no significant difference was observed in the incidence of radiolucent lines that were 12, 19, and 14%, respectively. Thus, we conclude that a BMI greater than 40 kg/m2 may be used as a cutoff to help guide patient education and treatment options for primary total knee arthroplasty.

The effects of obesity and morbid obesity on outcomes in TKA.

Cementless total knee arthroplasty (TKA) has had limited use in the United States, however, recent reports have demonstrated promising results, but there has been no meta-analysis to examine these outcomes in the past 5 years. In this review, 37 studies (2,940 patients and 3,568 TKAs) were identified and used, comparing cementless to cemented TKA. Pooled implant survivorship was compared using a fixed-effect meta-analysis between cementless and cemented TKA, and between cementless TKA with and without screw fixation. Cementless TKA had implant survivorship comparable to cemented TKA (odds ratio, 1.1; 95% confidence interval [CI], 0.62-2.00). The mean survivorship at 10 years for cementless TKA was 95.6% compared with 95.3% for cemented TKA. At 20-year follow-up, implant survivorship decreased to 76 and 71%, respectively. No difference was observed between fixation with or without screws (OR, 1.1; 95% CI, 0.16-7.5). Implant survivorship for cementless TKA was comparable to the current gold standard cemented TKAs.

Kimona Issa

Papers

Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications

The Economic Impact of Periprosthetic Infections Following Total Knee Arthroplasty at a Specialized Tertiary-Care Center

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

The effects of obesity and morbid obesity on outcomes in TKA.

Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis.