title: Embolic phenomena during computer-assisted and conventional total knee replacement.
abstract: Systemic emboli released during total knee replacement have been implicated as a cause of peri-operative morbidity and neurological dysfunction. We undertook a prospective, double-blind, randomised study to compare the cardiac embolic load sustained during computer-assisted and conventional, intramedullary-aligned, total knee replacement, as measured by transoesophageal echocardiography. There were 26 consecutive procedures performed by a single surgeon at a single hospital. The embolic load was scored using the modified Mayo grading system for echogenic emboli. Fourteen patients undergoing computer-assisted total knee replacement had a mean embolic score of 4.89 (3 to 7) and 12 undergoing conventional total knee replacement had a mean embolic score of 6.15 (4 to 8) on release of the tourniquet. Comparison of the groups using a two-tailed t-test confirmed a highly significant difference (p = 0.004). This study demonstrates that computer-assisted knee replacement results in the release of significantly fewer systemic emboli than the conventional procedure using intramedullary alignment.
authors.affiliation: Department of Orthopaedics Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. j.s.church@btinternet.com
authors.forename: J S
authors.initials: JS
authors.lastname: Church
authors.forename: J E
authors.initials: JE
authors.lastname: Scadden
authors.forename: R R
authors.initials: RR
authors.lastname: Gupta
authors.forename: C
authors.initials: C
authors.lastname: Cokis
authors.forename: K A
authors.initials: KA
authors.lastname: Williams
authors.forename: G C
authors.initials: GC
authors.lastname: Janes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome