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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 4, 481-485.
doi: 10.1302/0301-620X.89B4.18470  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Embolic phenomena during computer-assisted and conventional total knee replacement

J. S. Church, BSc, FRCS(Orth), Locum Consultant Orthopaedic Surgeon1; J. E. Scadden, FRCS(Orth), Consultant Orthopaedic Surgeon2; R. R. Gupta, FRCS(Orth), Consultant Orthopaedic Surgeon3; C. Cokis, FANZCA, Consultant Anaesthetist4; K. A. Williams, FANZCA, Consultant Anaesthetist5; and G. C. Janes, FRACS(Orth), Consultant Orthopaedic Surgeon6

1 Department of Orthopaedics Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
2 St. Mary’s Hospital, Newport, Isle of Wight PO30 5TG, UK.
3 St. Peter’s Hospital, Chertsey, Surrey KT16 0PZ, UK.
4 Hollywood Hospital, Monash Avenue, Perth 6009, Western Australia.
5 Mount Hospital, 146 Mounts Bay Road, Perth 6000, Western Australia.
6 Perth Orthopaedic & Sports Medicine Centre, 31 Outram Street, West Perth 6005, Western Australia.

Correspondence should be sent to Mr J. S. Church; e-mail: j.s.church{at}btinternet.com

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.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General