• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.504-511
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• 2021

Purpose: This study examined the difference between the drainage volume, blood loss, transfusion rate, volume, and complications with or without an intra-articular (IA) tranexamic acid (TXA) injection among patients who underwent simultaneous bilateral total knee arthroplasty (SBTKA) with bilateral knee joint osteoarthritis, including patients who have contraindications of intravenous administration. Materials and Methods: Among patients who underwent SBTKA from April 2016 to December 2018, 139 patients injected with 3 g of TXA in each side through a drainage tube after joint capsule repair (group T), and 57 patients (group A) who underwent the procedure without TXA between October 2007 and August 2010 were tested. No significant difference in age and sex was observed between the two groups (p=0.572, 0.474). TXA was injected in patients with contraindications of intravenous administrations. Patients who underwent SBTKA with inflammatory arthritis were excluded from this study. The average amount of drainage, blood loss, transfusion rate, volume and daily average transfusion rate, and hemoglobin (Hb) change by the postoperative day were compared. Complications, such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction, cerebral infarction, and infection, were investigated. Results: The average total blood losses in groups A and T were 2195.32±1175.63 ml and 1145.09±382.95 ml, respectively, and the average total drain volume was 1,178.30±48.59 ml and 774.19±310.06 ml, respectively; both were significantly lower in group T (p=0.002, <0.001). The transfusion rates were 77.2% (44/57) and 0.7% (1/139), which were significantly lower in group T (p<0.001). The total average transfusion volume in groups A and T were 735.44±550.83 ml and 4.60±54.28 ml, respectively, which were significantly lower in group T (p<0.001). Hb tended to increase for three or four days after surgery in group A and group T. Regarding complications, deep vein thrombosis was encountered in two cases (1.4%), and pulmonary thromboembolism was noted in three cases (2.2%) in group T, but there were no cases in group A. No infections, cerebral infarction, or myocardial infarction occurred. Conclusion: In SBTKA, IA injections of TXA reduced the average drain volume, blood loss, transfusion rate, and volume significantly and did not increase the incidence of complications, even in patients with contraindications of intravenous administration.

• Journal of Life Science
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• v.31 no.4
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• pp.418-424
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• 2021

Skin inflammation (dermatitis) is caused by varying skin damage due to ultraviolet radiation and microbial infection. Currently prescribed drugs for dermatitis include anti-histamine and steroid drug classes that soothe inflammation. However, incorrect or prolonged use of steroids can cause weakening of skin barriers as well as osteoporosis. Therefore, treating dermatitis with a drug that has minimal side effects is important. Statins, also known as 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, are cholesterol-lowering drugs that have been widely treated for hyperlipidemia and cardiovascular diseases. Interestingly, recent studies have shown the anti-inflammatory effects of statins in both experimental and clinical models for of osteoarthritis. This study investigated the possible anti-inflammatory effects of atorvastatin and fluvastatin in human keratinocytes (HaCaT cells), which are crucial components of skin barriers. Stimulation of HaCaT cells with IL-1β increased the expression of the COX2 protein, a major player of inflammatory responses. However, this induction of the COX2 protein was downregulated by pretreatments with atorvastatin and fluvastatin. Treatment with IL-1ß-induced the upregulation of other inflammatory genes (such as iNOS and MMP-1) and these expressions were similarly lowered by these two statin drug treatments. Taken together, these results indicated that atorvastatin and fluvastatin can reduce IL-1β-induced inflammatory responses in HaCaT cells. In conclusion, the findings suggest that atorvastatin and fluvastatin can be potential modulators for ameliorating skin inflammation.

• Journal of the Korean Orthopaedic Association
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• v.56 no.4
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• pp.310-316
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• 2021

Purpose: Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. Materials and Methods: A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. Results: The initial white blood cell count of joint fluid was 71,472±51,667/mm³ (32,400-203,904/mm³), and polymorphic leukocytes were 91.1%±2.6% (86%-95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6-10 hours), and the irrigation period was 8.2±3.2 days (4-15 days). The average length of hospitalization was 20.8±8.7 days (9-37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. Conclusion: In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.254-260
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• 2019

Purpose: To evaluate the relationship between the knee function at 1 year postoperation and the gap difference (90° flexion gap-extension gap) in total knee replacement. Materials and Methods: Eighty-two consecutive osteoarthritis knees that underwent primary total knee replacement using navigation from March 2017 June 2017 were evaluated prospectively. The gap was measured using navigation after reducing the patella with towel clips. After checking the average values of the medial and lateral gaps at extension and 90° flexion knee, the gap difference (90° flexion gap-extension gap) was calculated. The knees were divided into three groups according to the gap difference (gap difference<0 mm, 0 mm≤gap difference<2 mm, 2 mm≤gap difference). The Knee Society score (KSS) and maximal knee flexion were compared at 1 year postoperation among three groups. Results: The numbers of knees according to groups were 37, 29, and 16 knees in regular order. The average of the KSS knee, KSS function, and maximal knee flexion at the 1-year follow-up were 81.21±8.31, 71.34±9.84, and 126.48°±7.28°, respectively. No statistically significant difference in KSS was observed among the 3 groups. The third group (2 mm≤gap difference) showed a larger maximal knee flexion than the other groups in the Mann-Whitney test. Conclusion: The group of total knee replacement (2 mm≤90° flexion gap-extension gap) showed larger maximal knee flexion than the other groups at the 1-year follow-up in statistics.