Abstract
Introduction
Blood loss after TKA varied, but not uncommon with up to 1500 ml or a decrease in hemoglobin of 3–4 g/dL. In addition to improving prosthetic alignment, computer-assisted TKAs also contribute to reduced operative blood loss and systemic emboli. These observations imply that navigation TKAs may cause less microvascular endothelial damage than conventional TKAs. Cell adhesion molecules (CAMs) have been employed as markers for endothelial or vascular damage. We hypothesized serum levels of CAMs in patients receiving navigation TKAs may be different from those receiving conventional TKAs.
Material and Methods
A prospective comparative study, enrolling 87 patients with osteoarthritic knees was conducted. There were 54 navigation TKAs and 33 conventional TKAs. Levels of cell adhesion molecules (CAM) in sera and hemovac drainage were measured by ELISA before and 24 hours after the surgery. Hb and Ht were checked pre- and post-operatively. The blood loss was calculated though the formula by Nadler and Sehat et al.
Results
There were no significant differences in gender, affected side, age or BMI between the two group. The calculated volume of blood loss in the computer navigation group was 955 (772, 1164)mL, significantly lower (p=0.001) than the 1265 (963, 1475)mL in the conventional group. The baseline serum CAMs did not differ before surgery. Postoperative serum ICAM-1, VCAM-1 and PECAM-1 levels in the navigation group were 35.5% (p<0.001), 2.0% (p=0.037) and 49.3% (p<0.001) lower, respectively, than those in the conventional group.
Discussion
Complications secondary to bone marrow violation are significant concerns after TKA. We provided novel evidence that patients had decreased blood loss concomitant with mitigated postoperative elevation of levels of CAMs after navigation TKA, which is indicative of its less-invasive nature with regard to the integrity of femoral medullary cavity.
