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Scientific Articles   |    
Prevalence of Fat Embolism After Total Knee Arthroplasty Performed with or without Computer Navigation
Young-Hoo Kim, MD1; Jun-Shik Kim, MD1; Ki-Sook Hong, MD1; Youn-Jin Kim, MD1; Jong-Hak Kim, MD1
1 The Joint Replacement Center of Korea (Y.-H.K. and J.-S.K.), Departments of Clinical Pathology (K.-S.H.) and Anesthesiology (Y.-J.K. and J.-H.K.), Ewha Womans University DongDaMun Hospital, 70, ChogRo 6-Ga, ChongRo-Gu, Seoul, South Korea. E-mail address for Y.-H. Kim: younghookim@ewha.ac.kr
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, Seoul, South Korea

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jan 01;90(1):123-128. doi: 10.2106/JBJS.G.00176
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Abstract

Background: Total knee arthroplasty performed with computer-assisted navigation without breaching of the femoral medullary canal may decrease the prevalence of fat and/or bone-marrow-cell embolization. We performed this study to determine whether the use of navigation for primary total knee arthroplasty resulted in a different prevalence of fat and/or bone-marrow-cell embolization.

Methods: We enrolled 160 patients (210 knees) who were scheduled to undergo primary total knee arthroplasty with navigation and 160 patients (210 knees) who were scheduled to undergo primary total knee arthroplasty without navigation. Arterial and right atrial blood samples were obtained before insertion of a femoral alignment rod or cutting of the distal part of the femur (baseline); at one, three, five, and ten minutes after insertion of an alignment rod or cutting of the distal part of the femur; before insertion of a tibial component broach (baseline); at one, three, five, and ten minutes after insertion of a tibial component broach; and at twenty-four and forty-eight hours after the operation. We determined the presence of fat emboli and bone-marrow-cell emboli in histologic preparations of the blood samples.

Results: The prevalence of fat embolization was 49% (102 of 210 knees) in the total knee arthroplasty group managed with navigation and 52% (109 of 210 knees) in the total knee arthroplasty group managed without navigation (p = 0.2674). The prevalence of bone-marrow-cell embolization was 17% (thirty-six of 210 knees) in the group managed with navigation and 15% (thirty-one of 210 knees) in the group managed without navigation (p = 0.2591)

Conclusions: The prevalence of fat and/or bone-marrow-cell embolization was not significantly different between the patients who underwent total knee arthroplasty with navigation and those who underwent it without navigation.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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