One surgical team consisting of 2 senior orthopaedics surgeons performed all TJAs. The surgeons applied a standard posterolateral approach as previously described [10 (link)] for the patients undergoing THA, using the cementless prostheses (DePuy PINNACLE+CORAIL). For patients undergoing TKA, a standard medial parapatellar approach and a measured resection technique were used as previously described [9 (link), 11 (link)], the prosthesis was a cemented total knee system (DePuy Sigma PFC). For patients in the TXA group, TXA was administered as described before [11 (link)]. Briefly, all patients in the TXA group received intravenous TXA 5 to 10 min before the skin incision (20 mg/kg) and 3, 6, 12, and 24 h later (10 mg/kg) along with 1 g of topical TXA in 50 mL of normal saline solution. Tourniquet was used in all patients undergoing TKA. The surgeons applied the same modern perioperative pain control, clinical and rehabilitation protocols in all patients as previously described [9 (link)–11 (link)]. Considering the characteristic of haemophilia patient, only mechanical methods including compression elastic stockings and intermittent pneumatic compression were used for prophylaxis.
Pinnacle corail
Manufactured by DePuy
Sourced in United States
The PINNACLE+CORAIL is a hip replacement system designed for total hip arthroplasty. It consists of a femoral stem and acetabular cup components. The PINNACLE+CORAIL system is intended to provide stability and range of motion for patients undergoing total hip replacement surgery.
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Lab products found in correlation
4 protocols using pinnacle corail
1
Total Joint Arthroplasty Protocol for Hemophilia Patients
2
Standardized Approach to THA and TKA
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THAs were routinely performed using anterolateral approach and conventional instrumentation. A mixture of cemented (Exeter/Trident; Stryker, USA); n = 4) and uncemented (Pinnacle/Corail; DepuySynthes, USA); n = 66) prostheses were used. TKAs were routinely performed by the same surgeon using a medial parapatellar approach. A tourniquet was used for most surgeries unless the patient had vascular contraindications. Computer navigation was used in the vast majority of cases using the Stryker Articular Surface Mounted platform. Infiltration of tranexamic acid, adrenaline, and local anesthetic infiltration were used in all cases. Wound drains were not routinely used, and all patients followed a standardized clinical pathway with day 1 mobilization. An enhanced recovery protocol was not in use at our institution during this time.
3
Optimizing Day-Case Arthroplasty Protocols
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All day-case procedures were scheduled first or second on the theatre list. THA surgery was performed via a posterior approach with all cases receiving the same prosthesis combination (Corail/Pinnacle, DePuy Synthes, USA). UKA was performed using two models of prosthesis dependent on surgeon’s preference (Oxford, Biomet, UK, and ZUK, Lima Corporate, Italy). Seven consultants (UKA and THA) performed procedures on patients on the day-case pathway. The most day-case patients performed by a single surgeon was 24 and the lowest was 7.
The day-case anaesthetic protocol was devised by the anaesthetic team. The key elements are incorporated inFigure 1 (the full protocol can be found in Supplementary Material). The protocols for day-case and standard arthroplasty procedures were almost identical, with the key difference being the avoidance of opiates in the spinal.
The day-case anaesthetic protocol was devised by the anaesthetic team. The key elements are incorporated in
4
Transgluteal Approach for Total Hip Arthroplasty
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Surgery was performed using Freeman’s transgluteal approach [24 ]. In patients with a sclerotic canal, femoral preparation was done meticulously using a guidewire to locate the canal before sequential intramedullary reaming was undertaken. During the earlier period of study (1999–2004), hybrid or cemented Exeter™ (Stryker Howmedica) system was predominantly used. Uncemented JRI prosthesis was used in one patient bilaterally. In the later period, uncemented Corail-Pinnacle (Depuy), S-ROM (Depuy), or ABG (Stryker) prosthesis was used.
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