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Bloom DA, Lin CC, Manzi JE, Mojica ES, Telgheder ZL, Chapman CB, Konda SR. The Efficacy of Tranexamic Acid for the Treatment of Traumatic Hip Fractures: A Network Meta-Analysis. J Orthop Trauma 2023; 37:341-345. [PMID: 36821447 DOI: 10.1097/bot.0000000000002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To compare the efficacy of different dosages of intravenous (IV) tranexamic acid (TXA) in the treatment of traumatic hip fractures against that of the control group of no TXA. DATA SOURCES This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to perform a network meta-analysis on the use of TXA for the treatment of hip fractures. The study team used Ovid MEDLINE, Cochrane Reviews, Scopus, Embase, and Web of Science databases to perform the search. Studies that were published in English between the years 2010 and 2020 were selected. STUDY SELECTION/DATA EXTRACTION For inclusion in this study, selected articles were required to be randomized controlled trials with at least 1 control group that had no antifibrinolytic intervention to serve as a control, and IV formulations of TXA were used as part of the treatment group. Furthermore, all study participants must have undergone surgical intervention for traumatic hip fractures. Studies that did not immediately meet criteria for inclusion were saved for a review by the full investigating team and were included based on consensus. DATA SYNTHESIS All statistical analyses conducted for this study were performed using R software (R Foundation for Statistical Computing, Vienna, Austria). Network meta-analyses were conducted with a frequentist approach with a random-effects model using the netmeta package version 0.9-6 in R. The frequentist equivalent to surface under the cumulative ranking probabilities, termed " P score," was used to rank different treatments. CONCLUSION The use of TXA in the surgical management of traumatic hip fractures reduces the number of transfusions and perioperative blood loss, with minimal to no increased incidence of thrombotic events when compared with those in controls. When comparing formulations, no route of administration is clearly superior in reducing perioperative blood loss. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | | | | | | | - Cary B Chapman
- Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL; and
| | - Sanjit R Konda
- NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY
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Huang T, Zhang S, Liu X, Lv G, Huang H, Wang S, Zhao M, Xiong M, Yu W, Cheng Q, Huang T. Mid-Term Outcomes of Cemented or Uncemented Total Hip Arthroplasty for Failed Proximal Femoral Nail Antirotation Following Intertrochanteric Femur Fractures: A Retrospective Observational Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221132400. [PMID: 36238963 PMCID: PMC9551333 DOI: 10.1177/21514593221132400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The aim of this retrospective study was to assess the clinical outcomes of cemented or uncemented total hip arthroplasty (CTHA or UTHA) following prior failed proximal femoral nail antirotation (PFNA) fixation in patients with intertrochanteric femur fractures (IFFs). Materials and methods Data from 244 patients with IFFs who experienced a conversion of PFNA to CTHA (n = 120) or to UTHA (n = 124) due to screw cut-out, mal/nonunion, or osteonecrosis during 2008-2018 were retrospectively analyzed. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary outcome was the incidence of orthopedic complications; the secondary outcome was the Harris hip score (HHS). Results The median follow-up was 60 months (range, 50-67 months). The incidences of orthopedic complications were 10% in the PFNA to CTHA group and 19.3% in the PFNA to UTHA group (P = .040). Significant differences were also observed regarding the incidence of prosthesis revision (1.7% for PFNA to CTHA vs 7.2% for PFNA to UTHA, P = .036). From the three years after conversion surgery to the final follow-up, significant differences were detected in HHS between groups (each P < .05). At the final follow-up, a statistically significant difference was detected in the HHS (79.54±18.85 for PFNA to CTHA vs. 75.26±18.27 for PFNA to UTHA, P = .014). Conclusion The results of the study may demonstrate a significant statistical advantage with respect to the orthopedic complication rate and HHS in favor of CTHA compared to UTHA in patients with failed PFNA.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Wuhan
Third Hospital, Tongren
Hospital of Wuhan University, Wuhan,
China
| | - Shi Zhang
- Department of Anesthesiology,
Renmin
Hospital of Wuhan University, Wuhan,
China
| | - Xinhang Liu
- Department of Anesthesiology, East
Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gang Lv
- Department of Anesthesiology,
Renmin
Hospital of Wuhan University, Wuhan,
China
| | - Heng Huang
- Department of Anesthesiology, Wuhan
Fourth Hospital, Puai Hospital, Tongji Medical College,
Huazhong
University of Science and Technology,
Wuhan, China
| | - Shuxin Wang
- Department of Orthopaedics, The
First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan
Hospital, Fudan
University, Shanghai, China
| | - Min Xiong
- Department of Orthopaedics, Jinshan
Hospital, Fudan
University, Shanghai, China
| | - Weiguang Yu
- Department of Orthopaedics, The
First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
| | - Qiuxia Cheng
- Department of Obstetrics,
Renmin
Hospital of Wuhan University, Wuhan,
China,Qiuxia Cheng, Department of Obstetrics,
Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District,
Wuhan, Hubei, 430060, China.
| | - Ting Huang
- Department of Anesthesiology, East
Hospital, Renmin Hospital of Wuhan University, Wuhan, China,Ting Huang, Department of
Anesthesiology, Renmin Hospital of Wuhan University, No. 238, Jiefang Road,
Wuchang District, Wuhan, Hubei, 430060, China.
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3
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Mao S, Chen B, Zhu Y, Qian L, Lin J, Zhang X, Yu W, Han G. Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up. J Orthop Surg Res 2020; 15:447. [PMID: 32998756 PMCID: PMC7528391 DOI: 10.1186/s13018-020-01980-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/23/2020] [Indexed: 11/14/2022] Open
Abstract
Background Cemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population. Methods Using our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007–2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications. Results The mean follow-up time was 62.5 months (range, 50.1–76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4–8.2] for CTR vs 16.9% [95% CI, 14.7–17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3–10.7] for CTR vs 19.9% [95% CI, 18.2–20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4–6.7] for CTR vs 13.2% [95% CI, 12.1–13.8] for UTR, p = 0.026, respectively). Conclusion CTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.
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Affiliation(s)
- Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Baomin Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Ying Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Liang Qian
- Department of Anesthesiology, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628, Zhenyuan Road, Guangming New District, Shenzhen, 518107, China
| | - Jinluan Lin
- Department of Orthopaedics, The Affiliated Hospital of Fujian Medical University, Chazhong Road No. 20, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Xinchao Zhang
- Department of Orthopedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China.
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Guowei Han
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Levent A, Köse Ö, Linke P, Gehrke T, Çıtak M. Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah's Witness patients? Jt Dis Relat Surg 2020; 31:419-425. [PMID: 32962570 PMCID: PMC7607954 DOI: 10.5606/ehc.2020.76244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study aims to investigate the use of multiple blood management strategies and the effect of tourniquet on the estimated blood loss (EBL) in Jehovah's Witness (JW) patients who underwent primary total knee arthroplasty (TKA). PATIENTS AND METHODS Twenty-two self-reported JW patients (9 males, 13 females; mean age 66.8±8.6 years; range, 51 to 83 years) who underwent primary TKA between January 2014 and January 2020 in our institution were retrospectively reviewed. A standard blood management protocol that consisted of hypotensive anesthesia, local and systemic administration of tranexamic acid (TXA) and intraoperative cell salvage was applied to all patients. Patients were divided into two groups: with (n=11) and without (n=11) tourniquet use. The EBL was calculated according to Meunier's formula. Hemoglobin (Hgb), hematocrit (Hct), and EBL on the first and third postoperative days were compared statistically. RESULTS There was no significant difference between groups regarding postoperative Hgb (p=0.801 and p=0.767), Hct (p=0.617 and p=0.895), Hgb decline (p=0.311 and p=0.822), and EBL (p=0.067 and p=0.284) at first and third postoperative days. None of the patients required blood transfusion. No wound complication or symptomatic deep vein thrombosis was seen during the hospital stay. CONCLUSION Combined use of hypotensive anesthesia, intravenous administration of TXA, intraoperative periarticular injection, and cell salvage seem to be sufficient in controlling the blood loss in JW patients during TKA. Additional tourniquet use may not further decrease the EBL.
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Affiliation(s)
- Ali Levent
- Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767 Hamburg, Germany.
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Nunes NG, Oliveira JAA, Bezerra FMP, Nascimento VDD, Dumaresq DMH, Patrocinio MCA. Is Intraoperative Blood Cell Salvage Effective in Hip Surgery? Rev Bras Ortop 2019; 54:377-381. [PMID: 31435101 PMCID: PMC6702029 DOI: 10.1055/s-0039-1693054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Objective
The present study aims to evaluate the efficacy of blood cell salvage (CS) as a method of reducing allogeneic blood transfusion in patients submitted to transtrochanteric femoral and hip surgeries due to injury.
Methods
Prospective cohort of 38 patients from a school hospital submitted to hip or trochanteric surgeries and divided into two groups from August 2015 to February 2017. Patients with any malignancy or infectious condition were excluded from the study. Cell savage group (19 patients) received autologous blood using cell saver, whereas control group (19 patients) received just allogeneic blood, if needed. Red blood cell parameters, blood transfusion requirements, and clinical and surgical characteristics, such as age, gender, ASA scale and type of surgery, were compared both preoperatively and postoperatively. Data was processed in SPSS 20.0.
Results
There were no differences in the clinical parameters studied (age, gender and ASA scale). Red blood cell parameters on the first day postoperative were higher in the cell savage group (
p
< 0.05). No significant reduction of intraoperative and postoperative allogeneic blood transfusion requirements was found.
Conclusion
This study found that CS was not effective in reducing intraoperative and postoperative allogeneic blood transfusion requirements in patients submitted to transtrochanteric femoral and hip surgery.
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Affiliation(s)
- Nara Granja Nunes
- Serviço de Anestesiologia, Instituto Dr. José Frota, Fortaleza, CE, Brasil
| | - José Alberto Alves Oliveira
- Serviço de Ortopedia e Traumatologia, Hospital Infantil Albert Sabin, Hospital Geral de Fortaleza, Fortaleza, CE, Brasil
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Gulabi D, Yuce Y, Erkal KH, Saglam N, Camur S. The combined administration of systemic and topical tranexamic acid for total hip arthroplasty: Is it better than systemic? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:297-300. [PMID: 30954338 PMCID: PMC6739252 DOI: 10.1016/j.aott.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/10/2019] [Accepted: 03/03/2019] [Indexed: 11/20/2022]
Abstract
OBECTIVE The aim of this study was to evaluate the effect of combined intravenous and topical use of tranexamic acid (TXA) on total blood loss and transfusion rate in total hip arthroplasty. METHODS This prospective randomized study included 57 patients who had undergone total hip arthroplasty between September 2016 and September 2017. The IV administration group (Group 1) consisted of 26 patients (mean age: 63.73 ± 10.29 years), while the IV and topical administiration group (Group 2) consisted of 22 patients (62.82 ± 8.31 years). Demographic data and outcomes were obtained through a review of individual medical records. Medical comorbidities, body mass index (BMI), ASA and CCI, preoperative and postoperative hemoglobin levels, postoperative transfusion records and 90-day joint-related (implant subsidence, dislocation, postoperative anemia, deep infection, hematoma and/or wound problem, postoperative periprosthetic fracture) readmission rate and complication rate were compared between the groups. RESULTS No significant differences were observed between the 2 groups in terms of age, gender, height, weight, body mass index (BMI), the level of preoperative Hb values, and the American Society of Anesthesiologists (ASA) and Charleson Comorbidty Index (CCI) rating (p > 0.05). The mean postoperative Hgb in the group 2 was higher by a small amount compared to the group 1. No statistically significant difference was determined between the groups in respect of the Hgb values (p = 0.562). Hgb Delta in the group 2 was lower than that of the group 1. The difference between the groups in the Hgb Delta values was not statistically significant (p = 0.268). The mean total blood loss was lower in the group 2 than in the group 1 but the difference was not statistically significant (p = 0.788). There was no significant difference observed in terms of any adverse complications among the 2 groups (p > 0.05). CONCLUSION The combined administration of IV and topical TXA compared with IV alone can decrease total blood loss and the number of blood transfusions required without increasing the risk of DVT or/and PE in total hip arthroplasty. But the statistical analysis and clinical relevance is not significant. LEVEL OF EVIDENCE Level I Therapeutic Study.
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Affiliation(s)
- Deniz Gulabi
- Bahcesehir University, Faculty of Medicine, Orthopaedic and Traumatology Department, İstanbul, Turkey.
| | - Yucel Yuce
- Saglik Bilimleri University, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
| | - Kutlu Hakan Erkal
- Saglik Bilimleri University, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
| | - Necdet Saglam
- Saglik Bilimleri University, Umraniy Training and Research Hospital, Istanbul, Turkey.
| | - Savas Camur
- Saglik Bilimleri University, Umraniy Training and Research Hospital, Istanbul, Turkey.
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Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 43:2025-2030. [DOI: 10.1007/s00264-018-4137-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
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The Reinfusion of Autogenous Shed Blood After Unilateral Total Knee Arthroplasty Using the Perioperative Autologous Transfusion System OrthoPAT. Am J Ther 2015; 23:e1623-e1629. [PMID: 26291592 DOI: 10.1097/mjt.0000000000000308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aims to explore the use of postoperative autogenous shed blood reinfusion using Orthopedic Perioperative Autotransfusion System (OrthoPAT) system in treating patients undergoing unilateral total knee arthroplasty (TKA). Fifty patients undergoing unilateral TKA were enrolled as the experimental group A and were treated with reinfusion of autologous shed blood within 6 hours after unilateral TKA using OrthoPAT. Accordingly, 50 patients undergoing unilateral TKA were selected as the experimental group B and were treated with allogeneic blood transfusion. Different indexes were observed at different times. Patients in both groups had relatively stable hemodynamics, and there was no postoperative coagulopathy. Prothrombin time, thrombin time, and activated partial thromboplastin time were lower, and fibrinogen was higher in group A than that in group B 24 hours after surgery (all P < 0.05). White blood cell, red blood cell, hemoglobin, hematocrit (Hct), and platelet count levels in group A were lower than those in group B 12 hours after surgery (all P < 0.05). The postoperative complications of the 2 groups have significant difference (P < 0.05). Postoperative autogenous shed blood reinfusion using OrthoPAT system in the treatment of patients undergoing unilateral TKA may improve the coagulation function of patients and reduce the rejection caused by standard allogeneic blood transfusion.
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Wei W, Wei B. Comparison of topical and intravenous tranexamic acid on blood loss and transfusion rates in total hip arthroplasty. J Arthroplasty 2014; 29:2113-6. [PMID: 25155138 DOI: 10.1016/j.arth.2014.07.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/15/2014] [Accepted: 07/20/2014] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to determine whether topical tranexamic acid (TXA) carried similar hemostatic effect compared with intravenous TXA in total hip arthroplasty (THA). Three hundred and three THA patients were enrolled and randomized into 3 groups: no TXA group, topical and intravenous TXA group. The results showed that the topical and intravenous TXA group had reduced but similar blood transfusion rates (5.88% v. s. 5.94%, P = 0.816). No significant difference was detected in total blood loss between the two TXA groups [(963.4 ± 421.3) ml vs. (958.5 ± 422) ml P = 0.733]. We conclude that topical use of TXA was equally effective and safe compared with intravenous TXA in reducing blood loss and transfusion rate following THA without substantial complications.
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Affiliation(s)
- Wei Wei
- Department of Orthopaedic, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Biaofang Wei
- Department of Orthopaedic, Linyi People's Hospital, Linyi, Shandong, China
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