1
|
Kent LM, Hurley ET, Davey MS, Klifto CS, Mullett H. Low complication rate following reverse total shoulder arthroplasty at 90-days follow-up - A systematic review. J ISAKOS 2024; 9:205-210. [PMID: 37979691 DOI: 10.1016/j.jisako.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
IMPORTANCE As reverse total shoulder arthroplasty (RTSA) has become an increasingly common procedure, rates of post-operative complications leading to potential hospital readmission are of greater importance. No previous systematic reviews have focused exclusively on post-operative complications and mortality rates at 90 days post RTSA. OBJECTIVES The purpose of this study was to review complication, readmission, and mortality rates within 90 days post RTSA. EVIDENCE REVIEW Two independent reviewers performed a literature search using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science databases. Only studies reporting on outcomes of RTSA at 90-days follow-up specifically were considered for inclusion. FINDINGS Our search included 79,037 shoulders (62.1 % female) from a total of 15 studies with an average age of 72.4 ± 5.8 years. The overall 90-day re-admission rates were reported in nine studies as 6.1 % (4205/69,127) following RTSA. Additionally, a total of five studies reported the overall 90-day mortality rate as 1.1 % (19/1733). The overall pooled rate of medical complications was 3.9 % (2998/77,826) as reported in 13 studies, at 90-days post-RTSA, with the occurrence of anaemia being the most commonly reported outcomes as 2.9 % (1013/34,385) in six studies. The overall rate of surgical complications was 1.1 % reported in 13 studies (1327/77,826), with the pooled rate of surgical revisions of 1.5 % (607/40,563) at 90-days follow-up. A total of 8, 5, and 3 studies reported rates of dislocation, requirement for closed reduction and glenoid loosening as 0.9 % (344/37,995), 0.6 % (7/1180), and 0.3 % (30/9115) respectively at 90-days following RTSA. CONCLUSIONS AND RELEVANCE This study established that the overall rates of mortality and medical and surgical complications are low in the short-term following RTSA, with only 6 % of patients requiring re-admission in the first 90 days. LEVEL OF EVIDENCE IV - Systematic Review of all levels of evidence.
Collapse
Affiliation(s)
- Louise M Kent
- Sports Surgery Clinic, Dublin D09 C523, Ireland; Duke University Hospital, Durham, NC 27710, USA
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin D09 C523, Ireland; Duke University Hospital, Durham, NC 27710, USA.
| | - Martin S Davey
- Sports Surgery Clinic, Dublin D09 C523, Ireland; Duke University Hospital, Durham, NC 27710, USA
| | - Christopher S Klifto
- Sports Surgery Clinic, Dublin D09 C523, Ireland; Duke University Hospital, Durham, NC 27710, USA
| | - Hannan Mullett
- Sports Surgery Clinic, Dublin D09 C523, Ireland; Duke University Hospital, Durham, NC 27710, USA
| |
Collapse
|
2
|
Ghaffari S, Fateh S, Faramarzi F, Rafiei A, Razavipour M, Zafari P. The effect of tranexamic acid on synovium of patients undergoing arthroplasty and anterior cruciate ligament reconstruction surgery. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:3733-3742. [PMID: 37318523 DOI: 10.1007/s00210-023-02555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
Preoperative hemorrhage can be reduced using anti-fibrinolytic medicine tranexamic acid (TXA). During surgical procedures, local administration is being used more and more frequently, either as an intra-articular infusion or as a perioperative rinse. Serious harm to adult soft tissues can be detrimental to the individual since they possess a weak ability for regeneration. Synovial tissues and primary fibroblast-like synoviocytes (FLS) isolated from patients were examined using TXA treatment in this investigation. FLS is obtained from rheumatoid arthritis (RA), osteoarthritis (OA), and anterior cruciate ligament (ACL)-ruptured patients. The in vitro effect of TXA on primary FLS was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assays for cell death, annexin V/propidium iodide (PI) staining for apoptotic rate, real-time PCR for p65 and MMP-3 expression, and enzyme-linked immunosorbent assay (ELISA) for IL-6 measurement. MTT assays revealed a significant decrease in cell viability in FLS of all groups of patients following treatment with 0.8-60 mg/ml of TXA within 24 h. There was a significant increase in cell apoptosis after 24 h of exposure to TXA (15 mg/ml) in all groups, especially in RA-FLS. TXA increases the expression of MMP-3 and p65 expression. There was no significant change in IL-6 production after TXA treatment. An increase in receptor activator of nuclear factor kappa-Β ligand (RANK-L) production was seen only in RA-FLS. This study demonstrates that TXA caused significant synovial tissue toxicity via the increase in cell death and elevation of inflammatory and invasive gene expression in FLS cells.
Collapse
Affiliation(s)
- Salman Ghaffari
- Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soroosh Fateh
- Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Faramarzi
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Rafiei
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Razavipour
- Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Zafari
- Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, Iran.
| |
Collapse
|
3
|
Nejat MH, Khayami A, Daliri M, Ebrahimzadeh MH, Sadeghi M, Moradi A. Does tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:795. [PMID: 37803371 PMCID: PMC10557324 DOI: 10.1186/s12891-023-06835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND/OBJECTIVE Effective hemostasis has the potential to reduce inflammation and pain, leading to potential benefits in the early rehabilitation of patients who undergo elbow arthrolysis. In the present study, we aim to assesse the effects of tranexamic acid (TXA) on elbow arthrolysis postoperative blood loss, patients' pain perception according to the visual analog scale (VAS), elbow range of motion (ROM), and complications. METHODS We systematically searched PubMed, Web of Science, SCOPUS, and Cochrane Library. We included controlled trials, either randomized (RCT) or non-randomized studies of intervention (NRSI) comparing the effects of intravenous tranexamic acid (TXA) treatment with placebo/no treatment on postoperative blood loss, pain VAS score, elbow ROM, and complications, in patients who underwent open or closed elbow arthrolysis surgery. RESULTS One RCT, and three NRSIs met eligibility criteria. The meta-analysis determined that tranexamic acid application reduced drain output 34 mm on average (WMD: -34.00; 95% CI: -49.45, -18.55). There was a discrepancy among included articles in terms of intra-operative blood loss; although the study with the largest sample size (291 and 296 patients in the case and control groups, respectively) reported reduced intra-operative blood loss in patients who received TXA. The pooled estimation for the pain VAS score on the first day post-operatively indicates a reduction in pain among patients in the TXA group (WMD: -0.82; 95% CI: -1.36, -0.28). Results for ROM, and complications' rate such as hematoma and ulnar nerve palsy were not different between the two groups. CONCLUSION TXA may be beneficial to reduce elbow arthrolysis bleeding volume. However, it dose not seem to affect final elbow ROM and patients' pain score. Further high-quality clinical trials are needed to draw a robust conclusion on this topic.
Collapse
Affiliation(s)
- Mohammad Hadi Nejat
- Orthopedics Research Center, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhosein Khayami
- Orthopedics Research Center, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad H Ebrahimzadeh
- Orthopedics Research Center, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedics Research Center, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
4
|
Takahashi R, Kajita Y, Iwahori Y, Harada Y. Tranexamic acid has no effect on postoperative pain control after arthroscopic rotator cuff repair: A prospective, double-blind, randomized controlled trial. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 33:32-35. [PMID: 37693817 PMCID: PMC10491640 DOI: 10.1016/j.asmart.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 04/11/2023] [Accepted: 08/05/2023] [Indexed: 09/12/2023] Open
Abstract
Background The purpose of this study was to compare the efficacies of tranexamic acid (TXA) versus placebo after arthroscopic rotator cuff repair (ARCR). Methods This prospective, double-blind, and randomized study was conducted in 70 patients who underwent ARCR from 2021 to 2022 at our hospital. Thirty-four shoulders were randomly assigned to the TXA group, and 36 to the control group; TXA (10 mL) and normal saline (10 mL) were administered locally after surgery and in the control group, respectively. We evaluated visual analog scale pain scores at rest, during activity, and at night and the circumference and diameter of the shoulder joint in both groups preoperatively and at 1, 2, and 3 days, and 1 week after the surgery. We compared and analyzed the results between the groups. Statistical significance was set at a p-value of <0.05. Results There was no significant difference in the visual analog scale scores at rest, during activity, and at night between the groups (p > 0.05). The circumference and diameter of the shoulder joint were not also significantly different between both groups (p > 0.05). Conclusion Local TXA administration in patients who undergo ARCR does not significantly impact postoperative pain levels and the circumference and diameter of the shoulder joint.
Collapse
Affiliation(s)
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Japan
| |
Collapse
|
5
|
Takahashi R, Kajita Y, Iwahori Y, Harada Y. Tranexamic acid administration for arthroscopic rotator cuff repair: A prospective, double-blind, randomized controlled trial. J Orthop Sci 2023; 28:328-332. [PMID: 34949506 DOI: 10.1016/j.jos.2021.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/22/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to compare the efficacy of tranexamic acid versus placebo after arthroscopic rotator cuff repair. METHODS This prospective, double-blind, and randomized study involved 66 patients who consecutively underwent arthroscopic rotator cuff repair from 2020 to 2021 at our hospital. Thirty-three shoulders each were randomly assigned to the tranexamic acid and control groups. In the former group, 1000 mg of tranexamic acid (20 mL) was administered intravenously 10 min before surgery and the same volume of normal saline (20 mL) was administered intravenously in the control group. We evaluated visual clarity; visual analog scale pain scores at rest, during activity, and at night; the circumference and diameter of the shoulder joint in the groups before and after the surgery at 1, 2, and 3 days, and 1 week; estimated perioperative blood loss; and operative time. Visual clarity was rated using a numeric rating scale from grade 1 (poor) to grade 3 (clear) every 15 min throughout the surgery. We compared and analyzed the results between the groups. Statistical significance was set at a p-value of <0.05. RESULTS Visual clarity was found to be significantly better in the tranexamic acid group, with a greater percentage of grade 3 visual clarity (75.6 ± 11.2% vs 68.1 ± 13.4%, p = 0.045). The visual analog scale scores at rest and at night in the control group were significantly lower than those in the tranexamic acid group for 1 week postoperatively (13.8 ± 14.8 vs 5 ± 9.3, p = 0.008, 36.1 ± 23.3 vs 19.3 ± 24, p = 0.012). The circumference and diameter of the shoulder joint, estimated perioperative blood loss, and operative time were not significantly different between the two groups. CONCLUSION Intravenous administration of tranexamic acid is an alternative way to improve visual clarity in arthroscopic rotator cuff repair; however, there are no other significant differences compared to the administration of placebo.
Collapse
Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan; Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan.
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Japan.
| |
Collapse
|
6
|
Kelly M, Turcotte J, Fowler MB, West M, Lashgari C, Gelfand J. Impact of tranexamic acid on clinical and hematologic outcomes following total shoulder arthroplasty. Shoulder Elbow 2022; 14:544-550. [PMID: 36199511 PMCID: PMC9527491 DOI: 10.1177/17585732211023053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/23/2021] [Accepted: 05/17/2021] [Indexed: 01/17/2023]
Abstract
Background The purpose of this study is to evaluate the impact of intravenous tranexamic acid on clinical and hematologic outcomes after total shoulder arthroplasty. Methods Retrospective review was conducted for 282 consecutive patients undergoing either anatomic shoulder arthroplasty or reverse total shoulder arthroplasty. Univariate analysis and multivariate linear regression were used to compare outcomes for patients receiving intravenous tranexamic acid with those who did not. Results Of the 282 patients included in this study, 78 patients received intravenous tranexamic acid and 204 did not. Patients who received intravenous tranexamic acid had significantly lower pre- to postoperative change in hemoglobin and hematocrit, and decreased postoperative drain output. In addition, patients receiving intravenous tranexamic acid were significantly less likely to have a postoperative hematocrit <30. There were no significant differences in length of stay, rate of 30 day hematoma, surgical site infection, deep vein thrombosis, or readmission between groups. Conclusion Intravenous tranexamic acid is associated with a significant reduction in change in hematocrit and hemoglobin and postoperative drain output after both anatomic and reverse total shoulder arthroplasty. Despite improving hematologic outcomes for these patients, tranexamic acid appears to have little impact on clinical outcomes such as length of stay and 30-day complication rates.
Collapse
|
7
|
Ek ET, Wang KK, Bohan CM, Goulding NJ, Jamieson RP. Role of Tranexamic Acid in Arthroscopic Osteocapsular Release of the Elbow for Degenerative Arthritis. Orthop J Sports Med 2022; 10:23259671221089608. [PMID: 35464902 PMCID: PMC9019345 DOI: 10.1177/23259671221089608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Minimizing intra-articular bleeding and swelling is crucial in preventing the development of stiffness around the elbow. Tranexamic acid (TXA) has been shown to be an effective adjunct in reducing perioperative bleeding after surgery. Purpose: To determine the effect of intravenous (IV) TXA on postoperative drain tube output in arthroscopic osteocapsular release of the elbow for primary degenerative arthritis. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective cohort study of 83 consecutive patients with primary degenerative elbow arthritis who underwent an arthroscopic osteocapsular release between 2015 and 2018. They organized patients into a no-TXA group (control) and a group that was given 1.0 g of IV TXA before tourniquet release. The primary outcome measure was drain tube output, and secondary outcome measures included postoperative day 1 pain levels on a visual analog scale and early range of motion at 8 weeks. Differences between groups were analyzed using 1-way analysis of variance, the Mann-Whitney U test, or the Fisher exact test. Results: There were 43 patients in the no-TXA group and 40 patients in the TXA group. Administration of IV TXA resulted in a 51% decrease in mean intra-articular bleeding for the TXA group, as measured via drain tube output (88.8 ± 80.5 mL [no-TXA] vs 43.4 ± 52.4 mL [TXA]; P = .0016). In both groups, there were significant increases in elbow arc of motion when compared with preoperative measurements. There were no between-group differences in early range of motion (129.7° ± 12.4° [no-TXA] vs 131.7° ± 9.2° [TXA]; P = .549) or postoperative pain (1.9 ± 2.2 [no-TXA] vs 1.5 ± 1.7 [TXA]; P = .89). Conclusion: In this study, IV TXA significantly reduced postoperative intra-articular bleeding in patients who underwent arthroscopic osteocapsular release of the elbow for primary degenerative arthritis. However, there were no differences in postoperative range of motion or pain between patients who received TXA and controls.
Collapse
Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Kemble K. Wang
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
8
|
Goyal N, Wilson DJ, Wysocki RW, Fernandez JJ, Cohen MS. The use of tranexamic acid in open elbow release surgery. Shoulder Elbow 2022; 14:189-193. [PMID: 35265185 PMCID: PMC8899323 DOI: 10.1177/1758573220976055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tranexamic acid (TXA) has been effective in reducing perioperative blood loss in hip, knee, and shoulder arthroplasty. Our purpose was to assess the effect of TXA on perioperative blood loss for open elbow release. METHODS Consecutive open elbow releases performed between October 2016 and March 2020 were identified. Patients were included if both anterior and posterior joint releases with a single medial approach was performed. From November 2018 onward, intravenous TXA and topical TXA infused through a deep hemovac drain were administered as part of the perioperative protocol. Drain output, intraoperative blood loss, postoperative aspiration rate, and postoperative transfusion frequency were assessed. RESULTS Fifty patients (25 TXA, 25 non-TXA) were included. Drain output was significantly lower in the TXA-treated group compared to the non-treated group (121 mL vs. 221 mL; p = 0.003). There was no significant difference in intraoperative blood loss and the incidence of postoperative aspiration between groups. None of the patients received a blood transfusion or had a documented thromboembolic event. DISCUSSION The use of tranexamic acid with open elbow release surgeries resulted in decreased drain output, with no thromboembolic events. Perioperative tranexamic acid can be a safe and effective modality in reducing perioperative blood loss for open elbow release surgery.
Collapse
Affiliation(s)
- Nitin Goyal
- Nitin Goyal, 1611 W Harrison St, Chicago, IL 60612, USA.
| | | | | | | | | |
Collapse
|
9
|
Xiang X. [Interpretation of 2020 American Academy of Orthopaedic Surgeons (AAOS) on the Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1403-1410. [PMID: 34779165 DOI: 10.7507/1002-1892.202105085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Based on peer-reviewed systematic reviews and randomized controlled trials published between January 2000 and June 2019 with regards to the management of glenohumeral joint osteoarthritis (GJO), the American Academy of Orthopaedic Surgeons (AAOS) established the clinical practice guidelines for the treatment of GJO. The guidelines provided practice recommendations including risk factors, non-surgical treatment, surgical treatment, prosthesis selection, and perioperative management for GJO. The recommendations were graded according to different evidence strength. This paper interprets the guidline in order to provide reference for domestic medical workers.
Collapse
Affiliation(s)
- Xianxiang Xiang
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| |
Collapse
|
10
|
Hartland AW, Teoh KH, Rashid MS. Clinical Effectiveness of Intraoperative Tranexamic Acid Use in Shoulder Surgery: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:3145-3154. [PMID: 33475421 PMCID: PMC8411466 DOI: 10.1177/0363546520981679] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery. PURPOSE To investigate the clinical effectiveness of TXA in all types of shoulder surgery, including open and arthroscopic procedures. To investigate the effect of TXA on bleeding and non-bleeding-related outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS A protocol for the study was designed and registered with PROSPERO (CRD42020185482). The literature search included the MEDLINE, Embase, PsycINFO, and Cochrane Library databases. All randomized controlled trials evaluating the use of TXA against placebo, in all types of shoulder surgery, were included. Assessments were undertaken for risk of bias and certainty of evidence. The primary outcome was total blood loss. Secondary outcomes included those not directly related to bleeding. Data from comparable outcomes were pooled and analyzed quantitatively or descriptively, as appropriate. RESULTS Eight randomized controlled trials were included in the systematic review, and data from 7 of these studies were pooled in the meta-analysis. Pooled analysis demonstrated a significant reduction in 2 of 3 outcomes measuring perioperative bleeding with TXA compared with controls: estimated total blood loss (mean difference, -209.66 mL; 95% CI, -389.11 to -30.21; P = .02) and postoperative blood loss as measured by drain output (mean difference, -84.8 mL; 95% CI, -140.04 to -29.56; P = .003). Hemoglobin reduction was reduced but not statistically significant (mean difference, -0.33 g/dL; 95% CI -0.69 to 0.03; P = .07). This result became significant with sensitivity analysis excluding arthroscopic procedures. CONCLUSION This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required. CLINICAL RELEVANCE TXA can be used across shoulder surgery to reduced perioperative blood loss. The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time.
Collapse
Affiliation(s)
| | - Kar H. Teoh
- Princess Alexandra Hospital, Harlow,
Essex, UK
| | - Mustafa S. Rashid
- Nuffield Department of Orthopaedics,
Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Mustafa S. Rashid, MB ChB,
MSc, PhD, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal
Sciences, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK (
)
| |
Collapse
|
11
|
Perskin CR, Littlefield CP, Wang C, Umeh U, Egol KA. The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery. JBJS Rev 2021; 9:01874474-202107000-00009. [PMID: 34270510 DOI: 10.2106/jbjs.rvw.20.00292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Tranexamic acid (TXA) is a drug used to control hemorrhage by preventing the breakdown of fibrin. » TXA is a cost-effective treatment for trauma patients across a variety of economic settings. » Concerns of TXA causing thromboembolic events (TEEs) in orthopaedic trauma patients are not supported by evidence. » TXA has been shown to reduce blood loss in hip fracture surgery.
Collapse
|
12
|
Cunningham G, Hughes J, Borner B, Mattern O, Taha ME, Smith MM, Young AA, Cass B. A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1553-1560. [PMID: 33421559 DOI: 10.1016/j.jse.2020.11.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hematoma formation and the need for blood transfusions are commonly reported complications after shoulder arthroplasty. Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to decrease perioperative blood loss. The role of TXA is still being established in shoulder arthroplasty. MATERIALS AND METHODS We conducted a double-blind randomized controlled trial comparing intravenous TXA vs. placebo in 60 patients undergoing primary anatomic or reverse shoulder arthroplasty. Of these patients, 29 received a placebo whereas 31 received a single dose of 2 g of intravenous TXA. Patient demographic characteristics, as well as drain tube output, blood loss, hematoma formation, transfusion requirement, length of hospital stay, and pain score, were recorded. Patients were followed up for 12 weeks to assess for complications. RESULTS Patients who received TXA had a lower drain tube output at all time points: 41 mL vs. 133 mL at 6 hours, 75 mL vs. 179 mL at 12 hours, and 94 mL vs. 226 mL at 24 hours (P < .001 for all). They also had a higher postoperative hemoglobin (Hb) level (12.3 g/dL vs. 11.4 g/dL, P = .009), lower change in Hb level (1.7 g/dL vs. 2.3 g/dL, P = .011), lower total Hb loss (0.078 g vs. 0.103 g, P = .042), lower blood volume loss (0.55 L vs. 0.74 L, P = .021), higher postoperative hematocrit level (36.7% vs. 34.6%, P = .020), and lower hematocrit change (5.4% vs. 7.6%, P = .022). There was no significant difference in pain score or length of hospital stay, and no patients required a transfusion. CONCLUSION A single dose of 2 g of intravenous TXA decreases blood loss and drain tube output in primary anatomic and reverse arthroplasty of the shoulder. No differences were detected in the occurrence of complications, need for transfusion, pain score, or length of hospital stay. With the mounting evidence now available, patients undergoing elective primary shoulder arthroplasty should be given intravenous TXA to decrease perioperative blood loss.
Collapse
Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland
| | - Jeffery Hughes
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Benoit Borner
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Owen Mattern
- The Orthopaedic Group, Melbourne, VIC, Australia
| | - Mohy E Taha
- Division of Orthopaedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
| | - Margaret M Smith
- Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Allan A Young
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| |
Collapse
|
13
|
Donovan RL, Varma JR, Whitehouse MR, Blom AW, Kunutsor SK. Tranexamic acid use to decrease blood loss in primary shoulder and elbow replacement: A systematic review and meta-analysis. J Orthop 2021; 24:239-247. [PMID: 33854291 PMCID: PMC8022108 DOI: 10.1016/j.jor.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/07/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Tranexamic acid (TXA) is an inexpensive antifibrinolytic agent that significantly reduces peri-operative blood loss and transfusion requirements after total hip and knee replacement. This meta-analysis demonstrates the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). METHODS We systematically searched MEDLINE, EMBASE and CENTRAL from inception to September 03, 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss. Secondary outcomes included the need for blood transfusion, and post-operative venous thromboembolic (VTE) complications. Mean differences (MD) and relative risks with 95% confidence intervals (CIs) were reported. RESULTS Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss (MD -358mL), post-operative blood loss (MD -113mL), change in haemoglobin (Hb) (MD -0.71 g/dL) and total Hb loss (MD -35.3g) when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in post-operative blood loss, change in Hb, change in Hct and length of stay. There was no significant difference in transfusion requirements or VTE complications. CONCLUSION TXA administration in safe and effective in patients undergoing primary TSR: it significantly decreases blood loss compared with placebo and is associated with shorter length of stay compared with no treatment. No significant increase in VTE complications was found. TXA administration should be routinely considered for patients undergoing TSR. Further research is needed to demonstrate the treatment effect in patients undergoing TER.
Collapse
Affiliation(s)
- Richard L. Donovan
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Jonny R. Varma
- North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB, UK
| | - Michael R. Whitehouse
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Ashley W. Blom
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Setor K. Kunutsor
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
14
|
Complications and Readmissions After Reverse and Anatomic Total Shoulder Arthroplasty With Same-day Discharge. J Am Acad Orthop Surg 2021; 29:116-122. [PMID: 32501854 DOI: 10.5435/jaaos-d-20-00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent studies have demonstrated the safety of anatomic total shoulder arthroplasty (TSA) in an outpatient setting. No clinical studies, to date, have specifically analyzed complication and readmission rates after reverse total shoulder arthroplasty (RTSA) with same-day discharge. The purpose of this study was to compare the 90-day complication and readmission rates of patients undergoing TSA and RTSA with same-day discharge. METHODS Ninety-eight consecutive patients who underwent 104 shoulder arthroplasties with same-day discharge (52 TSA and 52 RTSA) between 2016 and 2019 were analyzed. Suitability for same-day discharge was determined preoperatively using the standardized criteria. Demographic variables, operative time, 90-day readmission, and complication rates were recorded and compared between groups. Differences between the patients undergoing TSA versus RTSA were evaluated with Student t-test, Mann-Whitney test, or Chi square tests as statistically appropriate and reported as P values. RESULTS Average age in the TSA cohort was significantly lower (60.1 ± 7.4 versus 67.5 ± 7.5, respectively; P < 0.001). Total operating room time was significantly shorter in the RTSA cohort (153 ± 30.1 minutes versus 171 ± 20.9). Three minor postoperative complications (5.8%) were observed in the TSA cohort (three seromas) within the 90-day postoperative period. There were four postoperative complications (7.7%) in the RTSA cohort (two postoperative seromas, one periprosthetic fracture, and one dislocation). None of the TSA patients required readmission and 1 RTSA (periprosthetic fracture) patient required readmission within 90 days. DISCUSSION RTSA with same-day discharge is a safe option for appropriately selected patients despite significantly increased age. 90-day readmission and complication rates between outpatient TSA and RTSA are similar. DATA AVAILABILITY Yes. TRIAL REGISTRATION NUMBERS NA. LEVEL OF EVIDENCE III (case-control).
Collapse
|
15
|
Belay ES, O'Donnell J, Flamant E, Hinton Z, Klifto CS, Anakwenze O. Intravenous tranexamic acid vs. topical thrombin in total shoulder arthroplasty: a comparative study. J Shoulder Elbow Surg 2021; 30:312-316. [PMID: 32592848 DOI: 10.1016/j.jse.2020.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Blood loss and transfusions have been highlighted as a significant predictor of postoperative morbidity. Tranexamic acid (TXA) has been shown to decrease blood loss and transfusion in shoulder arthroplasty. However, the utility of topical thrombin in total shoulder arthroplasty (TSA) is unknown. The purpose of this study was to assess the utility of topical thrombin in TSA and compare the effectiveness of topical thrombin to intravenous (IV) TXA. METHODS An institutional database was used to query shoulder arthroplasty patients from January 2017 to July 2019. Patients undergoing TSA were identified with CPT (Current Procedural Terminology) code (23742). After excluding reverse shoulder arthroplasty, arthroplasty for fracture or revision, the study groups were stratified based on intervention with IV TXA, topical thrombin, or neither. Patient demographics, American Society of Anesthesiologists (ASA) class, baseline coagulopathy, preoperative and postoperative hemoglobin levels, operative time, transfusion, length of stay, and 90-day readmission for each treatment group was obtained. RESULTS A total of 283 TSA cases were included for final analysis. There was no statistically significant difference in the baseline characteristics with age, body mass index, or ASA class. The postoperative hemoglobin level (mg/dL) was higher in the group that received either IV TXA or thrombin compared with no hemostatic agents (P = .001). Calculated blood loss in TSA was significantly higher in the group without hemostatic agents, 369.8 mL (standard deviation [SD] 59.5), compared with IV TXA or topical thrombin, 344.3 mL (SD 67.1) and 342.9 mL (SD 65.6) (P = .03). Operative time was highest in the group that received no hemostatic agents, 2.3 hours (SD 0.6) (P = .01). The transfusion rate for TSA treated with IV TXA or topical thrombin was equivalent (2.2%) but significantly lower than the no intervention group (12%) (P = .01). The odds ratio for transfusion with IV TXA was 0.16 (95% confidence interval [CI] 0.07-0.40, P = .001) and for topical thrombin, 0.1 (95% CI 0.02-0.42, P = .02). CONCLUSION Topical thrombin is an effective adjunct to reduce blood loss and transfusion risk after TSA and a reasonable intraoperative alternative for TXA for patients with contraindication to IV TXA.
Collapse
Affiliation(s)
- Elshaday S Belay
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Jeffrey O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Zoe Hinton
- Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
16
|
Rojas J, Srikumaran U, McFarland EG. Inconclusive evidence for the efficacy of tranexamic acid in reducing transfusions, postoperative infection or hematoma formation after primary shoulder arthroplasty: A meta-analysis with trial sequential analysis. Shoulder Elbow 2021; 13:38-50. [PMID: 33717217 PMCID: PMC7905512 DOI: 10.1177/1758573219896794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/05/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Tranexamic acid efficacy on clinically relevant adverse outcomes in patients undergoing shoulder arthroplasty has been contradictory. The aim of this review was to analyze whether tranexamic acid administration could decrease transfusions, infection and hematoma formation in patients undergoing shoulder arthroplasty. METHODS PubMed, EMBASE, and the Cochrane Library were searched up to May 2019 for randomized controlled trials comparing tranexamic acid to placebo in shoulder arthroplasty. Random-effect models were performed to meta-analyze the evidence. Trial sequential analysis was used to calculate and to establish the conclusiveness of the evidence derived from the meta-analysis. RESULTS Four randomized controlled trials comprising 375 patients were included. Meta-analysis showed no effect of tranexamic acid on transfusion rate (RR = 0.48 (adjusted 95% CI 0.05 to 3.85)). The possible effect of tranexamic acid on hematoma formation or infection rates after shoulder arthroplasty is non-estimable with the current evidence. The sample size necessary to reliably determine if tranexamic acid decreases transfusions, infection rates and hematoma formation is not available from the current literature as determined by the trial sequential analysis. DISCUSSION While tranexamic acid has proven its efficacy in decreasing blood loss in shoulder arthroplasty, this meta-analysis of randomized controlled trials clarifies that there is currently no conclusive evidence for a positive effect of tranexamic acid upon transfusion rate, infection rates or hematoma formation in patients undergoing primary shoulder arthroplasty.
Collapse
Affiliation(s)
- Jorge Rojas
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA,Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Uma Srikumaran
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA,Edward G McFarland, Division of Shoulder and Elbow Surgery, The Johns Hopkins University, 10753 Falls Road, Pavilion II, Suite 215, Lutherville, MD 21093, USA.
| |
Collapse
|
17
|
AAOS Clinical Practice Guideline: Management of Glenohumeral Joint Osteoarthritis. J Am Acad Orthop Surg 2020; 28:790-794. [PMID: 32804699 DOI: 10.5435/jaaos-d-20-00405] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
18
|
Paynter JW, Raley JA, Kyrkos JG, Paré DW, Houston H, Crosby LA, Parada SA. Routine postoperative laboratory tests are unnecessary after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:1656-1664. [PMID: 32192880 DOI: 10.1016/j.jse.2019.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obtaining postoperative laboratory studies after primary reverse shoulder arthroplasty (RSA) is a common practice. However, justification of this practice remains unclear. This study assesses the utility of routine postoperative laboratory studies in RSA. METHODS The electronic medical records of 369 patients who underwent RSA over 10 years were retrospectively reviewed. A total of 213 patients qualified for analysis. Primary outcomes were intervention related to abnormal laboratory values, length of stay, and 90-day emergency department visits/readmissions. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory values and postoperative visits/readmissions. RESULTS Of 213 patients analyzed, 188 (88.7%) had abnormal postoperative laboratory values: 69% had an abnormal hemoglobin (Hgb) or hematocrit level, but only 12% underwent interventions. Lower preoperative Hgb was a significant predictor of receiving a transfusion. A significant association existed between abnormal postoperative electrolyte and creatinine levels with lower body mass index (BMI) and higher Charlson Comorbidity Index (CCI). Only 4 patients (1.8%) received non-transfusion related intervention. Emergency department visits were not statistically different between patients with positive or negative laboratory tests (P = .73). CONCLUSION Because 87.3% of laboratory studies did not influence patient management, we recommend against routine testing for primary RSA. This study demonstrates that the practice of obtaining routine postoperative laboratory studies is not justified. We recommend selectively obtaining a postoperative basic metabolic profile in patients with increased American Society of Anesthesiologists classification and/or CCI with a lower BMI. We also recommend selectively ordering postoperative complete blood count in patients with a lower preoperative Hgb.
Collapse
Affiliation(s)
- Jordan W Paynter
- Department of Orthopaedics, Augusta University Medical Center, Augusta, GA, USA
| | - James A Raley
- Department of Orthopaedics, Augusta University Medical Center, Augusta, GA, USA
| | - Judith G Kyrkos
- Department of Orthopaedics, Augusta University Medical Center, Augusta, GA, USA.
| | - Daniel W Paré
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Harrison Houston
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Lynn A Crosby
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Stephen A Parada
- Department of Orthopaedics, Augusta University Medical Center, Augusta, GA, USA
| |
Collapse
|
19
|
Hartland AW, Teoh KH, Rashid MS. The use of intra-operative tranexamic acid in shoulder surgery: Protocol for a systematic review and meta-analysis. Int J Surg Protoc 2020; 22:15-18. [PMID: 32671310 PMCID: PMC7338573 DOI: 10.1016/j.isjp.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Blood loss is an important consideration in all types of shoulder surgery. Excessive bleeding is associated with increased morbidity. Tranexamic acid (TXA) is an antifibrinolytic agent. It has been demonstrated to be effective in reducing blood loss across multiple surgical specialties. The aim of this systematic review and meta-analysis is to review the literature evaluating clinical outcomes associated with the use of TXA in shoulder surgery. METHODS The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Literature search will include the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Randomised controlled trials (RCTs) evaluating the use of TXA against placebo, in all types of shoulder surgery, will be included. Our primary outcome is total blood loss (ml). Secondary outcomes include patient-reported outcome measures (PROMs), adverse events, and number of blood transfusions required. Risk of bias will be assessed within each study using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Data from comparable outcomes will be pooled and analysed quantitatively or descriptively as appropriate. ETHICS AND DISSEMINATION No ethical clearances required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal. It will be presented a various national and international conferences.
Collapse
Affiliation(s)
- Alexander W. Hartland
- Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UK
| | - Kar H. Teoh
- Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UK
| | - Mustafa S. Rashid
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK
| |
Collapse
|
20
|
Effect of tranexamic acid on blood loss after reverse total shoulder arthroplasty according to the administration method: a prospective, multicenter, randomized, controlled study. J Shoulder Elbow Surg 2020; 29:1087-1095. [PMID: 32423576 DOI: 10.1016/j.jse.2020.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ideal method of administering tranexamic acid (TXA) for reverse total shoulder arthroplasty (RTSA) remains unknown. We aimed to evaluate TXA efficacy according to 3 administration methods after RTSA. METHODS Overall, 102 patients who underwent RTSA using a single implant between September 2016 and November 2018 were randomized to the following groups according to the TXA administration method: intravenous (n = 34; 1 g + 0.9% normal saline 100 mL), topical (n = 33; 2 g + 0.9% normal saline 50 mL), and combined groups (n = 34). Patients were enrolled in 4 tertial referral hospitals for prospective multicenter studies. The primary outcome was a hemoglobin decrease in 24 hours postoperatively; secondary outcomes were total drain volume, transfusion rate, and calculated total blood loss. RESULTS Demographic data, including preoperative hemoglobin levels, were not different among the 3 groups, but the average age was higher in the combined group (P = .038). Hemoglobin decrease (1.8 ± 1.1 vs. 1.8 ± 1.0 vs. 2.0 ± 1.1 g/dL, P = .769), total drain volume (209.2 ± 147.6 vs. 167.2 ± 102.0 vs. 166.0 ± 118.7, P = .270), and total blood loss (701.1 ± 352.3 vs. 656.5 ± 285.6 vs. 699.0 ± 248.7 mL, P = .810) were not significantly different among the 3 groups (all P > .05). The transfusion rate was higher in the intravenous group (n = 4), whereas only 1 patient had transfusion in the topical group and none in the combined group, although the difference was not statistically significant (P = .084). CONCLUSION Blood loss did not differ among TXA administration methods after RTSA. However, considering the risk of complication in intravenous TXA, topical TXA after RTSA may be safer, even for patients with normal risk for venous thromboembolic complication.
Collapse
|