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Farhan-Alanie OM, Kennedy JW, Meek RMD, Haddad FS. Is it time to reconsider the use of hydrogen peroxide in hip and knee arthroplasty? Bone Joint J 2023; 105-B:97-98. [PMID: 36722068 DOI: 10.1302/0301-620x.105b2.bjj-2022-1090.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - R M D Meek
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK.,The Bone and Joint Journal, London, UK
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2
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Bailey D, Rizk EB. Origin and Use of Hydrogen Peroxide in Neurosurgery. Neurosurgery 2021; 89:E3-E7. [PMID: 33887767 DOI: 10.1093/neuros/nyab107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/30/2021] [Indexed: 01/19/2023] Open
Abstract
Hydrogen peroxide (H2O2) is a chemical with a wide range of applications. This includes its use in the medical field, in which its use has been ubiquitous but is most useful as an antiseptic and in achieving hemostasis. Neurosurgeons have been using H2O2 for well over a century, primarily for its hemostatic and antiseptic effects. This is in spite of the fact that the actual effectiveness of H2O2 as an antiseptic is questionable, and its use, in general, may be more dangerous than it appears. We review the application of H2O2 in medicine generally and, more specifically, in neurosurgery. This review outlines the reasoning behind the use of H2O2 as an antiseptic and details why it may not be as effective as one might think. We also detail its use as a hemostatic agent in neurosurgery, reviewing a number of techniques in which it has been useful in this role. Finally, we review the documented cases of complications associated with the use of H2O2 in neurosurgery. Ultimately, we conclude that the use of H2O2 in neurosurgery be reconsidered because of its lack of effectiveness as an antiseptic and potentially fatal complications.
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Affiliation(s)
- David Bailey
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Elias B Rizk
- Penn State Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Chan MM, Tse TST, Wan YCS, Wah Hung Y, Fan JCH. A rare and uncommon complication after use of hydrogen peroxide (H 2O 2): A review of use of H 2O 2 in orthopaedics. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720925089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hydrogen peroxide (H2O2) is a commonly used chemical agent in orthopaedic practice for antisepsis, haemostasis and preparation of bone bed for cementation. However, the associated risks of H2O2 usage are not widely known. We report a case of suspected air embolism after use of H2O2 during drainage of a septic arthritis of the shoulder. Upon our literature review, we were able to demonstrate H2O2 to be beneficial in antisepsis and care of chronic wounds. However, it has not been proven to be superior to other antiseptics commonly used in orthopaedic surgery. Regarding its use in cementation, there is evidence to show it is more effective than saline however, the use of pulsatile lavage appears to be the most important factor affecting the quality of cementation. H2O2 has not been shown to be helpful with haemostasis. Prior to the use of H2O2, one should be cautious and understand its associated risks and precautions.
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Affiliation(s)
| | - Tao Sun Tycus Tse
- Department or Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Yik-Cheung Samuel Wan
- Department or Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Yuk Wah Hung
- Department or Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Jason CH Fan
- Department or Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
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Chen H, Yang JS, Zou P, Zhao YT, Liu TJ, Tian Y, Ding KY, Liu P, Zhang JN, Hao DJ. Safety and Efficacy of Hydrogen Peroxide in Controlling Blood Loss and Surgical Site Infection After Multisegmental Lumbar Spine Surgery: A Retrospective, Case-Controlled Study. World Neurosurg 2020; 133:e303-e307. [DOI: 10.1016/j.wneu.2019.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
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5
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Xu X, Jiang J, Liu W, Li X, Lu H. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res 2019; 14:430. [PMID: 31829245 PMCID: PMC6907225 DOI: 10.1186/s13018-019-1497-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background Tranexamic acid (TXA) is widely used to reduce blood loss and transfusion rates in total hip arthroplasty(THA). Thromboelastography, which can monitor coagulation changes from clotting to fibrinolysis dynamically. In this study, thromboelastography was used to assess the dynamic changes in the coagulation of patients who underwent THA with the administration of TXA. Methods This randomized controlled trial consisted of 207 consecutive patients who underwent primary total hip arthroplasty. Patients were randomized into three groups: topical-TXA group received a topical application of TXA, IV-TXA group received an intravenous injection of TXA, and control group. Thromboelastography was performed 1 day before surgery and first, fourth, seventh days after surgery. The primary outcomes were thromboelastography parameters, the rates of deep vein thrombosis(DVT), and pulmonary embolism(PE). Secondary outcomes included perioperative blood loss, transfusion rates, and other perioperative complications. Results The mean calculated total blood loss in the Topical-TXA group were 832.7 ± 279.84 ml and 834.8 ± 322.94 ml in the IV-TXA group, which were significantly reduced (p < 0.05) compared with control groups at 1093.3 ± 379.7 ml. There were no significant differences between topical-TXA and IV-TXA groups in total blood loss or transfusion rates. K and R have reached a nadir from preoperative levels to 4th day postoperatively and then began to increase.α angle and CI peaked from preoperative levels to the fourth day postoperatively and then began to decline.IV-TXA significantly (p < 0.05) promoted coagulation levels compared with topical-TXA and control groups in the early postoperative period. Almost no significant differences were observed between topical-TXA and control groups in thromboelastography parameters.No significant differences were observed in the incidence of thromboembolic complications and other perioperative complications. Conclusions The topical administration of TXA had the same hemostatic effect as intravenous injection tranexamic acid. Coagulation function peaked on 4th day postoperatively and then began to decline. IV-TXA was more enhanced coagulation functions compared with topical-TXA.
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Affiliation(s)
- Xingming Xu
- Department of Orthopaedic, The Fifth Affiliated Hospital Of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong, China.,Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Wei Liu
- Department of Orthopaedic, The Fifth Affiliated Hospital Of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong, China.,Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Xiaofeng Li
- Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Huading Lu
- Department of Orthopaedic, The Fifth Affiliated Hospital Of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong, China.
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Qiu M, Zhang X, Cai H, Xu Z, Lin H. The impact of hemocoagulase for improvement of coagulation and reduction of bleeding in fracture-related hip hemiarthroplasty geriatric patients: A prospective, single-blinded, randomized, controlled study. Injury 2017; 48:914-919. [PMID: 28238301 DOI: 10.1016/j.injury.2016.11.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/27/2016] [Accepted: 11/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Uncontrolled bleeding is associated with poor outcomes and mortality in geriatric patients undergoing hemiarthroplasty. Hemocoagulase agkistrodon is a hemocoagulative, anti-hemorrhagic enzyme complex from Deinagkistrodon acutus snake venom. This study aimed to investigate the efficacy of hemocoagulase agkistrodon on coagulation and bleeding outcomes in fracture-related hemiarthroplasty. PATIENTS AND METHODS This was a prospective, single-blinded, randomized controlled trial carried out between October 2013 and September 2014 in 96 geriatric patients undergoing hemiarthroplasty for unilateral femoral neck fracture. Patients were administrated hemocoagulase agkistrodon (n=48) or normal saline (n=48). Intraoperative blood loss, transfusion volume and rate, and drainage were assessed. Hemoglobin (Hb) and coagulation parameters (prothrombin time [PT], thrombin time [TT], plasma fibrinogen [FIB], and activated partial thromboplastin time [aPTT]) were recorded preoperatively and 30min and 1, 3, and 5days after surgery. Complications were followed up for 4 weeks. RESULTS Compared to controls, hemocoagulase patients exhibited lower intraoperative blood loss (P<0.01) and postoperative blood loss, total drainage, mean transfusion volume, and transfusion rates (all P<0.05), with lower aPTT at 30min (P<0.05). No significant differences in postoperative FIB were observed. Controls exhibited significantly higher PP and TT on day 1, and Hb on days 1, 3, and 5 (P<0.05). No serious complications were reported. CONCLUSIONS Hemocoagulase reduced blood loss and transfusion in fracture-related hip hemiarthroplasty without increasing short-term adverse event rates. In geriatric populations, hemocoagulase could be used for limiting bleeding and related complications. TRIAL REGISTRATION This trial is registered in the Chinese Clinical Trial Register (no. ChiCTR-TRC-14004379).
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Affiliation(s)
- Meiguang Qiu
- Department of Surgery, Fujian Provincial Hospital Emergency Center; Provincial Clinical College of Fujian Medical University; Fujian Provincial Emergency Medicine Institute, Fuzhou, China
| | - Xuming Zhang
- Department of Surgery, Fujian Provincial Hospital Emergency Center; Provincial Clinical College of Fujian Medical University; Fujian Provincial Emergency Medicine Institute, Fuzhou, China.
| | - Hongru Cai
- Department of Surgery, Fujian Provincial Hospital Emergency Center; Provincial Clinical College of Fujian Medical University; Fujian Provincial Emergency Medicine Institute, Fuzhou, China
| | - Zhixian Xu
- Department of Surgery, Fujian Provincial Hospital Emergency Center; Provincial Clinical College of Fujian Medical University; Fujian Provincial Emergency Medicine Institute, Fuzhou, China
| | - Hao Lin
- Department of Surgery, Fujian Provincial Hospital Emergency Center; Provincial Clinical College of Fujian Medical University; Fujian Provincial Emergency Medicine Institute, Fuzhou, China
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Ugbeye ME, Lawal WO, Ayodabo OJ, Adadevoh IP, Akpan IJ, Nwose U. An Evaluation of Intra- and Post-operative Blood Loss in Total Hip Arthroplasty at the National Orthopaedic Hospital, Lagos. Niger J Surg 2017; 23:42-46. [PMID: 28584511 PMCID: PMC5441215 DOI: 10.4103/1117-6806.205750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss. Patients and Methods: A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated. Results: The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P < 0.001 and r = 0.517, P < 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively). Conclusion: Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time.
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Affiliation(s)
- Michael Ebiyon Ugbeye
- Department of Orthopaedic and Trauma Surgery, Division of Arthroplasty, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
| | - Wakeel Olaide Lawal
- Department of Orthopaedic and Trauma Surgery, Division of Arthroplasty, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
| | - Olusegun John Ayodabo
- Department of Orthopaedic and Trauma Surgery, Division of Arthroplasty, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
| | - Ine Prattson Adadevoh
- Department of Orthopaedic and Trauma Surgery, Division of Arthroplasty, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
| | - Imeh James Akpan
- Department of Orthopaedic and Trauma Surgery, Division of Arthroplasty, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
| | - Uche Nwose
- Department of Orthopaedic and Trauma Surgery, Division of Arthroplasty, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
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Husodo K, Kamal AF, Yusuf AA. Effect of povidone iodine and hydrogen peroxide on fracture healing: a histomorphometric study on rats. J Orthop Surg (Hong Kong) 2016; 24:245-9. [PMID: 27574271 DOI: 10.1177/1602400224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate the effect of povidone iodine and hydrogen peroxide on fracture healing in a rat model. METHODS The middle section of the right femur of 36 male Sprague Dawley rats was osteotomised with a saw. In the control group (n=9), the wound was irrigated with 100 ml 0.9% saline. In the 10% povidone iodine (n=9), 1% povidone iodine (n=9), and 3% hydrogen peroxide (n=9) groups, the wound was completely soaked with the respective solution for 2 minutes, and then irrigated with 100 ml saline. The osteotomy was fixed with an intramedullary Kirschner wire. Rats were euthanised at week 1, 2, and 5. In each femur, the percentage area of osseous, cartilaginous, and fibrous tissue in the callus was evaluated in 3 slides (one median and 2 paramedian). RESULTS The control group differed significantly to the other 3 groups (p=0.023 to p<0.001) in weeks 1, 2, and 5, except for the 1% povidone iodine group in terms of percentage of osseous (p=0.349) and fibrous (p=0.999) tissue. The healing process was similar in the 1% povidone iodine group and the control group, whereas healing was impaired in the 10% povidone iodine group and 3% hydrogen peroxide group, as indicated by the lower percentage of osseous tissue, higher percentage of fibrous tissue, and increased percentage of cartilaginous tissue between weeks 2 and 5 (delayed bone healing). CONCLUSION The 1% povidone iodine solution is recommended as the irrigation adjuvant in fracture surgery.
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Affiliation(s)
- K Husodo
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - A F Kamal
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - A A Yusuf
- Department of Histology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res 2015; 8:48-53. [PMID: 25886103 PMCID: PMC4173581 DOI: 10.4103/0259-1162.128908] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: This study was performed to test the effectiveness of topical tranexamic acid (TXA) in reducing blood loss in pelvic hemiarthoplasty surgeries compared with intravenous TXA, regarding the incidence of thromboembolic complications (deep vein thrombosis [DVT], pulmonary embolism (PE) and cerebrovascular stroke [CVS]). Patients and Methods: After obtaining institutional ethical approval 60 patients divided into three groups. Group A: Received intravenous TXA Group B: Received topical TXA Group C: Control group (placebo saline). All patients were received general anesthesia and post-operative bleeding, immediate and 24 h post-operatively, hemoglobin concentration, hematocrit, platelets and coagulation profile (prothrombin time, activated partial thromboplastin time and international normalized ratio) baseline, immediate and 24 h post-operatively. Thromboelastography was recorded baseline, immediate and 24 h post-operatively. Incidence of DVT, PE and CVS was recorded. Results: There was statistical significant elevation hemoglobin concentration and hematocrit in both Groups A and B, significant increase in blood loss in Group C, significant increase in number of patients receiving blood in Group C, there was a significant decrease in “r” and “k” times and a significant increase in maximum amplitude and α-angle in Group A, statistically significant increase in the incidence of thromboembolic events in the form of DVT, PE and CVS in Group A. Conclusion: Topical TXA is effective in decreasing post-operative blood loss with possible side-effects of this route of administration.
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Affiliation(s)
- Walid Mohamed Emara
- Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Khaled K Moez
- Department of Anesthesia, National Cancer Institute, Cairo University, Giza, Egypt
| | - Abeer H Elkhouly
- Department of Anesthesia, National Cancer Institute, Cairo University, Giza, Egypt
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10
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Darmanis SN, Hubble MJW, Howell JR, Whitehouse SL, Timperley AJ. Benefits of using modern cementing techniques in the acetabulum: the Rim Cutter. J Orthop Surg (Hong Kong) 2012; 20:316-21. [PMID: 23255637 DOI: 10.1177/230949901202000310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To compare radiological records of 90 consecutive patients who underwent cemented total hip arthroplasty (THA) with or without use of the Rim Cutter to prepare the acetabulum. METHODS The acetabulum of 45 patients was prepared using the Rim Cutter, whereas the device was not used in the other 45 patients. Postoperative radiographs were evaluated using a digital templating system to measure (1) the positions of the operated hips with respect to the normal, contralateral hips (the centre of rotation of the socket, the height of the centre of rotation from the teardrop, and lateralisation of the centre of rotation from the teardrop) and (2) the uniformity and width of the cement mantle in the 3 DeLee Charnley acetabular zones, and the number of radiolucencies in these zones. RESULTS The study group showed improved radiological parameters and were closer to the anatomic centre of rotation both vertically (1.5 vs. 3.7 mm, p<0.001) and horizontally (1.8 vs. 4.4 mm, p<0.001) and had consistently thicker and more uniform cement mantles (p<0.001). There were 2 radiolucent lines in the control group but none in the study group. CONCLUSION The Rim Cutter resulted in more accurate placement of the centre of rotation of a cemented prosthetic socket, and produced a thicker, more congruent cement mantle with fewer radiolucent lines.
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11
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Choosing the optimum swab for canal drying in cemented total hip replacement. Hip Int 2011; 21:107-11. [PMID: 21279959 DOI: 10.5301/hip.2011.6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2010] [Indexed: 02/04/2023]
Abstract
During total hip replacement, the reamed medullary canal of the femur should represent a clean, dry surface. We compared the effectiveness of 4 different cotton swabs in a synthetic femur that had been reamed to receive a size 1 Exeter trial prosthesis. Swab sizes included a 2.5 cm and a 7.5 cm diameter ribbon gauze, a pair of 10 x 7.5 cms square swabs and a larger surgical packing swab (20 x 22 cms). The ability of the swabs to pack the femur was assessed using both plain radiographs and colour photography (after femoral section). After retrieval from the canal, the total dry weight of the cotton inserted was recorded as was the time required to withdraw each swab type. Only the narrowest (2.5 cm diameter) ribbon gauze was found to achieve comprehensive packing as far as the cement restrictor but it required a longer time for removal, and there may be a case for using larger ribbon gauze in larger femora. The mass of cotton delivered to the canal using small square swabs was half of that delivered using narrow ribbon gauze.
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12
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Mandibular nerve block can improve intraoperative inferior alveolar nerve visualization during sagittal split mandibular osteotomy. J Craniomaxillofac Surg 2011; 39:164-8. [DOI: 10.1016/j.jcms.2010.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/17/2010] [Accepted: 04/23/2010] [Indexed: 11/21/2022] Open
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Bishop NE, Schoenwald M, Schultz P, Püschel K, Morlock MM. The condition of the cement mantle in femoral hip prosthesis implantations--a post mortem retrieval study. Hip Int 2009; 19:87-95. [PMID: 19462363 DOI: 10.1177/112070000901900202] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Despite numerous studies demonstrating the characteristics of the optimal cement mantle in joint replacement, the clinical state of the cement mantle is rarely assessed. A random sample of 214 cemented implanted femoral hip components was retrieved post mortem from Hamburg, Germany, and sectioned to investigate the quality of the cement mantle. The most common observation made in at least one measured region per retrieval was debonding (82% of stems), followed by a thin cement mantle (74%), stem-bone contact (48%), soft tissue at the stem interface (44%), no cement-bone interdigitation (30%), a gap at the stem interface (28%), voids in the cement (22%) and cracks and blood in the cement mantle (<10%). 21% of stems demonstrated complete debonding of the interface. However, distributions of all other defects were local, with less than 10% of stems demonstrating any imperfection in more than 21% of the regions assessed. No progressive damage was observed with implantation duration. The results suggest that current implantation technique may be adequate for proper implant function over the service life in the older patient population. However, for younger and more active patients, perfection of the cementation technique is crucial, particularly in modern implant systems such as resurfacing. The frequency of almost all defects could be further reduced by careful implantation technique, providing the increased service life necessary for the ever younger, more physically demanding, patient population.
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Affiliation(s)
- Nicholas E Bishop
- Biomechanics Section, TUHH Hamburg University of Technology, Hamburg, Germany.
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14
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Kolt JD, Robin DA, Carr AM, Chew DKT, Critchley IJ, Horton RW. Safety of autologous drainage blood reinfusion following total knee arthroplasty prepared with hydrogen peroxide. Knee 2007; 14:12-8. [PMID: 17142045 DOI: 10.1016/j.knee.2006.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 10/04/2006] [Accepted: 10/15/2006] [Indexed: 02/02/2023]
Abstract
In a clinical in vivo study, wound blood collected from an autologous reinfusion drain of patients undergoing elective total knee arthroplasty was examined to investigate if hydrogen peroxide bone surface preparation had an adverse effect on blood destined to be reinfused. The post-operative drain blood of thirty-eight patients was collected after pre-implantation bone preparation being performed either with or without the use of hydrogen peroxide. Filtered drain blood samples were analyzed and mean results for treatment / control groups respectfully were: haemoglobin (g/L) 98.6/100.9, p=0.7221; haemoglobin change from baseline (g/L) -39.1/-32.9, p=0.2117; MCV (fL) 94.6/93.1, p=0.2897; MCV change from baseline (fL) 2.0/2.5, p=0.6417; potassium (mmol/L) 4.5/4.6, p=0.8212; free haemoglobin (g/L) 1.2/1.3, p=0.4387; methaemoglobin (%) 0.2/0.2, p=0.8112; presence of echinocytes (%) 14/18, p=1.0000. These were all within safe limits for reinfusion. Under the study conditions, application of hydrogen peroxide followed by thorough lavage of the knee joint did not appear to result in any untoward degradation of the extravasated blood that might preclude its use for postoperative autologous drainage blood reinfusion.
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Affiliation(s)
- Jeremy D Kolt
- The Children's Hospital at Westmead, New South Wales, Australia.
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15
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Lichtenbaum R, de Souza AA, Jafar JJ. Intratumoral Hydrogen Peroxide Injection During Meningioma Resection. Oper Neurosurg (Hagerstown) 2006; 59:ONS470-3; discussion ONS473. [PMID: 17041519 DOI: 10.1227/01.neu.0000233908.69004.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Meningiomas, although histologically benign, pose a particular challenge to the neurosurgeon because of their extensive and exuberant vascularity. They often bleed extensively during resection until separated from their blood supply. There are a wide variety of hemostatic agents available to the neurosur-geon. Most of these means of hemostasis involve some sort of chemical, electrical, or compressive action. Although anecdotally known to be useful, the use of hydrogen peroxide as an intracranial hemostatic agent in meningioma surgery has not been formally reported. We report a technique of meningioma resection that uses intratumoral hydrogen peroxide injection, reducing the potential for blood loss and shortening resection times.
METHODS:
Seventy-five patients underwent resection of a meningioma using the direct intratumoral H2O2 injection technique. The locations of these meningiomas included convexity and cranial-based lesions. None of the patients underwent preoperative endovascular embolization.
RESULTS:
The use of this technique greatly facilitated the removal of these tumors. No evidence of air embolism occurred during Doppler surveillance and no other significant side effects attributable to H2O2 application were observed. @@CONCLUSION:@@ We demonstrate a previously unreported technique of meningi-oma resection that uses direct intratumoral hydrogen peroxide injection, potentially reducing blood loss, shortening resection times, and obviating the need for preoperative embolization.
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Affiliation(s)
- Roger Lichtenbaum
- Department of Neurosurgery, New York University School of Medicine, New York, New York 10016, USA
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Guerin S, Harty J, Thompson N, Bryan K. Hydrogen peroxide as an irrigation solution in arthroplasty – A potential contributing factor to the development of aseptic loosening. Med Hypotheses 2006; 66:1142-5. [PMID: 16481122 DOI: 10.1016/j.mehy.2005.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 12/14/2005] [Indexed: 11/27/2022]
Abstract
The reason for revision of primary total hip arthroplasty is quoted as aseptic loosening in 60.6% of cases between 1979 and 2003 in the Swedish National Hip Arthroplasty Registry. Much research effort has been directed toward enhancing the bone-cement interface of total joint arthroplasties, in an attempt to reduce this complication. Haemostatic agents have been popularized as effective means of retarding the development of potentially harmful debris interposition adjacent to, and blood lamination patterns within, the methylmethacrylate. Such agents include hydrogen peroxide (H(2)O(2)), local freezing saline, saline at room temperature and adrenaline solution. One main concern with the use of hydrogen peroxide is whether it affects the material properties of bone cement such that in the long term it contributes to aseptic loosening. This would have enormous clinical consequences. Preliminary studies indicate that porosity increases and that the tensile strength and yield stresses are reduced by up to a factor of 10 by contaminating samples with increasing concentrations of hydrogen peroxide. We postulate that the current use of hydrogen peroxide as an irrigation solution in arthroplasty contributes to the development of aseptic loosening.
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Affiliation(s)
- S Guerin
- Department of Mechanical and Manufacturing Engineering, Cork Institute of Technology, Bishopstown, Ireland.
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Shigematsu M, Kitajima M, Ogawa K, Higo T, Hotokebuchi T. Effects of hydrogen peroxide solutions on artificial hip joint implants. J Arthroplasty 2005; 20:639-46. [PMID: 16310001 DOI: 10.1016/j.arth.2005.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2003] [Accepted: 11/01/2004] [Indexed: 02/01/2023] Open
Abstract
This study was designed to elucidate the erosive effect of hydrogen peroxide solutions on the materials used for total-hip arthroplasty (THA). As test materials, cross-linked polyethylene, Ti-6Al-4V alloy, and thermal sprayed hydroxyapatite (HA) were used. Changes upon soaking in 3% hydrogen peroxide, before soaking, 1 minute after soaking, 10 minutes after soaking, and 180 minutes after soaking were examined. Scanning electron microscope, Fourier transform infrared analysis, and x-ray diffraction were used for this examination. Hydrogen peroxide did not affect polyethylene, although notable changes in the Ti-6Al-4V alloy and HA did occur. These results indicate that caution should also be exercised to minimize erosion of prosthesis consisting of HA and Ti alloy when hydrogen peroxide solutions are used during total-hip arthroplasty.
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Affiliation(s)
- Masamori Shigematsu
- Department of Orthopedic Surgery, Saga University, Nabeshima, Saga-City, Japan
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Owers KL, Leaver AA, Bannister GC. The optimal depth for femoral cement insertion in total hip replacement. An anatomical and clinical study into cementing technique in the proximal femur. Hip Int 2002; 12:135-138. [PMID: 28124356 DOI: 10.1177/112070000201200220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In retrograde cementing, blood often rises proximally on the surface of injected cement. This blood contamination weakens the cement-bone interface. The major source of bleeding into the proximal femoral medullary canal is the severed nutrient artery. The aims of this study were to define the clinically relevant anatomy of the nutrient artery supplying the proximal femur and establish the optimum depth of cement insertion to minimise blood contamination. Sixty cadaveric femora were radiographed with a wire placed in the nutrient foramen to assess the distance from the tip of the greater trochanter to its entry into the proximal femoral medullary canal. The nutrient artery entered the medullary canal at an average of 13.9 cm from the tip of the greater trochanter and never more proximal than 10.3cm. In 30 patients undergoing primary total hip replacement, cement was inserted retrogradely at 7.5cm, 10 cm or 15 cm from the tip of the greater trochanter and blood contamination recorded. There was blood in significantly fewer cases when cement was inserted at 10cm. Cement insertion 10cm distal to the tip of the greater trochanter appears to occlude the bleeding nutrient artery and should give a stronger proximal cement-bone interface. (Hip International 2002; 2: 135-8).
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Affiliation(s)
- K L Owers
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol - England
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Sherman R, Chapman WC, Hannon G, Block JE. Control of bone bleeding at the sternum and iliac crest donor sites using a collagen-based composite combined with autologous plasma: results of a randomized controlled trial. Orthopedics 2001; 24:137-41. [PMID: 11284596 DOI: 10.3928/0147-7447-20010201-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a randomized controlled trial, hemostatic effectiveness of a collagen-based composite (experimental group) was compared with standard hemostatic methods (ie, electrocautery and collagen sponge) (control group) at two bone sites. Hemostatic success, time to "controlled bleeding," and time to "complete hemostasis" were determined at the sternal edge following median sternotomy (n=64) and at the iliac crest following bone graft harvest (n=19). Almost twice the percentage of sternal edge patients (83% versus 44%, P=.002) and nearly three times the percentage of iliac crest patients (83% versus 29%, P<.05) achieved complete hemostasis in the experimental group compared to controls. Time to controlled bleeding and complete hemostasis for all bone sites also favored the experimental group over the control group at highly significant levels (P<.0001 for most comparisons). There were no adverse events related to experimental treatment use. The results support the use of this investigational hemostatic agent to control cancellous bone bleeding.
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Affiliation(s)
- R Sherman
- University of Southern California School of Medicine, Los Angeles, USA
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Langdown AJ, Field J, Grote J, Himayat H. Aprotinin (Trasylol) does not reduce bleeding in primary total hip arthroplasty. J Arthroplasty 2000; 15:1009-12. [PMID: 11112196 DOI: 10.1054/arth.2000.8102] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This is a randomized, double-blind, controlled study of the effects of aprotinin (Trasylol) during primary total hip arthroplasty. Sixty patients were randomized to receive either 1.5 x 10(6) KIU of aprotinin or a similar volume of normal saline as a bolus preoperatively. Blood loss was measured from the femoral canal at the time of surgery. An estimate of the total blood loss during the operation was made, and the transfusion requirement was recorded. There was no significant difference between the groups in terms of total blood loss, postoperative hemoglobin, or transfusion requirement. In the group that received aprotinin, there was a trend toward reduced blood loss from the femoral canal, but this was not statistically significant. The results of this study do not support the routine use of aprotinin in primary total hip arthroplasty.
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Affiliation(s)
- A J Langdown
- Trauma Service, John Radcliffe Hospital, Oxford, United Kingdom
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Lawton RL, Morrey BF. The use of heparin in patients in whom a pulmonary embolism is suspected after total hip arthroplasty. J Bone Joint Surg Am 1999; 81:1063-72. [PMID: 10466639 DOI: 10.2106/00004623-199908000-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The morbidity and mortality associated with pulmonary embolism are well known, as is the benefit of the use of heparin in patients who have a pulmonary embolism. However, the patterns of heparin use as well as its undesirable effects, especially in patients who have recently had a total hip arthroplasty, have been less well studied. Thus, concern arises regarding the use of heparin in patients who have no firm evidence of a pulmonary embolism. The purpose of the current study was to track the use of heparin and associated orthopaedic complications in patients in whom a pulmonary embolism was suspected after a total hip arthroplasty. METHODS The records of 150 patients in whom a pulmonary embolism had been suspected after a total hip arthroplasty were reviewed retrospectively. The rates of individual complications (such as stroke, infection, and hematoma) and those of groups of complications (such as medical complications, orthopaedic complications, and all complications combined) were recorded and then were stratified according to the treatment (with or without heparin), the presence or absence of pulmonary embolism, and other variables. RESULTS Thirty-two (47 percent) of sixty-eight patients who were managed with heparin had complications compared with sixteen (20 percent) of eighty-two patients who were not thus managed (p = 0.0006). Specifically, patients who were managed with heparin were more likely to have gastrointestinal bleeding, hematological complications, a loose prosthesis, a hematoma, or an early revision arthroplasty (p<0.05 for all). With the numbers available, the use of heparin was not found to be significantly associated with an increased risk of death, stroke, or infection at the site of the prosthesis. Interestingly, thirty-one (31 percent) of ninety-nine patients who had ventilation-perfusion scans that demonstrated normal findings or findings indicating a low probability of pulmonary embolism were given heparin before the diagnosis of a pulmonary embolism was excluded, and sixteen (52 percent) of these thirty-one had complications. CONCLUSIONS Given this risk profile, we advise against the use of heparin before the diagnosis of pulmonary embolism is established in patients who have had a total hip arthroplasty. This recommendation is supported by algorithms, in widely read medical texts, pertaining to the use of heparin in patients in whom a pulmonary embolism is suspected.
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Affiliation(s)
- R L Lawton
- Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Due to the increased risks associated with allogenic blood transfusion, blood management in surgical procedures, especially in orthopedic settings, should include reduction of perioperative blood loss. Preoperative nursing assessment will help define patients at increased risk for transfusion. Both nonpharmacologic and pharmacologic techniques can help minimize allogenic transfusion by reducing blood loss. One such method of managing anemia and reducing patient exposure to allogenic transfusion is the perioperative use of recombinant human erythropoietin--erythropoietin alfa--an innovative surgical blood management tool. Increased awareness by perioperative nurses of the use of erythropoietin alfa and patient implications can contribute to the overall blood conservation goal.
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