1
|
Gali JC, Brotto AFDC, de Mello DPP, Mauad JR, Gali Filho JC. Simultaneous Bilateral Total Knee Arthroplasty May be Safe. Rev Bras Ortop 2023; 58:428-434. [PMID: 37396089 PMCID: PMC10310411 DOI: 10.1055/s-0042-1756152] [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: 03/17/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives This study aims to analyze the safety of a simultaneous bilateral total knee arthroplasty (SBTKA) and to investigate patients' satisfaction with the procedure performed concomitantly. Methods In a prospective study, we evaluated 45 patients undergoing SBTKA performed by two surgical teams. The mean age of the patients was 66.9 years; 33 subjects were female (73.3%) and 12 (26.6%) were male. We followed a protocol of intra- and postoperatively measures to ensure the safety of this procedure. We evaluated the surgery time and blood loss by hematocrit (Ht) and hemoglobin (Hb) levels on the first postoperative day, the percentage of patients who received a transfusion of packed red blood cells, and the number of required units. We also recorded perioperative complications, and, at the end of 3 months, we asked patients about their preference between the simultaneous or staged procedure. Results The mean surgery time was 169 minutes. In the postoperative period, there was an average decrease of 28.2% in Htc and 27.0% in Hgb. A total of 16 patients (35.5%) received a transfusion of packed red blood cells (mean, 1.75 units per patient requiring a transfusion). There were 12 minor complications (26.6%) and 2 major complications (4.4%); furthermore, no patient had a clinical diagnosis of deep vein thrombosis, and there were no deaths. Conclusions: The SBTKA procedure may be considered safe if performed in selected patients and with a care protocol to prevent complications. This type of procedure was unanimously approved by patients.
Collapse
Affiliation(s)
- Julio Cesar Gali
- Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas e da Saúde de Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil
| | - Anna Flavia de Crescenzo Brotto
- Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas e da Saúde de Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil
| | - Danilo Pássaro Pires de Mello
- Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas e da Saúde de Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil
| | - Juliana Ribeiro Mauad
- Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas e da Saúde de Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil
| | | |
Collapse
|
2
|
Sun C, Zhang X, Ma Q, Tu Y, Cai X, Zhou Y. Impact of tourniquet during total knee arthroplasty when tranexamic acid was used: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:18. [PMID: 35033124 PMCID: PMC8760757 DOI: 10.1186/s13018-021-02898-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/30/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The efficacy of tourniquet use during primary total knee arthroplasty (TKA) is thought to reduce intraoperative blood loss, improve surgical exposure, and optimize cement fixation. Tranexamic acid (TXA) use can decrease postsurgical blood loss and transfusion requirements. This review aimed to appraise the effects of tourniquet use in TKA for patients with tranexamic acid use. Methods A meta-analysis was conducted to identify relevant randomized controlled trials involving TXA plus a tourniquet (TXA-T group) and use of TXA plus no tourniquet (TXA-NT group) in TKA. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through October 2021. Results We identified 1720 TKAs (1690 patients) assessed in 14 randomized controlled trials. Compared with the TXA-NT group, the TXA-T group resulted in less intra-operative blood loss (P < 0.00001) and decreased duration of surgery (P < 0.00001), however more hidden blood loss (P = 0.0004) and less knee range of motion (P < 0.00001). No significant differences were found between two groups in terms of decrease in hemoglobin (P = 0.84), total blood loss (P = 0.79), transfusion rate (P = 0.18), drainage volume (P = 0.06), Visual Analogue Scale (VAS) at either the day of surgery (P = 0.2), 1 day (P = 0.25), 2 day (P = 0.39), 3 day (P = 0.21), 5 day (P = 0.21), 7 day (P = 0.06) or 1 month after surgery (P = 0.16), Hospital for Special Surgery (HSS) score at either 7 day (P = 0.10), 1 month (P = 0.08), 3 month (P = 0.22) or 6 month after the surgery (P = 0.92), Knee circumference (P = 0.28), length of hospital (P = 0.12), and complications such as intramuscular venous thrombosis (P = 0.81), deep venous thrombosis (P = 0.10), superficial infection (P = 0.45), deep wound infection (P = 0.64), and delayed wound healing (P = 0.65). Conclusion No big differences could be found by using or not tourniquet when use the TXA, though some benefits are related to operation time and less intra-operative blood loss by using tourniquet and TXA, Using the tourniquet was related to more hidden blood loss and less knee range of motion. More adequately powered and better-designed randomized controlled trials (RCTs) studies with long-term follow-up are required to validate this study.
Collapse
Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.1 68 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Qi Ma
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Yan Tu
- Department of Nursing, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Yonggang Zhou
- Department of Orthopaedic Surgery, The First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
| |
Collapse
|
3
|
D’Souza RS, Duncan CM, Whiting DR, Brown MJ, Warner MA, Smith HM, Kremers HM, Stewart TM. Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty. Bosn J Basic Med Sci 2021; 21:471-476. [PMID: 33119480 PMCID: PMC8292867 DOI: 10.17305/bjbms.2020.5060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Tranexamic acid (TXA) reduces blood loss and transfusion rates in unilateral total knee arthroplasty (TKA), but there is limited data regarding its efficacy in bilateral TKA. This study reports the impact TXA has on clinical outcomes and hospital cost of care in simultaneous, primary bilateral TKA. The 449 patients were retrospectively reviewed. Primary outcomes included the rates of allogeneic and autologous blood transfusion. Secondary outcomes included hospital length of stay (HLOS), post-hospital discharge disposition, 30-day thromboembolic events (TEE), and mean hospital cost of care. Total direct medical costs were obtained from an institutional research database and adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Our study revealed that in patients undergoing simultaneous bilateral TKA, TXA use was associated with reduced allogeneic (OR 0.181, 95% CI 0.090-0.366, p < 0.001) and combined allogeneic and autologous transfusion rates (OR 0.451, 95% CI 0.235-0.865, p = 0.017). TXA was associated with a HLOS reduction of 0.9 days (β-coefficient -0.582, 95% CI -1.008--0.156, p = 0.008), an increased likelihood of hospital discharge over skilled nursing facility (SNF) (OR 2.25, 95% CI 1.117-4.531, p = 0.023) and reduced total hospital cost of care by 6.45% (p < 0.001), room and board costs by 11.76% (p < 0.001), and transfusion costs by 81.65% (p < 0.001). In conclusion, TXA use in bilateral TKA is associated with lower blood transfusion rates, reduced hospital length of stay, reduced cost of hospital care and skilled nursing facility avoidance.
Collapse
Affiliation(s)
- Ryan S. D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Christopher M. Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Daniel R. Whiting
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael J. Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew A. Warner
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Hugh M. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Thomas M. Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|