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DeFrancesco CJ, Reichel JF, Gbaje E, Popovic M, Freeman C, Wong M, DeMeo D, Liu J, Gonzalez Della Valle A, Ranawat A, Cross M, Sculco PK, Haskins S, Kim D, Maalouf D, Kirksey M, Jules-Elysee K, Soffin EM, Kumar K, Beathe J, Figgie M, Inglis A, Garvin S, Alexiades M, DelPizzo K, Russell LA, Sideris A, Saleh J, Zhong H, Memtsoudis SG. Effectiveness of oral versus intravenous tranexamic acid in primary total hip and knee arthroplasty: a randomised, non-inferiority trial. Br J Anaesth 2023; 130:234-241. [PMID: 36526484 PMCID: PMC9900725 DOI: 10.1016/j.bja.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tranexamic acid (TXA) reduces rates of blood transfusion for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Although the use of oral TXA rather than intravenous (i.v.) TXA might improve safety and reduce cost, it is not clear whether oral administration is as effective. METHODS This noninferiority trial randomly assigned consecutive patients undergoing primary THA or TKA under neuraxial anaesthesia to either one preoperative dose of oral TXA or one preoperative dose of i.v. TXA. The primary outcome was calculated blood loss on postoperative day 1. Secondary outcomes were transfusions and complications within 30 days of surgery. RESULTS Four hundred participants were randomised (200 THA and 200 TKA). The final analysis included 196 THA patients (98 oral, 98 i.v.) and 191 TKA patients (93 oral, 98 i.v.). Oral TXA was non-inferior to i.v. TXA in terms of calculated blood loss for both THA (effect size=-18.2 ml; 95% confidence interval [CI], -113 to 76.3; P<0.001) and TKA (effect size=-79.7 ml; 95% CI, -178.9 to 19.6; P<0.001). One patient in the i.v. TXA group received a postoperative transfusion. Complication rates were similar between the two groups (5/191 [2.6%] oral vs 5/196 [2.6%] i.v.; P=1.00). CONCLUSIONS Oral TXA can be administered in the preoperative setting before THA or TKA and performs similarly to i.v. TXA with respect to blood loss and transfusion rates. Switching from i.v. to oral TXA in this setting has the potential to improve patient safety and decrease costs.
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Affiliation(s)
| | - Julia F Reichel
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Ejiro Gbaje
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Marko Popovic
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Carrie Freeman
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Marisa Wong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Danya DeMeo
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Amar Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Stephen Haskins
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - David Kim
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Maalouf
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Meghan Kirksey
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Kethy Jules-Elysee
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Kanupriya Kumar
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan Beathe
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Mark Figgie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Allan Inglis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sean Garvin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Michael Alexiades
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Linda A Russell
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Alexandra Sideris
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Jawad Saleh
- Pharmacy Department, Hospital for Special Surgery, New York, NY, USA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Hashimoto A, Sonohata M, Kii S, Kawano S, Mawatari M. Hydroxyapatite-coated cementless total hip arthroplasty for patients undergoing dialysis: a study of 30 hips with a minimum follow-up period of 5 years. BMC Musculoskelet Disord 2021; 22:842. [PMID: 34592965 PMCID: PMC8485528 DOI: 10.1186/s12891-021-04718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The number of total hip arthroplasties (THAs) performed for patients undergoing dialysis is increasing. However, there are few reports of cementless THA for patients undergoing dialysis. This study investigated the mid-term to long-term results of hydroxyapatite (HA)-coated cementless THA for dialysis patients. Methods This single-center, retrospective study enrolled dialysis patients undergoing primary HA-coated cementless THA. A total of 24 patients (30 hips) were included in the final analyses. The Harris hip score and radiographic results were assessed preoperatively and during the final follow-up examination. Postoperative complications and mortality rates were recorded. The mean follow-up period was 109 months (range, 60–216 months). Results The total Harris hip score significantly improved from 40 to 84 points. The overall cumulative survival rates with revision as the endpoint were 100% at 5 years and 90.4% at both 10 and 15 years. Stress shielding was observed in 24 hips (80%). No deaths were related to the primary THA. Complications included periprosthetic fracture for one patient (3.3%), blood transfusion for nine patients (30%), shunt blockage for two patients (6.7%), deep infection for one patient (3.3%), and dislocation for two patients (6.7%). Conclusions HA-coated cementless THA resulted in good mid-term outcomes for patients undergoing dialysis with no mortality risk. However, the procedure involved a relatively high perioperative risk of blood transfusion. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04718-3.
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Affiliation(s)
- Akira Hashimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Shunsuke Kawano
- Research Center of Arthroplasty, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
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Cao J, Zhou Y, Xin W, Zhu J, Chen Y, Wang B, Qian Q. Natural outcome of hemoglobin and functional recovery after the direct anterior versus the posterolateral approach for total hip arthroplasty: a randomized study. J Orthop Surg Res 2020; 15:200. [PMID: 32487264 PMCID: PMC7268999 DOI: 10.1186/s13018-020-01716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most successful orthopedic surgeries. There are many common surgical approaches for THA. The direct anterior approach (DAA) and posterolateral approach (PLA) were compared, leading to controversial results. METHODS We report on a prospective randomized study which compared the changes of perioperative hemoglobin (Hb), the Harris hip score (HHS) and a visual analog scale (VAS) pain score following THA using DAA or PLA. A total of 130 participants were randomly divided into two groups (65 DAA versus 65 PLA). Perioperative ΔHb and other clinical outcomes were recorded. RESULTS A total of 130 participants completed follow-up, while 14 patients were not recorded in blood outcomes due to blood transfusions and complications. The average Hb decrease immediately after surgery in the DAA group was greater than that in the PLA group (21.1 versus 15.8 g/L, P < .001). However, post-operative Hb descent velocity was slower in the DAA group, and the lowest point was reached earlier. No significant differences in ΔHb levels could be observed after 1 month in the two groups. When compared with the PLA group, the DAA group had a shorter incision (9.1 versus 13.5 cm, P < .001) and shorter hospital stay (4.2 versus 4.7 days, P = .004). However, the operation time of the DAA group was longer (88.0 versus 66.8 min, P < .001). The DAA group had a better HHS and VAS pain score at 6 weeks post-surgery. However, no significant differences were observed at later time points. CONCLUSION We concluded that DAA performed better on enhanced recovery after surgery (ERAS) than PLA in THA, while both DAA and PLA could result in a positive, similar result after 3 months. TRIAL REGISTRATION The study was registered by the Chinese Clinical Trial Registry (ChiCTR1900020770, 19 January 2019).
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Affiliation(s)
- Jia Cao
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China
| | - Yiqin Zhou
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China
| | - Wei Xin
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China
| | - Jun Zhu
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China
| | - Yi Chen
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China.
| | - Bo Wang
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China.
| | - Qirong Qian
- Department of Joint Surgery and Sports Medicine, Shanghai Changzheng Hospital, Second Military Medical University, No.415, Fengyang Road, Shanghai, 200003, China.
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Yoon BH, Kim TY, Ko YS, Lee YK, Ha YC, Koo KH. Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis. PLoS One 2018; 13:e0206480. [PMID: 30379905 PMCID: PMC6209331 DOI: 10.1371/journal.pone.0206480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/12/2018] [Indexed: 01/13/2023] Open
Abstract
Background Tranexamic acid (TXA) has been demonstrated to minimize blood loss after total hip arthroplasty. There are three main routes: intravenous (IV), intra-articular (topical), and combined (IV and topical) but little consensus support which is most effective and safe. We performed network meta-analysis.to assess the comparative efficacy and safety of three different administration routes of TXA. Methods Twenty-five randomized controlled trials (RCT) were evaluated. Interventions were classified as: combined, IV multiple, IV single, topical and placebo. The primary outcome was effectiveness (transfusion rate, total blood loss, and total drain out). The secondary outcome was safety, based on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE). Results A total of 2227 patients were included in the 5 categories: 564 IV single, 319 IV multiple, 398 topical, 120 combined, and 826 placebo. A network meta-analysis identified the most effective interventions in terms of reducing the need for transfusion as follows: combined = 98.2%, IV single = 54.0%, IV multiple = 78.6%, topical = 66.1%, placebo = 0.0%. Compared with placebo, the IV single, IV multiple, topical, and combined interventions showed no difference in the rate of occurrence of DVT and PE. Conclusions A network meta-analysis indicated that combined administration of TXA (IV and topical) was effective in reducing the transfusion rate after hip arthroplasty compared with IV or topical alone. As no high-risk patients were evaluated in the RCTs, it is not known whether the combined method is safer for patients susceptible to DVT or PE.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Tae-young Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
- * E-mail:
| | - Young Seung Ko
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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