No Effect of a Bipolar Sealer on Total Blood Loss or Blood Transfusion in Nonseptic Revision Knee Arthroplasty—A Prospective Study With Matched Retrospective Controls

2017 ◽  
Vol 32 (1) ◽  
pp. 177-182 ◽  
Author(s):  
Christian Skovgaard Nielsen ◽  
Kirill Gromov ◽  
Øivind Jans ◽  
Anders Troelsen ◽  
Henrik Husted
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Prospective Study ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Total Blood ◽  
Revision Knee Arthroplasty ◽  
Bipolar Sealer ◽  
A Prospective Study

scholarly journals Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yimin Zhang ◽  
Bao Lang ◽  
Guifeng Zhao ◽  
Fengming Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Total Blood ◽  
Study Results ◽  
Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

scholarly journals A prospective study about the preoperative total blood loss in older people with hip fracture

2016 ◽  
Vol Volume 11 ◽  
pp. 1539-1543 ◽  
Author(s):  
Jie-Zhou Wu ◽  
Peng-Cheng Liu ◽  
Wei Ge ◽  
Ming Cai
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
Older People ◽  
Prospective Study ◽  
Total Blood Loss ◽  
Total Blood ◽  
A Prospective Study

scholarly journals Total blood loss in total knee arthroplasty. A comparison of drain-clamped and non drain-clamped operations.

1990 ◽  
Vol 38 (4) ◽  
pp. 1739-1742 ◽  
Author(s):  
Harumichi Senda ◽  
Kazutoshi Nomura ◽  
Mitsuyoshi Oda ◽  
Mako Hirano ◽  
Masaaki Sakisaka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Total Blood ◽  
Total Knee

scholarly journals A randomized, non-crossover, parallel-group analysis of tranexamic acid in minimizing blood loss and transfusions in total knee arthroplasty

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Nikhil Mudgalkar
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Acid Group ◽  
Total Blood Loss ◽  
Blood Transfusions ◽  
Total Blood ◽  
Parallel Group ◽  
Total Knee

Objectives: Total knee arthroplasty is associated with significant blood loss, necessitating blood transfusions. Due to the obvious risks and costs of allogeneic blood transfusions, techniques to minimize blood loss in surgery are needed. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during total knee arthroplasty. Materials and Methods: A prospective, randomized, double-blind, parallel-group, non-crossover trial was carried out in Prathima Hospital, Karimnagar. The trial involved 28 ASA I and II patients undergoing unilateral knee arthroplasty, 14 in each of the control and study groups. In the study group, a 10 mg/kg bolus of tranexamic acid was administered slowly IV 30 min before tourniquet deflation, followed by a 1 mg/kg/hr infusion for 12 h, compared to the standard medical treatment in the control group. Total blood loss during and after surgery was compared between the two classes. We also compared the hemoglobin drop after surgery, the number of people who needed blood transfusions, and the number of units needed between the two classes. Any complications were also reported. Results: Total blood loss in the tranexamic acid group was 543.3 ± 184.85 versus 685.83 ± 176.74, a statistically significant difference (P < 0.05). Intraoperative blood loss was comparable, but post-operative blood loss was significantly lower in the tranexamic acid group (389.16 ± 174 ml vs. 514.36 ± 143.89 ml), indicating that it was statistically significant (P < 0.05). There were no complications reported from any of the groups. Conclusion: Tranexamic acid is an effective strategy for minimizing overall blood loss and blood transfusions in patients undergoing total knee arthroplasty.

scholarly journals The Effect of Pharmacological Thromboprophylaxis, Tourniquet and Drainage on Hemorrhagic Complications in the Early Stage after Knee Arthroplasty: Preliminary Results

2019 ◽  
Vol 25 (3) ◽  
pp. 70-80 ◽  
Author(s):  
A. R. Kasimova ◽  
S. A. Bozhkova ◽  
R. M. Tikhilov ◽  
A. V. Saraev ◽  
A. I. Petukhov ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Intraoperative Blood Loss ◽  
Thromboembolic Complications ◽  
Total Blood ◽  
Additional Risk ◽  
Hemorrhagic Complications ◽  
Pharmacological Thromboprophylaxis

Background — venous thromboembolic complications (VTC) are potential life-threatening complications following knee arthroplasty (KA). An optimal thromboprophylaxis strategy should reduce the risk of developing VTC without increasing the risk of hemorrhagic complications. The purpose of the study is to evaluate the effect of the drugs (acetylsalicylic acid, dabigatran etexilate and rivaroxaban) for the pharmacological thromboprophylaxis and the features of the surgical procedure (use of the tourniquet and drainage) on hemorrhagic complications in early periods after knee arthroplasty. Materials and Methods. 335 patients (65 men and 270 women), without additional risk factors for the development of thromboembolic complications, were included into the study. Those patients were admitted for planned primary / revision knee arthroplasty and corresponded to inclusion / non-inclusion criteria. Patients were randomized into three clinical groups, depending on the drug used thromboprophylaxis. During the inpatient treatment period, all patients recorded the development of symptomatic VTCs and the development of hemorrhagic complications. According to the clinical indications, the number of knee joint punctures was taken into account: patella balloting, restricted flexion and a smooth joint contour. Results. Symptomatic VTCs were not observed during the study period. The volume of intraoperative blood loss did not depend on the drugs used for  thromboprophylaxis, and was determined only by the surgical technique (ρs= -0.615, p = 0.0001). The use of the tourniquet during the procedure significantly reduced intraoperative blood loss (p = 0.023). No relation between surgical technique and anemia on the 5th day (ρs = 0.11, p = 0.05), as well as between surgical technique and total blood loss (ρs = 0.12, p = 0.01) was established; weak reliable correlation between the use of the tourniquet and hidden blood loss (ρs = -0.22, p = 0.01) was reported. A negative average significant correlation was observed (ρs = -0.42, p = 0.01) for the volume of total blood loss and hemoglobin level on the 5th day after the surgery. The number of postoperative punctures was comparable in the study groups. Conclusion. Sample of present size is not sufficient to make conclusions about the equal efficacy of using acetylsalicylic acid, dabigatran and rivaroxaban for thromboprophylaxis after knee arthroplasty in patients without additional risk factors for thrombosis. Data on the significant correlation of the surgical technique with the volume of intraoperative and latent blood loss, as well as total blood loss and hemoglobin level on the 5th day after the operation allow to suggest a possible effect of the drug for thromboprophylaxis on blood loss stargin from 2nd day after the procedure. 

scholarly journals THE USE OF ANTIFIBRINOLYTICS IN HIP TRAUMA SURGERY IN A PUBLIC HEALTH SYSTEM: A PROSPECTIVE STUDY

2021 ◽  
Vol 29 (6) ◽  
pp. 304-307
Author(s):  
JOSÉ ALBERTO ALVES OLIVEIRA ◽  
GABRIELLA CRISTINA COELHO DE BRITO ◽  
FRANCISCA MAGNA PRADO BEZERRA ◽  
CARLOS ALFREDO DE CARVALHO NETO ◽  
JONATAS BRITO DE ALENCAR NETO ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Prospective Study ◽  
Surgical Approach ◽  
Trauma Surgery ◽  
Level Of Evidence ◽  
Total Blood ◽  
Significance Level ◽  
Estimated Blood Loss ◽  
Significant Difference

ABSTRACT Objective: To evaluate the use of tranexamic acid (TXA) and ε-aminocaproic acid (EACA) in reducing blood loss in hip and proximal femur trauma surgery. Methods: Prospective study with 49 patients surgically treated in a trauma hospital between Nov/2015 and Feb/2017. The patients were divided in two groups: TXA (n = 24) and EACA (n = 25). The comparison was made according to gender, age at the time of surgery, ASA, fracture and surgery type, estimated blood loss during surgical approach, hemoglobin and hematocrit levels pre and post-operative, and pharmacological cost. The data was processed using SPSS 22.0 with significance level of p < 0,05. Results: No significant difference was found in the variables age, gender, ASA and estimated blood loss during surgical approach. No patient needed blood transfusion. When evaluated post-operatively, the hemoglobin and hematocrit values decrease had no significant difference between the antifibrinolytics (p > 0.05). When analyzing total cost for both pharmacological agents, higher cost was observed in EACA than in TXA (US$ 16.09 - US$ 2.73), resulting in a US$ 13.36 addition per patient. Conclusion: Antifibrinolytic use was efficient on lowering the total blood loss, without the need of blood transfusion. Level of evidence II, Prospective Comparative Study.

scholarly journals Effect of Tourniquet use on Blood Loss, Pain, Functional Recovery, and Complications in Robot-assisted Total Knee Arthroplasty: A Prospective, Double-blinded, Randomized Controlled Trial

2021 ◽  
Author(s):  
Yahao Lai ◽  
Hong Xu ◽  
Qiang Su ◽  
Xufeng Wan ◽  
Mingcheng Yuan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Range Of Motion ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Robot Assisted ◽  
Total Blood ◽  
Total Knee

Abstract Background: Robot-assisted total knee arthroplasty (TKA) has been largely studied to confirm its advantages in terms of accurate component positioning, microembolus formation, less blood loss and so on, but is currently usually performed under tourniquet due to its longer operative time than conventional TKA. The aim of this study was to estimate the effects of tourniquet use in robot-assisted TKA on blood loss, pain, functional recovery, and complications.Methods: Patients scheduled for robot-assisted TKA were prospectively randomized into a tourniquet or non-tourniquet group (each n = 14). The primary outcome measure was blood loss. The secondary outcome measures were operation time; visual analog scale (VAS) pain scores; time to achieve the first straight-leg raise; swelling of the thigh, knee, and calf; range of motion; Hospital for Special Surgery score; length of stay; and postoperative complications. Results: There was no significant difference in total blood loss between the tourniquet and non-tourniquet groups (738.57 ± 276.158 vs. 866.85 ± 243.422 ml, P = 0.061). The tourniquet group showed significantly lower intraoperative blood loss (P < 0.001), but higher hidden blood loss (P = 0.002). The non-tourniquet group showed better knee range of motion on POD 1-3 (all P < 0.001), less thigh swelling on PODs 2 and 3 (P < 0.05), earlier straight-leg raising (P = 0.044), and shorter length of stay (P = 0.044). Thigh pain VAS score at 1 month after surgery was significantly greater in the tourniquet group (P < 0.001), as was knee pain during activity and at rest on PODs 2-3 (all P < 0.05). The tourniquet group also showed a significantly higher rate of tension blisters (28.8% vs. 7.1%, P = 0.038). Conclusions: Tourniquet use during robot-assisted TKA dose not reduce total blood loss and it appears to increase postoperative pain, aggravate muscle injury, and prolong postoperative recovery.Trial registration: ChiCTR, ChiCTR2100041800. Registered 5 January 2021, http://www.chictr.org.cn/index.aspx

scholarly journals Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid

2016 ◽  
Vol 6 (3) ◽  
Author(s):  
Tyler Steven Watters ◽  
Daniel L Levy ◽  
Raymond H Kim ◽  
Todd M Miner ◽  
Douglas A Dennis ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Transfusion Requirement ◽  
Total Blood Loss ◽  
Total Blood ◽  
Perioperative Blood Loss ◽  
Estimated Blood Loss ◽  
Total Knee

AbstractBackground: The use of a tourniquet during total knee arthroplasty (TKA) continues to be a matter of debate. Advantages of tourniquet use include improved visualization, decreased intraoperative and total blood loss, and possibly decreased transfusion requirement. However, the recent widespread adoption of antifibrinolytic therapy with tranexamic acid (TXA), may negate these benefits. The purpose of this study was to evaluate perioperative blood loss and transfusion requirement with two different tourniquet application strategies, and surgery without the use of a tourniquet during routine, primary cemented TKA.Methods: A retrospective cohort study was performed of 300 patients undergoing TKA at a single institution after the implementation of a routine intravenous TXA administration protocol and consisted of three groups based on tourniquet usage: tourniquet inflation before incision and deflation following cement hardening (TQ), tourniquet inflation prior to cement application and deflation following hardening (Partial TQ), and no tourniquet usage (No TQ). Each group consisted of 100 consecutive patients. Perioperative blood loss, change in hematocrit and transfusion requirement were compared between groups. Results: Total blood loss (estimated blood loss and drain output) was lowest in the TQ group, however this was only due a slight decrease in intraoperative estimated blood loss. There was no difference in post-operative drain output, or change in hematocrit levels from preoperative values. There were no transfusions in the Partial TQ and No TQ groups, whereas there were 5 transfusions in the TQ group.Conclusions: In the era of routine TXA administration during TKA, tourniquet usage does not appear to have a benefit in regards to perioperative blood loss or transfusion requirement. 

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 31 (07) ◽  
pp. 654-663 ◽  
Author(s):  
Wen-Li Dai ◽  
Ai-Guo Zhou ◽  
Hua Zhang ◽  
Jian Zhang
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Total Blood Loss ◽  
Transfusion Rate ◽  
Thromboembolic Complications ◽  
Total Blood ◽  
Total Knee ◽  
Primary Total Knee

AbstractThe use of tranexamic acid (TXA) during primary total knee arthroplasty (TKA) is well documented. However, considering the potential side effects, including deep vein thrombosis (DVT) and pulmonary embolism (PE), the ideal route of administration remains controversial. Therefore, we performed a meta-analysis to compare the efficacy of topical versus intravenous TXA and explore the most effective regimen in patients undergoing primary TKA. We conducted a systematic literature search in PubMed, Embase, and the Cochrane database through July 2016 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of topical and intravenous TXA in primary TKA. We assessed the risk of bias using the Cochrane Collaboration's tool. We assessed the quality of evidence using the GRADE profiler software. A total of 15 RCTs including 1,240 participants met the inclusion criteria. We found no statistically significant difference between topical and intravenous TXA in terms of transfusion rate (p = 0.75), total blood loss (p = 0.51), total drain output (p = 0.60), maximum hemoglobin drop (p = 0.24), length of stay (p = 0.08), and thromboembolic complications (p = 0.73). Subgroup analyses showed that compared with 1 g topical TXA, 2 g topical TXA was more effective to reduce blood transfusion rate and total blood loss, and did not increase thromboembolic complications. We also found three times intravenous TXA was more effective than one time of intravenous TXA to reduce blood transfusion rate and total blood loss without increasing of thromboembolic complications. Topical TXA had a similar efficacy to intravenous TXA in reducing blood transfusion and blood loss, and did not increase the risk of thromboembolic complications in primary TKA. Besides, the current meta-analysis suggested that three times of intravenous TXA is efficient and safe. We also recommended 2 g topical TXA instead of 1 g topical TXA because it was more efficient to reduce blood transfusion rate and total blood loss and did not increase thromboembolic complications.

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