scholarly journals Impact of tourniquet on short-term outcomes in opening wedge high tibial osteotomy with modern tranexamic acid protocols: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Limin Wang ◽  
Zhen Zhang ◽  
Wei Xiong ◽  
Qian Fang ◽  
Yunfeng Tang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Retrospective Cohort ◽  
Postoperative Recovery ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Total Blood ◽  
Significant Difference

Abstract Background The use of a tourniquet during high tibial osteotomy (HTO) is a routine procedure, but there is currently no research on the benefits and potential risks of tourniquet use during HTO. The aim of this study was to investigate the impact of tourniquet on perioperative blood loss, early functional recovery and complications in opening wedge HTO with modern tranexamic acid protocols. Methods This was a retrospective cohort study of patients who underwent unilateral opening wedge HTO between January 2019 and September 2020. All patients were divided into two groups according to whether a tourniquet was applied during HTO. Patients in both groups received the same surgical procedures, tranexamic acid protocols and other perioperative treatments. Preoperative baseline data, intraoperative data, early postoperative recovery and all complications during the 3-month follow-up were collected and compared between the two groups. Results A total of 62 patients were enrolled in this study, including 32 in the tourniquet group and 30 in the non-tourniquet group. There was no significant difference in preoperative baseline data between the two groups (P > 0.05 in all). Intraoperative blood loss in the tourniquet group was significantly lower than that in the non-tourniquet group (80.22 ml versus 94.00 ml, P < 0.001), but there was no difference in total blood loss (187.39 ml versus 193.31 ml, P = 0.714). And no patient in either group required blood transfusion. In terms of early postoperative recovery, tourniquet use significantly increased pain scores and reduced knee range of motion on the first and second postoperative days, but there was no significant difference between the two groups at postoperative third day and third month. Furthermore, there was no significant difference between the two groups in terms of lower limb force line correction, length of stay, Knee Society Score or the incidence of complications during the 3-month follow-up (P > 0.05 in all). Conclusions In opening wedge HTO with modern tranexamic acid protocols, not using a tourniquet does not increase perioperative total blood loss or the risk of complications, but facilitates early postoperative recovery by reducing pain and increasing range of motion.

scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals Comparison of outcomes of ORIF versus bidirectional tractor and arthroscopically assisted CRIF in the treatment of lateral tibial plateau fractures: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiangtian Deng ◽  
Hongzhi Hu ◽  
Yiran Zhang ◽  
Weijian Liu ◽  
Qingcheng Song ◽  
...  
Keyword(s):  
Cohort Study ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tibial Plateau ◽  
Clinical Score ◽  
Lateral Tibial Plateau ◽  
Significant Difference

Abstract Background Lateral tibial plateau fractures (TPFs) are often treated with conventional open reduction and internal fixation (ORIF) through standard anterolateral sub-meniscal arthrotomy. There has been increasing support for “bidirectional rapid redactor” device-assisted closed reduction and internal fixation (CRIF) for treating TPFs. The aim of the present study is to compare the clinical and radiological outcomes between CRIF and ORIF procedures. Methods We performed a retrospective cohort study of 55 lateral TPF patients (Schatzker types I–III) who accepted surgical treatment at our trauma level 1 center between January 2016 and January 2018. They were divided into the CRIF group (32 patients) and the ORIF group (23 patients) based upon the different surgical protocols. The patients’ clinical outcome analysis was evaluated by using the Knee Society Score (KSS) and Rasmussen’s clinical score. For radiological assessment, changes in tibial plateau width (TPW), articular depression depth (ADD), medial proximal tibial angle (MPTA), and posterior tibial slope angle (PTSA) were evaluated using radiographs and computed tomography (CT) scan. Results The CRIF group had a mean follow-up of 28.9 months, and the ORIF group had a mean follow-up of 30.7 months (p>0.05). Furthermore, there was no statistically significant difference in terms of age, gender, injury mechanism, follow-up time, time interval from injury to surgery, and Schatzker classification in the two groups. With respect to the clinical outcomes including the KSS score and Rasmussen’s clinical score, there was also no significant difference (p>0.05). Nevertheless, the CRIF group had lower intra-operative blood loss, shorter hospitalization days, and better range of movement of the knee joint than the ORIF group (p<0.05). Furthermore, CRIF had better radiological results when compared to the ORIF group using Rasmussen’s radiological score (p<0.05), although no significant difference was observed in TPW, ADD, MPTA, and PTSA between the two groups (p>0.05). Conclusion The present study showed that CRIF could achieve comparable clinical outcomes and better radiological results for treating lateral TPFs as compared with conventional ORIF.

scholarly journals Comparison Between Bilateral Simultaneous Total Hip Arthroplasty With and Without Drainage; a Retrospective Cohort Study

2021 ◽  
Author(s):  
Min-Gwang Kim ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Postoperative Bleeding ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Consecutive Series ◽  
Transfusion Rate ◽  
Total Blood

Abstract BackgroundThere are many reports staged bilateral THA without drainage is a better method than with drainage in many ways. However, there is little report regarding bilateral simultaneous THA (BSTHA) without drainage. This study aimed to evaluate the differences in the clinical outcomes and complication rate of BSTHA with drainage and without drainage.MethodsBetween October 2015 and April 2019, a retrospective cohort study was conducted with modified minimally invasive two-incision method and a consecutive series of 41 BSTHA performed with drainage were compared to 37 BSTHA performed without drainage. It was assessed clinically and radiographically for a mean of 2.1 ± 0.8 years (range, 1.0-4.8 years). Postoperative hematologic values (Hgb drop, Hct drop, total blood loss, transfusion rate), pain susceptibility, functional outcome, and complication were compared in the drained group and the non-drained group. All patients preoperatively received intravenous tranexamic acid (TXA) and intraoperatively received intra-articular TXA on each hip. Statistical analyses were performed using the independent t tests, Chi-squared or Fisher’s exact tests. A significance level of ≤ 0.05 was used for all statistical tests.Results Mean postoperative Hgb (g/dL, p < 0.001) & Hct drop (%, p < 0.001), mean total blood loss (ml, p < 0.001) and mean transfusion unit (IU, p < 0.001) were significantly lower in the BSTHA without drainage than in the BSTHA with drainage group. But the mean dose of morphine equivalent (mg, p < 0.001) was significantly larger in BSTHA without drainage.ConclusionBSTHA without drainage can reduce postoperative blood loss and the requirement for transfusion without increasing other complication. But BSTHA without drainage is more painful method than BSTHA with drainage. Therefore, BSTHA without drainage will be a good option to reduce the burden on the patient by reducing postoperative bleeding if it can control pain well after surgery.

scholarly journals Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial

2021 ◽  
Vol 10 (15) ◽  
pp. 3272
Author(s):  
Man-Soo Kim ◽  
In-Jun Koh ◽  
Yong-Gyu Sung ◽  
Dong-Chul Park ◽  
Won-Jun Ha ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
High Tibial Osteotomy ◽  
Total Blood Loss ◽  
Wound Complications ◽  
Control Group ◽  
Transfusion Rate ◽  
Tibial Osteotomy ◽  
Total Blood ◽  
Wedge High Tibial Osteotomy

(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.

scholarly journals Topical versus intravenous tranexamic acid in total knee arthroplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668430 ◽  
Author(s):  
Sanjay Meena ◽  
Francesco Benazzo ◽  
Saumitra Dwivedi ◽  
Matteo Ghiara
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Clinical Trials ◽  
Total Blood Loss ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
China National Knowledge Infrastructure ◽  
Tourniquet Time ◽  
Total Blood ◽  
Significant Difference

Purpose: The aim of this meta-analysis is to examine the efficacy and safety of intra-articular tranexamic acid (TXA) when compared to intravenous (IV) route. Methods: The literature search was conducted using PubMed, Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure (CNKI). All randomized controlled trials evaluating the effectiveness of topical route and IV route of TXA administration were included. Results: Eight randomized clinical trials comprising of 857 patients were included in this analysis. We found no statistically significant difference in terms of total blood loss, drain output, transfusion requirement, thromboembolic complication, tourniquet time and surgical duration. Conclusion: Topical TXA has a similar efficacy to IV-TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications.

Does left atrial appendage morphology have any impact on the results of percutaneous closure?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Constantin ◽  
A Cinaud ◽  
F Brigadeau ◽  
A Lepillier ◽  
B Pierre ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Left Atrial ◽  
Retrospective Cohort ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Atrial Appendage ◽  
Significant Difference ◽  
The Impact

Abstract Introduction Transcatheter left atrial appendage (LAA) occlusion is an alternative treatment in patients with atrial fibrillation (AF), high CHADSVASC Score and a contra-indication to anticoagulants. This retrospective cohort study aims to evaluate the impact of LLA morphology on procedure outcomes. Methods Patients from eight French centers who underwent left atrial appendage occlusion from February 2012 to January 2017 were included in this retrospective cohort study. LLA morphology was described by preoperative cardiac computed tomography (CT). Clinical data and Transoesophageal echocardiography (TEE) or CT results were collected during follow-up. Results Among 469 included patients, LAA morphologies were described in 215 cases 45.8%), 150 patients (70%) were implanted with Watchman devices, 57 (26%) with Amplatzer devices and 8 procedures (4%) failed. LAA Morphology was Chicken Wing (34%), Windsock (45%), cauliflower (18%) and 3% had another morphology including Cactus. There was no difference in patient characteristics between the different morphology groups. Mean follow-up was 9.6±11 months, during which 190 patients underwent LAA imaging (TEE in 171 and CT in 19 patients). There was no significant difference in the failure rate (p=0.72), duration of the procedure (p=0.065), peri-device leak (p=0.83) device-related thrombus (p=0.96) and the occurrence of stroke (p=1) during follow-up. Conclusion LLA morphology did not influence complication occurrence after occlusion in this cohort. Funding Acknowledgement Type of funding source: None

scholarly journals The effect of tranexamic acid on blood loss in non-urgent trauma patients undergoing major orthopaedic surgery: A retrospective cohort study

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Vasileia Nyktari ◽  
◽  
Helen Diamantaki ◽  
Georgios Stefanakis ◽  
Emmanouela Koutoulaki ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Orthopaedic Surgery ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Transfusion Requirements ◽  
Major Orthopaedic Surgery

Objectives: This study aims to clarify the role of prophylactic TXA on blood loss and transfusion requirements in a subgroup of trauma patients undergoing major orthopaedic surgery on a non-urgent basis. Study design: This is a retrospective cohort study Setting: Tertiary University Hospital of Crete (2017-2018) Patients/participants: Polytrauma patients who underwent delayed major orthopaedic surgery Main outcome measurement: Significant haemorrhage occurrence in relation to TXA administration. In a subgroup of patients Rotational Thromboelastometry (ROTEM) was used to reveal their haemostatic profile prior to TXA administration. Methods: Data from anaesthetic and ICU records were analyzed regarding age, sex, body mass index, ASA physical status, Injury Severity Score, Caprini Score, intraoperative blood loss, number of packed red blood cells units transfused, volume of crystalloids administered, operation duration, preoperative and postoperative haemoglobin values, and days from hospital admission to surgery. ROTEM analysis in a subgroup of patients revealed their haemostatic profile prior to TXA administration. Results: Twenty five out of 46 patients received prophylactic TXA treatment. After adjustment for confounding factors, the odds ratio for the composite endpoint for prophylactic TXA (n=25) vs no TXA (n=21) was 1.27 (95% confidence interval, CI 0.39-4.16). Propensity matched analysis confirmed the absence of a difference between patients with and without TXA. In all patients analyzed with ROTEM normal or hypercoagulable status was revealed. Conclusions: In trauma patients undergoing major orthopaedic surgery more than 12 hours after the initial injury, TXA has no effect on blood loss and transfusion requirements. Keywords: tranexamic acid; blood loss; transfusion; orthopaedic trauma surgery; spine surgery; pelvis surgery; significant bleeding in orthopaedic surgery

scholarly journals Multiple Intravenous Tranexamic Acid Doses After Open Wedge-high Tibial Osteotomy(OW-HTO) Further Reduce Perioperative Blood Loss and Drainage Volume: A Retrospective Study

2021 ◽  
Author(s):  
Zhimeng Wang ◽  
Yao Lu ◽  
Lu Liu ◽  
Leilei Song ◽  
Teng Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
High Tibial Osteotomy ◽  
P Value ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Drainage Volume ◽  
Estimated Blood Loss ◽  
Postoperative Drainage ◽  
Wedge High Tibial Osteotomy

Abstract Background Studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in opening wedge high tibial osteotomy(OW-HTO). However, a consensus has not been established regarding the best dosing regimen and timing. In the present study, we aimed to compare three different dosages of intravenous (IV) TXA in OW-HTO.Material and methods A retrospective analysis of the clinical data obtained from patients administered with OW-HTO treatment for knee osteoarthritis from February 2016 to December 2019 was conducted. All operations were performed under general anaesthesia. TXA1 group (18 patients) received 1g of IV TXA administered 15 to 30 minutes pre-operation. TXA2 group (18 patients) received an additional dose of IV TXA (1g) 3 h after incision and the TXA3 group (18 patients) received an additional (third) dose 6 h later(1g). The blood loss and adverse events were compared between the three groups. Functional analysis, quality of life (QoL), and pain assessment were performed based on their corresponding scoring system.Results Baseline data were comparable for all groups. The postoperative drainage volume was calculated for the TXA3 group and the estimated blood loss was significantly reduced (p-value <0.05). The treatment effectively maintained postoperative Hb at a high level (p-value <0.05). In addition, a faster recovery, better QoL, reduced postoperative pain, and no complications were observed in patients belonging to the group TXA3.Conclusion Based on our results, three doses of IV TXA can effectively and safely reduce estimated blood loss and postoperative drainage volume in patients undergoing OW-HTO with additional associated benefits.

Retrospective cohort study of 68 sacral giant cell tumours treated with nerve-sparing surgery and evaluation on therapeutic benefits of denosumab therapy

2020 ◽  
Vol 102-B (2) ◽  
pp. 177-185 ◽  
Author(s):  
Chiao Yee Lim ◽  
Xingyu Liu ◽  
Fangzhou He ◽  
Haijie Liang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Giant Cell ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Control Group ◽  
Nerve Sparing ◽  
Therapeutic Benefits ◽  
Significant Difference ◽  
Giant Cell Tumours

Aims To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs). Methods This is a retrospective cohort study of patients with GCT who presented between January 2011 and July 2017. Intralesional curettage was performed and patients treated from 2015 to 2017 also received denosumab therapy. The patients were divided into three groups: Cohort 1: control group (n = 36); cohort 2: adjuvant denosumab group (n = 9); and cohort 3: neo- and adjuvant-denosumab group (n = 17). Results There were 68 patients within the study period. Six patients were lost to follow-up. The mean follow-up was 47.7 months (SD 23.2). Preoperative denosumab was found to reduce intraoperative haemorrhage and was associated with shorter operating time for tumour volume > 200 cm3. A total of 17 patients (27.4%) developed local recurrence. The locoregional control rate was 77.8% (7/9) and 87.5% (14/16) respectively for cohorts 2 and 3, in comparison to 66.7% (24/36) of the control group. The recurrence-free survival (RFS) rate was significantly higher for adjuvant denosumab group versus those without adjuvant denosumab during the first two years: 100% vs 83.8% at one year and 95.0% vs 70.3% at two years. No significant difference was found for the three-year RFS rate. Conclusion Preoperative denosumab therapy was found to reduce intraoperative haemorrhage and was associated with shorter operating times. Adjuvant denosumab was useful to prevent early recurrence during the first two years after surgery. Cite this article: Bone Joint J 2020;102-B(2):177–185.

scholarly journals 289 Blood Loss in Robotic-Assisted Knee Arthroplasty: A Retrospective Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Khan ◽  
K Dhillon ◽  
P Mahapatra ◽  
R Popat ◽  
D Nathwani
Keyword(s):  
Blood Loss ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
Postoperative Recovery ◽  
Total Blood Loss ◽  
Total Blood ◽  
Robotic Assisted ◽  
Parametric Data ◽  
Significant Difference ◽  
Student’S T

Abstract Introduction Significant blood loss is associated with a delayed postoperative recovery in joint arthroplasty. Emerging evidence suggests robotic-assisted knee arthroplasty reduces soft-tissue trauma, length of stay, and can facilitate a faster recovery. This study compares the total blood loss in patients undergoing robotic-assisted knee arthroplasty compared to conventional methods. Method Patients undergoing robotic-assisted total knee arthroplasty (TKA) or unicomparmental knee arthroplasty (UKA) were identified using patient records. Robotic-assisted groups were compared against contemporary sex-matched controls undergoing jig-based arthroplasty. The mean total blood loss was estimated using the Gross equation. Statistical significance was identified using the Student's t-test and Mann-Whitney U test for parametric and non-parametric data, respectively. Results Robotic TKA and UKA groups were successfully matched to contemporary controls (n = 50 in all groups). No differences in preoperative haematological parameters or blood volume were found between the robotic-assisted and control groups. Robotic TKA experienced 23.7% less blood loss compared to control TKA (911.0ml vs 1193.7ml, p &lt; 0.01) which was found to be statistically significant. There was a non-significant difference in mean total blood loss in robotic UKA compared to control UKA (821.7ml vs 854.7ml, p = 0.69). Conclusions The use of a robotic surgical system reduces blood loss in TKA but not UKA in knee arthroplasty.

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