scholarly journals Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jin Li ◽  
Ruikang Liu ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Transfusion Rate ◽  
Tourniquet Time ◽  
Total Knee ◽  
Primary Total Knee

Abstract Background The optimal dosage and administration approach of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains controversial. In light of recently published 14 randomized controlled trials (RCTs), the study aims to incorporate the newly found evidence and compare the efficacy and safety of intra-articular (IA) vs. intravenous (IV) application of TXA in primary TKA. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched for RCTs comparing IA with IV TXA for primary TKA. Primary outcomes included total blood loss (TBL) and drain output. Secondary outcomes included hidden blood loss (HBL), hemoglobin (Hb) fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time. Result In all, 34 RCTs involving 3867 patients were included in our meta-analysis. Significant advantages of IA were shown on TBL (MD = 33.38, 95% CI = 19.24 to 47.51, P < 0.001), drain output (MD = 28.44, 95% CI = 2.61 to 54.27, P = 0.03), and postoperative day (POD) 3+ Hb fall (MD = 0.24, 95% CI = 0.09 to 0.39, P = 0.001) compared with IV. There existed no significant difference on HBL, POD1 and POD2 Hb fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time between IA and IV. Conclusion Intra-articular administration of TXA is superior to intravenous in primary TKA patients regarding the performance on TBL, drain output, and POD3+ Hb fall, without increased risk of perioperative complications. Therefore, intra-articular administration is the recommended approach in clinical practice for primary TKA.

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.

scholarly journals Correction to: Better outcomes after mini‑subvastus approach for primary total knee arthroplasty: a Bayesian network meta‑analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Paolo Aretini ◽  
Arne Driessen ◽  
Yasser El Mansy ◽  
Valentin Quack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bayesian Network ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Subvastus Approach ◽  
Total Knee ◽  
Primary Total Knee

A correction to this paper has been published: https://doi.org/10.1007/s00590-021-03026-9

scholarly journals Robot-Assisted Navigation versus Computer-Assisted Navigation in Primary Total Knee Arthroplasty: Efficiency and Accuracy

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Tanner C. Clark ◽  
Frank H. Schmidt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Secondary Outcome ◽  
Computer Assisted ◽  
Robot Assisted ◽  
Tourniquet Time ◽  
Assisted Navigation ◽  
Total Knee ◽  
Primary Total Knee

Background. Since the introduction of robot-assisted navigation in primary total knee arthroplasty (TKA), there has been little research conducted examining the efficiency and accuracy of the system compared to computer-assisted navigation systems. Objective. To compare the efficiency and accuracy of Praxim robot-assisted navigation (RAN) and Stryker computer-assisted navigation (CAN) in primary TKA. Methods. This was a retrospective study consisting of 52 patients who underwent primary TKA utilizing RAN and 29 patients utilizing CAN. The primary outcome measure was navigation time. Secondary outcome measures included intraoperative final mechanical axis alignment, intraoperative robot-assisted bone cut accuracy, tourniquet time, and hospitalization length. Results. RAN navigation times were, on average, 9.0 minutes shorter compared to CAN after adjustment. The average absolute intraoperative malalignment was 0.5° less in the RAN procedures compared to the CAN procedures after adjustment. Patients in the RAN group tended to be discharged 0.6 days earlier compared to patients in the CAN group after adjustment. Conclusions. Among patients undergoing TKA, there was decreased navigation time, decreased final malalignment, and decreased hospitalization length associated with the use of RAN when compared to CAN independent of age, BMI, and pre-replacement alignment.

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