Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement?

The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA.

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Improved Early Postoperative Range of Motion in Total Knee Arthroplasty Using Tranexamic Acid: A Retrospective Analysis

The Journal of Knee Surgery ◽

10.1055/s-0038-1636914 ◽

2018 ◽

Vol 32 (02) ◽

pp. 160-164

Author(s):

Michael Boin ◽

Andrew Froehle ◽

Matthew Lawless ◽

Jedediah May ◽

Matthew Dorweiler

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Demographic Data ◽

Retrospective Chart Review ◽

Control Group ◽

Treatment Groups ◽

Significant Difference ◽

Total Knee

AbstractThe use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has become common practice. Recent literature has demonstrated a reduction in postoperative knee swelling and drain output while using TXA. Our purpose is to analyze the range of motion (ROM) following TKA in patients who received TXA compared with a control group. We hypothesize that patients treated with TXA will have improved early postoperative ROM when compared with controls. A retrospective chart review was performed for patients who underwent TKA from 2010 to 2012 performed by a single orthopaedic surgeon. Patients were stratified into three cohorts by route of TXA administration including intravenous (IV), topical, and a control group. Dependent variables analyzed included extension, flexion, and total arc ROM on each postoperative day (POD), average ROM across all three postoperative days, as well as pre-to-postoperative differences in ROM. Demographic data were recorded for each patient. A total of 174 patients were included for analysis, 75 controls and 99 receiving TXA. A significant difference was found between the treatment groups and the control for all variables (for each, p ≤ 0.002). There were no significant differences in ROM between the IV and topical TXA treatment groups (for each, p ≥ 0.558). A multivariate analysis demonstrated no significant difference between the groups in complication rate or demographic variables. The use of TXA may improve early postoperative ROM following TKA.

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Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality

OTO Open ◽

10.1177/2473974x20975020 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2473974X2097502

Author(s):

Joseph Chang ◽

Sen Ninan ◽

Katherine Liu ◽

Alfred Marc Iloreta ◽

Diana Kirke ◽

...

Keyword(s):

Virtual Reality ◽

Local Anesthesia ◽

Controlled Trial ◽

Care Center ◽

Tertiary Care ◽

Depression Scale ◽

Control Group ◽

Procedure Time ◽

Pain Scores ◽

Distress Scale

Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1

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Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.007515 ◽

2016 ◽

Vol 15 (2) ◽

pp. 120-125 ◽

Cited By ~ 1

Author(s):

Ari Zekcer ◽

Ricardo Del Priori ◽

Clauber Tieppo ◽

Ricardo Soares da Silva ◽

Nilson Roberto Severino

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Intravenous Administration ◽

Knee Arthroplasty ◽

Duplex Ultrasound ◽

Control Group ◽

Perioperative Bleeding ◽

Total Knee

Abstract Background Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. Objectives To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. Methods All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a “topical group” (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an “intravenous group” (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. Results Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). Conclusions Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.

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Indications of blood transfusion following total knee replacement at a tertiary care center in central Saudi Arabia

Journal of Musculoskeletal Surgery and Research ◽

10.4103/jmsr.jmsr_43_20 ◽

2020 ◽

Vol 4 (3) ◽

pp. 132

Author(s):

AliA Alhandi ◽

AbdullahA Alturki ◽

ReemaS Algufaili ◽

MajedN Alnefaie ◽

ShadenA Almojel ◽

...

Keyword(s):

Saudi Arabia ◽

Blood Transfusion ◽

Total Knee Replacement ◽

Knee Replacement ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Total Knee

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Periarticular injection of tranexamic acid promotes early recovery of the range of knee motion after total knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499019864693 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901986469

Author(s):

Hitoshi Hirose ◽

Hiroyasu Ogawa ◽

Kazu Matsumoto ◽

Haruhiko Akiyama

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Control Group ◽

Early Recovery ◽

Periarticular Injection ◽

Maximum Flexion ◽

Maximum Flexion Angle ◽

Total Knee

Purpose: Tranexamic acid (TXA) is a commonly used compound that reduces postoperative blood loss. Periarticular injection of TXA is a recently reported procedure with some advantages such as cost-effectiveness and the ease of performance over an intravenous or topical administration. However, its association with functional recovery remains unclear. This study aimed to examine the effect of periarticular injection of TXA on early postoperative recovery of knee functionality after total knee arthroplasty (TKA). Methods: Eighty-four patients who underwent primary unilateral TKA from February 2013 to August 2016 were classified into two groups based on whether they received TXA injection (44 cases each in the TXA and control groups). Patients in the TXA group received periarticular injection of TXA (1000 mg) just prior to incision closure. Ten-meter walk test (s), pain visual analog scale, knee extension muscle force (N), range of motion (ROM) (maximum flexion angle, maximum extension angle, and motion arc), and blood loss (mL) were assessed. Results: The maximum flexion angle and maximal extension angle on postoperative day (POD) 4, POD7, POD10, and POD14 in the TXA group were significantly larger than those in the control group. The postoperative drained blood in the TXA group was significantly less than that of the control group (543.9 ± 464.3 mL and 814.9 ± 481.4 mL, respectively, p < 0.05). No significant difference was observed in the other parameters at any time point. Conclusion: Periarticular injection of TXA significantly promotes early recovery of knee ROM after TKA. Level of Evidence: Level IV, therapeutic case series.

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Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia

Saudi Medical Journal ◽

10.15537/smj.2017.6.17475 ◽

2017 ◽

Vol 38 (6) ◽

pp. 598-603 ◽

Cited By ~ 1

Author(s):

Abdullah Al-Turki ◽

Abdulaziz Al-Araif ◽

Bshaer Badakhan ◽

Mohammed Al-Nazzawi ◽

Suliman Alghnam ◽

...

Keyword(s):

Saudi Arabia ◽

Blood Transfusion ◽

Total Knee Replacement ◽

Knee Replacement ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Total Knee

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The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

Medical Journal of Indonesia ◽

10.13181/mji.v25i4.1502 ◽

2017 ◽

Vol 25 (4) ◽

pp. 234-9 ◽

Cited By ~ 2

Author(s):

Aryo N. Triyudanto ◽

Andri M.T. Lubis

Keyword(s):

Blood Transfusion ◽

Tranexamic Acid ◽

Postoperative Bleeding ◽

Control Group ◽

Transfusion Rate ◽

Intraoperative Bleeding ◽

Post Surgery ◽

Drain Removal ◽

Significant Difference ◽

Total Knee

Background: Despite the advances in the design and fixation of implants in total knee replacement (TKR). the amount of postoperative bleeding is still an important issue that has not been resolved. This study aimed to measure the effectiveness of various tranexamic acid administration. Methods: This was a randomized controlled trial study, held from August 2014 to February 2016 at Cipto Mangunkusumo Hospital, Jakarta. Twenty two patients having TKR were divided into three groups: the control group, the tranexamic acid intra-articular-intraoperative group, and the intravenous preoperative group. Intraoperative bleeding, haemoglobin (Hb) level on preoperative to five-day-post-surgery, total drain production, total blood tranfusion needed and the drain removal timing were recorded and compared. Numerical data were analyzed by using parametric and non-parametric test, depended on the normality of the data. Results: The amount of blood transfusion needed in both the intra-articular group (200±SD 100 mL) and the intravenous group (238±SD 53 mL) were significantly different compared to those in the control group (1,016±SD 308.2 mL) (p=0.001). Meanwhile, there was no significant difference between the amount of blood transfusion needed in the intra-articular group and the intravenous group. Total drain production in the intra-articular group (328±SD 193 mL) and intravenous group (391±SD 185 mL) was significantly different compared to the control group (652±SD 150 mL) (p=0.003). No significant difference between the levels of both preoperative and postoperative haemoglobin, the amount of intraoperative bleeding, and the duration of drain usage. Conclusion: Intravenous and intra-articular tranexamic acid effectively decreased transfusion volume and drain production in patients undergoing TKR.

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Demonstration of an expedited breast care (EBC) clinic

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.16023 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 16023-16023 ◽

Cited By ~ 2

Author(s):

A. Lopez ◽

C. C. Venker ◽

A. Howerter ◽

G. P. Barker ◽

A. Bhattacharyya ◽

...

Keyword(s):

Light Microscopy ◽

Breast Biopsy ◽

Digital Images ◽

Care Center ◽

Tertiary Care ◽

Control Group ◽

Tertiary Care Center ◽

Oncology Care ◽

Breast Care ◽

To Receive

16023 Background: Women report waiting for a breast biopsy result as a time of psychological distress. Waiting also delays entry into definitive oncology care, and patients in underserved communities may be lost to follow up. In this proof-of-concept demonstration, an Expedited Breast Care (EBC) clinic was developed to give patients the opportunity to receive same-day biopsy results. Methods: Patients requiring core breast biopsy at a community hospital were approached sequentially to participate. Following surgical biopsy, tissue underwent ultra-rapid fixation and processing. After paraffin sections were prepared and stained, the glass histopathology slides were imaged with a virtual slide scanner. Digital images were stored on a server and viewed on the Internet by a telepathologist at a tertiary care center. Light microscopy review was concurrently performed as the gold standard. After telepathology review and light microscopy confirmation, patients presented to the telemedicine suite to receive biopsy results. A teleoncologist at the tertiary care center presented all pathology results to the patient, whether benign or malignant. Time and patient satisfaction data were collected. Results: Nine patients have participated. Within 2 hours from the time the tissue arrived at the laboratory, digital images were available to the telepathologist. The teleoncologist presented results to patients within 3–5 hours after the biopsy procedure. Patients reported satisfaction with the same-day service, and stated they would seek EBC again in the event of a future breast biopsy. Many patients expressed relief at receiving results so promptly and felt they had avoided the stress of waiting longer for results. The elapsed time from mammogram to definitive oncology care was shorter for EBC patients compared to a control group of patients at a clinic not offering EBC, although the results did not reach statistical significance (Mann-Whitney U: Z = −1.804, p = 0.0713). Conclusions: These data indicate EBC can be successfully accomplished. Current studies to assess EBC’s role in facilitating prompt entry into definitive oncology care are underway. By incorporating rapid tissue processing with telepathology and teleoncology, EBC can improve access to breast care in underserved areas. [Table: see text]

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