Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

Background Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. Methods The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. Results The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. Conclusions Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.

Impact of tourniquet during total knee arthroplasty when tranexamic acid was used: a meta-analysis of randomized controlled trials

Introduction The efficacy of tourniquet use during primary total knee arthroplasty (TKA) is thought to reduce intraoperative blood loss, improve surgical exposure, and optimize cement fixation. Tranexamic acid (TXA) use can decrease postsurgical blood loss and transfusion requirements. This review aimed to appraise the effects of tourniquet use in TKA for patients with tranexamic acid use. Methods A meta-analysis was conducted to identify relevant randomized controlled trials involving TXA plus a tourniquet (TXA-T group) and use of TXA plus no tourniquet (TXA-NT group) in TKA. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through October 2021. Results We identified 1720 TKAs (1690 patients) assessed in 14 randomized controlled trials. Compared with the TXA-NT group, the TXA-T group resulted in less intra-operative blood loss (P < 0.00001) and decreased duration of surgery (P < 0.00001), however more hidden blood loss (P = 0.0004) and less knee range of motion (P < 0.00001). No significant differences were found between two groups in terms of decrease in hemoglobin (P = 0.84), total blood loss (P = 0.79), transfusion rate (P = 0.18), drainage volume (P = 0.06), Visual Analogue Scale (VAS) at either the day of surgery (P = 0.2), 1 day (P = 0.25), 2 day (P = 0.39), 3 day (P = 0.21), 5 day (P = 0.21), 7 day (P = 0.06) or 1 month after surgery (P = 0.16), Hospital for Special Surgery (HSS) score at either 7 day (P = 0.10), 1 month (P = 0.08), 3 month (P = 0.22) or 6 month after the surgery (P = 0.92), Knee circumference (P = 0.28), length of hospital (P = 0.12), and complications such as intramuscular venous thrombosis (P = 0.81), deep venous thrombosis (P = 0.10), superficial infection (P = 0.45), deep wound infection (P = 0.64), and delayed wound healing (P = 0.65). Conclusion No big differences could be found by using or not tourniquet when use the TXA, though some benefits are related to operation time and less intra-operative blood loss by using tourniquet and TXA, Using the tourniquet was related to more hidden blood loss and less knee range of motion. More adequately powered and better-designed randomized controlled trials (RCTs) studies with long-term follow-up are required to validate this study.

Hidden Blood Loss of Total Knee FVIII Prophylaxis in Hemophilia Arthritis : An Analysis of Influencing Factors

BackgroundTotal knee arthroplasty is the leading way to treat hemophilia arthritis. At present, there is a lack of research on the influencing factors of blood loss in total knee arthroplasty for hemophilia arthritis. This study comprehensively explores the definite factors affecting the hidden blood loss in total knee arthroplasty for hemophilia patients.Materials and methodsNinety-two hemophilia A patients who underwent total knee arthroplasty in our center were included. Demographic characteristics, laboratory data, surgical data, and complications were collected. The Gross equation and Sehat equation were used to calculate the estimated value of hidden blood loss. Multivariate stepwise linear regression analysis was used to determine the influencing factors of hidden blood loss.ResultThe hidden blood loss of hemophilia patients undergoing total knee arthroplasty was 1069.51±341.99mL, and the age was positively correlated with the hidden blood loss (P<0.001), while tranexamic acid, FVIII prophylaxis, and incremental invivo recovery were negatively correlated with the hidden blood loss (P<0.001, P=0.008, P=0.017).ConclusionElderly patients have a greater risk of blood loss, and additional preventive measures can be appropriately added. Intraoperative intra-articular injection of tranexamic acid is recommended to reduce hidden blood loss, FVIII prophylaxis is recommended for every patient. We recommend that all HA patients measure the incremental invivo recovery and develop a personalized coagulation factor infusion regimen.

Study protocol: haemostatic efficacy and safety of preemptive antifibrinolysis with multidose intravenous tranexamic acid in elderly hip fracture patients: design of a prospective randomised controlled trial

IntroductionHip fracture surgery is often associated with substantial blood loss and a high allogeneic blood transfusion (ABT) rate. Preoperative hidden blood loss (HBL) has been observed clinically but there is little evidence for the efficacy of tranexamic acid (TXA) in controlling preoperative HBL. We designed a randomised controlled trial to evaluate the efficacy of preemptive antifibrinolysis with multidose intravenous TXA (IV-TXA) in reducing preoperative HBL in elderly patients with hip fractures.Methods and analysisThis is a prospective, randomised, placebo-controlled clinical trial. Patients older than 65 years diagnosed with primary unilateral femoral neck fracture or intertrochanteric fracture will be randomly assigned to group A (receiving 100 mL of intravenous normal saline every 12 hours preoperatively and 1.5 g of IV-TXA every 12 hours postoperatively for 3 days) or group B (receiving 1.5 g of IV-TXA every 12 hours preoperatively and 1.5 g of IV-TXA every 12 hours postoperatively for 3 days). The primary outcomes will be the hidden blood loss, haemoglobin decrease and ABT rate. The secondary outcomes include the levels of inflammatory factors (such as C reactive protein) and coagulation and fibrinolysis parameters (such as D-dimer). Other outcomes such as injury time, length of stay and hospitalisation expenses will also be compared between groups.Ethics and disseminationThis study has been approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. The findings of the study will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberChiCTR2100045960.

Impact of Tourniquet During Total Knee Arthroplasty when Tranexamic Acid was used: A Meta-analysis of Randomized Controlled Trials

Introduction：The efficacy of tourniquet use during primary total knee arthroplasty (TKA) is thought to reduce intraoperative blood loss, improve surgical exposure, and optimize cement fixation. Tranexamic acid（TXA）use can decrease postsurgical blood loss and transfusion requirements. This review aimed to appraise the effects of tourniquet use in TKA for patients with tranexamic acid use.Methods：A meta-analysis was conducted to identify relevant randomized controlled trials involving TXA plus a tourniquet（TXA-T group）and use of TXA plus no tourniquet（TXA-NT group） in TKA. Web of Science，PubMed, Embase，Cochrane Controlled Trials Register,、Cochrane Library、Highwire、CNKI, and Wanfang database were searched from 2010 through October 2021.Results: We identified 1720 TKAs (1690 patients) assessed in 14 randomized controlled trials. Compared with the TXA-NT group, the TXA-T group resulted in less intra-operative blood loss (P＜0.00001) and decreased duration of surgery (P＜0.00001), however more hidden blood loss(P=0.0004) and less knee range of motion (P＜0.00001). No significant differences were found between two groups in terms of decrease in hemoglobin (P=0.84), total blood loss (P=0.79), transfusion rate( P=0.18) ,drainage volume(P=0.06) , Visual Analogue Scale(VAS) at either the day of surgery (P=0.2)、1 day(P=0.25)、2 day(P=0.39)、3 day(P=0.21)、5 day(P=0.21)、7day (P=0.06)or 1 month after surgery(P=0.16), Hospital for Special Surgery (HSS) score at either 7 day （P=0.10)、 1month（P=0.08)、 3 month（P=0.22) or 6 month after the surgery（P=0.92), Knee circumference（P=0.28）,length of hospital(P=0.12), and complications such as intramuscular venous thrombosis(P=0.81), deep venous thrombosis(P=0.10), superficial infection(P=0.45), deep wound infection(P=0.64) and delayed wound healing(P=0.65).Conclusion: No big differences could be found by using or not tourniquet when use the TXA, though some benefits are related to operation time and less intra-operative blood loss by using tourniquet and TXA, Using the tourniquet was related to more hidden blood loss and less knee range of motion. More adequately powered and better-designed randomized controlled trials （RCTs）studies with long-term follow-up are required to validate this study.

Changes in thromboelastography to predict ecchymosis after knee arthroplasty: a promising guide for the use of anticoagulants: a case control study

BackgroundEcchymosis is one of the worrisome complications after total knee arthroplasty (TKA) and interferes with functional rehabilitation. Current clinical guidelines do not provide individualized approaches for patients with ecchymoses. In this study, we used thromboelastography (TEG) to determine the coagulation state after TKA and to then explore markers that predict the occurrence of ecchymosis events after TKA.MethodsIn our cohort, patients were divided into ecchymosis (n=55) and nonecchymosis (n=137) groups according to whether ecchymosis events occurred after TKA. Rivaroxaban 10 mg/d was taken orally for thromboprophylaxis after surgery. All patients completed TEG testing. Correlation analysis was used to determine the risk factors for ecchymosis after TKA, and receiver operating characteristic (ROC) curves for variables with significant correlation were plotted.ResultsIn all, 55 of the 192 patients (28.65%) developed ecchymosis surrounding the surgical site. Multivariate analysis showed that hidden blood loss (OR = 1.003 and p =.005) and changes in the coagulation index (ΔCI) values (OR = 0.351 and p =.001) were risk factors for ecchymosis after TKA. Using the Youden index, 0.1805 was determined as the optimal threshold value of ΔCI for predicting the occurrence of ecchymosis, with a sensitivity of 74.55% and specificity of 72.99%.ConclusionsΔCI is a promising marker as an alarm for the occurrence of ecchymosis after TKA.Trial registrationChinese Clinical TrialRegistry, ChiCTR, NO. ChiCTR1800017245. Registered 19 July 2018 - Prospective registered, http://www.chictr.org.cn

Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without

Tourniquet-use has been described in litera- ture as a surgical factor leading to increased post-operative hidden blood loss in total knee arthroplasty (TKA). The hypothesis for this retro- spective study was that low-pressure tourniquet TKA would offer the benefits of tourniquet surgery without the potential negative effects on late blood loss after the procedure. Therefore, this study evaluated total (TBL) and hidden blood loss (HBL) in TKA with or without a tourniquet. We retrospectively compared two groups : one group (n= 54) undergoing TKA without a tourniquet and one group with a low-pressure tourniquet (n= 110). The outcomes compared were hemoglobin levels 2 weeks before surgery and at days 2 and 4 after surgery to calculate total and hidden blood loss, transfusion rate, and functional outcome. A higher total blood loss was observed in the no tourniquet group with a mean loss of 1073 mL against 890 mL in the tourniquet group (p-value = 0,003). Hidden blood loss values between both groups were statistically not significant : in the no-tourniquet group, Hb drop between D2 and D4 was 0.5 g/dL against 0.4 g/ dL in the low-pressure tourniquet group. The tourniquet-less group did not present with better functional scores. This study showed that low- pressure tourniquet use reduces TBL without increasing HBL in TKA.

Comparative analysis of hidden blood loss in total knee arthroplasty

The aim of the study was to investigate the influential factors for hidden blood loss after a total knee arthroplasty and their relationship with the total blood loss. Total knee arthroplasty (TKA) is a crucial treatment of late-stage knee osteoarthritis. Measured blood loss is significantly inconsistent with the hemoglobin (HB) drop postoperatively. Fifty-four patients, 20 males and 34 females, were retrospectively analyzed. The preoperative blood loss and therefore the hidden blood loss following TKA were calculated by the Gross formula. The typical perioperative blood loss was found to be 780±220 ml and therefore the average hidden blood loss was 280±180 ml. No significant differences were found in hidden blood loss for males compared to females. Hidden blood loss may not be reduced by hemostasis during operation with a deflated tourniquet.