knee and hip arthroplasty
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2021 ◽  
Vol 11 (1) ◽  
pp. 48
Author(s):  
Jaroslaw Pecold ◽  
Mahdi Al-Jeabory ◽  
Maciej Krupowies ◽  
Ewa Manka ◽  
Adam Smereka ◽  
...  

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Huibin Long ◽  
Zhichang Li ◽  
Dan Xing ◽  
Yan Ke ◽  
Jianhao Lin

Abstract Background Numerous systematic reviews investigating the benefit of the usage of drainage after primary total hip or knee arthroplasty have been published with divergent conclusions. We aim to determine the best available evidence and consider risk of bias of these articles and to provide recommendations. Methods A systematic search of systematic reviews published through to May 2020 was performed in MEDLINE, EMBASE and Cochrane library. Methodological quality, risk of bias and best evidence choice of included articles were evaluated by AMSTAR instrument, ROBIS tool and Jadad decision algorithm, respectively. We selected systematic reviews with high methodological quality and low risk of bias ultimately as best evidence. Results Twelve meta-analyses were included lastly. According to the ROBIS tool, seven of the included systematic reviews were with low risk of bias and five with high risk of bias. The Jadad decision algorithm suggested that two reviews conducted by Zan et al. for hip and Si et al. et al. for knee were selected as the best evidence, with highest AMSTAR score and low risk of bias. Conclusions Ten systematic reviews were included as low-quality with only two high-quality studies. Based on the current available evidence, we have insufficient confidence to draw conclusion that whether to use closed suction drainage for both total knee and hip arthroplasty. To verify the necessity and benefit of using closed suction drainage after primary total knee and hip arthroplasty, and develop exact recommendations, further studies are still required.


2021 ◽  
pp. 1-6
Author(s):  
Daphne Bron ◽  
Wolterbeek Nienke ◽  
Rudolf Poolman ◽  
Diederik Kempen ◽  
Diyar Delawi

2021 ◽  
Vol 27 (5) ◽  
pp. 570-577
Author(s):  
A.G. Aliev ◽  
◽  
A. Riakhi ◽  
A.P. Sereda ◽  
E.V. Veber ◽  
...  

Abstract. Introduction The Covid-19 pandemic has led to quite significant changes in the length of hospital stay of orthopedic patients. Meanwhile, there has been a tendency for early discharge after arthroplasty for quite some time due to the increasing burden on health care systems that became possible due to the implementation of accelerated rehabilitation protocols. This study is dedicated to the effect of discharge terms on the incidence of postoperative complications. Material and methods A retrospective study of 1,837 patients who underwent primary/revision THA and TKA at our center in 2020 was carried out. The impact of the pandemic was assessed by comparing the duration of hospitalization, the incidence of complications and functional status in patients operated on before and after the introduction of epidemiological restrictions. Purpose of the study To assess the impact of the Covid-19 pandemic on the length of patients’ hospital stay after knee and hip arthroplasty. Results The total duration of hospitalization after primary THA was reduced by 35 % (from 11.8 ± 3.3 to 7.7 ± 2.6 bed-days), and by 38 % (from 19.9 ± 7.5 to 12.8 ± 6.3 bed-days) after revision THA. The overall readmission rate (for surgical and nonsurgical complications) after primary THA was 4.1 % before the pandemic and 4.3 % during the pandemic; for primary TKA it was 2.1 % and 5.1 %, respectively; for revision THA – 13.9 % and 4.5 %, revision TKA – 4.4 % and 9.8 %, respectively. Comparative assessment for each diagnosis separately did not show significant difference. Evaluation of the questionnaire survey using the Oxford hip/knee score also showed the absence of a statistically significant relationship between the time of discharge and the functional state of the operated joint. The interviewing of patients regarding the infection with coronavirus yielded positive answers in 22 % (n = 419). The onset of symptoms during hospitalization or within 14 days after discharge was noted by 4 % of respondents (n = 75). Conclusion The incidence of complications and unfavorable outcomes did not depend on the length of hospital stay after THA and TKA.


2021 ◽  
Vol 13 ◽  
pp. 1271-1276
Author(s):  
Alvaro Francisco Lopes Sousa ◽  
Layze Braz de Oliveira ◽  
Herica Emilia Félix de Carvalho ◽  
Ivonizete Pires Ribeiro ◽  
Inês Fronteira ◽  
...  

Objetivo: avaliar a prevalência de complicações no pós-operatório e sua associação com variáveis sociodemográficas e clínicas. Métodos: Trata-se de um estudo descritivo, de seguimento prospectivo, realizado com 99 pacientes de um hospital de ensino. Os participantes foram selecionados por amostragem intencional (referencia) e seguidos por 30 dias após a alta do hospital. Realizou-se análises descritivas, univariadas e bivariadas Resultados: 32 (32,3%) pacientes desenvolveram ao menos uma complicação, sendo que 10 (10,1%) desenvolveram mais de uma complicação num seguimento de 30 dias. Dor (31; 31,3%) e Infecção (12; 12,1%) foram as complicações mais prevalentes. Identificou-se associação estatística entre o desfecho clinico dos pacientes submetidos a cirurgia de joelho e quadril e a presença de complicações no pós-operatório (p<0,001). Conclusão: A ocorrência de complicações no pós-operatório de artroplastia de joelho e quadril num seguimento de 30 dias foi elevada, com destaque para a dor e infecção local.  


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Whitham ◽  
J O'Callaghan ◽  
M Flintoft-Burt ◽  
V Shah

Abstract Aim Operation notes provide essential information about the techniques and implants used in surgery. Accurate documentation is important to improve patient outcomes and reduce rising litigation costs within the NHS. The aim of this audit was to assess compliance to recent guidance for hip and knee arthroplasty documentation, issued by the Getting It Right First Time (GIRFT) programme in 2019. Method Data was collected retrospectively from operation notes of all primary total/unicompartmental knee and hip arthroplasties during August 2019 and again in October 2019 at a DGH. Documentation was audited against data items from the GIRFT knee and hip arthroplasty ‘best practice’ guidelines. Interventions between timeframes included clinician education and a discussion of the guidelines between local surgeons. Results In audit rounds 1 and 2 twenty-six and 34 patients had THRs and 23 and 28 had knee arthroplasties respectively. 100% compliance was seen in 5/23 THR criteria and 9/27 knee criteria. Average compliance for knee documentation rose from 71% to 74% but no improvement was seen for THR (68% vs 64%). Those with least improvement related to assessment of range of movement and vascular status at the end of surgery. Conclusions Although compliance was good against the majority of data points there was minimal change following a local education intervention. The development and use of fully compliant departmental operation note templates would provide further clarity about steps performed and surgeon rationale should patient care later be scrutinised. The template would also act as an invaluable educational tool for trainees reflecting on the case.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Mepani ◽  
F Raheman ◽  
P Nasr

Abstract Aim To induce a change in practice with regard to pre-op G&S sampling. This is common practice in elective orthopaedics. Transfusion rates are negligible. Therefore, omitting this practice can reduce the financial burden on the Trust. Method Patient's undergoing elective primary total knee or hip arthroplasty over a 1-year period were retrieved from a database. Data regarding pre/post-op haemoglobin levels and transfusion status was obtained from patient case notes and Trust ICE pathology reporting system. Results There were a total of 454 patient's (251 undergoing TKR, 203 undergoing THR). Four patient's (1.6%) in the TKR group and 11 patient's (5.4%) in the THR group required transfusion. Of these patient's, 5 had cardiac problems and 6 had pre-operative anaemia. Conclusions Routine G&S sampling is unnecessary in the majority of cases and should only be reserved for certain cases (patient's with significant cardiac problems and those with a transfusion history). Patient's with pre-operative anaemia should have optimisation of haemoglobin level prior to the procedure.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256072
Author(s):  
Gregory Baxter-Parker ◽  
Lloyd Roffe ◽  
Elena Moltchanova ◽  
Jay Jefferies ◽  
Siddarth Raajasekar ◽  
...  

Knee and hip arthroplasty are common surgeries within an aging population. Some data has suggested that knee arthroplasty is more traumatic to the body than hip arthroplasty due to the increased complexity and load bearing nature of the joint. Here, we compare the stress of the two surgeries by measuring urinary neopterin and total neopterin as biomarkers of oxidative stress and inflammation. Urinary neopterin and total neopterin (neopterin + 7,8-dihydroneopterin) levels were analysed in 28 knee and 22 hip arthroplasty patients pre- and post-operatively to determine oxidative stress and inflammation levels. Total neopterin was 31.1% higher with knee arthroplasty (p<0.05). Urinary neopterin was 32.8% higher in the knee arthroplasty group versus hips. The increase in neopterin and total neopterin following a post-surgical decrease in levels was significant in both groups. Levels of neopterin and total neopterin were varied between patients, but all increased following surgery and subsided by day 28. The increased levels of urinary neopterin and total neopterin from knee arthroplasty indicate that knee osteoarthritis and arthroplasty is a more significant trauma to the body than hip osteoarthritis and arthroplasty surgery. This is also shown by faster inflammatory resolution following hip arthroplasty.


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