[Show abstract][Hide abstract] ABSTRACT: Tranexamic acid was intra-articularly injected in total knee arthroplasty (TKA) to reduce blood loss and transfusion. However, no single study has been large enough to definitively determine whether it is safe and effective. To determine the safety and efficacy of intra-articular tranexamic acid in TKA, the authors searched various databases for relevant randomized controlled trials. Mean difference (MD) in total blood loss, risk ratio (RR) for transfusion, and complication rate in the tranexamic acid-treated group vs the placebo group were calculated. Seven randomized controlled trials, including 622 patients (174 men and 448 women), were identified. All 7 placebo-controlled randomized trials had a low risk of bias. The pooled results showed a positive effect of tranexamic acid in all treatment groups, with significant reduction in total blood loss (MD, -396.42 mL [95% confidence interval (CI), -629.64 to -163.20]; P=.0009). However, there was significant heterogeneity in the finding (chi-square=27.16, df=3, I(2)=89%; P<.00001) among studies. The pooled results indicated that 5.8% (18 of 309) of tranexamic acid-treated patients required transfusion compared with 27.2% (85 of 313) of placebo-treated patients. This difference was significant (RR, 0.22; 95% CI, 0.14-0.35; P<.00001). There was no significant difference between the groups in the incidence of deep venous thrombosis (RR, 0.83; 95% CI, 0.35-1.98; P=.68) or pulmonary embolism (RR, 0.54; 95% CI, 0.10-2.85; P=.46). In all, intra-articular tranexamic acid significantly reduced total blood loss, drainage, reduction of hemoglobin, and the need for transfusion without increasing the incidence of deep venous thrombosis and pulmonary embolism. Intra-articular tranexamic acid is safe and efficacious in TKA.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this research is to compare the clinical results of different drainage methods in total knee arthroplasty (TKA).
This retrospective comparative study included 55 patients who accepted primary unilateral TKA between October 2010 and November 2012. The patients were classified according to the drainage method used: 25 patients in the autotransfusion drainage group, 12 patients in the delayed drainage group, and 18 patients in the routine drainage group. Otherwise, the same operative procedures and postoperative care were applied to all patients. The variables recorded included total amount of postoperative drainage (including intraoperative blood loss); cases of allogenic blood transfusion; body temperatures on postoperative days 1, 3, and 7; and pre- and postoperative hemoglobin level. Some other elements such as postoperative swelling, range of motion, and wound healing were also compared.
Patients who underwent autotransfusion were found to have an amount of drainage (799.2 +/- 196.7 mL) significantly greater than that in the routine drainage group (666.1 +/- 155.0 mL), which in turn was significantly greater than that in the delayed drainage group (381.7 +/- 129.2 mL). The postoperative hemoglobin level in the delayed drainage group (91.5 +/- 7.9 g/L) was similar to that in the autotransfusion group (92.0 +/- 9.6 g/L), while that in the routine drainage group (81.3 +/- 9.9 g/L) was significantly lower. The patients in the autotransfusion group were observed to have higher body temperatures than those in the other two groups. In the routine drainage group, eight cases accepted allogenic blood transfusion, and the percentage (44.4%) was significantly higher than that in the other two groups. There were no significant between-group differences in swelling, healing qualities, and range of motion.
Delayed postoperative drainage may reduce blood loss and the chance of allogenic blood transfusion compared with routine drainage and may also reduce the chance of postoperative fever and extra costs compared with autotransfusion.
Full-text · Article · Nov 2013 · Journal of Orthopaedic Surgery and Research
[Show abstract][Hide abstract] ABSTRACT: In current study of femoral head necrosis and femoral neck fractures, more attentions has been paid to relationship between the femoral head trabecular bone within the spatial structure and its biomechanics. In this connection, PMMA (polymethyl methacrylate), special square iron, dental base acrylic resin liquid and powder were used to embed and fix human dry femur. Then, M618 Lie Axle Rectangle Desk Plane Grinding Machine was applied to grind the femur specimen, and then air blower clean, two-dimensional cross section image was obtained by using scanner. With Mimics software reconstruction, a three-dimensional model of spatial structure of trabecular bone was obtained, and the trabecular bone three-dimensional parameters were calculated. The authors obtained clear three-dimensional model of trabecular bone, reconstructed the real anatomic morphology of proximal femur. This is a good method to research into the interior structure of femur and to provide the foundation for the three-dimensional finite element analysis.
No preview · Article · Feb 2011 · Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi