{"title":"在双侧全膝关节置换术中，术中追加关节周围氨甲环酸可减少引流管输出量，但对保护总失血量无益：回顾性观察","authors":"Arghya Kundu Choudhury , Anil Regmi , Bishwa Bandhu Niraula , Tushar Gupta , Souvik Paul , Roop Bhusan Kalia","doi":"10.1016/j.jcot.2024.102770","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The preferred procedure for end-stage arthritic knees is Total Knee Arthroplasty (TKA). Hidden blood loss during and after surgery is one of the most frequent side effects of TKA. This study aims to assess the impact of an extra intraoperative dosage of local periarticular tranexamic acid (TXA) on total blood loss and drain output following bilateral TKA in comparison to conventional triple dose IV TXA.</div></div><div><h3>Methods</h3><div>Patients who had bilateral simultaneous TKA between January 2021 and November 2022 were the subjects of a single centre based retrospective observational analysis. In group 1 and group 2, 80 knees (IV TXA with periarticular TXA) were compared to a matched paired control set of 80 knees (3 dose IV TXA).</div></div><div><h3>Results</h3><div>In all, 80 patients having 160 TKAs performed were included in the study. When the two groups' total and concealed blood losses were compared, they were found to be statistically insignificant; nevertheless, first group's drain output was considerably lower than the second group due to the use of an additional dose of periarticular TXA. Comparable declines in Hb, HCT, and platelet count were observed among the two groups. The secondary goal indicated that although there was no significant difference in range of motion between the groups 72 h after surgery, group 2 had a higher rate of hospital re-admissions within 30 days compared to group 1.</div></div><div><h3>Conclusion</h3><div>The study demonstrated that peri-articular TXA administration during bilateral simultaneous TKA resulted in no additional benefit to the total or hidden blood loss conservation, except reducing the drain amount. However, a unique finding of the current study suggests decreased chances of wound complications and lesser 30-day readmission rate among patients receiving peri-articular TXA. Present study thus advocates the use of TXA as an effective peri-articular adjunct after TKA when a negative suction drain is being used post-operatively.</div></div><div><h3>Level of evidence</h3><div>Level III, Retrospective comparative study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"57 ","pages":"Article 102770"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An additional intra-operative peri-articular tranexamic acid decreases the drain output but does not benefit in total blood loss conservation during bilateral Total Knee Arthroplasty: A retrospective observation\",\"authors\":\"Arghya Kundu Choudhury , Anil Regmi , Bishwa Bandhu Niraula , Tushar Gupta , Souvik Paul , Roop Bhusan Kalia\",\"doi\":\"10.1016/j.jcot.2024.102770\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The preferred procedure for end-stage arthritic knees is Total Knee Arthroplasty (TKA). Hidden blood loss during and after surgery is one of the most frequent side effects of TKA. This study aims to assess the impact of an extra intraoperative dosage of local periarticular tranexamic acid (TXA) on total blood loss and drain output following bilateral TKA in comparison to conventional triple dose IV TXA.</div></div><div><h3>Methods</h3><div>Patients who had bilateral simultaneous TKA between January 2021 and November 2022 were the subjects of a single centre based retrospective observational analysis. In group 1 and group 2, 80 knees (IV TXA with periarticular TXA) were compared to a matched paired control set of 80 knees (3 dose IV TXA).</div></div><div><h3>Results</h3><div>In all, 80 patients having 160 TKAs performed were included in the study. When the two groups' total and concealed blood losses were compared, they were found to be statistically insignificant; nevertheless, first group's drain output was considerably lower than the second group due to the use of an additional dose of periarticular TXA. Comparable declines in Hb, HCT, and platelet count were observed among the two groups. The secondary goal indicated that although there was no significant difference in range of motion between the groups 72 h after surgery, group 2 had a higher rate of hospital re-admissions within 30 days compared to group 1.</div></div><div><h3>Conclusion</h3><div>The study demonstrated that peri-articular TXA administration during bilateral simultaneous TKA resulted in no additional benefit to the total or hidden blood loss conservation, except reducing the drain amount. However, a unique finding of the current study suggests decreased chances of wound complications and lesser 30-day readmission rate among patients receiving peri-articular TXA. Present study thus advocates the use of TXA as an effective peri-articular adjunct after TKA when a negative suction drain is being used post-operatively.</div></div><div><h3>Level of evidence</h3><div>Level III, Retrospective comparative study.</div></div>\",\"PeriodicalId\":53594,\"journal\":{\"name\":\"Journal of Clinical Orthopaedics and Trauma\",\"volume\":\"57 \",\"pages\":\"Article 102770\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Orthopaedics and Trauma\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0976566224004399\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Orthopaedics and Trauma","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0976566224004399","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
An additional intra-operative peri-articular tranexamic acid decreases the drain output but does not benefit in total blood loss conservation during bilateral Total Knee Arthroplasty: A retrospective observation
Background
The preferred procedure for end-stage arthritic knees is Total Knee Arthroplasty (TKA). Hidden blood loss during and after surgery is one of the most frequent side effects of TKA. This study aims to assess the impact of an extra intraoperative dosage of local periarticular tranexamic acid (TXA) on total blood loss and drain output following bilateral TKA in comparison to conventional triple dose IV TXA.
Methods
Patients who had bilateral simultaneous TKA between January 2021 and November 2022 were the subjects of a single centre based retrospective observational analysis. In group 1 and group 2, 80 knees (IV TXA with periarticular TXA) were compared to a matched paired control set of 80 knees (3 dose IV TXA).
Results
In all, 80 patients having 160 TKAs performed were included in the study. When the two groups' total and concealed blood losses were compared, they were found to be statistically insignificant; nevertheless, first group's drain output was considerably lower than the second group due to the use of an additional dose of periarticular TXA. Comparable declines in Hb, HCT, and platelet count were observed among the two groups. The secondary goal indicated that although there was no significant difference in range of motion between the groups 72 h after surgery, group 2 had a higher rate of hospital re-admissions within 30 days compared to group 1.
Conclusion
The study demonstrated that peri-articular TXA administration during bilateral simultaneous TKA resulted in no additional benefit to the total or hidden blood loss conservation, except reducing the drain amount. However, a unique finding of the current study suggests decreased chances of wound complications and lesser 30-day readmission rate among patients receiving peri-articular TXA. Present study thus advocates the use of TXA as an effective peri-articular adjunct after TKA when a negative suction drain is being used post-operatively.
期刊介绍：
Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.
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