Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty.

BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss and transfusion rates in total joint arthroplasty. Blood loss and allogenic transfusion rates have not been well studied in patients receiving TXA and undergoing bilateral staged total knee arthroplasty (TKA). The purpose was to evaluate the effect of TXA on blood loss, hemoglobin (Hb) changes, and transfusion in patients undergoing staged bilateral TKA. STUDY DESIGN AND METHODS: The authors compared 51 patients undergoing staged bilateral TKA who received TXA (2 g; subjects) with 70 who did not (controls). There were no significant differences between the groups in terms of demographics or preoperative Hb. For each TKA, 1 g of TXA was administered intravenously 15 minutes before incision and 1 g was administered intravenously at tourniquet release. Blood loss, Hb levels, and transfusions were recorded. Statistical analyses were performed using computer software. Significance was set at 0.05. RESULTS: Subjects had a significantly lower (p < 0.001) mean (±SD) blood loss (373.8 ± 264.6 mL vs. 871.6 ± 457.7 mL), significantly higher (p < 0.005) Hb levels on Postoperative Days 1 and 2, and a significantly lower (p < 0.001) mean (±SD) number of transfused allogenic blood units (0.60 ± 0.84 units vs. 1.53 ± 1.30 units). CONCLUSIONS: TXA reduces blood loss, improves postoperative Hb, and decreases the allogenic blood transfusion requirements for patients undergoing bilateral staged TKA. TXA is an option for patients choosing bilateral staged TKA to decrease the risks associated with blood transfusion or when autologous blood is not available.

All-polyethylene tibial components in obese patients are associated with low failure at midterm followup.

BACKGROUND: In the United States, the obese population has increased markedly over the last four decades, and this trend continues. High patient weight places additional stress on TKA components, which may lead to increased polyethylene wear, osteolysis, radiolucencies, and clinical failure. Metal-backed tibial components and all-polyethylene tibial components in the general population have comparable osteolysis and failure, but it is unclear whether these components yield similar osteolysis and failure in obese patients. QUESTIONS/PURPOSES: We therefore determined the (1) function, (2) occurrence of osteolysis, and (3) complications in a cohort of obese patients receiving all-polyethylene tibial components. PATIENTS AND METHODS: Between September 17, 1996, and December 19, 2002, we implanted all-polyethylene tibial components in 90 obese patients (125 knees); 24 patients (33 knees) died and 13 patients (17 knees) were lost to followup, leaving 53 patients (59%) with 75 knees. All surgeries were cruciate-retaining, tricompartmental TKAs. We evaluated patients with Knee Society Scores and serial radiographs. Minimum followup was 7 years (mean, 10.4 years; range, 7-14 years). RESULTS: At latest followup, mean Knee Society Score was 92 points. There were five tibial radiolucencies, all less than 1 mm and characterized as nonprogressive. We observed minimal, nonprogressive osteolysis in one knee. One patient required reoperation after a traumatic event. There were no implant-related failures and no implants at risk of failure. CONCLUSIONS: At an average 10-year followup, all-polyethylene tibial components were functioning well in this obese group. These findings confirm the effectiveness of all-polyethylene tibial components in obese patients.

When can I drive?: brake response times after contemporary total knee arthroplasty.

BACKGROUND: After right total knee arthroplasty (TKA), patients are usually eager to return to driving. Previous studies suggest 6 weeks postsurgery is a safe time. However, recent advances in surgical technique, pain management, and rehabilitation have theoretically improved recovery after TKA. QUESTIONS/PURPOSES: We therefore determined if (1) the timeframe for return to driving, as determined by attainment of preoperative braking levels, would be shorter after contemporary right TKA than that reported previously for a traditional TKA; and (2) gender or age influence recovery of baseline response time. METHODS: Brake response times for all 29 patients undergoing right-sided TKA between January 17, 2008, and January 29, 2009, were scheduled to be measured by a trained occupational therapist before surgery and at 4, 6, and 8 weeks after surgery. For each patient, testing was discontinued once the preoperative level was achieved. RESULTS: All patients returned to baseline braking levels by 4 weeks after surgery. Gender and age did not influence recovery times. CONCLUSIONS: If other requirements for driving are met, surgeons may consider allowing patients treated with contemporary right TKAs to drive 4 weeks after surgery.