Intravenous vs Intra-Articular Tranexamic Acid in Total Knee Arthroplasty: A Randomized, Double-Blind Trial.

BACKGROUND: Tranexamic acid (TXA) is commonly used in primary total knee arthroplasty (TKA); however, the most appropriate route of administration is still debated. This study was conducted to compare the 2 most commonly used routes of TXA administration, intravenous (IV) and intra-articular (IA). METHODS: This study was conducted as a double-blind, randomized, noninferiority trial and included patients undergoing primary unilateral TKA. Patients were randomized to receive IV or IA TXA and compared for postoperative fall in hemoglobin (Hb) on day 1 (primary outcome) and day 2, and blood transfusion rates, length of stay, and complications. RESULTS: Of the 183 patients recruited, 168 were included and supplied complete data. The between-group difference in mean Hb fall at day 1 was 0.08 g/dL with the Hb fall higher in the IA group. The 95% confidence interval was -0.18 to 0.34 which did not reach the noninferiority margin of 0.5 g/dL. No significant difference was seen in the secondary outcomes. CONCLUSION: IA TXA is noninferior to IV TXA in terms of fall in Hb on the first postoperative day. Due to the potential for reduced serum levels and easier administration (single dose), this trial supports the use of IA TXA for primary TKA.

Osteolysis in third-generation alumina ceramic-on-ceramic hip bearings with severe impingement and titanium metallosis.

The most common cause of long-term failure of total hip arthroplasty is osteolysis and aseptic loosening secondary to wear debris. Combinations of hard materials such as ceramic-on-ceramic generate smaller volumes of particulate wear debris than traditional combinations such as metal-on-polyethylene. We describe 2 cases where osteolysis arose in hips with third-generation alumina ceramic-on-ceramic couplings. Periarticular tissue in both cases contained titanium wear debris due to impingement of the neck of the titanium femoral component against the rim of the titanium shell and ceramic debris from edge loading wear (stripe wear) of the ceramic. It is not clear whether the titanium debris, the ceramic debris, or both caused the osteolysis. These cases illustrate that the risk of osteolysis persists, even with third-generation alumina ceramics.

Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty.

The influence of different femoral alignment systems on blood loss and the need for blood transfusion after total knee arthroplasty (TKA) was studied. The blood loss was retrospectively recorded in two similar groups of consecutive patients. The first group consisted of 46 patients in whom TKA was performed using the intramedullary femoral alignment system and the second group consisted of 45 patients in whom the procedure was performed with the extramedullary system. In the intramedullary group, the mean volume of drained blood was 758 mL, whereas in the extramedullary group it was 613 mL (P < .05). More patients in the intramedullary. group required blood transfusions, but no significant difference was noted in the number of blood units transfused per patient. Extramedullary femoral alignment instrumentation reduces blood loss after cementless TKA.

An incidental finding of chondroid lipoma at total hip arthroplasty.

Chondroid lipoma is a rare benign lipomatous soft tissue tumor which presents as a painless lump. This case report presents the incidental finding of such a tumor at total hip replacement and briefly reviews the literature regarding the histopathological features of this recently described neoplasm.