20-70% of patients need blood transfusion postoperatively. There remain safety concerns regarding allogenic blood transfusion. Tranexamic acid (TA) is a synthetic antifibrinolytic agent that has been successfully used to stop bleeding in other specialties. We applied TA topically prior to the wound closure to find out the effect on blood loss as well as need for subsequent blood transfusion. This method of administration is quick, easy, has less systemic side effect and provides a higher concentration at the bleeding site. A double blind randomised controlled trial of 154 patients who underwent unilateral primary cemented total knee replacement. Patients were randomised into tranexamic acid group (1g drug mixed with saline to make up 20mls) or placebo (20ml 0.9% saline). The administration technique and drain protocol was standardised for all patients. Drain output was measured at 24 hours, and both groups compared for need of Blood transfusion. Outcome measures - blood loss, transfusion, complications, Euroqol and Oxford Knee Score.PURPOSE OF STUDY
MATERIALS AND METHODS
We report the results of patellofemoral joint replacement done at our institution for predominantly patellofemoral arthritis. Patellofemoral joint replacement has always been a controversial subject, particularly in elderly patients where a more predictable result can be obtained with TKA. Patellofemoral joint replacement surgery was commenced at our institute in 2002 using the Avon design (Stryker corp, UK,) pioneered at the Avon Orthopaedic centre, Southmead, Bristol, UK. We report retrospective analysis of 43 consecutive Patellofemoral replacements done in 39 patients between 2002 and 2006, with a minimum of 6 months follow-up. 38 patients (5 bilateral) were available for review while 1 patient died 3 years after the operation following unrelated causes. They were all assessed clinically and radiologically on the last follow up. Follow-up ranged from 6 to 56 months, average being 21 months. Females outnumbered males by 3:1. All patients were scored pre and postoperatively using Melbourne Knee scoring system (Bartlett et al) and Knee Functional Score. The average Melbourne Knee score increased from 10 to 25 postoperatively, while the knee functional score increased from 57 to 85. Postoperative flexion ranged from 100–140°, average being 116°. Commonest complication was clicking (17%), half of which resolved by arthroscopic lateral release. 87% patients graded the result as excellent or good, while 2% (1 patient) rated it as poor. 59% patients had radiologically proven early tibiofemoral arthritis preoperatively, out of which progression was noted in 28% at the last follow-up. No complications related to deep infection or loosening were noted, and one knee needed revision on account of progression of lateral compartment arthritis. With revision as the end point, the survivorship was 97.7% at average of 2 years after surgery.
