Tourniquets and tranexamic acid (TXA) are commonly used in total knee arthroplasty (TKA), but there is not consensus on how these interventions affect blood transfusion rates and total blood loss. Few studies examine the combined use of both interventions. We compared outcome measures and transfusion rates following TKA, with and without the use of tourniquet and TXA. Retrospective cohort study of 477 consecutive patients undergoing primary TKA at a single center between 2008 and 2013. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquet-unassisted (TU) group. Subanalysis was performed on those patients receiving TXA.Background
Methods
1152 ABG I primary hip arthroplasties were performed in 1037 patients from 1991–1997. Osteoarthritis was diagnosed in 93% of cases. The average age was 65 years; there were 536 females and 501 males. Mean follow-up was 79.6 months.
The average age of the fracture group was 73 years, compared to 65 years for the whole series (p<
0.0001). The incidence of periprosthetic fracture increased with age. The relative risk for patients over 70 years for peri-prosthetic fracture is 4.7 greater (95% CI 2.14–10.21). Distinct fractures patterns were related to time from initial surgery. Four fractures occurred within three months of surgery; these early fractures exhibited a particular pattern. The remaining 24 occurred between four and 114 months after surgery. These late fractures exhibited a different but consistent fracture pattern. Two fractures in the early group were identified immediately post-operatively. All others presented after minor low energy trauma. The mean cortical index in the fracture group was 47% and in the matched group 51%. If the pre-operative cortical index is below 50%, the risk of periprosthetic fracture is 4.75 greater (odds ratio 4.75 CI 1.5–15.00). All fractures were adequately classified and managed by guidelines in the Vancouver classification.