The Nottingham
Objectives. We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. Methods. We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1.2 g, and the other 30 mg/kg, maximum 2.5 g as a single pre-operative dose. The primary outcome for this study was the requirement for blood transfusion within 30 days of surgery. Secondary measures included length of hospital stay, critical care requirements, re-admission rate, medical complications and mortality rates. Results. A total of 1914 THA and 2537 TKA procedures were evaluated. In THA, the higher dose of TXA was associated with a significant reduction in transfusion (p = 0.02, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.58 to 0.96) and rate of re-admission (p < 0.001, RR 0.50, 95% CI 0.35 to 0.71). There were reductions in the requirement for critical care (p = 0.06, RR 0.55, 95% CI 0.31 to 1.00), and in the length of stay from 4.7 to 4.3 days (p = 0.02). In TKA, transfusion requirements (p = 0.049, RR 0.64, 95% CI 0.41 to 0.99), re-admission rate (p = 0.001, RR 0.56, 95% CI 0.39 to 0.80) and critical care requirements (p < 0.003, RR 0.34, 95% CI 0.16 to 0.72) were reduced with the higher dose. Mean length of stay reduced from 4.6 days to 3.6 days (p < 0.01). There was no difference in the incidence of deep vein thrombosis, pulmonary embolism, gastrointestinal bleed, myocardial infarction, stroke or death in THA and TKA between cohorts. Conclusion. We suggest that a single pre-operative dose of TXA, 30 mg/kg, maximum 2.5g, results in a lower transfusion requirement compared with a lower dose in patients undergoing elective primary
Aims. Osteoporosis and abnormal bone metabolism may prove to be significant
factors influencing the outcome of arthroplasty surgery, predisposing
to complications of aseptic loosening and peri-prosthetic fracture.
We aimed to investigate baseline bone mineral density (BMD) and
bone turnover in patients about to undergo arthroplasty of the hip
and knee. Methods. We prospectively measured bone mineral density of the
Reports of improved functional outcome of Metal on Metal Hip Resurfacing Arthroplasty (mHRA) to Total Hip Replacement needs to be balanced with concerns of metal ion release. By removing cobalt-chrome, cHRA reduces these risks. To the author's knowledge, there is no data available on functional outcomes of cHRA, therefore the aim of the study was to compare the function between cHRA patients and mHRA patients. 24 patients received a unilateral cHRA (H1, Embody) and was compared to 24 age and gender matched patients with a unilateral mHRA (BHR, Smith and Nephew). All patients completed the Oxford
Abstract. BACKGROUND. Hemi-arthroplasty (HA) as a treatment for fractured neck of femur has slightly increased since 2019 and remarkably after the COVID pandemic. The main drawback of the treatment is ongoing cartilage deterioration that may require revision to THR. OBJECTIVE. This study assessed cartilage surface damage in
Hip precautions are currently practiced in three-quarters of trauma hospitals in the UK, despite national recommendations from the ‘Blue Book’ not stating it as a requirement. Valuable therapist time is utilised alongside the need for specialised equipment, which can potentially delay discharge whilst it is being arranged.
Objective of this study was to explore the current practice of the use of
Solid organ transplant (SOT) recipients present an increased medical risk; however, few studies analyze the outcomes of these patients undergoing
Abstract. Introduction. In general the life expectancy of population is improving. This is causing to increase case load of peri-prosthesis fractures after joint replacements. We present our results of peri-prosthesis fracture around
Cannulated
Between 2016–2019, 4 patients developed
Cam-type femoroacetabular impingement is caused by bone excess on the femoral neck abutting the acetabular rim. This can cause cartilage and labral damage due to increased contact pressure as the cam moves into the acetabulum. However, the damage mechanism and the influence of individual mechanical factors (such as sliding distance) are poorly understood. The aim of this study was to identify the cam sliding distance during impingement for different activities in the
Abstract. Objectives. Up to 19% of patients who undergo surgery for an acute
Artificial Intelligence (AI) is becoming more powerful but is barely used to counter the growth in health care burden. AI applications to increase efficiency in orthopedics are rare. We questioned if (1) we could train machine learning (ML) algorithms, based on answers from digitalized history taking questionnaires, to predict treatment of
Femoro-acetabular impingement involves a deformity of the
Reduction of length of stay (LOS) without compromising quality of care is a trend observed in orthopaedic departments. To achieve this goal the pathway needs to be optimised. This requires team work than can be supported by e-health solutions. The objective of this study was to assess the impact of reduction in LOS on complications and readmissions in one hospital where accelerated discharge was introduced due to the pandemic. 317 patients with primary total
Abstract. Objective. This study assesses the prevalence of major and minor discordance between
In 2020 almost 90% of femoral heads for total
The HIPGEN study funded under EU Horizon 2020 (Grant 7792939) has the aim to investigate the potential of the first regenerative cell therapy for the improvement of recovery after muscle injury in
Pelvic bone defect in patients with severe congenital dysplasia of the