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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 74 - 74
1 Mar 2013
Huff T Chimento GF Babin S Brandner L
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Total joint arthroplasty is one of the most common procedures performed in orthopaedic surgery. Over 600,000 total hip and total knee replacements are performed in the United States each year. At our 550 bed tertiary care facility, 437 total knee arthroplasties were performed in 2010 and 426 in 2011. Tranexamic acid is an antifibrinolyic synthetic derivative of aminocaproic acid used to prevent hemorrhage in patients undergoing surgical procedures. Several studies show decreased blood loss in patients receiving both intravenous and topical tranexamic acid.

Beginning in 2011, our surgeons began using topical tranexamic acid in an irrigation solution of 3 grams in 100 mL of normal saline after implant placement and prior to closure of the incision. Our study is a retrospective review comparing patients receiving total knee arthroplasties before and after the institution of tranexamic acid. The purpose of our study was to assess estimated perioperative blood loss, determining the cost effectiveness of using tranexamic acid while comparing adverse effects of using topical tranexamic acid in total knee arthroplasty. Our study includes 683 primary total knees, 373 that received did not receive topical tranexamic acid and 310 that did, from January 1, 2010 to October 31, 2011. There were no demographic differences between the 2 groups. Topical tranexamic acid significantly (p<0.0001) decreased blood loss in patients receiving primary total knee arthroplasties. There were no differences between groups in thromboembolic events or joint infections. Tranexamic acid significantly (p<0.0001) decreased both blood bank cost and total cost of stay resulting in nearly $1,500 savings per patient to our institution.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_I | Pages - 61
1 Mar 2002
Simon P Delloye C Bressier F Nyssen-Behets C Banse X Babin S Schmitt D
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Purpose: Only very partial integration of massive allografts is generally achieved, affecting bone-graft junctions and the peripheral cortical. In clinical practice, this is not a major problem for massive reconstructions with a sleeve prosthesis but can be a handicap for junctional grafts or osteoarticular grafts where weak recolonisation can be a source of complications.

Material and methods: Extraperiosteal resection measuring 5 cm in length was made in the mid shaft region and bridged by a cyropreserved non-irradiated allograft before stabilisation with a static locked nail. Three groups of ten sheep were studied. The first group received a simple allograft without perforation; the allograft was perforated in the second group (1.1 mm drill bit); and the perforations in the allograft in the third group were lined with decalcified bone powder with assumed potential for inducing bone growth. The implantation was studied after a delay of six months. There were three infections so the analysis was made on 27 grafts. Plain x-rays (consolidation of the graft-bone junctions), histomorphometrics (porosity, new peripheral and endomedullary bone deposit, cortical thickness), and bone density were studied.

Results: Rate of bone-graft consolidation was not significantly different in the three groups. The callus was more endosteal in groups 2 and 3 (p< 0.02) and endomedullary bone deposit was greater (p=0.0001) than in group 1 without perforation. There was approximately three times more bone deposit in the perforated allografts than in the non-perforated allografts; Adjunction of demineralised bone around the perforated grafts did not lead to any significant difference compared with the perforated allografts (group 2).

Discussion: Significantly more bone deposit observed with perforated allografts should lead to better biomechanical behaviour. This is being tested in further work.

Conclusion: Perforations induce a significant increase in new bone deposit in massive cortical allografts, remodelling is much more active and extensive than with non-perforated allografts. It would be logical to propose perforated allografts for junctional or osteochondral massive cortical grafts.