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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 73 - 73
1 Oct 2019
Sershon RA Fillingham Y Abdel MP Malkani AL Schwarzkopf R Padgett DE Vail TP Nam D Nahhas CR Culvern C Valle CJD
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Background

The purpose of this multicenter, randomized clinical trial was to determine the optimal dosing regimen of tranexamic acid (TXA) to minimize perioperative blood loss for revision total hip arthroplasty (THA).

Methods

Six centers prospectively randomized 155 revisions to one of four regimens: 1g of intravenous (IV) TXA prior to incision, a double dose regimen of 1g IV TXA prior to incision and 1g IV TXA during wound closure, a combination of 1g IV TXA prior to incision and 1g intraoperative topical TXA, or three doses of 1950mg oral TXA administered 2 hours preoperatively, 6 hours postoperatively, and on the morning of postoperative day one. Randomization was based upon revision subgroups to ensure equivalent group distribution, including: femur only, acetabulum only, both component, explant/spacer, and second stage reimplantation. Patients undergoing an isolated modular exchange were excluded. An a priori power analysis (alpha = 0.05; beta = 0.80) determined 40 patients per group were required to identify a 1g/dL difference in postoperative hemoglobin reduction between groups. Per-protocol analysis involved an analysis of variance, Fisher's exact tests, and two one-sided t-tests for equivalence.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 9 - 9
1 Oct 2018
Malkani AL Denehy K Ong K Hagan D
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Introduction

Cephalomedullary nails (CMN) are commonly used for the treatment of intertrochanteric (IT) hip fractures. Total hip arthroplasty (THA) is commonly used as a salvage procedure for failed IT hip fractures that progress to post-traumatic arthritis. This study analyzed the complications of THA following treatment of failed IT hip fractures with cephalomedullary nails.

Methods

Patients who had a primary THA were identified from the 5% subset of Medicare Parts A/B from 2002–2015. A subgroup with previous CMN for IT hip fracture within the previous 5 years was identified and compared to the remaining THA patients without prior CMN. Length of stay (LOS) was compared using both univariate and multivariate analysis. Infection, dislocation, revision, and readmission were compared between those with and without prior CMN, using multivariate analysis (adjusted for demographic, hospital, and clinical factors).