Objectives

To investigate the value of tranexamic acid (TA) in reducing blood loss and blood transfusion after TKR and other clinical outcomes such as deep venous thrombosis (DVT), pulmonary embolism (PE), ischaemic heart diseases and mortality.

PURPOSE OF STUDY

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.

Introduction: Today’s aging population has resulted in an increase in the number of major orthopaedic surgical interventions in the elderly. Total knee replacement (TKR) is one of the commonest operations in orthopaedic practice. The fourth annual report of the National Joint Registry showed that there were 60 986 TKR performed in England and Wales in 2006. The true figure is probably much higher. Literature showed that 20–70% of patients who had TKR needed 1–3 units of blood.

Although safer than ever, allogeneic transfusion is still associated with risks for the recipient (haemolysis, infection, immunosuppression, transfusion-related acute lung injury and even death).

Tranexamic acid (TA) is a synthetic antifibrinolytic agent that has been successfully used to stop bleeding after dental operation, removal of tonsils, prostate surgery, heavy menstrual bleeding, eye injuries and in patients with Haemophilia.

In this study Tranexamic acid was applied topically to the exposed tissue around the knee joint prior to the wound closure and tourniquet release. It is anticipated that this method of administration is quick, easy, associated with less systemic side effect. Also, it provides a higher concentration of the Tranexamic acid at the bleeding site.

Objectives: To find out whether Tranexamic acid can reduce blood loss and subsequent blood transfusion significantly after total knee replacement when applied topically without extra side effects.

Design: A double blind randomised controlled trial of 150 patients who underwent unilateral primary cemented total knee replacement. This number gives a 90% power to detect a 50% reduction in blood loss and 80% power to detect a reduction in blood transfusion from current local standard 30% to 10%.

Outcome Measures: Blood loss, transfusion, Length of stay, complications, Euroqol and Oxford Knee Score.

Results: The two groups were comparable in age, weight, height, BMI, Tourniquet time, and type of anaesthesia. There has been significant differences in the amount of blood loss and blood transfusion in favour of tranexamic acid (p-values are 0.001 and 0.007 respectively). Fourteen patients needed blood transfusion ranged from 2–6 units. Thirteen were in the Placebo group and only one in the Tranexamic acid. There has been no significant difference among other outcomes in particular complications rates such as DVT and pulmonary embolism.

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.