The obesity crisis in the United States has caused a significant increase of hip arthritis. Surgical complication rates are higher in this population and guidelines are being used to select patients who are acceptable candidates for surgical intervention. This retrospective study evaluated the complication rates for obese patients undergoing total hip replacement compared to non-obese patients as defined by the World Health Organization (WHO). Additionally, we compared complication rates of the direct anterior approach (ATHA) versus the posterior approach (PTHA) in a consecutive group of patients using similar protocols. This study is an IRB approved retrospective review of 210 patients undergoing ATHA and 201 patients undergoing PTHA during the same time period by 2 experienced, high-volume total joint surgeons. Non-obese patients were compared to obese patients using WHO body mass index (BMI) classification. Minor and major complications were reviewed as well as surgical time, length of stay, disposition, and short-term outcome measures (including pain scores, narcotic use, and assistive device use).BACKGROUND
METHODS
Allogeneic blood transfusion (ABT) remains a widely used therapeutic intervention in patients undergoing total knee arthroplasty (TKA). There is mounting evidence that tranexamic acid (TXA), a powerful antifibinolytic, can significantly reduce perioperative blood loss with a concomitant lower ABT rate. In May 2012, TXA intravenous infusion was introduced as standard therapy in all patients undergoing major hip and knee arthroplasty. The TXA protocol included infusing 1 gm prior to incision and 1 gm after lowering the tourniquet. Nadir hemoglobin (Hb) level has been shown to be the single most important predictor of ABT in patients undergoing TKA. It is often used as the main trigger for ABT and in research trials examining restrictive transfusion trials. There is a paucity of information regarding the impact of TXA on Hb levels in patients undergoing primary TKA. The purpose of this retrospective study was to examine the impact of TXA on hemoglobin levels in primary TKA patients. Patients undergoing primary single, or bilateral, TKA from a single orthopedic surgeon from the years 2009–2010 before TXA infusion (n=78) were compared to patients undergoing the same operation after TXA was introduced as a therapeutic intervention (n=97). TKA is a very standardized operation that has stayed consistent over the convening years in terms of surgical technique and intra-operative management. The following Hb values were selected for analysis between the two groups: pre-surgical Hb value, immediate post-operative Hb, nadir Hb, and discharge Hb. Paired t-test was used for analysis with p-value set at 0.05. Additional data analysis included: length of stay (LOS) and rate of ABT.Introduction
Methods
