Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol A multicentre, prospective, randomized, double-blind, placebo-controlled trial was undertaken involving 229 patients undergoing primary cementless THA using a posterior approach, whose extended rivaroxaban thromboprophylaxis started on the day of surgery. There were 98 male and 131 female patients, with a mean age of 65.5 years (32 to 91). The primary outcome, perioperative RBL, was evaluated at 72 hours postoperatively. The efficacy of short- and long-TXA protocols in the reduction of perioperative RBL was compared with a placebo group.Aims
Patients and Methods
Young adults with hip pain secondary to femoroacetabular
impingement (FAI) are rapidly being recognised as an important cohort
of orthopaedic patients. Interest in FAI has intensified over the
last decade since its recognition as a precursor to arthritis of
the hip and the number of publications related to the topic has
increased exponentially in the last decade. Although not all patients
with abnormal hip morphology develop osteoarthritis (OA), those
with FAI-related joint damage rapidly develop premature OA. There
are no explicit diagnostic criteria or definitive indications for
surgical intervention in FAI. Surgery for symptomatic FAI appears
to be most effective in younger individuals who have not yet developed
irreversible OA. The difficulty in predicting prognosis in FAI means
that avoiding unnecessary surgery in asymptomatic individuals, while
undertaking intervention in those that are likely to develop premature
OA poses a considerable dilemma. FAI treatment in the past has focused
on open procedures that carry a potential risk of complications. Recent developments in hip arthroscopy have facilitated a minimally
invasive approach to the management of FAI with few complications
in expert hands. Acetabular labral preservation and repair appears
to provide superior results when compared with debridement alone.
Arthroscopic correction of structural abnormalities is increasingly becoming
the standard treatment for FAI, however there is a paucity of high-level
evidence comparing open and arthroscopic techniques in patients
with similar FAI morphology and degree of associated articular cartilage damage.
Further research is needed to develop an understanding of the natural
course of FAI, the definitive indications for surgery and the long-term
outcomes. Cite this article:
Over recent years hip arthroscopic surgery has
evolved into one of the most rapidly expanding fields in orthopaedic surgery.
Complications are largely transient and incidences between 0.5%
and 6.4% have been reported. However, major complications can and
do occur. This article analyses the reported complications and makes recommendations
based on the literature review and personal experience on how to
minimise them.
