ABSTRACT
<p><b>OBJECTIVE</b>To investigate the efficacy and safety of tranexamic acid in patients who receiving unilateral total knee arthroplasty (TKA).</p><p><b>METHODS</b>From March 2011 to March 2012, clinical data of 95 patients who received primary unilateral TKA were analyzed retrospectively, including 23 male and 72 female patients, age from 60 to 87 years, mean (71 ± 4) years. The patients in treatment group received 0.5 g of tranexamic acid inside knee joint after capsule closure, and patients in control group did not receive tranexamic acid. Two groups of patient's age, height, weight and disease diagnosis and other parameters of the differences were no statistical significance (P > 0.05). The amounts of intraoperative blood loss, postoperative visible blood loss, the hidden blood loss, and blood transfusion, the number of patients needing blood transfusion, symptoms of deep venous thrombosis and lower extremity ecchymosis were observed. The values of preoperative and 3 hours of postoperative D-dimer and related coagulation markers were recorded. Group t test was used to compare between the two groups.</p><p><b>RESULTS</b>There were no significant differences in intraoperative blood loss (P > 0.05). The amounts of postoperative visible blood loss, the hidden blood loss was significant different (t = 17.51 and 64.18, P < 0.05). Transfusion of both groups were (470 ± 150) ml and (708 ± 245) ml. The value of postoperative hemoglobin and hematocrit was lower in control group as compared with those in treatment group (t = -18.88 and -13.05, P < 0.05). No deep venous thrombosis was observed through Doppler ultrasound examination. Postoperative 3 hours D-dimer in the two groups for (0.91 ± 0.44) and (1.21 ± 0.65) mg/L, were significantly higher than that of preoperative (0.36 ± 0.11) and (0.37 ± 0.14) mg/L, with a statistically significant difference (t = 5.40 and 44.68, P < 0.05), and the control group was higher than treatment group (t = 1.99, P < 0.05). There was not statistically significant difference between the coagulation indicators of the two groups.</p><p><b>CONCLUSIONS</b>The local application of tranexamic acid intraoperatively in unilateral TKA patients could significantly reduce the amounts of postoperative blood loss and blood transfusion to avoid TKA patients' perioperative anemia-related complications. It is also safe, ecnomic and easy to use during surgery.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antifibrinolytic Agents , Therapeutic Uses , Arthroplasty, Replacement, Knee , Postoperative Hemorrhage , Retrospective Studies , Tranexamic Acid , Therapeutic Uses , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To discuss the minimal invasive arthroscopic surgery technique and clinical results of both the medial and lateral meniscal transplantation following the anterior cruciate ligament reconstruction with double bundles and bone tunnels.</p><p><b>METHODS</b>In August 2008 a minimal invasive surgery of both the medial and lateral meniscal allograft transplantation following anterior cruciate ligament reconstruction was preformed for 1 case with both the medial and lateral meniscectomy by arthroscopic surgery. The method of two bone plugs attached on tibial plateau was employed for medial meniscal allograft transplantation and the technique the bridge in slot for lateral meniscal allograft transplantation. The VAS, Lysholm score and IKDC rating were recorded before and after operation. The stability of knee was assessed by Lachman test, drawer sign and pivot shift test.</p><p><b>RESULTS</b>The patient was followed up 26 month after the operations. The degrees of knee flexion, extension and function of walk were normal. The Lachman test, drawer sign and pivot shift test were nearly normal. The VAS after operation was 2 points lower than that before operation. The Lysholm score post-operation was 20 points higher than pre-operation. The IKDC became B degree in late following-up from C degree before the operation. MRI revealed anterior cruciate ligament graft was continuous and the meniscal allograft was normal shape on year 1 after the operation. The posterior horn of medial meniscal allograft and anterior corner of lateral meniscal allograft showed slightly shrunk. The second-look arthroscopy showed that the healing occurring between meniscal allograft and the capsule and meniscal allograft was normal shape on month 18 after the operation. The anterior horn of medial and lateral meniscus was slightly worn.</p><p><b>CONCLUSIONS</b>Both the medial and lateral meniscal transplantation following the anterior cruciate ligament reconstruction in appropriately selected patients with the medial and lateral meniscus-deficient knee may recover the knee mechanic balance and stability, which is a option of treatment for that young and activity patients. It is proposed that the medial and lateral meniscal grafts harvested from a single donator. Attention should be paid to the direction of the bone tunnels fixing the horns of the meniscus in order to avoid communication with the tunnels of anterior cruciate ligament reconstruction.</p>