Comparative Analysis of Topical Versus Intravenous Administration of Epsilon-Aminocaproic Acid on Blood Management in Total Knee Arthroplasty.

Introduction: Although the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA. Methods: This cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay. Results: Of the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001). Conclusions: The topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.

Diaphyseal derotational osteotomy with intramedullary fixation for correction of excessive femoral anteversion in children.

Nearly all children with femoral anteversion spontaneously remodel by age 8. Femoral derotational osteotomies are performed in older children with persistent excessive femoral anteversion when children or adolescents are limited in activities of daily living or sports. Procedures for correction of the anteversion vary, and no one procedure has been shown to be superior. Since 1997 the authors have corrected idiopathic excessive femoral anteversion thorough a diaphyseal osteotomy with fixation using a rigid intramedullary pediatric femoral nail. The purpose of this study was to describe the technique and results of this new technique. A retrospective study was conducted of all femoral derotational osteotomies performed with a pediatric femoral nail in 13 consecutive patients and 21 affected limbs. All patients complained preoperatively of frequent tripping during sports and activities of daily living. The mean preoperative rotation included internal rotation of 77 degrees and external rotation of 15 degrees. Standing AP radiographs of all patients were obtained at final follow-up. All patients were evaluated clinically and radiographically at a minimum of 1 year after surgery. All patients noted improvement in the ability to participate in activities without tripping. No patient limped at final follow-up. No intraoperative or postoperative complications occurred. Healing of the osteotomy was present at a mean of 6 weeks. All osteotomies healed in anatomic alignment. Mean final hip rotation included internal rotation of 40 degrees and external rotation of 57 degrees. No patient had substantial changes of valgus or femoral neck narrowing at final follow-up. Femoral derotational osteotomy with fixation using a small-diameter rigid intramedullary nail placed through the lateral aspect of the greater trochanter is a safe, accurate, and effective method of correcting excessive femoral anteversion in symptomatic children.