Topical use of tranexamic acid in primary total knee arthroplasty: a comparative study.

INTRODUCTION: Perioperative blood management represents a major issue in knee arthroplasty. The aim of the present observational study is to compare two different methods of topical tranexamic acid (TXA) administration (periarticular and intraarticular) in primary knee arthroplasty. PATIENTS AND METHODS: The present is an observational comparative study. A total of 66 consecutive patients receiving topical injection of TXA after unilateral primary knee arthroplasty due to osteoarthritis were recorded. Patients were divided into two groups: group 1; periarticular injection of TXA and group 2; intraarticular injection. RESULTS: Transfusion rate in group 1 was found to be 15%, compared to 44% in group 2 (p-value= 0.015). In transfused patients the mean received blood units were 1.2 (SD=0.44) in group 1, compared to 1.06 (SD=0.24; p-value=0.34) in group 2. The mean hospital stay of group 1 patients was 7.94 days (SD=2.79), compared to 9.58 days (SD=3.26; p-value=0.03) in group 2. DISCUSSION: The main findings of the study are that statically significant higher transfusion rates, as well as longer in-hospital stay were found in the intraarticular group, when compared to the periarticular group. According to these two parameters the present study has shown that the topical periarticular TXA injection is superior to the intraarticular one. Further research is of utmost importance in order to conclude to the optimum combination of knee arthroplasty perioperative blood management.

New insights into the development of popliteal cysts.

BACKGROUND: This prospective study was designed to investigate the aetiology of popliteal (Baker's) cysts. METHODS: Some 426 legs in 312 individuals were investigated with ultrasonography for the presence of a popliteal cyst. Participants included healthy volunteers, patients with a painful knee, and a group of patients with signs and symptoms of deep vein thrombosis (DVT). The location, thickness and content of all cysts were recorded. In addition, the popliteal fossa was dissected in four cadaver knees. RESULTS: The prevalence of popliteal cyst increased with age and was significantly higher in those aged over 50 years (P < 0.001). Compared with controls (incidence 3.0 per cent), cysts were more common in patients with DVT symptoms (9.5 per cent; P = 0.141) and those with painful knees (19.8 per cent; P < 0.001). All cysts were located in the posteromedial aspect of the popliteal fossa; the majority extended between the deep fascia and the medial head of the gastrocnemius muscle. At this level an area without external support of the posterior capsule was identified between the two expansions of the semimembranosus muscle from the medial side (the oblique popliteal ligament and the expansion over the popliteus muscle) and the posterior cruciate ligament from the lateral side. This area was also located in the knee dissections. No association was found between popliteal cyst and acute DVT. CONCLUSION: Popliteal cysts are relatively common in patients over 50 years old with a painful knee or with signs and symptoms of DVT. They form in the posteromedial popliteal fossa because the synovial capsule does not provide anatomical support in this region.

Solid variant of aneurysmal bone cyst: a case report with bilateral involvement of the distal femoral metaphyses.

An extremely rare case of bilateral, symmetrical involvement of distal femoral metaphyses by the solid variant of aneurysmal bone cyst (ABC) in a boy aged 13 years is described. Although there is no difference between the conventional ABC and the solid variant in terms of clinical and radiological presentation, the lesion is solid, composed of fibrohistiocytic cells with abundant giant cells and/or areas of florid, heterotopic ossification, while aneurysmal channels are sparse or absent. The lesion needs to be differentiated from giant cell tumour of bone, when the osteoclastic component predominates, while fibrous dysplasia, osteoblastoma and even osteosarcoma need to be excluded any time ossification is prominent. Careful evaluation of the clinical, radiological and pathological findings is necessary.