Comparing Steri-Strip and surgical staple wound closures after primary total knee arthroplasties.

BACKGROUND: Steri-Strips (3M, Two Harbors, MN, USA) have recently been employed for skin closures after orthopedic surgeries. Here we compare the performance of Steri-Strips and skin staples for wound closure after primary total knee arthroplasties (TKAs). METHODS: A total of 76 consecutive osteoarthritic knees (71 patients) that underwent a primary TKA at our facility were included in this study. Thirty-eight knees received Steri-Strips for wound closure and were evaluated prospectively. The other 38 knees were closed with skin staples (Staple group) and evaluated retrospectively. RESULTS: No deep or superficial infections developed in this series. Although Steri-Strips detached from three knees during the 10-day postoperative period, no dehiscence was observed. Thirteen knees developed blisters around the surgical incision in the Steri-Strip group compared with five knees in the Staple group. The average operative time for the Steri-Strip group was 60.6 min (SD 7.3) compared with 54.1 min (SD 6.9) in the Staple group. There were significant differences in operative time (p < 0.001) and tourniquet time (p < 0.001) between the two groups. The average time until patients were permitted to start showering was significantly shorter in the Steri-Strip group (p = 0.0496). The material cost for Steri-Strips was approximately $3.00 USD for one operation compared with $26 USD for skin staplers. CONCLUSIONS: Wound closure with Steri-Strips after a TKA does not require postoperative material removal and may have improved safety, comfort, cosmesis and cost-effectiveness compared with traditional skin closures. LEVEL OF EVIDENCE: Level II, Prognostic study.

Effect of a single injection of tranexamic acid on blood loss after primary hybrid TKA.

BACKGROUND: Control of perioperative blood loss is important in total knee arthroplasty (TKA), especially cementless or hybrid TKA. There is increasing interest in the use of tranexamic acid (TXA) for this purpose, however, studies to date have mainly evaluated the effects of various TXA administration regimens on patients who have undergone cemented TKA. We sought to determine (1) whether administration of TXA reduces blood loss after hybrid TKA, and (2) whether an autologous blood reinfusion system is necessary in TKA patients who are treated with TXA. METHODS: Ninety-five patients (100 knees) who underwent hybrid primary TKA (cemented tibia, uncemented femur) were included in this study. The initial 50 knees were treated without TXA and the following 50 were treated with TXA. Intravenous TXA (1000 mg) was administered shortly before deflation of the tourniquet. All continuous variables were expressed as median values. RESULTS: Total volumes of blood lost at postoperative 1 day were 590 mL and 150 mL and autotransfusion of collected blood was performed in 88% and 16% of patients in the without and with TXA groups, respectively. A median volume of 400 mL of collected blood was returned to the patients in the without TXA group, and 0 mL to the patients in the with TXA group. The calculated volumes of blood lost were 761 mL and 683 mL (p=0.2250), respectively. CONCLUSIONS: One intravenous injection of 1000 mg TXA may help to control postoperative blood loss and reduce the need for postoperative autologous blood reinfusion after hybrid TKA. LEVEL OF EVIDENCE: Level II.