Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose.

PURPOSE: There is no consensus on the optimum timing of administration of tranexamic acid (TA) in bilateral total knee arthroplasty (TKA). We aimed to determine whether the timing of administration of single-dose intravenous TA (either given preoperatively or intraoperatively) has a significant effect on blood loss reduction. METHODS: We compared two cohorts of patients with end-stage arthritis of knees who underwent bilateral TKA and were given single-dose intravenous TA (1 g or 15 mg/kg) at different times during surgery. The retrospective cohort group consisting of 40 patients (preoperative (PO) group) received TA before the skin incision. The prospective cohort consisting of 40 patients (intraoperative (IO) group) received TA 10 min before deflating the tourniquet on the first knee. Primary outcome measures were mean hemoglobin difference, A (between PO and day 1 postoperative hemoglobin), mean hemoglobin difference, B (between PO and lowest postoperative hemoglobin), and rate of allogeneic blood transfusion. Secondary measure was drain blood loss. RESULTS: Both cohorts were well matched with respect to age, gender, duration of surgery, and length of hospital stay. The hemoglobin drop in the IO group was significantly lesser than the PO group on the first postoperative day (2 vs. 2.9 g/dL, p < 0.001). Although statistically insignificant, the patients in the IO group received less allogenic transfusion of packed cell units than in the PO group (11/40, 27.5% vs. 14/40, 35% ). Mean hemoglobin difference, B, and secondary drain loss were comparable in both groups. CONCLUSION: Single-dose intravenous TA given before the start of surgery is as effective as a dose given during arthroplasty of the first knee in reducing blood loss in bilateral TKA.

Coexisting Upper Lumbar-Disc Herniation and Lumbosacral Radiculoplexus Neuropathy: A Diagnostic Challenge: A Case Report.

CASE: An elderly man presented with nontraumatic, acute onset of paralysis of the right quadriceps and the hip flexors, adductors, and abductors without backache or signs of nerve-root tension. Magnetic resonance imaging showed evidence of upper lumbar-disc extrusion with foraminal stenosis as well as right-sided inflammatory lumbar plexitis involving the L2, L3, and L4 nerve roots. However, the pattern of neurological involvement and relatively rapid and full recovery following treatment with parenteral corticosteroids suggested a diagnosis of chemical radiculitis. CONCLUSION: It is important to differentiate chemical radiculitis from both lumbar plexopathy and a herniated nucleus pulposus because it can be treated nonoperatively, with the expectation of a relatively rapid and full recovery.

Compressive Ulnar Neuropathy Due to a Ganglion Cyst and Thickened Cubital Tunnel Retinaculum Fifty Years After Osteomyelitis Variolosa of the Elbow: A Case Report.

CASE: Ulnar neuropathy developed acutely in a fifty-four-year-old man with an arthritic and deformed elbow as the result of osteomyelitis variolosa, a complication of smallpox, which he contracted at the age of five years. Intraoperatively, a ganglion cyst arising from the joint and a pathologically thick cubital tunnel retinaculum were found to be compressing the nerve. Surgical excision of the ganglion, release of the cubital tunnel retinaculum, and anterior transposition of the ulnar nerve resulted in substantial clinical improvement at one year. CONCLUSION: The deformity and limited motion that can develop in the elbow over time following osteomyelitis variolosa may predispose the patient to ulnar neuropathy caused by a ganglion cyst arising in the compromised cubital tunnel.