A tranexámsav vérvesztést és kis vérzéses szövődményeket befolyásoló hatása cementes csípő protézis beültetés után [Effect of tranexamic acid on blood loss and soft-tissue swelling following cemented total hip replacement]

Introduction: Tranexamic acid (TXA) is widely used during elective joint replacement to reduce blood loss and decrease the transfusion requirement. Aim: This study assessed the efficacy of tranexamic acid in reducing minor bleeding complications following primary cemented total hip replacement, when rivaroxaban is used as thromboprophylaxis, the complicated wound healing effect of which has been published recently. Method: Consecutive patients undergoing hip replacement were studied. Patients receiving tranexamic acid perioperatively between January 2014 and November 2014 were designated as the TXA-group. We compared these data with those of a group of patients who underwent the same procedure between February 2012 and December 2012 (control group), before the introduction of tranexamic acid. The authors investigated the effect of tranexamic acid on surgical wound bleeding and discharge, area of hematoma on the skin surface, thigh volume changes, calculated perioperative blood loss and transfusion requirement. Results: 168 patients, 81 in the TXA-group and 87 in the control group were included. The extent of postoperative thigh swelling was significantly less in the TXA-group, 270.3 mL (129.1-449.0) as compared with the control group, 539.8 mL (350.0-864.8, p<0.001). Tranexamic acid significantly reduced wound bleeding during the first 24 hours postoperatively (p<0.001). The amount of calculated blood loss was significantly less in the TXA-group (1150 mL [780-1496] versus 1579 mL [1313-2074] in the control group, p<0.001). Transfusion requirement was remarkably lower in the TXA-group than in the control group (15% versus 39%). Conclusions: Tranexamic acid reduces postoperative thigh volume, wound bleeding and area of hematoma on the skin surface when rivaroxaban is used as the anticoagulant. Further large scale studies could help establish the clinical relevance and long-term outcome of minor bleeding complications

A tranexámsav vérvesztést és kis vérzéses szövődményeket befolyásoló hatása cementes csípőprotézis beültetése után = Effect of tranexamic acid on blood loss and soft-tissue swelling following cemented total hip replacement

Absztrakt: Bevezetés: A tranexámsav (TXA) napjainkban rutinszerűen használt gyógyszer elektív ízületi protetizálás esetében, a műtét során kialakuló vérveszteség, illetve transzfúziós igény csökkentése céljából. Célkitűzés: A dolgozat célja, hogy értékelje a tranexámsav kis vérzési szövődményekre kifejtett hatását cementes csípőprotézis beültetése során, amikor rivaroxabant használunk antikoagulánsként, melynél az elmúlt időszakban több vizsgálat is nagyobb arányban előforduló sebgyógyulási zavart igazolt. Módszer: Retrospektív módon vizsgáltuk a csípőprotézis-beültetésen átesett betegeket. Azok a betegek, akiket 2014. január és november között perioperatív tranexámsavval kezeltek, a TXA-csoportba kerültek. Ezt a csoportot a 2012 februárja és decembere között, a tranexámsav bevezetése előtt hasonló beavatkozáson átesett betegek adataival hasonlítottuk össze (kontrollcsoport). Vizsgáltuk a tranexámsavnak a műtéti seb vérzésére és váladékozására, a seb körül látható bőrfelszíni haematoma méretére, a combtérfogat-változásra és a számított perioperatív vérveszteségre kifejtett hatását. Eredmények: Összesen 168 beteget vontunk be a vizsgálatunkba, 81 beteget a TXA-csoportba és 87 beteget a kontrollcsoportba. A posztoperatív combtérfogat-növekedés kisebb mértékű, mindössze 270,3 ml (129,1–449) volt a TXA-csoportban, míg 539,8 ml (350–864,8) a kontrollcsoportban (p<0,001). A számított perioperatív vérveszteség kisebb volt a TXA-csoportban (1150 ml [780–1496]), mint a másik csoportban (1579 ml [1313–2074]) (p<0,001). A tranexámsavval kezelteknél a transzfúziós igény több mint a felére csökkent, itt a betegek 15%-a, míg a kontrollcsoportban a 39%-uk kapott vért. Következtetések: A tranexámsav csökkentette a posztoperatív combtérfogat-növekedés, a műtéti sebvérzés és a bőrfelszínen látható haematoma mértékét akkor is, amikor rivaroxabant használtunk antikoagulánsként. További nagy esetszámú kutatások szükségesek, hogy vizsgálják a tranexámsavnak a kis vérzési szövődményekre és azok potenciális szövődményeire (posztoperatív fertőzés) kifejtett hosszú távú hatását. Orv Hetil. 2019; 160(12): 456–463. | Abstract: Introduction: Tranexamic acid (TXA) is widely used during elective joint replacement to reduce blood loss and decrease the transfusion requirement. Aim:This study assessed the efficacy of tranexamic acid in reducing minor bleeding complications following primary cemented total hip replacement, when rivaroxaban is used as thromboprophylaxis, the complicated wound healing effect of which has been published recently. Method: Consecutive patients undergoing hip replacement were studied. Patients receiving tranexamic acid perioperatively between January 2014 and November 2014 were designated as the TXA-group. We compared these data with those of a group of patients who underwent the same procedure between February 2012 and December 2012 (control group), before the introduction of tranexamic acid. The authors investigated the effect of tranexamic acid on surgical wound bleeding and discharge, area of hematoma on the skin surface, thigh volume changes, calculated perioperative blood loss and transfusion requirement. Results: 168 patients, 81 in the TXA-group and 87 in the control group were included. The extent of postoperative thigh swelling was significantly less in the TXA-group, 270.3 mL (129.1–449.0) as compared with the control group, 539.8 mL (350.0–864.8, p<0.001). Tranexamic acid significantly reduced wound bleeding during the first 24 hours postoperatively (p<0.001). The amount of calculated blood loss was significantly less in the TXA-group (1150 mL [780–1496] versus 1579 mL [1313–2074] in the control group, p<0.001). Transfusion requirement was remarkably lower in the TXA-group than in the control group (15% versus 39%). Conclusions: Tranexamic acid reduces postoperative thigh volume, wound bleeding and area of hematoma on the skin surface when rivaroxaban is used as the anticoagulant. Further large scale studies could help establish the clinical relevance and long-term outcome of minor bleeding complications. Orv Hetil. 2019; 160(12): 456–463

Pathological femoral neck fracture caused by an echinococcus cyst of the vastus lateralis - case report

<p>Abstract</p> <p>Background</p> <p>Musculoskeletal hydatid cysts are rare, but being locally invasive, can potentially cause significant deformity or pathological fracture.</p> <p>Case presentation</p> <p>A 39 y.o. male presented to our orthopaedic outpatient clinic complaining of severe right hip pain, and inability to ambulate. Symptoms were not preceded by trauma. Subsequent imaging confirmed a large, 17 × 3 × 5 cm echinococcus cyst in the vastus lateralis, causing erosion of the proximal metaphysis of the femur. As a consequence the patient suffered a non-traumatic pathological intertrochanteric femur fracture. The patient was treated with an en-bloc excision of the lesion - the affected soft tissue envelope containing the large cyst - and as a second surgical step a cemented total hip replacement (THR) was implanted under the same anaesthetic.</p> <p>The manuscript reviews the literature regarding musculoskeletal hydatid disease.</p

Conservative treatment of periprosthetic femur fractures around metaphyseal short stems – a feasible option?

Periprosthetic femoral fractures are rare but significant events following total hip replacement. Metaphyseal short stems have recently been popularized as a bone preserving alternative to conventional uncemented total hip replacement. We present two periprosthetic femur fractures which occurred around two different metaphyseal uncemented stem designs. Successful conservative treatment was possible in both cases achieving bony union and excellent clinical results. Keywords: Periprosthetic femur fracture, Uncemented short stems, Total hip replacemen

Comparison of minor bleeding complications using dabigatran or enoxaparin after cemented total hip arthroplasty

BACKGROUND: Orally administered chemical thromboprophylactic agents for total hip replacement (THR) have become popular in recent years. Certain clinical trials suggest that the efficacy and the risk of major bleeding after administration of direct thrombin inhibitor dabigatran etexilate are equivalent to the clinical trial comparator, subcutaneous low-molecular-weight heparin enoxaparin. Our aim was to compare and evaluate the incidence of minor haemorrhagic and soft-tissue adverse effects of enoxaparin and dabigatran. MATERIALS AND METHODS: 122 patients who were treated by elective cemented primary THR were enrolled in our quasi-randomised study. Two groups were formed according to which perioperative thromboprophylactic agent was used: 61 patients in enoxaparin group versus 61 patients in dabigatran group. Thigh volume changes, calculated perioperative blood loss, area of haematoma, wound bleeding, duration of wound discharge and intensity of serous wound discharge on postoperative day 3 and day 7 were recorded. RESULTS: The duration and intensity of serous wound discharge differed significantly between the two groups. Duration of wound discharge after drain removal was 2.2 (+/-2.7) days in the dabigatran group and 1.2 (+/-1.9) days in the enoxaparin group (p < 0.05). Significant increase in serous discharge was found in the dabigatran group (p < 0.05) on third and seventh postoperative days compared to the enoxaparin group. CONCLUSION: Both thromboprophylactic agents were found to have appropriate antithrombotic effects after THR. However, dabigatran was associated with an increased incidence of prolonged serous wound discharge, which might cause longer hospitalization and might instigate the use of prolonged antibiotic prophylaxis