Postoperative bleeding adversely affects total knee arthroplasty outcomes in hemophilia

Göker, Barlas; Çağlar, Ömür; Kınıklı, Gizem İrem; Aksu, Salih; Tokgözoğlu, A. Mazhar; Atilla, Bülent

doi:10.1016/j.knee.2022.10.001

Cited by 7 publications

(10 citation statements)

References 28 publications

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“…Serious complications can arise from TKA and THA due to uncontrolled postoperative bleeding, which is often associated with prolonged rehabilitation and worsened mortality [19][20][21]. Blood loss is a serious complication experienced by patients undergoing these procedures, where one study reported that the overall transfusion rate was 11% in TKA patients and 18% in THA patients [8].…”

Section: Discussionmentioning

confidence: 99%

The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review

Do,

Vachirakorntong,

Kawana

et al. 2024

JCM

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Background/Objectives: Blood loss can be a serious complication in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Various methods are used by surgeons to achieve hemostatic control in these patients. Complications are associated with perioperative blood loss. In this systematic review, we examined the efficacy of using bone wax to control bleeding in patients undergoing THA and TKA. Methods: The PRISMA model was used to systematically identify and aggregate articles for this study. The PubMed and EMBASE databases were used to search individual studies that examined the use of bone wax in THA or TKA. After applying the search term “bone wax”, 2478 articles were initially identified. After inclusion and exclusion criteria were applied, three articles were aggregated for this systematic review. Results: The use of bone wax in THA and TKA decreased blood loss in patients undergoing these operations. Postoperative blood loss following surgery was lower in the bone wax groups compared to the control groups as well. Patients in the bone wax groups also required fewer blood transfusions than those who did not receive bone wax. Conclusions: Bone wax appears to be another modality that can be used by physicians to maintain hemostatic control in THA or TKA patients. Reduced blood loss and transfusion rates in surgery can increase patient outcomes. More studies are needed to examine the efficacy of bone wax in comparison with other hemostatic tools.

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Section: Discussionmentioning

confidence: 99%

The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review

Do,

Vachirakorntong,

Kawana

et al. 2024

JCM

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“…However, the rate has decreased within the last two decades due to enhanced perioperative hematologic treatment 14 . Another study further showed that 34% of their patients suffered from postoperative major bleeding, which significantly led to worse functional outcomes and a high complication rate in TKA of hemophilia patients 15 . Furthermore, aseptic loosening after THA is one of the most common complications.…”

Section: Discussionmentioning

confidence: 99%

“…14 Another study further showed that 34% of their patients suffered from postoperative major bleeding, which significantly led to worse functional outcomes and a high complication rate in TKA of hemophilia patients. 15 Furthermore, aseptic loosening after THA is one of the most common complications. Despite three cases out of 52 (5.77%) showing aseptic loosening in THA, there was no necessity for revision due to the limited follow-up period.…”

Section: Adverse Events and Complicationsmentioning

confidence: 99%

A Retrospective, Long‐term Follow‐up of the Clinical Outcomes and Cost‐effectiveness of Single‐anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy

Peng

Jiang

Zheng

et al. 2023

Orthopaedic Surgery

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Objective: Although total joint replacement (TJR) procedures are efficacious, perioperative high-dose factors replacement therapy (FRT) to avoid catastrophic bleeding represents a significant hurdle, particularly for patients with multiple joint affection. Double simultaneous bilateral TJRs were reported as safe and cost-effective. However, little is known about multiple TJRs. The feasibility and effects remain debatable. Surgeons need to weigh the high cost of FRT against safety. Accordingly, we aimed to evaluate the clinical outcomes and cost-effectiveness of single-anesthetic multiple-joint procedures of lower limbs in end-stage hemophilic arthropathy. Methods:Our retrospective cohort study retrieved data from an inpatient database of patients with hemophilia who underwent total knee arthroplasty (TKA), total hip arthroplasty (THA), and/or ankle arthrodesis from January 2000 to April 2016. Complications, hospital stays, transfusion, doses of clotting factor, medical costs, range of motion (ROM), Harris hip scores (HHSs) and Hospital for special surgery knee scores (HSSs) were recorded. A P value < 0.05 was considered significant.Results: A total number of 81 patients were included in this study, among which 89 TKAs and 52 THAs were performed. Compared to the single TJR group, the simultaneous multiple TJR group showed a significantly higher rate of blood transfusions (P < 0.05). But no significant differences were found in the length of hospital stays, factor consumption, hospitalization costs excluding prosthesis expenses, and total complication rates. Finally, similar postoperative ROM, HHS, and HSS were witnessed in two groups (P value > 0.05). Conclusion:Our data indicated that simultaneous multiple TJRs are a safe and cost-effective choice for treating hemophilic patients with multiple HA-affected lower limb joints.

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“…Blood transfusion may not only cause multiple serious complications, including infection, immune response, disease transmission, cardiovascular dysfunction, and even death, but also increase treatment costs. [7,8] After TKA, the fibrinolytic system is transiently activated and the use of a tourniquet also induces local fibrinolysis. [9] JL and YXG contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of efficacy between tranexamic acid and epsilon-aminocaproic acid for total knee arthroplasty: A meta-analysis of randomized controlled trials

Li,

Guo,

2023

Medicine

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Background: Tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) have been demonstrated to reduce blood loss following total knee arthroplasty (TKA). This meta-analysis aimed to compare the efficacy and safety of TXA and EACA in reducing blood loss in primary TKA patients. Methods: A search of the PubMed, Embase, and Cochrane Library databases identified all relevant studies published until December 2022. Randomized controlled trials (RCTs) reporting a comparison of TXA and EACA for TKA patients were selected. The main outcomes were total blood loss (TBL), hemoglobin (Hb) drop on postoperative day 3, intraoperative blood loss, operation time and the transfusion rate were evaluated. The weighted mean differences (WMD) and risk ratio (RR) with 95% confidence intervals (CI) were calculated using a fixed-effects or random-effects model. Stata 12.0 software was used for meta-analysis. Results: Six studies involving 739 (TXA:372; EACA:367) patients were included in this meta-analysis. There was no significant difference in terms of intraoperative blood loss, Hb drop on postoperative day 3, operation time, tourniquet time (TT), transfusion rate and the occurrence of deep venous thrombosis (DVT) between the 2 treatments groups. However, compared with EACA, TXA significant reduced TBL (WMD, 174.60; 95% CI, −244.09 to −105.11). Conclusion: Our research did not demonstrate TXA to be superior to EACA in reducing need for transfusion and Hb drop. TXA was superior than EACA in reducing TBL in TKA patients. More RCTs with identical inclusion criteria and dose and duration of treatment, are required to confirm these findings.

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Postoperative bleeding adversely affects total knee arthroplasty outcomes in hemophilia

Cited by 7 publications

References 28 publications

The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review

The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review

A Retrospective, Long‐term Follow‐up of the Clinical Outcomes and Cost‐effectiveness of Single‐anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy

Comparison of efficacy between tranexamic acid and epsilon-aminocaproic acid for total knee arthroplasty: A meta-analysis of randomized controlled trials

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