The Journal of arthroplasty
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Randomized Controlled Trial
Prospective, randomized trial to evaluate efficacy of a thrombin-based hemostatic agent in total knee arthroplasty.
Total knee arthroplasty (TKA) can be associated with substantial blood loss, leading to increased morbidity and transfusion rates. The study objective was to evaluate routine use of a thrombin-based topical hemostatic matrix in reducing blood loss and transfusion requirements in primary TKA. 108 patients were enrolled in a prospective, randomized, single-center trial. Patients receiving the hemostatic agent demonstrated a lower mean calculated blood loss (1325.2±464.8mL vs. control, 1509.3±432.8mL; P=0.02), drain output (415.6±202.0mL vs. control, 579.9±306.7mL; P=0.008), and length of stay (3.3±0.8days vs. control, 3.7±1.1days; P=0.03), without a statistically significant difference in mean hemoglobin loss or transfusion requirements. The clinical utility of this hemostatic agent to reduce transfusions after uncomplicated, primary TKA continues to remain unclear.
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Our study aimed to determine the impact of resident involvement on the 30-day postoperative complication rates following primary total hip arthroplasty (THA). Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, 13,109 primary THAs were identified, of which 3462 (26.4%) had resident involvement. ⋯ We did find, however, that increased operative time, comorbidities, age, obesity, prior history of stroke and/or cardiac surgery were all independent risk factors for short-term complication. Our findings suggest that resident involvement does not increase 30-day complication rates following primary THA.
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Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most common surgical procedures that necessitate blood transfusion. The purpose of this study was to examine the trends in the utilization of blood transfusions in THA and TKA in the US from 2000 to 2009 by analyzing the Nationwide Inpatient Sample (NIS). During the last decade, the allogeneic blood transfusion (ALBT) rate increased (THA: 11.2% to 19.1%, TKA: 7.7% to 12.4%), whereas the predonated autologous blood transfusion (PR-ABT) rate decreased (THA: 7.7% to 3.9%, TKA: 6.1% to 2.4%) in primary unilateral THA and TKA patients in US hospitals. Overall blood transfusion rates remained stable over time in primary unilateral THA and TKA patients.
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We examined the predictors of allogeneic blood transfusion (ALBT) in primary unilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA), analyzing the Nationwide Inpatient Sample between 2000 and 2009. Multivariate logistic regression analysis was performed. ⋯ No autologous-related blood transfusion was a significant predictor of ALBT in THA, however, not in TKA. We believe that the utilization of ALBT in THA and TKA can decrease by taking these factors into consideration for patient blood management before surgery.
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We compared the medium-term outcomes of age and gender matched patients with unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). We retrospectively reviewed the pain, function and total knee society scores (KSS) for 602 UKAs and age and gender matched TKAs between 2001 and 2013. Function scores remained significantly better in UKAs from preoperative until 3years follow up. ⋯ Total KSS for both groups were not significantly different in the study. Fewer medical complications were reported in UKA group. 6.30% of UKAs and 2.99% of TKAs were revised. The theoretical advantages of UKA were not borne out, other than in immediate postoperative complications.