Evaluating the Efficacy and Safety of Combined Administration of Systemic and Topical Tranexamic Acid in Total Knee Arthroplasty

Introduction

Tranexamic acid (TXA) is an antifibrinolytic agent, thatagent that reduces substantial blood loss in total knee arthroplasty (TKA) surgeries without increasing the risk of thromboembolic complications. The purpose of our study was to assess the effectiveness and safety of the combined use of intravenousIV and topical TXAtranexamic acid in uncomplicated primary Total knee Arthroplasty (TKA) without complications.

Materials and Methods

In this prospective study, we enrolled 61 patients who underwent unilateral primary TKR and were randomly divided into two groups: Group I received intravenous (IV) TXA and Group II received both IV and intraarticular (IA) TXA. Patients assigned to Group I received IV TXA preoperatively 30 mins before surgery and postoperatively at 3 and 6 hours after surgery, whereas in the combined group, in addition to IV doses, topical TXA was applied as mop 2 g of TXA diluted in 30 mL of isotonic sodium chloride solution) intraarticularly for about 5 minutes before closing the arthrotomy. We measured total blood loss (TBL), ) and mean reduction in haemoglobin (Hb) levels as primary outcomes. Transfusion rates, incidence of thromboembolic events (TE), and other adverse effects as secondary outcomes. Total blood loss TBL and Hb drops was were noted on the 3rd post-operative day. All the patients were followed-up for 6 months to note the incidence of deep venous thrombosisDVT and Thromboembolic Events (TE). An Iindependent t-test was used to evaluate between--group differences. P < 0.05 as is the cut-off for statistically significant differences.

Results

The Total blood loss (TBL) in Group I was 780.05 ± 158.05 mL, compared to 660.80 ± 156.45 mL in Group II. (P < 0.001). The Hb drop was significantly lower in IV TXA group (2.3 ± 0.37) than the combined TXA group (1.40 ± 0.32). Furthermore, both groups required no transfusions. No thromboembolic complications was were noted postoperatively and at 6 6-month follow-up.

Conclusion

TXATranexamic acid in total knee replacement surgery effectively decreases blood loss and significantly reduces the need for blood transfusions. Based on our study, the combined use of intravenous (IV) and IAintraarticular TXA in total knee replacement was found to be superior in reducing blood loss and significantly reducing the need for blood transfusions in TKA.

The Functional Outcome of Surgical Management of Spondylolisthesis with Posterior Stabilization and Fusion

Introduction

Spondylolisthesis is a spinal condition characterized by the forward displacement of one vertebra over another, leading to instability and associated symptoms. Surgical intervention is often recommended for patients with symptomatic spondylolisthesis unresponsive to conservative treatment. The objective of this study was to analyze the functional outcomes of surgical management utilizing posterior stabilization and fusion techniques in patients with spondylolisthesis.

Materials and Methods

This is a prospective study conducted on 30 patients who underwent surgical treatment for spondylolisthesis with posterior trans-pedicular screw fixation with conventional or reduction screws and fusion. Meyerding's grade of listhesis, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI) score and pain scores such as visual analog scale (VAS), numerical rating scale 11 (NRS-11), and pain relief rate were used to analyze the functional outcome.

Results

Postoperatively, Meyerding's grade of listhesis and the JOA score had improved significantly. The ODI score and pain scores such as VAS, NRS-11, and pain relief rate were better after surgical interventions. There was full motor recovery in 13 patients and 14 patients had full sensory recovery, while six patients had sensory blunting at the time of the time of the last follow-up. Twenty-six (80.7%) patients had clinically successful results and radiological/clinical fusion while four of the patients did not achieve a clinically successful result and radiological/clinical fusion. The average time for bony fusion was 5.58 months with the earliest being 4 months and the latest 12 months. Intraoperatively, one patient had screw slippage and one had a dural tear. Postoperatively, four patients had infection, two patients were presented with deep infection, and the instrumentation had been removed.

Conclusion

This study demonstrated favorable functional outcomes and improvements in pain, disability, and quality of life measures following surgical intervention.