Waddell Bradford S, Zahoor Talal, Meyer Mark, Ochsner Lock, Chimento George
Department of Orthopaedics, Ochsner Medical Center, New Orleans, Louisiana.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
J Knee Surg. 2016 Jul;29(5):423-9. doi: 10.1055/s-0035-1564599. Epub 2015 Sep 26.
Tranexamic acid (TXA) has been shown to decrease hemoglobin loss and reduce the need for transfusions in primary hip and knee arthroplasty. Our study evaluated the safety and efficacy of topical TXA in revision TKA for periprosthetic joint infection (PJI). We performed a retrospective review of patients who underwent removal of hardware with antibiotic spacer placement (stage 1) and/or revision TKA (stage 2) for PJI at our institution between September 2007 and July 2013. During that time, 49 patients underwent stage-1 procedures (20 knees with TXA, 29 without TXA) and 47 patients underwent stage-2 revisions (28 with TXA, 19 without TXA). We evaluated hemoglobin loss, need for transfusion, reinfection rate, length of stay (LOS), complications, and mortality with and without the use of TXA in these patients. All data sets were analyzed with a two-sample t-test. Average follow-up was 3.15 years (range, 1-7 years). TXA use led to a significantly lower percentage drop in the postoperative lowest hemoglobin compared with the preoperative hemoglobin in stage-1 surgeries (19.8 vs. 30.05%, p = 0.0004) and stage-2 revisions (24.5 vs 32.01%, p = 0.01). In both groups, TXA use was associated with a significant reduction in transfusion rates (stage-1, 25 vs 51.7%, p = 0.04; stage-2, 25 vs. 52.6%, p = 0.05). There was a nonstatistical decreased LOS in both groups in which TXA was used (stage 1, 5.15 vs. 6.72 days, p = 0.055; stage 2, 5.21 vs. 6.84 days, p = 0.09). There was no difference in the reinfection rate (4 vs. 4, p = 0.56) or mortality rate between groups (0 vs. 2 non-TXA group). A single upper extremity deep vein thrombosis occurred in a stage-1 patient who received TXA, and no pulmonary embolism occurred. We show that topical TXA is safe and effective for use in both stages of revision TKA for PJI. Previous studies have shown TXA to aggravate a staphylococcal infection in mice; however, topical TXA doesn't appear to negatively effect on the treatment of PJI in our patients and did not increase the reinfection, complication, or mortality rate.
氨甲环酸（TXA）已被证明可减少初次髋关节和膝关节置换术中血红蛋白的流失，并减少输血需求。我们的研究评估了局部应用TXA在翻修全膝关节置换术（TKA）治疗假体周围关节感染（PJI）中的安全性和有效性。我们对2007年9月至2013年7月期间在本机构因PJI接受取出内固定物并放置抗生素间隔物（1期）和/或翻修TKA（2期）的患者进行了回顾性研究。在此期间，49例患者接受了1期手术（20例膝关节使用TXA，29例未使用TXA），47例患者接受了2期翻修手术（28例使用TXA，19例未使用TXA）。我们评估了这些患者使用和未使用TXA时的血红蛋白流失、输血需求、再感染率、住院时间（LOS）、并发症和死亡率。所有数据集均采用两样本t检验进行分析。平均随访时间为3.15年（范围1 - 7年）。在1期手术中，与术前血红蛋白相比，使用TXA导致术后最低血红蛋白下降的百分比显著更低（19.8%对30.05%，p = 0.0004），在2期翻修手术中也是如此（24.5%对32.01%，p = 0.01）。在两组中，使用TXA均与输血率显著降低相关（1期，25%对51.7%，p = 0.04；2期，25%对52.6%，p = 0.05）。在使用TXA的两组中，住院时间均有非统计学意义的缩短（1期，5.15天对6.72天，p = 0.055；2期，5.21天对6.84天，p = 0.09）。两组之间的再感染率（4对4，p = 0.56）或死亡率（非TXA组0对2）无差异。1例接受TXA的1期患者发生了1例上肢深静脉血栓形成，未发生肺栓塞。我们表明，局部应用TXA在翻修TKA治疗PJI的两个阶段中使用都是安全有效的。先前的研究表明TXA会加重小鼠的葡萄球菌感染；然而，局部应用TXA在我们的患者中似乎对PJI的治疗没有负面影响，也没有增加再感染、并发症或死亡率。
