Lacko Marek, Jarčuška Pavol, Schreierova Daniela, Lacková Antónia, Gharaibeh Ahmad
Department of Orthopedics and Traumatology of Locomotors Apparatus, Medical Faculty of P. J. Safarik University and University Hospital of L. Pasteur, Kosice, Slovakia.
Jt Dis Relat Surg. 2020;31(1):8-13. doi: 10.5606/ehc.2020.72061.
This study aims to analyze the effect of intravenous administration of tranexamic acid (TA) on reducing the risk of revision for acute and delayed periprosthetic joint infection (PJI) after primary total knee replacement (TKR).
This prospective observational cohort study included 1,529 TKRs (396 males, 1,133 females; mean age 67.8 years; range, 44 to 85.1 years) performed between January 2003 and October 2017. We analyzed the revision rate for acute and delayed PJI in a group of 787 TKRs with preoperatively intravenously administered TA (TA group) in comparison with a group of 742 TKRs without administration of TA (non-TA group). Multiple logistic regression analysis was used to evaluate significant predictors of TKR revision for acute and delayed PJI.
Revision surgery due to PJI was recorded in one patient in the TA group and eight patients in the non-TA group. Cumulative revision rate of TKR was significantly lower in the TA group (0.13% vs. 1.08%, hazard ratio 0.113; 95% confidence interval [CI] 0.0147-0.937; p=0.043). Multivariate logistic regression analysis confirmed two predictors of revision: being aged over 75 years at the time of primary surgery (odds ratio [OR] 8.464; 95% CI: 2.016-35.54; p=0.004) and male gender (OR: 7.9; 95% CI: 1.879-33.26; p=0.005). The use of TA was shown as the significant protective factor (OR: 0.109; 95% CI: 0.0128-0.929; p=0.043).
We have found a lower cumulative revision rate of TKR for acute and delayed PJI when TA was used. We think that the preoperative intravenous use of TA may be an effective, safe and inexpensive method for the prevention of PJI.
本研究旨在分析静脉注射氨甲环酸（TA）对降低初次全膝关节置换术（TKR）后急性和延迟性假体周围关节感染（PJI）翻修风险的影响。
这项前瞻性观察性队列研究纳入了2003年1月至2017年10月期间进行的1529例TKR手术（396例男性，1133例女性；平均年龄67.8岁；范围44至85.1岁）。我们分析了787例术前静脉注射TA的TKR患者（TA组）与742例未注射TA的TKR患者（非TA组）中急性和延迟性PJI的翻修率。采用多因素logistic回归分析评估TKR因急性和延迟性PJI翻修的显著预测因素。
TA组有1例患者因PJI进行了翻修手术，非TA组有8例。TA组TKR的累积翻修率显著更低（0.13%对1.08%，风险比0.113；95%置信区间[CI]0.0147 - 0.937；p = 0.043）。多因素logistic回归分析确定了两个翻修预测因素：初次手术时年龄超过75岁（优势比[OR]8.464；95%CI：2.016 - 35.54；p = 0.004）和男性性别（OR：7.9；95%CI：1.879 - 33.26；p = 0.005）。使用TA被证明是显著的保护因素（OR：0.109；95%CI：0.0128 - 0.929；p = 0.043）。
我们发现使用TA时，TKR因急性和延迟性PJI的累积翻修率更低。我们认为术前静脉使用TA可能是预防PJI的一种有效、安全且廉价的方法。
