Mei Lin, Li Hongxing, Zhu Weihong, Luo Yong, Mao Xinzhan
Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China.
Ann Palliat Med. 2020 Sep;9(5):2466-2473. doi: 10.21037/apm-19-372. Epub 2020 Aug 31.
The risk of blood loss differs among subtypes of revision total hip arthroplasty (THA), and different tranexamic acid (TXA) protocols have rarely been studied in those conditions. The present study aimed to evaluate the efficacy and safety of intravenous and intravenous plus topical TXA in a subtype of revision THA.
We retrospectively reviewed 91 patients who underwent unilateral major revision THA from 2010 to 2018. The major revision was defined as a subtype of revision THA, which included concomitant femoral and acetabular components revision, revision for periprosthetic femoral fracture (PFF), and one-stage revision for periprosthetic joint infection (PJI). In the intravenous group, 23 patients received intravenously 1 g of TXA 30 minutes before the incision with the second dose 3 hours later. In the combined group, 20 patients received intravenously 1 g of TXA 30 minutes before the incision with the second dose 3 hours later, and 2 g of TXA was topically injected around the joint capsule when the fascia layer was closed. Forty-eight patients who underwent revision procedures without TXA constituted the control group. Within the three groups, we compared demographic variables, operation-related data, transfusion volume, transfusion rate, calculated blood loss, postoperative drainage volume, and venous thromboembolism (VTE) risk.
Compared with the control group, both intravenous and combined TXA significantly reduced intraoperative transfusion volume (3.43±2.32 vs. 4.68±2.63 units, P=0.044; 2.78±1.91 vs. 4.68±2.63 units, P=0.004; respectively) and total transfusion volume (4.16±2.73 vs. 5.73±3.05 units, P=0.036; 3.50±2.74 vs. 5.73±3.05 units, P=0.005; respectively), and there were significant reductions of postoperative drainage volume (250.87±204.54 vs. 455.73±303.93 mL, P=0.003; 285.00±218.14 vs. 455.73±303.93 mL, P=0.017; respectively) and calculated blood loss (1,322.49±656.13 vs. 1,698.66±728.39 mL, P=0.031; 1,237.13±545.32 vs. 1,698.66±728.39 mL, P=0.012; respectively). One patient had a symptomatic pulmonary embolism, and two patients had calf muscular vein thrombosis in the control group. There were two patients and one patient with calf muscular vein thrombosis in the intravenous group and the combined group, respectively. Perioperative transfusion volume, transfusion rate, and calculated blood loss were comparable between the intravenous group and the combined group.
Both intravenous TXA and combined TXA significantly reduced perioperative transfusion volume and calculated blood loss in unilateral major revision THA with comparable perioperative transfusion rate and risk of VTE. More researches are required to explore the optimal TXA administration protocol in subtypes of revision THA.
翻修全髋关节置换术（THA）的不同亚型中失血风险存在差异，在这些情况下不同的氨甲环酸（TXA）方案鲜有研究。本研究旨在评估静脉注射TXA以及静脉注射联合局部应用TXA在一种翻修THA亚型中的疗效和安全性。
我们回顾性分析了2010年至2018年期间接受单侧主要翻修THA的91例患者。主要翻修被定义为翻修THA的一种亚型，包括股骨和髋臼组件联合翻修、假体周围股骨骨折（PFF）翻修以及假体周围关节感染（PJI）一期翻修。在静脉注射组，23例患者在切口前30分钟静脉注射1 g TXA，3小时后注射第二剂。在联合组，20例患者在切口前30分钟静脉注射1 g TXA，3小时后注射第二剂，在关闭筋膜层时在关节囊周围局部注射2 g TXA。48例未使用TXA进行翻修手术的患者构成对照组。在三组之间，我们比较了人口统计学变量、手术相关数据、输血量、输血率、计算失血量、术后引流量以及静脉血栓栓塞（VTE）风险。
与对照组相比，静脉注射TXA组和联合TXA组均显著降低了术中输血量（分别为3.43±2.32单位对4.68±2.63单位，P = 0.044；2.78±1.91单位对4.68±2.63单位，P = 0.004）和总输血量（分别为4.16±2.73单位对5.73±3.05单位，P = 0.036；3.50±2.74单位对5.73±3.05单位，P = 0.005），并且术后引流量（分别为250.87±204.54 mL对455.73±303.93 mL，P = 0.003；285.00±218.14 mL对455.73±303.93 mL，P = 0.017）和计算失血量（分别为1322.49±656.13 mL对1698.66±728.39 mL，P = 0.031；1237.13±545.32 mL对1698.66±728.39 mL，P = 0.012）也有显著减少。对照组有1例出现有症状的肺栓塞，2例出现小腿肌肉静脉血栓形成。静脉注射组和联合组分别有2例和1例出现小腿肌肉静脉血栓形成。静脉注射组和联合组之间围手术期输血量、输血率和计算失血量相当。
静脉注射TXA和联合应用TXA均显著降低了单侧主要翻修THA的围手术期输血量和计算失血量，围手术期输血率和VTE风险相当。需要更多研究来探索翻修THA亚型中TXA的最佳给药方案。
