Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

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Background Anatomical exclusion criteria for the MitraClip procedure have included rheumatic heart disease (RHD) involving the mitral valve. This was primarily because RHD is typically associated with mitral stenosis (MS). Case summary We report the case of an 85-year-old male who had recurrent heart failure admissions from severe rheumatic mitral regurgitation (MR). This was successfully treated with the MitraClip system. Discussion Our case demonstrated the possibility of rheumatic MR being treated by the MitraClip system in appropriately selected patients. Careful examination of the mechanism of MR to determine suitability for MitraClip must be done as well as exclusion of significant MS.

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