Are we scientifically ready to adopt tranexamic acid as a routine in arthroplasty?

Sezgin, Erdem Aras; Atik, O. Şahap

doi:10.5606/ehc.2019.19003

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Using TXA decreases blood transfusion rates by decreasing intra-and postoperative blood loss. [22] It also decreases the risk of revision for acute and delayed PJI after total knee replacement. [23] In our study, we found that 119 participants (34%) did not use TXA, with operators with the lowest usage rates.…”

Section: Discussionmentioning

confidence: 99%

Assessment of periprosthetic joint infection prevention methods amongst Turkish orthopedic surgeons in total joint replacement: A survey

Çimen

2020

Jt Dis Relat Surg

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Periprosthetic joint infection (PJI) remains a challenging complication and is a leading reason for failure following total joint arthroplasty (TJA). There is a significant economic burden to the treatment of PJI. [1] In addition to the economic burden, elderly patients with comorbid conditions are at increased risk of postoperative morbidity and mortality when undergoing treatment of PJI. [2] Currently, many different strategies are used to mitigate the risk of PJI after TJA and newer approaches are constantly in development. Several organizations have subsequently recommended evidence-based guidelines for the prevention of PJI and surgical site infections (SSIs). The most notable are the International Consensus Meeting (ICM), [3] World Health Organization (WHO), [4] and the Center for Disease Control and Prevention (CDC) [5] guidelines. In parallel to new scientific developments, these guidelines sometimes change their recommendations. However, the alignment of orthopedic surgeons with these guidelines may differ due to their experiences Objectives: This study aims to assess the methods employed by Turkish orthopedic surgeons to prevent periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). Patients and methods: The data obtained for this study, conducted between January 2019 and February 2019, were gathered by sending out an online survey to Turkish Society of Orthopedics and Traumatology members (n=2,267). A total of 354 orthopedic surgeons responded and completed survey. The survey had 23 questions which include the experience, academic position, hospital where the physician works, monthly arthroplasty numbers, and infection prevention methods employed before, during, and after surgery. Results: The period for antibiotics prophylaxis showed variability, with about 63% of surgeons using prophylaxis longer than 24 hours. In terms of academic position, 52.4% of professors and 52.8% of associate professors used prophylaxis for the first 24 hours whereas this rate was 31.3% in operators (p=0.01). Of surgeons, 50.7% who perform more than 10 arthroplasties per month and 33.6% of surgeons who perform less than 11 arthroplasties per month used 24-hour antibiotic prophylaxis (p=0.006). Blood glucose level assessment prior to surgery was performed by the majority of surgeons (94%). A total of 118 orthopedic surgeons (33.3%) performed methicillinresistant Staphylococcus aureus (MRSA) decolonization with 54.7% of associate professors, 59.5% of professors, and 24.7% of operators (p=0.001). Only 60 surgeons (16.9%) checked vitamin D levels. Conclusion: Our study results demonstrated that the majority of orthopedic surgeons in Turkey do not follow the antibiotic prophylaxis recommendations and they use antibiotic prophylaxis for longer periods. Professors and associate professors, and surgeons with higher monthly arthroplasty numbers than surgeons with lower monthly arthroplasty numbers follow the recommended periods more than their counterparts. Most surgeons assess blood glucose levels whereas a small num...

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Section: Discussionmentioning

confidence: 99%

Assessment of periprosthetic joint infection prevention methods amongst Turkish orthopedic surgeons in total joint replacement: A survey

Çimen

2020

Jt Dis Relat Surg

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“…However, controversy still goes on about its total dose, timing, and route of application. [ 24 - 30 ] However, in a recent meta-analysis, the combined use of TXA (both IV and topical) has been shown to be more effective over IV use only. [ 31 ] Consistently, a combined TXA application was carried out in our protocol.…”

Section: Discussionmentioning

confidence: 99%

Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients?

Levent

2020

Jt Dis Relat Surg

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“…[1] Although the use of TXA through intravenous (IV) route is an effective and safe way, topical use is particularly recommended for patients with the risk of thromboembolism. [2] In a recent meta-analysis, there was no significant difference between IV and topical administration routes regarding the need for transfusion and postoperative complications. [3] The tendon is comprised of 95% type I collagen, and a much smaller percentage of type III collagen.…”

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confidence: 98%

Histopathological and immunohistochemical investigation of the local and systemic effects of tranexamic acid on the healing of the Achilles tendon in rats

et al. 2021

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Objectives This study aims to compare the effects of systemic and local applications of tranexamic acid (TXA) on tendon healing using a rat Achilles tendon injury model. Patients and methods Thirty-six adult male albino Wistar rats (aging 3-4 months; weighing 350 to 400 g) were used in this study conducted between December 2019 and January 2020. The Achilles tendon was performed bilateral tenotomy and surgically repaired. Postoperatively, 1 mL of TXA was administered to each leg locally in the local group, whereas 2 mL of TXA was intraperitoneally administered in the systemic group. The control group was left untreated. Half of the rats were sacrificed on Day 15 and the other half on Day 30. Tendon healing was evaluated with the Bonar and the Movin scoring systems and immunohistochemical methods. Results The systemic group had the highest Bonar and Movin scores on Day 15. All groups exhibited tendon healing on Day 30, with no significant differences among the groups. The tenocyte morphology was found to be more impaired in both TXA groups on Day 30 (p=0.013). Ground substance scores were lower in the systemic group on Day 30 (p=0.028). The fiber structure and arrangement scores were higher in the systemic group on Day 15 (p=0.007 and p=0.032). Immunohistochemical analyses showed that galectin-3 values exhibited a significant difference in all groups on Day 30 (p=0.020). In all groups, it was determined that type I collagen values showed an increasing trend on Day 30, compared to the values on Day 15, whereas type III collagen values showed a decreasing trend. Conclusion Our results demonstrated that local and systemic use of TXA does not impair tendon healing. Although advanced studies are needed, our study suggests that TXA application reduces the development of fibrosis.

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Are we scientifically ready to adopt tranexamic acid as a routine in arthroplasty?

Cited by 6 publications

References 13 publications

Assessment of periprosthetic joint infection prevention methods amongst Turkish orthopedic surgeons in total joint replacement: A survey

Assessment of periprosthetic joint infection prevention methods amongst Turkish orthopedic surgeons in total joint replacement: A survey

Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients?

Histopathological and immunohistochemical investigation of the local and systemic effects of tranexamic acid on the healing of the Achilles tendon in rats

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