Aprotinin and classic wound drainage are unnecessary in total hip replacement a prospective randomized trial (original) (raw)
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Clinical Orthopaedics & Related Research, 2013
Background Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty. Questions/purposes We determined (1) the rate of wound complications related to use of NPWT for persistent incisional drainage after hip arthroplasty; (2) the rate of resolution of incisional drainage using this modality; and (3) risk factors for failure of NPWT for this indication. Methods In a pilot study we identified 109 patients in whom NPWT was used after hip arthroplasty for treating postoperative incisional drainage between April 2006 and April 2010. On average, the NPWT was placed on postoperative Day 3 to 4 (range, 2-9 days) and applied for 2 days (range, 1-10 days). We then determined predictors of subsequent surgery. Patients were followed until failure or a minimum of 1 year (average, 29 months; range, 1-62 months). Results Eighty-three patients (76%) had no further surgery and 26 patients (24%) had subsequent surgery: 11 had superficial irrigation and débridement (I&D), 12 had deep I&D with none requiring further surgery, and three ultimately had component removal. Predictors of subsequent surgery included international normalized ratio level greater than 2, greater than one prior hip surgery, and device application greater than 48 hours. There were no wound-related complications associated with NPWT. Conclusions The majority of our patients had cessation of wound drainage with NPWT. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Factors Associated with Prolonged Wound Drainage After Primary Total Hip and Knee Arthroplasty
The Journal of Bone & Joint Surgery, 2007
Background: Prolonged wound drainage following total hip or tota! knee arthroplasty has been associated with an increased risk of postoperative morbidity. The purpose of this study was to determine the pharmacologie, surgical, and patient-specific factors that are associated with prolonged wound drainage and the relationship of this complication to the length of hospital stay and the rate of wound infections. Methods: We conducted a retrospective observational study of 1211 primary total hip arthroplasties and 1226 primary total knee arthroplasties. Prospectively collected data Included body mass index, intraoperative blood loss, surgical time, type of prophylaxis against deep venous thrombosis, and length of hospital stay The association of these factors with the duration of postoperative wound drainage was analyzed. An acute infection developed after fifteen primary total hip arthroplasties and ten primary total knee arthroplasties. The patients with an acute postoperative infection were compared with their uninfected counterparts, and an odds ratio was determined to estimate the risk of prolonged wound drainage resulting in a wound infection. Results: Morbid obesity was strongly associated with prolonged wound drainage in the total hip arthroplasty group (p = 0.001) but not in the total knee arthroplasty group (p = 0.590). An increased volume of drain output was an independent risk factor for prolonged wound drainage in both groups. Patients who received low-molecular-weight heparin for prophylaxis against deep venous thrombosis had a longer time until the postoperative wound was dry than did those treated with aspirin and mechanical foot compression or those who received Coumadin (warfarin); this difference was significant on the fifth postoperative day (p = 0.003) but not by the eighth postoperative day Prolonged wound drainage resulted in a significantly longer hospital stay in both groups (p < 0.001). Each day of prolonged wound drainage increased the risk of wound infection by 42% following a total hip arthroplasty and by 29% following a total knee arthroplasty Conclusions: Morbid obesity, the use of low-molecular-weight heparin, and a higher drain output were associated with a prolonged time until the postoperative wound was dry following a primary total hip arthroplasty whereas a higher drain output was the only risk factor associated with prolonged drainage following a primary total knee arthroplasty. Prolonged drainage was associated with a higher rate of infection following a primary total hip arthroplasty, whereas obesity was the only identified independent risk factor for postoperative infection following a primary total knee arthroplasty Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
EFORT Open Reviews, 2021
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are successful orthopaedic procedures with an ever-increasing demand annually worldwide, and persistent wound drainage (PWD) is a well-known complication following these procedures. Despite many definitions for PWD having been proposed, a validated description remains elusive. PWD is a risk factor for periprosthetic joint infection (PJI). PJI is a devastating complication of THA and TKA, and a leading cause of revision surgery with dramatic morbidity and mortality and a significant burden on health socioeconomics. Prevention of PJI has become an essential focus in THA and TKA. Understanding the pathophysiology, risk factors and subsequent management of PWD may aid in decreasing the rate of PJI. Risk factors of PWD can be divided into modifiable and non-modifiable patient risk factors, pharmacological and surgical risk factors. No gold standard treatment protocol to address PWD exists; however, non-operative options progr...
Hemiarthroplasty of Hip – A prospective study for Conservation of Blood Loss
Innovative publication, 2016
Background: Hemiarthroplasty of hip joint is a very commonly performed surgery. Several studies have been done which support the use of tranexamic acid in total knee joint replacements and few in total hip replacements. These studies have shown interesting positive results, but its benefits in hemiarthroplasty of hip joint have not yet widely known. This study aims to establish the role of tranexamic acid in reducing the intra and post-operative bleeding in case of hemiarthroplasty of hip. Material and Methods: This is a prospective study of thirty four patients who underwent hip hemiarthroplasty for fracture neck of femur. The patients were divided as treatment (Group A; n=17) and control (Group B; n=17) group. All the patients were alternatively assigned these two groups. In group A, the patients who underwent surgeries around hip joint were given a bolus dose of tranexamic acid intravenously 10mg/kg body weight about 10 minutes before starting skin incision and in group B, equal volume of normal saline was injected. Total blood loss during surgery was calculated by weighing the mops used and soiled by blood and measuring the volume of blood accumulated in suction apparatus used for the surgery. Pre and postoperative haemoglobin levels were compared. The volume of fluid accumulated in the post-operative suction drain was also recorded and the data collected were analysed. Results: The treatment group showed intra operative blood loss of <600ml in 64.7% of patients and none lost >1000ml blood. Drain fluid after twenty four hours was <100 ml in 70.6% and >150ml only in one (5.9%). The difference in pre and post-operative Hb levels was <1gm in 76.5% of patients. Conclusion: Tranexamic acid given intravenously before surgical skin incision is very effective in conserving bleeding during hip hemiarthroplasty; the drug is of significant advantage as compared to the control group.
Does Intra-articular Tranexamic Acid Decrease Blood Loss in Total Hip Arthroplasty?
Journal of Orthopedics and Joint Surgery, 2020
Background: Blood is the nurturing liquid that delivers oxygen to the cells of the body and removes carbon dioxide and waste from the body. Blood is considered as liquid gold. Total hip replacement causes blood loss and in turn needs blood transfusion. The aim of the study is to find the role of intra-articular tranexamic acid (TXA) in control of blood loss in total hip replacement surgeries. Materials and methods: A prospective study of 50 patients who underwent total hip replacement surgery. The study group and control group patients were selected through the card method. In the study group after the skin closure, 2 g of TXA was injected through the drain tube and drain tube was clamped for 1 hour and then released. Blood loss during the first and second postoperative periods from suction drain was calculated. Results: Four hundred and fifty-five milliliters was the mean first postoperative day blood collected in the drain tube in the control group while study group had 283 mL. Similarly, the second day mean postoperative day drain was 89 mL in control group and 25 mL in study group. The mean first and second postoperative day blood loss was statistically significant between the groups. Discussion: There was a considerable reduction of transfusions in postoperative period; hence, there was a reduced hospitalization cost and less risk of transmitted infections and transfusion reactions. There is a negligible risk of thrombosis in patients who had intravenous TXA not the intra-articular TXA. Conclusion: Intra-articular TXA is an effective tool in controlling blood loss and reducing blood transfusions in hip replacement surgeries.
Are Surgical Drains Necessary in Total Hip Arthroplasty
2020
Background: Using a drain is a routine practice to reduce hematoma formation following a total hip arthroplasty (THA). A prospective randomized study was undertaken to compare the drain and non-drain group in terms of blood transfusion need and local complications like hematoma formation. Methods: Total 168 patient undergoing primary THA were enrolled and randomly allocated into drainage (76 patients) and nondrainage groups (92 patients).The primary outcome measures were local complication like wound hematoma formation, patient discomfort, wound complications, and need for transfusion rates and drop in hemoglobin in postoperative phase while secondary outcome measures were estimated blood loss through the drain, length of hospital stay. All patients received intraoperative tranexamic acid as per single protocol. Results: The intra operative blood loss during THA was comparable in both groups with all surgeons using the posterolateral approach. The drain group had more patient discom...
Anesthesia & Analgesia, 2005
Patients who receive allogeneic blood transfusions after orthopedic surgery have a longer duration of hospitalization, and this cannot be explained by a more frequent incidence of infections in transfused patients. To determine whether transfusion of allogeneic blood interferes with wound healing and therefore increases the duration of hospitalization, we performed an observational study in 444 consecutive patients scheduled for elective primary hip surgery. Transfusion, wound, and infection variables were collected at five time points during treatment. Of the 444 consecutive patients studied, 92 received blood transfusions during their perioperative course. Thirty-one percent of transfused patients developed wound-healing disturbances versus 18% of the nontransfused group (P Ͻ 0.05); allogeneic blood transfusion was the only significant predictor for development of minor wound-healing disturbances. Duration of hospitalization was prolonged in transfused patients (12.3 versus 9.8 days) and could be predicted by 4 significant variables: requirement for blood transfusion (adds 2.7 Ϯ 0.5 days), presence of wound-healing disturbances (adds 1.3 Ϯ 0.5 days), duration of surgery (adds 0.2 Ϯ 0.1 days/ 10 min), and patient's age (adds 0.9 Ϯ 0.2 days/10 yr). These data suggest that allogeneic blood transfusion is associated with an increased incidence of wound-healing disturbances and that prevention of allogeneic blood transfusion may be relevant in limiting the duration of admission after elective orthopedic surgery. (Anesth Analg 2005;100:1416 -21)