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Volume 3, Issue 4 (Suppl)
J Clin Exp Orthop
ISSN:2471-8416
Osteoporosis and Arthroplasty 2017
December 04-05, 2017
&
11
th
International Conference on
Joint Event
OSTEOPOROSIS, ARTHRITIS & MUSCULOSKELETAL DISORDERS
December 04-05, 2017 | Madrid, Spain
10
th
INTERNATIONAL CONFERENCE ON ARTHROPLASTY
J Clin Exp Orthop 2017, 3:4(Suppl)
DOI: 10.4172/2471-8416-C1-003
Use of intravenous tranexamic acid with a bipolar sealer system for blood loss reduction in primary total
knee arthroplasty – A randomized, controlled clinical trial
Stephen M Walsh
1,2
, Alexandru Seviciu
1
, Irwin Gross
1
and
Samreen Fathima
1
1
Eastern Maine Medical Center, USA
2
DownEast Orthopedic Associates, USA
Introduction:
Total knee arthroplasty (TKA) bears risk of blood transfusion increasing complication rates, cost, and length of
stay. Methods studied previously to reduce transfusions include tranexamic acid (TXA) and a bipolar sealer. Our center has nearly
eliminated transfusions via pre-operative anemia management. We decided to test both tools to determine any effect on change in
hemoglobin as a primary endpoint.
Methods:
A four armed, double-blind, placebo controlled, prospective design was chosen. Groups included total knees with TXA or
placebo and a bipolar sealer group with TXA or placebo. TXA was bolused 20 mg/kg IV and the bipolar sealer was used to “paint”
the knee. Patients >18 undergoing primary TKA were included and excluded with adverse reaction to TXA, coagulation disorder,
platelets <100,000, history of DVT, PE, CVA, acquired defective color vision, renal insufficiency, or coronary stents. An estimated
sample size of 35 per group provided 80% power to detect a difference of 0.5 g/dL comparing delta hemoglobin pre-op day of surgery
to post-op day 2. Comparisons utilized one-way ANOVA and Fisher’s least significant difference test for continuous variables, and
Pearson’s chi-square test for categorical variables. 127 patients ultimately provided the necessary statistical endpoint.
Results:
The mean hemoglobin change from baseline to post-operative days 2 was significantly lower in both groups with TXA
compared to the control group (P=0.002).The groupwith the bipolar sealer alone showed no difference compared to control (P=0.074).
Conclusion:
The data show that mean hemoglobin drop is lowered by TXA following total knee arthroplasty. There was no significant
change due to the bipolar sealer compared to control. Multiple modalities have been shown to reduce transfusions following total
knee. This study supports the use of TXA in primary total knee arthroplasty and calls into question to efficacy of the bipolar sealer.
swalsh@downeastortho.com