The Journal of arthroplasty
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We examined the predictors of allogeneic blood transfusion (ALBT) in primary unilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA), analyzing the Nationwide Inpatient Sample between 2000 and 2009. Multivariate logistic regression analysis was performed. ⋯ No autologous-related blood transfusion was a significant predictor of ALBT in THA, however, not in TKA. We believe that the utilization of ALBT in THA and TKA can decrease by taking these factors into consideration for patient blood management before surgery.
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Mortality following hip arthroplasty is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. Relevant variables available from the 2011 NJR data set were included in the Cox model. ⋯ Schemper's statistic showed that only 18.98% of the variation in mortality was explained by the variables available in the NJR data set. It is inappropriate to use NJR data to study an outcome affected by a multitude of confounding variables when these cannot be adequately accounted for in the available data set.
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Comparative Study
Historical implant or current best standard? Minimum five year follow-up outcomes of cemented Thompson hemiarthroplasties.
UK NICE guidelines recommend abandoning the Thompson hemiarthroplasty (TH) in favour of a 'proven prosthesis' such as the Exeter Trauma Stem. The aim of this study was to assess the hip fracture treatment with the TH. ⋯ The TH remains a reliable and proven implant in appropriate patients (over the age of 80, with low activity levels, low ambulatory status and who maybe cognitively impaired), due to low complication and revision rates. Modern implants may provide better function or longevity, but there is little evidence to support abandoning the TH.
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Understanding the impact of obesity on elective total joint arthroplasty (TJA) remains critical. Perioperative outcomes were reviewed in 316 patients undergoing primary TJA. ⋯ Additionally, PBF of 43.5 was associated with a 2.4× greater likelihood of blood transfusion, PBF of 36.5 with a 1.9× greater likelihood for LOS >3 days, and PBF of 36.0 with a 1.4× greater likelihood for discharge to an extended care facility. PBF may be a more effective measure than BMI to use in screening for perioperative risks and acute outcomes associated with obese total joint patients.
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Tranexamic acid (TXA) has been used successfully in primary total knee arthroplasty (TKA) to minimize blood loss and transfusions. The purpose of this study is to determine its efficacy in patients undergoing revision TKA. ⋯ When stratified by type of revision, treatment patients undergoing femoral and tibial component revision had lower transfusion rates than the controls (P=0.03). Given the drawbacks of allogenic blood transfusion, we highly recommend the use of TXA in revision TKA, especially when both components are being revised.