The Journal of arthroplasty
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Randomized Controlled Trial
Weighted versus uniform dose of tranexamic acid in patients undergoing primary, elective knee arthroplasty: a prospective randomized controlled trial.
In a prospective, randomized, double-blinded, controlled study (25 controls), TA was infused parenterally before tourniquet release in two study groups. Group 1 (n = 20) received a 1 g dose, and group 2 (n = 20) received a 20 mg/kg dose. ⋯ Two blood transfusions were given to one patient in the weighted group, compared to 19 transfusions (10 patients) in the control group. This study suggests that a single 1-g dose can be used with the same efficacy as a weighted 20 mg/kg dose.
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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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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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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.
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Reimbursement continues to decrease for orthopaedic surgeons specializing in total joint arthroplasty (TJA). Practice information from the Medical Group Management Association (MGMA) Cost Survey and Private practice Compensation Survey and CMS locality reimbursement data was used to develop a practice model for a TJA specialist performing 300 TJA per year (66% knees, 33% hips, 15% revision surgery), evaluating 3000 outpatient visits per year based on, current Medicare reimbursement rates. ⋯ When MGMA practice expense data are applied to the Medicare-only model, the salary level is unsustainable. Further decreases in Medicare Part B reimbursement will only worsen the disparity.