Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2021
Multicenter StudyIs there a role of tranexamic acid in rheumatoid arthritis with total knee arthroplasty? Findings from a multicenter prospective cohort study in China.
Tranexamic acid (TXA) has proven to be effective in reducing the blood loss associated with total knee arthroplasty (TKA) in patients with osteoarthritis. However, there still exists a paucity of evidence regarding the effectiveness of intravenous TXA in patients with rheumatoid arthritis. The aim of this study was to explore the efficacy and safety of intravenous TXA on blood loss after TKA in Chinese patients with rheumatoid arthritis. ⋯ TXA can effectively diminish blood loss, reduce transfusion, shorten LOS and decrease hospitalization costs after TKA in Chinese patients with rheumatoid arthritis, without increasing the risk of complications.
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Arch Orthop Trauma Surg · Mar 2021
Rate of venous thromboembolism after surgical treatment of proximal humerus fractures.
The rate of venous thromboembolism following surgical treatment of proximal humerus fractures is not well established. ⋯ The incidence of symptomatic VTE after surgery for proximal humerus fractures is low. Chemical VTE prophylaxis in patients after surgical fixation for proximal humerus fractures is not universally indicated. Selective prophylaxis for patients with systemic risk factors may be warranted.
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Arch Orthop Trauma Surg · Mar 2021
Short-term mortality after primary and revision total joint arthroplasty: a single-center analysis of 103,560 patients.
The demand for total joint arthroplasty (TJA) is increasing worldwide with excellent long-term results. In general, TJA provides several benefits to the patients but also causes possible complications. The aim of our study was to describe trends in mortality after TJA in a high-volume arthroplasty center, and to examine the potential risk factors. ⋯ This is the largest single-center study presenting the short-term mortality rate following TJA. Consequently, TJA is a safe procedure with a low short-term mortality rate. However, depending on the type of surgery, certain risk factors cannot be eliminated. In order to further reduce the mortality, procedures as such should continue to be performed at specialized centers under standardized conditions.
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Arch Orthop Trauma Surg · Mar 2021
WALANT-Epinephrine injection may lead to short term, reversible episodes of critical oxygen saturation in the fingertips.
Although the WALANT technique's long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. It was hypothesized that, temporarily, critical levels of tissue perfusion may occur. ⋯ Injection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. However, this was fully reversible within minutes and does not cause long-term complications.
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Arch Orthop Trauma Surg · Mar 2021
Should all hip and knee prosthetic joints be aspirated prior to revision surgery?
It is essential to exclude a periprosthetic joint infection (PJI) prior to revision surgery. It is recommended to routinely aspirate the joint before surgery. However, this may not be necessary in a subgroup of patients. The aim of our study was to investigate if specific clinical and implant characteristics could be identified to rule out a PJI prior to revision surgery. ⋯ Implants with solely mechanical failure without signs of loosening and low inflammatory parameters probably do not require a synovial fluid aspiration. These results need to be confirmed in a larger cohort of patients. In case of prosthetic loosening, all joints need to be aspirated before surgery as no specific characteristic could be identified to rule out an infection.