Intravenous Tranexamic Acid for Reducing Perioperative Blood Loss During Revision Surgery for Vancouver Type B Periprosthetic Femoral Fractures After Total Hip Arthroplasty: A Retrospective Study.

Releken Yeersheng,Qiu‐Ru Wang,Zhou‐Yuan Yang,Peng‐De Kang,Dong‐Hai Li

doi:10.1111/os.12592

Abstract

ObjectiveTo explore the efficacy and safety of intravenous tranexamic acid for reducing perioperative blood loss and allogeneic blood transfusions in revision surgery for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty (THA).MethodsWe retrospectively reviewed 129 patients who underwent revision surgeries because of Vancouver type B periprosthetic femoral fractures from January 2008 to September 2018. Patients were divided into two groups according to whether they received intravenous tranexamic acid (n = 72) or not (n = 57). The two groups were compared in terms of estimated intraoperative blood loss, visible blood loss, hidden blood loss, the volume of allogeneic blood transfusion and the incidence of symptomatic venous thromboembolism (VTE). Patients were also compared depending on the Vancouver classification (Vancouver type B1, B2, and B3).ResultsRegardless of the subtype of Vancouver classification, patients who received tranexamic acid showed significantly lower estimated intraoperative blood loss, visible blood loss, hidden blood loss, and allogeneic blood transfusion volume. Use of tranexamic acid was not associated with significant changes in the incidence of postoperative symptomatic VTE. Similar results were obtained with subgroups of patients who had the Vancouver type B1, B2, or B3 periprosthetic femoral fractures.ConclusionsThe administration of intravenous tranexamic acid can safely and effectively reduce perioperative blood loss and allogeneic blood transfusions in revision surgery for Vancouver type B periprosthetic femoral fractures, without increasing the risk of symptomatic VTE.

Highlights

Total hip arthroplasty (THA) is a widely used method to treat non-infective end-stage diseases of the hip joint which can effectively relieve pain and improve patient quality of life[1]
Inclusion Criteria and Exclusion Criteria Inclusion criteria included the following: (i) the patients underwent revision hip arthroplasty because of the Vancouver type B Periprosthetic femoral fractures (PFF) in the Department of Orthopaedics at our institution between January 2008 and September 2018; (ii) the patients were treated with tranexamic acid in a way which became standard from December 2012 at our institution; tranexamic acid was routinely administered as an intravenous preoperative dose (15 mg/kg) in all PFF cases, and it was administered again intravenously at the point when the surgery exceeded 2 h; (iii) the patients were not treated with tranexamic acid; and (iv) the related outcomes of patients were complete in the medical records
General Results Our final analysis involved 57 patients treated before December 2012 who did not use tranexamic acid, as well as 72 patients treated after December 2012 who received intravenous tranexamic acid as per routine practice at our hospital (Table 2)

Summary

Introduction

Total hip arthroplasty (THA) is a widely used method to treat non-infective end-stage diseases of the hip joint which can effectively relieve pain and improve patient quality of life[1]. It is estimated that the number of primary. THAs and total hip revisions will increase by 174% and 137% respectively from 2005 to 2030 in the United States[2]. Disclosure: The authors declare that they have no conflict of interest. Received 13 July 2019; accepted 18 November 2019.

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