The Value of Tranexamic Acid in Reducing Blood Loss following Hip Reconstruction in Children with Cerebral Palsy.

I Majid,S Alshryda,E Morakis,B Somanchi,A Foster

doi:10.1155/2015/827027

Abstract

This is a retrospective study of 51 consecutive hip reconstructions in children with cerebral palsy performed between 2011 and 2013. Tranexamic acid (TXA) was used in 14 hip reconstructions only. Transfusion rate was higher, postoperative Hb was lower, and patients stayed longer in the TXA group. This did not reach a statistical significance (P = 0.75, 0.5, and 0.71, resp.). More than half of the patients who had TXA underwent bilateral hip reconstructions in comparison with 27% only in the non-TXA group. Bilateral hip reconstructions mean more surgery, more blood loss, and more blood transfusion. The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels. Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated. Ideally this should be explored further in an adequately powered, randomised controlled trial where risk of bias is minimized.

Highlights

Cerebral palsy (CP) is caused by an injury to the immature brain usually occurring during or shortly after birth
Fifty-one hip reconstructions were performed in children with CP in our institute: 14 received tranexamic acid (TXA), 37 did not
Blood transfusion rate is considered to be a reliable outcome measure and it is of great importance for patients, healthcare providers, and managers and it is chosen as the primary outcome for our study

Summary

Introduction

Cerebral palsy (CP) is caused by an injury to the immature brain usually occurring during or shortly after birth. All functions of the brain may be affected, the motor function is usually the most vulnerable [1]. The gross motor function classification system (GMFCS) categorises the functional capabilities of children with CP into 5 levels (Table 1) [2]. Hip joint dislocation is a common problem in children with CP that can cause significant pain and interference with personal care and hygiene. Surgical hip reconstruction reduces the hip joint through soft tissue releases and bony cuts of the femur and/or pelvis (Figure 1). Blood loss and subsequent blood transfusion are a normal consequence of hip reconstruction [3, 4]

Methods

Results

Conclusion