Intra-articular Hemarthrosis Research Articles

Administration of Tranexamic Acid to Reduce Intra-articular Hemarthrosis in ACL Reconstruction: A Systematic Review.

Background:Although tranexamic acid (TXA) has been shown to reduce bleeding in joint replacement procedures, its effectiveness for anterior cruciate ligament reconstruction (ACLR) has not been widely reported.Purpose:To evaluate the effectiveness of TXA to reduce postoperative hemarthrosis and improve clinical outcomes after ACLR.Study Design:Systematic review; Level of evidence, 2.Methods:A systematic review of the literature following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was performed; literature retrieval was carried out using the MEDLINE, Embase, and Cochrane Library electronic databases. The inclusion criteria were comparative studies in English that reported the administration of intravenous or intra-articular TXA versus other modalities or placebo in patients undergoing ACLR.Results:Six studies comprising 418 patients who were treated with TXA were included. Heterogeneity among studies did not allow for the pooling of data. Five studies showed decreased drainage volume in the first 24 or 48 hours postoperatively as compared with control (ACLR with no TXA). Four studies showed lower hemarthrosis grades and visual analog scale scores in TXA versus control in the early postoperative period, although this difference was not evident at 4 weeks postoperatively. No studies showed differences in infection, deep venous thrombosis, or adverse events between the TXA and control groups.Conclusion:The current best available evidence suggests that TXA administration at the time of ACLR results in decreased intra-articular bleeding (measured using a drainage system), hemarthrosis grade, and pain when compared with control.

Tranexamic Acid has no Effect on Post-Operative Hemarthrosis or Pain Control Following ACL Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blind Randomized Controlled Double-Blind Trial (169)

Objectives:Tranexamic acid (TXA) is a commonly used medication in orthopaedic procedures, reducing perioperative bleeding and need for transfusion. The purpose of this double-blind randomized controlled study was to evaluate if IV TXA for primary anterior cruciate ligament (ACL) reconstruction with bone-patella tendon-bone (BTB) could reduce perioperative blood loss or postoperative intra-articular hemarthrosis without postoperative drains.Methods:A controlled, randomized, double-blinded trial was conducted in 110 patients who underwent ACLR with BTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-gram boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated, and the volume of blood (ml) was recorded. Additionally, perioperative blood loss (ml); Visual Analog Scale (VAS) on postoperative days (POD) 1-7 and post-operative weeks (POW) 1, 6 and 12; postoperative opioid consumption POD 1-7; range of motion (ROM) and ability to straight leg raise (SLR) at POW 1, 6, 12; and pre and postoperative thigh circumference ratio (TCR).Results:There was no significant difference in perioperative blood loss between the experimental and control groups (32.5ml v. 35.6ml, p=0.47). The experimental group had 23 knees aspirated; control group had 26 knees aspirated (p=0.56). No significant difference seen in postoperative hemarthrosis volume with IV TXA (26.7ml v. 37.3ml, p=0.12). There was no significant difference in VAS score between the two groups (p=0.15), additionally, there was no difference in postoperative opioid consumption (p=0.33). There was no significant difference in ROM or ability to SLR, or pre- nor post-operative TCR (p > 0.05 for all).Conclusions:IV TXA in patients who undergo ACLR with BTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early post-operative recovery regarding ROM or quadriceps reactivation.

The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction for reducing postoperative hemarthrosis: a prospective randomized study

BackgroundHemarthrosis after anterior cruciate ligament (ACL) reconstruction can create many adverse joint effects. Tranexamic acid (TXA) can be used to minimize hemarthrosis and associated pain after ACL reconstruction. We aimed to compare the efficacies of intravenous (IV) administration and intra-articular (IA) injection of TXA during ACL reconstruction for reducing postoperative hemarthrosis.MethodsA total of 120 patients who underwent arthroscopic ACL reconstruction were included in this prospective and randomized study. All patients were randomized into three groups: IV group, IA group and placebo group. Patients in the IV group received intravenously administered TXA (15 mg/kg in 100 mL of saline solution) 10 min before tourniquet release; patients in the IA group received intra-articular TXA (15 mg/kg in 100 mL of saline solution) injected via the drainage tube; and patients in the placebo group received an equivalent volume of normal saline administered into the knee joint cavity and intravenously. Drainage tubes were removed 24 h after surgery, and all enrolled patients experienced a 4-week follow-up period. The drain output volume, visual analogue scale (VAS) score, patellar circumference, hemarthrosis grade and Lysholm score of all patients were recorded.ResultsBoth the IV group and the IA group had significantly lower drain output volumes at day 1, lower VAS scores at weeks 1 and 2, smaller patellar circumferences at weeks 1 and 2, and lower hemarthrosis grades at weeks 1 and 2 than the placebo group (p < 0.05). There were no significant differences in drain output volume, VAS score, patellar circumference or hemarthrosis grade between the IV group and the IA group at any time point (p > 0.05). No obvious differences in Lysholm score were observed between any pair of groups at week 4 (p > 0.05)). Neither infection nor deep vein thrombosis occurred in any group.ConclusionsBoth intravenous administration and intra-articular injection can reduce intra-articular hemarthrosis, joint pain and swelling during ACL reconstruction. No significant difference in the efficacies of reducing hemarthrosis, joint pain and swelling was found between intravenous administration and intra-articular injection.Trial registrationThe study was registered by the Chinese Clinical Trial Registry (The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction; ChiCTR-INR-17012217; August 1, 2017).

Intra-articular Administration of Tranexamic Acid Has No Effect in Reducing Intra-articular Hemarthrosis and Postoperative Pain After Primary ACL Reconstruction Using a Quadruple Hamstring Graft: A Randomized Controlled Trial.

Background:Insufficient data are available to support the routine use of tranexamic acid (TXA) in anterior cruciate ligament (ACL) surgeries with respect to administration method and frequency, exposure duration, dose, and adverse effects.Purpose:To investigate whether intra-articular (IA) administration of TXA could reduce hemarthrosis and postoperative pain in patients after ACL reconstruction.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 47 patients were included in this study, which was performed between July 2017 and May 2019. Single-bundle reconstructions using autologous hamstring tendon grafts were performed in all patients. The patients were randomized into 2 groups: the TXA group (received the index procedure with 100-mL IA injection of TXA [30 mg/mL]) and a control group (did not receive IA injection of TXA). No patients received a drain. Blood loss was calculated on the basis of hemoglobin balance at postoperative day (PD) 2. The visual analog scale (VAS) for pain score was assessed at PD 3. The midpatellar circumference was measured at PD 2 and PD 5. Knee range of motion (ROM) was evaluated 6 weeks after surgery.Results:The mean ± SD blood loss was 467 ± 242 mL in the TXA group and 558 ± 236 mL in the control group. No significant differences were found for blood loss (P = .20), VAS pain scores (P = .28), ROM at postoperative week 6 (P = .61), or patellar circumference at PD 2 (P = .75) and PD 5 (P = .84).Conclusion:This study showed that IA administration of 3.0 g of TXA had no effect in reducing blood loss and postoperative pain after primary anatomic single-bundle ACL reconstruction using quadruple hamstring autografts.Registration:NCT04042688 (ClinicalTrials.gov identifier).

Intra-articular Administration of 3.0g Tranexamic Acid Has no Effect on Reducing Intra-articular Hemarthrosis and Postoperative Pain After Primary Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Intra-articular Administration of 3.0g Tranexamic Acid Has no Effect on Reducing Intra-articular Hemarthrosis and Postoperative Pain After Primary Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Efficiency of Tranexamic Acid in Management of Surgical Orthopedic Bleeding in Patients with Haemophilia

Haemophilia is an inherited bleeding disorder (gonosomala recessive, related to chromosome X, with transmission from carrying women to male descendents) characterised from the clinic point of view by important bleeding, secondary to some minimum and biologic traumas by deficiency of trombo-plastino-formation, consecutive to either a deficit of factor VIII (haemophilia A), or the factor IX (haemophilia B). The most characteristic manifestation of hemophilia is intra-articular � hemarthrosis. Its repetitive character leads to irreversible lesions of the articular structures, inducing lesions of the synovium with degenerative effects over the articular cartilage and destructive effects for the subchondral bone tissue. In time, these lesions require orthopaedic surgery to improve the locomotor activity. Managing an efficient hemostasis is vital during surgery, due to high risk of bleeding triggered by coagulopathy and surgery. Numerous studies carried out underlined the efficiency of the tranexamic acid (TXA) in reducing bleeding, in different surgery branches, by inhibiting the enzymatic degradation of fibrin. In orthopaedic surgery, the tranexamic acid is frequently used in case of hip and knee arthroplasties, reducing the bleeding and blood transfusion necessary to the treatment of posthaemorrhagic anemia. This paper wants to assess the efficiency of the tranexamic acid in realization of hemostasis to another category of patients, haemophiliac patients with indication of total hip and knee endoprosthesis.

Reducing Intra-articular Hemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction by the Administration of Intravenous Tranexamic Acid

Background: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Hemarthrosis and pain adversely affect the functional outcomes of ACL reconstruction in the early postoperative period. Purpose: To evaluate the effects of administering tranexamic acid (TXA) to minimize knee joint hemarthrosis and associated pain. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 105 patients who underwent arthroscopic ACL reconstruction were enrolled in this prospective, randomized, double-blind study. The patients who were randomized to the TXA group (n = 53) received intravenous TXA; the control group (n = 52) did not receive TXA. The anesthetist, surgeon, observer, and patients were blinded to the study groups (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet, and an intravenous infusion of 10 mg/kg/h was continued for 3 hours after completion of the operation. In the control group, an equal volume of placebo was administered at the same rate and by the same route. The volume of drained blood was measured 24 hours postoperatively. Pain was evaluated using a visual analog scale (VAS) at a consistent time in the evening of postoperative day 3 and postoperative weeks 2 and 3. The Lysholm knee scoring scale was used to record patient satisfaction and knee function during postoperative weeks 2 and 4. Results: Significant differences were observed between the volume of fluid drained (60 mL [TXA group] vs 150 mL [control group]; P < .001) (between-group difference [95% CI], −90 [−114.15 to −65.85]) and hemarthrosis grade in postoperative weeks 1 and 2. In addition, the pain outcome improved in the TXA group after day 3 (VAS score, 1.4) compared with that in the control group (VAS score, 2.9) (P < .001) (95% CI, −1.51 to −0.49). The VAS scores of the TXA group at the end of weeks 2 and 3 were also significantly lower than those in the control group (P < .001) (95% CI, −2.00 to −1.00). The median Lysholm score at the end of week 2 was 70 (range, 40-85) in the control group and 75 (range, 50-90) in the TXA group; at the end of week 4, the score was 75 (range, 50-85) in the control group and 80 (range, 70-85) in the TXA group. A significant difference in the Lysholm score was observed between the 2 groups (P < .001) (95% CIs, 0.08-9.92 and 4.00-10.00 for weeks 2 and 4, respectively). Although range of motion was similar between the groups at the end of week 4, the mean was 107.36° ± 8.36° in the TXA group and 103.65° ± 7.68° in the control group on postoperative day 2 (P = .020) (95% CI, 0.60-6.81). The mean hemarthrosis values at the end of weeks 1 and 2 were significantly lower in the TXA group than in the control group (P < .001), and the need for aspiration in the TXA group during the early postoperative period was significantly lower than in the control group (P < .001). There were no infections in either group, and no patient developed deep venous thrombosis by postoperative day 3. Conclusion: The results of this prospective, randomized study show that TXA reduced the amount of postoperative hemarthrosis and decreased the need for aspiration of the knee after arthroscopic ACL reconstruction. Consequently, TXA reduced pain and improved range of motion of the knee in the early postoperative period without side effects.

Open Reduction and Smooth Kirschner Wire Fixation for Unstable Slipped Capital Femoral Epiphysis

Reduction of unstable slipped capital epiphysis has a bad reputation, especially in severe slips. Treatment frequently causes avascular necrosis (AVN). This study analyzes the role of capsulotomy with evacuation of intraarticular fluid and gentle reduction done as an emergency procedure followed by fixation with unthreaded Kirschner wires (K-wires). We treated 64 consecutive cases of unstable slips (37 boys and 27 girls) following the same protocol. Instability was recognized in those children who had experienced a fall or a stumble, followed by acute hip pain, with radiological evidence of capital femoral separation and ultrasonographic evidence of joint effusion. The protocol consisted of capsulotomy, evacuation of intraarticular effusion or hematoma, controlled gentle reduction, and fixation of the reduced physis by smooth K-wires. Surgery was done as an emergency procedure if possible within 24 hours after the onset of acute symptoms. There were 20 mild slips with slip angles less than 31 degrees, 24 moderate with slip angles between 31 and 50 degrees, 20 slips were severe with slip angles between 51 and 90 degrees. In 61 cases, reduction was successful without being followed by AVN. Three patients, 2 girls and 1 boy, developed partial AVN (4.7%). Two avascular necroses occurred in moderate slips, one in a severe slip, and none in the mild slips. The outcome of 60 patients (34 boys and 26 girls) with unstable slips could be evaluated clinically and radiographically with a mean follow-up of 4.9 years (range, 18 months-104 months). The Iowa hip score in these 60 cases reached an average of 94.5 points out of 100. Open reduction and evacuation of intraarticular hemarthrosis or effusion detected by ultrasound and smooth K-wire fixation done as an emergency is a safe and reliable treatment option for unstable slips with a low AVN rate. The severity of the slip does not influence the rate of AVN and the outcome measured by the Iowa hip score.

Hemarthrosis and hip joint pressure in femoral neck fractures.

In a prospective clinical study the intraarticular pressure of 55 patients with intracapsular femoral neck fractures was measured intraoperatively with the hip in different positions. Intraarticular hemarthrosis was quantified by a preoperative sonography examination. In 75% of the patients, increased intraarticular pressure caused by the hemarthrosis was found. The spontaneous median pressure increased significantly from 22 mm Hg with extension (28 mm Hg) and internal rotation of the hip joint (56 mm Hg). The lowest pressure was found in 70 degrees flexion (15 mm Hg). The median pressures increased within the first 24 hours after injury from 26 mm Hg in the first 6 hours to 46 mm Hg from 7 to 24 hours. Even in the first and second weeks after trauma, increased median pressures were detected (8.5 mm Hg and 13 mm Hg, respectively). No significant difference was found between undisplaced and displaced fracture types. Because increased joint pressure in other studies correlates with reduced perfusion of the femoral head, it can be deduced that reduction maneuvers without capsulotomy can compromise the circulation of the femoral head. Capsulotomy and osteosynthesis of the femoral neck at the earliest time possible is the best prophylaxis of tamponade. If the osteosynthesis is delayed, a preoperative sonography after admission and a control sonogram after 6 hours is recommended. In the event of relevant hemarthrosis, immediate therapeutic drainage is suggested for patients who will receive joint conserving osteosynthesis.