http://jbjs.org/ en-us Wed, 23 May 2012 00:00:00 GMT Wed, 23 May 2012 15:13:16 GMT Silverchair editor@jbjs.org webmaster@jbjs.org http://jbjs.org/article.aspx?articleID=1167330 Wed, 23 May 2012 00:00:00 GMT <span class="paragraphSection"><div class="boxTitle">Introduction:</div>Blood loss following total knee arthroplasty can lead to substantial morbidity and the need for blood transfusions. Hemostatic agents have been used to minimize blood loss and to decrease transfusion rates. Floseal is a thrombin-based hemostatic agent with unknown efficacy for achieving these goals in patients undergoing total knee arthroplasty.<div class="boxTitle">Methods:</div>We performed a prospective randomized controlled trial on the use of Floseal in patients undergoing total knee arthroplasty, with the primary end point being blood loss as measured through drain output. Demographic characteristics, operative side, diagnosis, intraoperative details, implant choice, hospital course, laboratory values, visual analog scale pain scores, knee range of motion, adverse events, transfusion rates, and deviations from protocol were recorded.<div class="boxTitle">Results:</div>A total of 196 patients were enrolled, with ninety-seven patients being randomized to the Floseal group and ninety-nine patients being randomized to the control group. There were no significant differences between the Floseal and control groups in terms of drain output at twenty-four hours (711 compared with 702 mL; p = 0.823). No differences were noted between the groups in terms of operative side, diagnosis, intraoperative details, implant choice, hospital course, laboratory values, visual analog scale pain scores, knee range of motion, or transfusion rates. Complications occurred infrequently. In the acute postoperative period, there were two cases of cellulitis (one in each group), two deep venous thromboses (one in each group), and one paralytic ileus (in the control group), all of which resolved with nonoperative measures. At the six-week follow-up, one patient in the Floseal group had died from a cause unrelated to surgery, two patients (one in each group) had suture abscesses with cellulitis that resolved with postoperative antibiotics, and four patients (two in each group) underwent knee manipulation under anesthesia to achieve improved knee motion. With the numbers available, there was no significant association between Floseal use and the occurrence of these adverse events.<div class="boxTitle">Conclusions:</div>The present study showed that Floseal had no demonstrable effect on blood loss as measured through drain output following total knee arthroplasty. There were also no notable adverse events associated with its use. The usefulness of Floseal as a hemostatic agent in total knee arthroplasty remains unclear.<div class="boxTitle">Level of Evidence:</div>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</span> http://jbjs.org/article.aspx?articleID=1167330 http://jbjs.org/article.aspx?articleID=1167331 Wed, 23 May 2012 00:00:00 GMT <span class="paragraphSection"><div class="boxTitle">Background:</div>Total knee arthroplasty is associated with substantial blood loss and the risks of transfusion. Conflicting reports have been published regarding the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty. We performed a meta-analysis to investigate the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty.<div class="boxTitle">Methods:</div>A meta-analysis was performed to assess the effectiveness and safety of using tranexamic acid in total knee arthroplasty. Randomized controlled trials that had been published before May 2011 were retrieved, and fifteen studies met the inclusion criteria. The weighted mean difference in blood loss, number of transfusions per patient, prothrombin time, and postoperative activated partial thromboplastin time and the summary odds ratio of transfusion, deep-vein thrombosis, and pulmonary embolism were calculated in the group of patients who received tranexamic acid and the group of patients who received a placebo.<div class="boxTitle">Results:</div>The amount of blood loss and the number of blood transfusions per patient were significantly less and the proportion of patients who required a blood transfusion was smaller in the tranexamic acid group compared with the placebo group. No significant difference in prothrombin time, activated partial thromboplastin time, deep-vein thrombosis, and pulmonary embolism was detected between the tranexamic acid group and the placebo group.<div class="boxTitle">Conclusions:</div>The meta-analysis shows that the use of tranexamic acid for patients undergoing total knee arthroplasty is effective and safe for the reduction of blood loss.<div class="boxTitle">Level of Evidence:</div>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</span> http://jbjs.org/article.aspx?articleID=1167331