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New cost-effectiveness study highlights benefits of unicondylar knee arthroplasty.


 January 8, 2015

Although Total Knee Arthroplasty (TKA) generally achieves excellent outcomes on a range of measures, patients may experience impaired functional activity and residual pain postoperatively. Compared with TKA, Unicondylar Knee Arthroplasty (UKA) may achieve a more normal gait, decreased perioperative trauma, and faster rehabilitation. Consequently, UKA may be a valuable alternative to TKA. However, there is general consensus in the literature that UKA has a higher revision rate than TKA. AMR Advanced Medical Research staff participated in a research project that was undertaken to assess the cost-effectiveness of UKA versus TKA, taking a Belgian payer's perspective.   


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Most downloaded paper in Hip International


Apr 1, 2014

 

AMR's research project conducted in collaboration with Dr Hervé Hourlier showed the following: Thirty mg/kg TXA single shot is as safe as continuous infusion! As a single shot of TXA it is also less cumbersome, it is recommended as part of routine care in THR patients.

Although prophylactic tranexamic acid (TXA) is a safe, low-cost option to reduce bleeding in patients undergoing total hip replacement (THR), its optimal dose and duration is unknown. We compared the safety and effectiveness of TXA given as either a single injection or continuous infusion in THR patients, hypothesising that a second TXA dose would not offer any clinical advantages over the single injection.
Materials and methods: One hundred and sixty-four patients undergoing unilateral THR were randomised. Exclusion criteria were history of thromboembolic events (TE), epilepsy, thrombophilia, and severe chronic renal failure. Patients received either a single dose of 30 mg/kg TXA on induction of surgery (one shot [OS] group), or a loading dose of 10 mg/kg TXA followed two hours later by a continuous infusion of 2 mg/kg per hour for 20 hours (one day [OD] group). The primary outcome was blood loss (BL) calculated from haematocrit levels. Secondary outcomes were mortality and TE events within 90 days postoperatively.
Results: All patients completed treatment, with none lost to follow-up. Mean BL was 1107 ± 508 ml in Group OS and 1047 ± 442 ml in Group OD (p = 0.43). No patients were transfused prior to Day 10 postoperatively. At final follow-up, no patients had died, and there were no occurrences of major TE.
Conclusion: The 30 mg/kg TXA single shot was as safe as continuous infusion. As it is also less cumbersome, we recommend it as part of routine care in THR patients.

The original article can be accessed here

 
 
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