The purpose of this multicenter, randomized clinical trial was to determine the optimal dosing regimen of tranexamic acid (TXA) to minimize perioperative blood loss for revision total hip arthroplasty (THA). Six centers prospectively randomized 155 revisions to one of four regimens: 1g of intravenous (IV) TXA prior to incision, a double dose regimen of 1g IV TXA prior to incision and 1g IV TXA during wound closure, a combination of 1g IV TXA prior to incision and 1g intraoperative topical TXA, or three doses of 1950mg oral TXA administered 2 hours preoperatively, 6 hours postoperatively, and on the morning of postoperative day one. Randomization was based upon revision subgroups to ensure equivalent group distribution, including: femur only, acetabulum only, both component, explant/spacer, and second stage reimplantation. Patients undergoing an isolated modular exchange were excluded. An Background
Methods
115 patients undergoing primary unilateral THA were randomized to either DAA or MPA. Groups did not differ in mean age, sex, or mean body mass index. Functional results included time to discontinue gait aids, discontinue all narcotics, and independence with various activities of daily living. Activity in study subjects was measured with 5 wearable activity monitoring sensors with tri-axial MEMS accelerometers and validated custom algorithms and conducted over three days at pre-op, 2 weeks, 8 weeks, and one year. SF-12, WOMAC, and HHS scores to one year were also tabulated. Early functional recovery slightly favoured DAA compared to MPA; time to discontinue walker (10 vs. 14.5 days), time to discontinue all gait aids (17.3 vs 23.6 days), ascend stairs with gait aid (5.4 vs. 10.3 days), and to walk 6 blocks (20.5 vs. 26.0 days). There were no other differences in early functional milestones. Activity monitoring at two weeks postoperatively slightly favoured DAA; mean steps per day were 3897 versus MPA 2,235, percent of day active, DAA 10.5% versus MPA 6.9%. There was no difference in activity monitoring pre-operatively, at two months, or at one year. There was no difference at one year with the SF-12. There was no difference in the SF-12 mental component or the HOOS at any time point. There was no loosening or subsidence of any of the components in any hip. Both the direct anterior and posterior approach provided excellent early postoperative recovery with a low complication rate. The direct anterior patients had slightly faster recovery than the mini-posterior approach patients, with slightly shorter times to achieve milestones of function and as measured by advanced, quantitative activity monitoring at 2 weeks postoperatively.
Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (Aims
Patients and Methods
