The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group. We prospectively studied 270 patients with primary hip osteo-arthritis who underwent a straight forward THR between February 2012 and September 2013. The first 70 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray before closure and the last 100 patients received 1g TA on induction. Demographic data, comorbidities, surgical time, surgeon grade, anaesthetic type, haemoglobin drop post-operative and transfusion requirements were analysed using one-way ANOVA. The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the 3 groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 & 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0% vs 10%, p = 0.05). The LOS was significantly shorter in the tranexamic acid group than fibrin sealant group and in the fibrin sealant group compared with control group. There was no significant difference between the groups with regards to proportion of patients with wound leaking problems. No other complications (e.g. VTE) were encountered Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.
The purpose of this study was to investigate the usefulness of PET-CT in the diagnosis and treatment of long bone infections following trauma. All patients referred to the limb reconstruction service for management of non-unions were treated by the same protocol. PET-CT with FDG was performed in all patients to assess if the non-union site was infected and if so, the extent of the infection. Those requiring operative management were treated in a 2-stage manner. Initially with debridement based on PET-CT; sampling for microbiology and histology; and then Teicoplanin and Ciprofloxacin. If samples were positive then the patients were treated for a total of 6 weeks with antibiotics based on microbiology advice before undergoing definitive fixation. The sensitivity, specificity, PPV, and NPV were then calculated for PET-CTs ability to predict presence of infection using extended cultures and histology as the gold standard. 38 consecutive patients underwent surgery, 24 male and 14 female. 24 were deemed infected on extended culture or histology. PET-CT was anecdotally found to be extremely useful at determining the extent of infection to plan debridement. PPV 0.83 NPV 0.89 Sensitivity 0.96 Specificity 0.61 As well as providing unique ability to demarcate areas of bony infection in the presence of metalwork, the ability to detect or exclude infection was exceptional. This is a test, however, which is operator dependent and requires a skilled Nuclear Radiology Consultant to accurately interpret images. In our relatively small pilot study the accuracy improved noticeably over one year. PET-CT has potential to be a powerful tool in the diagnosis and treatment of long bone infection following trauma and certainly warrants further investigation.
