COMPARISON OF THE EFFECTS OF TRANEXAMIC ACID AND HEMOVAC DRENAGE ON HEMOGLOBIN DECREASE IN TOTAL KNEE ARTHROPLASTY

Öz

Objective: The aim of this study was to evaluate patients who used hemovac drains after primary total knee arthroplasty and patients who received tranexamic acid without hemovac drenage; To compare in terms of erythrocyte suspension need and infection rates after surgery. Material and Methods: After the approval of the local ethics committee, the files of patients who underwent total knee arthroplasty due to gonarthrosis between 2018 and 2020 were obtained from the hospital archive. All patients who received 1 gram of transexamic acid while the joint capsule was closing were included in the study. Patients who underwent hemovac were included in the study by lot method by an orthopedic specialist who was not in the study team. Twenty patients in both groups were taken in the study. Results: The mean age of the patients included in the study was found to be 67.8 ± 9.1 (51-90). 35 of the 40 patients were women, 20 patients were operated on the right knee and 20 patients on the left knee. There was no statistically significant difference between the groups in terms of age, gender, and the operated side. Erythrocyte suspension was not given in any of the patients who were applied tranexamic, and in the group in which hemovac drain was applied, an average of 1.6 erythrocyte suspension was given to 5 patients. A statistically significant difference was found between the groups in terms of the need for ES transfusion. Conclusion: Intra-articular transamine application after primary total knee arthroplasty causes less blood loss and need for transfusion of blood products compared to hemovac drain application. There was no statistically significant difference between the pre-operative Hb values of the patients. Hemoglobin decrease was found higher in the group in which hemovac drain was applied at 24 and 48 hours, and the difference was considered statistically significant.

Anahtar Kelimeler

• total knee replacement
• transfusion
• bleeding

Total Diz Artroplastisinde Tranexamic Asit ve Hemovak Dren Kullanımın Hemoglobin Düşüşü Üzerine Etkilerinin Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı primer total diz artroplastisi sonrası hemovak dren kullanılmış hastalarla, hemovak kullanılmayıp traneksamik asit uygulanmış hastaları; cerrahi sonrası eritrosit süspansiyonu ihtiyacı ve enfeksiyon oranları bakımından karşılaştırmaktır. Gereç ve Yöntemler: Yerel etik kurul tarafından onay alındıktan sonra 2018 – 2020 yılları arasında gonartroz nedeniyle bağkesen total diz artroplastisi yapılan hastaların dosyalarına hastane arşivinden ulaşıldı. Cerrahi alanın kapatılması sırasında eklem kapsülü kapatıldıktan sonra içine 1 gram transeksamik asit uygulanan hastalar dahil edilirken, hemovak uygulanan hastalar çalışma ekibine dahil olmayan bir ortopedi uzmanı tarafından kura yöntemi ile çalışmaya dahil edildi. Her iki grupta 20’şer hasta çalışmaya alındı. Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 67,8 ± 9,1 (51 – 90) olarak bulunmuştur. Kırk hastanın 35’i kadındır, 20 hastanın sağ, 20 hastanın sol dizi opere edilmiştir. Gruplar yaş, cinsiyet, ameliyat olan taraf açısından değerlendirildiğinde istatistiksel olarak anlamlı fark görülmemiştir. Traneksamik uygulanan hastaların hiçbirinde eritrosit süspansiyonu verilmemiş, hemovak dren uygulanan grupta 5 hastaya ortalama 1,6’ü eritrosit süspansiyonu verilmiştir. ES transfüzyonu ihtiyacı açısından gruplar arasında istatistiksel olarak anlamlı fark bulunmuştur. Hastaların işlem öncesi Hb değerleri arasında istatistiksel olarak anlamlı fark görülmemiştir. Hemoglobin düşüşü 24 ve 48. saatlerde de hemovak dren uygulanan grupta daha fazla bulunmuş ve aradaki fark istatistiksel olarak anlamlı kabul edilmiştir. Sonuç: Primer total diz artroplastisi sonrası eklem içi transamin uygulaması hemovak dren uygulamasına göre daha az kan kaybına ve kan ürünüleri transfüzyon ihtiyacına neden olmaktadır

Anahtar Kelimeler

• total diz protezi
• transfüzyon
• kanama

Kaynakça

1. Crockarell JR, Guyton JL, Canale ST. Campbell’s Operative Orthopaedics. Arthroplasty of Ankle and Knee Volume 1, Edition 10. 2003; 243-315.
2. Bong MR, Patel V, Chang E, Issac PS, Hebert R, Di Cesare PE. Risk associated with blood transfusion after total knee arthroplasty. J arthroplasty 2004; 19: 281-7.
3. Kalairajah Y,Simpson D, Cossey AJ, Verrall GM, Springins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surgery 2005;87: 1480-2.
4. Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion of red blood cells. Blood transfusion 2009; 7: 49-64.
5. Çavuşoğlu AT, Ayanoğlu T, Esen E, Atalar H, Turanlı S. Total diz artroplastisinde eklem içi tranekzamik asit uygulaması sistemik uygulama kadar etkin ve güvenilir midir? Tek merkez randomize kontrollü çalışma. Joint diseases and related surgery 2015; 26: 164-7.
6. Dincel YM, Sarı A, Çetin MÜ, Günaydın B. Comparison of the tranexamic acid use with tourniquet and drain application in 170 primary total knee prosthesis cases. İnternationel journal of orthopedic sciences 2019; 5: 853-8.
7. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement a systematic rewiev and meta-analysis. The jornal of bone and joint surgery 2011; 93: 1577-85.
8. Peng H, Wang L, Weng X, Zhai J, Lin J, Jin J, et al. Effect of tranexamic acid on symptomatic venosus thromboembolism in patients undergoing primary total knee arthroplasty. Clinical research orthopedics and traumatology 2020; 16: 603-12.

9. Arslan A, Görmeli G. Using intra-articular tranexamic acid in total knee replacement surgery with and without bleeding control: a prospective randomized double blind study. European review for medical and fharmalogical sciences 2018; 22: 6127-32.
10. Shin YS, Yoon JR, Lee HN, Park SH, Lee DH. Intravenosus versus topical tranexamic acid administrations in primary total knee arthroplasty: a meta-analysis. Knee surgery sports traumatology arthroscopy 2016; 16: 4235-6.
11. Dai WL, Zhou AG, Zhang H, Zhang J. Most effective regimen of tranexamic acid for reducing bleeding and transfusions in primary total knee Arthroplasty: A meta-analysis of randomized controlled trials. J Knee Surgery 2018 Aug; 31: 654-63.
12. Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop. 2015; 39: 653-8.
13. Si HB, Yang TM, Zeng Y, Shen B. No clear benefit or drawback to the use of closed drainage after primary to tal knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disorder 2006; 17: 183.