The Clinical Efficacy Of Tranexamic Acid In The Reduction Of Perioperative During Simultaneous Bilateral Total Hip Arthroplasty

Objective:With the development of technology of Total Hip Arthroplasty(THA)and the hip joint prosthesis,THA has been the most effective and proven treatment for severe hip diseases currently,which including Osteonecrosis of the Femeral Head(ONFH),Osteoarthritis of Hip(OA),Developmental Dysplasia Of The Hip(DDH).Speaking of Rheumatoid Arthritis(RA)and Ankylosing Spondylitis(AS)which destroy the hip joint,the THA is also an effective treatment.Many diseases can destroy bilateral hip joint,such as ONFH,OA,RA and AS,etc,which can cause serious dysfunction of the bilateral hip joint,compromising quality of life.According to those patients,Bilateral Total Hip Arthroplasty(Bi-THA)is a kind of effective method,includings Simultaneous Bilateral Total Hip Arthroplasty(Sbi-THA)and Staged Bilateral Total Hip Arthroplasty.Obviously,the amount of perioperative blood loss during Sbi-THA much than unilatral THA,increasing the risk of allogeneic blood trasfusion and substantial economic burden.Allogeneic blood transfusion may result in potentially serious complications,such as immunologis reaction and virus infection.For this reason,a lot of interventions have been taken by many doctors and anesthetists to reduce the perioperative blood loss and postoperative transfusion rates,such as preoperative autologous donation,cell salvsge,tourniquet,controlled hypotension,regional anesthesia,the use of Erythropoietin(EPO),Autologous Blood Transfusion(ABT),and the use of antifibrinolytics.Compared with other antifibrinolytic drugs,Tranexamic Acid(TXA)is cheaper and safer.Many review and meta-analyses have upheld the safety and efficacy of TXA in unibilateral THA,but is rarely about Sbi-THA.This article aims to explore the clinical efficacy of Tranexamic acid in the reduction of perioperative during simultaneous bilateral total hip arthroplasty.Methods:We retrospectively investigated 82 patients who underwent Sbi-THA in Qilu hospital from May 2012 to June 2016,of who 42 patients were received TXA(observation group),40 patients were not receive TXA(control group).All patients inluding 34 females and 48 males,whose age is from 28 to 75 years old and the average age is 54.43±10.53 years olds,of which 59 patients were diagenosed to be ONFH and 23 patients were diagenosed to be OA of bilateral hip.The BMI is from 21.97 to 32.18kg/m2,and the average of BMI is 26.28±2.36kg/m2.The way of TXA and saline solution was intravenous drip in 10 min before cutting skin and the dosage is 15mg/kg.We recorded the preoperative Hb,HCT,HHS,Total blood loss and Hb,HCT,HHS of postoperative day1,day3 and day7.Besides,we recorded the result of preoperative and postoperative venous ultrasound of lower limbs,the postoperativetransfusion rates,the DVT rates and other complcations.we compared the clinical parameters of all results by SPSS 19.0.When P<0.05,the statistical significance was confirmed.Result:All patients were followed-up.The preoperative Hb?the preoperative HCT wasno significant difference were found between the two groups(p>0.05).In the observation group,the Hb and HCT of postoperative day 1 was 99.26 ± 11.81 g/L,32.68%±3.75%respectively,and the Hb,HCT of postoperative day 3 was 84.73 ±10.96g/L,28.72%±5.32%respectively,and the Hb,HCT of postoperative day 7 was 104.18±11.87g/L,32.07%±3.57%respectively.In the control group,the Hb and HCT of postoperative day 1 was 92.33±14.48g/L,28.38%±3.71%respectively,and the Hb,HCT of postoperative day 3 was 76.08 ± 11.60g/L,25.35%±3.51%respectively,and the Hb,HCT of postoperative day 7 was 105.76± 11.14g/L,30.93%±3.74%respectively.There was significant difference between the two groups in postoperative day 1 and day 3(p<0.05),but no significant difference between the two groups in postoperative day7(p>0.05).The total blood loss was 1546.08m1±258.54ml in observation group;but 1890.42ml±280.18ml in control group(p<0.05),There was significant difference between the two groups.In the control group,there were 21 patients receiving the blood transfusion and the postoperative transfusion rates was 52.50%.In the observation group,there were 10 patients receiving the blood transfusion and the postoperative transfusion rates was 23.81%.There was significant difference between the two groups(p<0.05).In the control group,5 DVT was found and the ratio of postoperative DVT was 11.90%.In the observation group,4DVT was found and the ratio of postoperative DVT was 10.00%.In the observation group,2 ACS was found and the ratio of postoperative ACS was 4.76%.In the observation group,1 dislocation was found and the ratio of postoperative dislocation was 2.38%.There was no significant difference between the two groups in DVT,ACS and dislocation(p>0.05).There was no pulmonary embolismin and wound infection both between two groups postoperatively.Conclusion:TXA(15mg/kg)intravenous infusion can significantly decrease the postoperative blood loss and ratio of blood transfusion during simultaneous bilateral total hip arthroplasty.Besides,TXA(15mg/kg)doesn't increase the rate of postoperative DVT.The clinical efficacy of TXA(15mg/kg)in the reduction of perioperative during simultaneous bilateral total hip arthroplasty was effective and safety.