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Intraarticular epsilon aminocaproic acid versus tranexamic acid in total knee arthroplasty
Guerreiro JPF, Balbino JRM, Rodrigues BP, Danieli MV, Queiroz AO, Cataneo DC
Acta ortopedica brasileira. 2021;29(6):312-315
Abstract
OBJECTIVE To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). METHODS This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. RESULTS In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. CONCLUSIONS The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.
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Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial
Danieli MV, Guerreiro JPF, Queiroz AO, da Rosa Pereira H, Cataneo DC
International orthopaedics. 2020
Abstract
PURPOSE Evaluate the effects of intra-operative leucocyte-poor-platelet-rich plasma (PRP) (type P3-Bβ with endogenous activation) injection in International Cartilage Repair Society (ICRS) grade III knee chondral injuries treated by chondroplasties, to increase and ameliorate the repair tissue. METHODS Patients were divided into two groups. Group A (control) consisted of 31 patients and Group B (PRP) 33 patients, totaling 64 patients analyzed. Patients also could had associated injuries (meniscal and/or ACL) being equally divided between both groups to avoid bias. PRP was injected at the end of surgery in group B. The patient outcomes were assessed using subjective International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity forms, prior to the surgery and three, six, 12, and 24 months after surgery (medium-term follow up). RESULTS IKDC and KOOS scores showed increase at each evaluation time points after surgery in both groups, but the treated Group (B) showed a higher increase with statistically significant difference. The Tegner activity scores were higher for the treated group only at six and 12 months. CONCLUSION Based on the subjective IKDC, KOOS, and Tegner scores, those patients affected by ICRS grade III chondral injuries undergoing arthroscopic chondroplasty who were also treated with PRP showed better and faster outcomes than the control group. Independently from the associated injury (meniscal or ACL). This difference could be measured for up to two years.
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Clinical usefulness of prethymectomy plasmapheresis in patients with myasthenia gravis: a systematic review and meta-analysis
Reis TA, Cataneo DC, Cataneo AJM
Interactive cardiovascular and thoracic surgery. 2019
Abstract
OBJECTIVES Our goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis. METHODS MEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis. RESULTS The total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08-1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11-4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07-1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93-43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02-0.65; I2 = 63%). CONCLUSIONS Plasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.
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Platelet-rich plasma (prp) and tranexamic acid (txa) applied in total knee arthroplasty
Guerreiro JPF, Lima DR, Bordignon G, Danieli MV, Queiroz AO, Cataneo DC
Acta ortopedica brasileira. 2019;27(5):248-251
Abstract
Objective: To evaluate the efficacy of platelet-rich plasma (PRP) and tranexamic acid (TXA) applied in total knee arthroplasty. Methods: We selected and randomized 84 patients. TXA was applied in 23 patients, PRP in 20, and PRP in combination with TXA in 20. Hemoglobin was measured preoperatively and 24 and 48 hours postoperatively. The function questionnaire, pain scale and gain of knee flexion were monitored until the second postoperative year. Results: There was a difference (p <0.01) in the decrease in hemoglobin 48 hours after surgery between the TXA group and the control and PRP groups. In terms of pain, the TXA group at 24 and 48 hours after surgery and the PRP group at 48 hours after surgery showed advantages (p <0.01). Knee flexion gain in the first 24 hours postoperatively was better in the TXA group (p <0.05). Conclusion: TXA was effective in lowering the drop in hemoglobin level, reducing pain and improving movement gain 48 hours after the procedure. PRP was not effective in reducing bleeding or improving knee function after arthroplasty, but provided better control of postoperative pain. Level of Evidence I, Randomized, blinded, prospective clinical trial.
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Application of tranexamic acid in total knee arthroplasty - prospective randomized trial
Guerreiro JPF, Badaro BS, Balbino JRM, Danieli MV, Queiroz AO, Cataneo DC
The Open Orthopaedics Journal. 2017;11:1049-1057.
Abstract
BACKGROUND The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. Bleeding may cause local complications consequently greater pain and reduced function postoperatively. No study has related the use of TXA to these facts. OBJECTIVE The aim was to evaluate the effects of TXA haemoglobin, Western Ontario and McMaster Universities Index (WOMAC), pain intensity and flexion gain after TKA. METHODS 43 patients were randomized and then underwent TKA. TXA was applied to 22 of these patients before closure of the joint capsule. Haemoglobin measurements (mg/dL) were taken preoperatively and 24 and 48 hours after surgery. The WOMAC questionnaire and pain visual analogue scale (VAS) were applied, and flexion gain was measured up to the second postoperative month. Statistical analysis compared the results to determine whether there were differences between the groups for each of the evaluated times. RESULTS There were differences in favour of the drug 48 hours postoperatively for the haemoglobin variable (p = 0.01), in pain evaluation, 24 and 48 hours, postoperatively (p < 0.01) and in flexion gain, 24 hours after surgery (p = 0.03). There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively, in pain assessment 7 days, 21 days and 2 months, postoperatively, in flexion gain 48 hours, 7 days, 21 days and 2 months, postoperatively and in WOMAC after 2 months. CONCLUSION In addition to reducing bleeding, topical TXA improved pain and increased flexion gain in the first hours after TKA. TRIAL REGISTRATION RBR-9b4qgq.