Abstract

INTRODUCTION Total knee replacement (TKR) is associated with significant blood loss in intra- and postoperative periods. This trial was designed to determine the efficacy of tranexamic acid (TXA) in the reduction of perioperative blood loss and the need for blood transfusion in patients undergoing primary TKR. MATERIALS AND METHODS This study was performed at a tertiary care institute with 30 cases of primary unilateral TKR. The patients were randomly divided into two groups comprising 15 patients each. Group A comprised patients who received TXA by intravenous route and locally. Group B served as control, which comprised patients who had not received TXA. Patients were assessed in terms of intraoperative and postoperative blood loss, reduction in haemoglobin, the requirement of blood transfusion, and any untoward effects of TXA at 24 and 72 hours after surgery. RESULTS In group A, the mean number of swabs used intraoperatively was 2.3 ± 0.5 swabs while in group B, the mean number was 4.3 ± 0.7 swabs (p = 0.0000). The mean drop in the postoperative haemoglobin concentration in group A was 0.6 gm/dl (24 hours) and 1.3 gm/dl (72 hours), with a mean postoperative drain collection of 247.3 ± 50.6 ml (24 hours) and 316.7 ± 55.6 ml (72 hours). In comparison, the mean drop in the postoperative haemoglobin in group B was 1.5 gm/dl (24 hours) and 2.3 gm/dl (72 hours), with a mean drain collection of 474 ± 30.7 ml (24 hours) and 453.3 ± 37.7 ml (72 hours) (p < 0.001). In group A, significantly fewer patients (four) required blood transfusion while 13 patients required blood transfusion in group B (p = 0.0004). CONCLUSION The data from this study conclude that the use of TXA in TKR significantly reduces perioperative blood loss and the need for postoperative blood transfusion without significantly altering the liver and renal functions and coagulation profile of patients.

Abstract

AIMS AND OBJECTIVES To measure the additional effect of platelet-rich plasma (PRP) on functional outcome of anterior cruciate ligament tear managed by augmenting anterior cruciate ligament (ACL) reconstruction with PRP. METHODS The present study was conducted on patients with ACL tear admitted in the department of orthopaedics, King George's Medical University, Lucknow wherein a total of 70 subjects were assigned into two groups of 35 patients each randomly, viz Group 1 in which the patients were treated by quadruple hamstring graft alone and Group 2 in which the patients were treated with augmented hamstring graft with PRP. The standardized anterior drawer test, Lachman's test, Lysholm knee score were quantified both preoperatively and postoperatively at different follow-ups and also tibial tunnel widening was measured postoperatively at different follow-ups. RESULT The present study had 70 patients with ACL tears. The mean age of patients in non-PRP groups was 29.71 ±2.99 years while that in the PRP group was 28.34±4.32 years. On comparing the improvement in grades at pre-op, immediate postop, 6 weeks, and 3 months follow-ups, there was no statistically significant difference between the two groups. The tibial tunnel widening also showed no significant difference between the two groups. CONCLUSION In our study, it was found that both the groups showed improvements in grades of anterior drawer test and Lachman's test postoperatively but the difference between both the groups was not significant. Similarly, while comparing the improvements in Lysholm knee score and tibial tunnel widening among both the groups, the difference was not significant. Follow up of 3 months was a limiting factor in our study. This technique needs further clinical evaluation to assess the long-term results.

Abstract

A total of 100 patients with stage III or IV head or neck cancer, a performance status of 0-1, and anemia with hemoglobin (Hb) < 10 g/dL at baseline who where to receive chemotherapy concomitantly or sequentially with radiotherapy were randomized to receive either epoetin beta 10,000 IU thrice weekly (TW) (n = 52) and oral iron starting 10-15 days before the start of treatment or epoetin beta 30,000 IU once weekly (OW) (n = 48) and oral iron before the start of treatment. The mean Hb in patients on the thrice weekly (11. 96 g/dL) and once weekly (12. 50 g/dL) dosing schedules increased significantly (p < 0. 01) at the end of the treatment in comparison to respective baseline values of 9. 38 g/dL and 9. 41 g/dL; levels were 1. 2-fold higher, which was significant (p < 0. 01), for patients on the once weekly schedule. That said, there was significant improvement (p < 0. 01) in mean linear analog scale assessment (LASA) scores for energy level (EL), ability to perform daily activities (AL), and overall quality of life (QOL) for patients on both dosing schedules but these improvements did not differ significantly between schedules (p > 0. 05). The 2-year overall survival for patients on both dosing schedules did not differ significantly (p > 0. 05). Epoetin beta therapy was found to be equally beneficial and well tolerated for patients on both thrice weekly and once weekly dosing schedules.