Comparison of Local and Systemic Effects of Tranexamic Acid and Transcollation<sup>®</sup> in Total Knee Arthroplasty

Special Article - Knee Arthroplasty

Austin J Musculoskelet Disord. 2017; 4(1): 1040.

Comparison of Local and Systemic Effects of Tranexamic Acid and Transcollation® in Total Knee Arthroplasty

Boddu C1*, Nett MP2, Cushner FD3 and Scuderi GR4

¹Clinical Fellow, NSLIJ Adult Reconstruction/Knee, Lenox hill hospital, USA

²Orthopedic Service Line, Northshore Long Island Jewish Health System, USA

³Chief of Orthopedics-Southside Hospital, USA

4Orthopedic Service Line, Northshore Long Island Jewish Health System

*Corresponding author: Chandrakanth Boddu, Clinical Fellow, NSLIJ Adult Reconstruction/Knee, Lenox hill hospital, USA

Received: November 11, 2016; Accepted: February 02, 2017; Published: February 06, 2017

Abstract

Background: Use of tranexamic acid (TXA) is a pharmacological intervention to achieve hemostasis during total knee arthroplasty (TKA). Transcollation® using Aquamantys® (radiofrequency bipolar hemostatic sealing device) is a physiological hemostatic sealing method to achieve hemostasis during TKA. The local and systemic postoperative effects of these two interventions were never compared in the total knee arthroplasty literature.

Methods: This is a retrospective cohort study. Two groups of patients who underwent unilateral TKAs were identified: the TXA group and the Aquamantys® group. There were 96 patients in the TXA group and 95 patients in the Aquamantys® group. The proportion of cases in the TXA group and Aquamantys® group that developed each individual clinically significant local and systemic effect postoperatively was calculated and the odds ratio of such an outcome among these two groups was analyzed.

Results: There was a clinically meaningful trend towards decreased odds of developing superficial surgical site infection requiring antibiotic therapy in the TXA group compared to Aquamantys® group. We also found that on postoperative day 1, the odds of developing fever >101°F is low in TXA group compared to Aquamantys® group.

Conclusions: This study provides preliminary clinical evidence that is suggestive of beneficiary effect of TXA on wound healing after TKA, specifically, the prevention of superficial surgical site infection.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Keywords: Total Knee Arthroplasty; Tranexamic Acid; Transcollation®; Aquamantys®; Surgical Site Infection (SSI); Wound Healing

Introduction

In addition to meticulous surgical technique, at least one pharmacological and one physical intervention is available clinically to reduce perioperative blood loss in patients undergoing a total knee arthroplasty (TKA). The pharmacological intervention to decrease the blood loss during TKA is the use of tranexamic acid (TXA), a synthetic anti-fibrinolytic agent that reversibly blocks the lysine-binding sites of plasminogen and inhibits fibrinolysis [1]. The physical intervention to decrease the blood loss during TKA is the use of Transcollation® using Aquamantys®, a radiofrequency bipolar hemostatic sealing device that heats saline to just less than 100°C and causes coagulation and sealing of superficial tissues [2].

TXA is an effective method to reduce blood loss and transfusions in patients undergoing TKA [3,4]. The beneficial effect of Transcollation® using Aquamantys® or similar devices in reducing the perioperative blood loss has been well studied in orthopedic literature including spine surgery [5,6] and hip arthroplasty [7-10].

There are at least three reasons why this study was conducted. One, we did not come across any published literature on the effect of Transcollation® using Aquamantys® or similar devices in TKA.

Two, the local effects of either TXA or Aquamantys® in TKA was not studied, specifically, in terms of their effect on wound healing. Three, the systemic effects of using TXA and Aquamantys® in TKA were also not studied beyond their effect on blood loss.

Methods

This is a retrospective, therapeutic, cohort study. The time period during which the clinical data was collected is from Feb 2012 to Mar 2013. The study was conducted at two tertiary level care hospitals belonging to the same health care system where the senior author (FDC) had operating privileges. All the surgeries were performed by the senior author (FDC). All of the patients at one tertiary level care hospital received TXA during surgery during the study period were considered for inclusion in the ‘TXA group’. All of the patients at another tertiary level care hospital received Transcollation® using Aquamantys® during the surgery during the same study period were considered for inclusion in the ‘Aquamantys® group’.

We preliminarily identified a total of 97 patients who received TXA while performing TKA (Figure 1). Among these 97 patients, all except one patient had a follow up record for at least one year postoperatively. Excluding that one patient with a follow up for less than one year, the remaining 96 patients were included in the cohort ‘TXA group’.