Correlation Analysis Between Urethane Treatment And Total Knee Arthroplasty: Randomized Controlled Trials And Systematic Evaluation

Objective1.To assess the efficacy and safety of different time of tranexamic acid(TXA)and different dosage of TXA on reducing blood loss in primary unilateral total knee arthroplasty(TKA).2.To assess the effectiveness and safety of using TXA in TKA.Methods1.From December 2014 to June 2016,236 patients with osteoarthritis,who received primary unilateral TKA,were included in the study.The patients were randomly divided into five groups.Group A has 48 cases,blank control group;Group B has 48 cases,who received intravenous TXA(10 mg/kg)before tourniquet inflation;Group C has 48 cases,who received intravenous TXA(20 mg/kg)before tourniquet inflation;Group D has 46 cases,who received intravenous TXA(10 mg/kg)before tourniquet deflation;Group E has 46 cases,who received intravenous TXA(20 mg/kg)before tourniquet deflation.Data on total blood loss,intraoperative blood loss,drainage volume,post-operative blood loss,and hiddern blood loss,the incidence of blood transfusion and of thrombotic events were analysised with SPSS 19.0.p<0.05 was considered significant.2.Relevant literatures were systemically retrieved using PubMed,Web of Knowledge,and Cochrane Central Register of Controlled Trials(CENTRAL).Eligible randomized controlled studies investigate the safe and effective role of using TXA in reducing transfusion rate and blood loss in TKA were included in this Meta analysis.Main effect sizes are total blood lose,drainage volume,hidden blood lose,rate of blood transfusion,volume of blood transfusion,rate of deep venous thrombosis and pulmonary embolism.The software,RevMan 5.3 was used to analyze collected data.Results1.The total blood loss,post-operative overt blood loss,post-operative drainage,hiddern blood loss and morbility of blood transfusion were reduced when i.v TXA was applied compared with blank control group(P<0.05).TXA(20mg/kg)was more effective in reduction the total blood loss,post-operative overt blood loss,post-operative drainage,hiddern blood loss and morbility of blood transfusion than 10mg/kg group in the same time of drug administration(P<0.05).When the dosage of TXA was constant,TXAadministed before the inflation of touniqute was more effective than before the deflation of the touniqute in reduction of the the total blood loss,post-operative overt blood loss,post-operative drainage,hiddern blood loss(P<0.05).However,the incidence of blood transfusion was not different to each other.Furthermore,the incidence of thrombosis was no different to the blank control group(P>0.05).2.Nineteen studies with a number of 1952 individuals(1019 in TXA group and 933 in control group)were suitable for this meta-analysis.Intravenous TXA significantly reduced the total blood loss(MD-345.00,95%CI:-451.18,-238.82,P ? 0.00001),preoperative blood lose(MD-62.56,95%CI:-107.32,-17.79,P=0.006),drainage volume(MD-313.44,95%CI:-387.84,-239.05,P ? 0.00001),hidden blood lose(MD-192.78,95%CI:-207.23,-178.34,P?0.00001)when compared with the control group.TXA was associated with a 50% risk reduction in transfusion rate(RR 0.50,95%CI: 0.42,0.61,P?0.00001).Constantly,TXA did not appear to contribute to differences in incidence of deep venous thrombosis,pulmonary embolism.ConclusionIn the primary unilateral TKA,intravenous applications of TXA can effecitively reduce peri-operative blood loss and transfusion.TXA(20mg/kg)is more effective in reducing the blood loss and transfusion incidence.Early infusion of TXA is more effective in reducing blood loss.