AIM: To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). MATERIAL AND METHOD: We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. RESULTS: The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011). CONCLUSION: In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.

• MeSH
• antifibrinolytika * MeSH
• aplikace lokální MeSH
• intravenózní podání MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• totální endoprotéza kolene * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

PURPOSE OF THE STUDY This study aims to describe and analyze the age differences in the 24-hour movement behavior patterns among a sample of adults and older adults with end-stage knee osteoarthritis referred for total knee arthroplasty (TKA). MATERIAL AND METHODS A total of 86 patients referred for TKA were included in this study. Sleep duration, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed using multi-day 24-hour raw data from wrist-worn accelerometers. Compositional data analysis was used to analyze the differences between the age categories. RESULTS On average (SD), the adults were 59.0 (± 4.9) years; 63% female. The older adults were 72.4 (± 5.5) years; 58% female. The adults reached 23.9 milli-gravitational units (mg) as a mean acceleration over the whole day; 34% (8.1 h/day) of the time was classified as sleep, 48.9% (11.7 h/day) as SB, 12.1% (2.9 h/day) as LPA, and 5.1% (72.9 min/day) as MVPA. The older adults reached 21.3 mg; 35.2% (8.4 h/day) of the time was classified as sleep, 50.4% (12.1 h/day) as SB, 11.3% (2.7 h/day) as LPA, and 3.1% (44.9 min/day) as MVPA. Compared with the older adults, the proportion of time spent in total MVPA (P = 0.008) and MVPA bouts of ≥1 min were greater (P ≤ 0.028) in the adult group, while the proportion of time spent in total SB was lower (P = 0.045). No age difference was found for the proportion of time spent asleep. DISCUSSION Sleep, SB, and PA are exclusive and exhaustive parts of the overall 24-h day. Using accelerometer-based measures of 24-hour movement behavior to describe these behaviors more accurately is crucial for a better understanding of patients with end-stage KOA. CONCLUSIONS Our findings suggest that the adults and older adults referred for TKA are physically active despite suffering from severe knee osteoarthritis. Such a high level of physical activity may be difficult to increase by TKA postoperatively. If replicated by other studies, 24-hour movement behaviors should be implemented among the examinations required before TKA. Key words: knee osteoarthritis, accelerometer, sedentary behaviour, physical activity, sleep, 24-hour lifestyle behaviour.

• MeSH
• analýza dat MeSH
• cvičení MeSH
• lidé MeSH
• sedavý životní styl MeSH
• senioři MeSH
• spánek MeSH
• totální endoprotéza kolene * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIM: We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. METHODS: In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). RESULTS: Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). CONCLUSION: The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.

• MeSH
• antifibrinolytika aplikace a dávkování   MeSH
• aplikace lokální MeSH
• artróza kolenních kloubů chirurgie   MeSH
• fibrin-fibrinogen - produkty degradace metabolismus   MeSH
• hematokrit MeSH
• hemoglobiny metabolismus   MeSH
• intravenózní podání MeSH
• krvácení při operaci * MeSH
• kyselina tranexamová aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plazminogen metabolismus   MeSH
• pooperační krvácení epidemiologie   MeSH
• senioři MeSH
• totální endoprotéza kolene metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

• Publikační typ
• tisková chyba MeSH

PURPOSE OF THE STUDY To determine the optimal strategy for tranexamic acid (TXA) administration in diabetic patients, smokers and obese patients (BMI > 30 kg/m2) undergoing primary total knee arthroplasty (TKA). MATERIAL AND METHODS The total of 400 consecutive patients indicated for primary TKA were randomised into 4 basic groups with different TXA administration regimens. Group 1 (IV1) had a single intravenous dose (15 mg TXA/kg) applied prior to skin incision. Group 2 (IV2) got two intravenous doses (15 mg TXA/kg): one prior to skin incision and one subsequently 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 ml of saline irrigated topically at the end of the surgery. Group 4 (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Follow-up period was one year postoperatively. RESULTS In the group of diabetic patients (n = 87; 21.7%) the lowest TBL was observed in the order: IV1, IV2 > COMB > TOP. In the obese patients (BMI > 30 kg/m2; n = 242; 60.5%), TBL was significantly lower in the intravenous regimens (IV1: p = 0.002; IV2: p = 0.005, respectively) than in the TOP regimen. In the smoking patients (n = 30; 7.5%), TBLs were significantly lower in the order: IV1 > IV2 > COMB > TOP. DISCUSSION Individualised approach to prevention and therapy is a recent trend, also because comorbidities significantly affect the result of the intervention. In the case of diabetes, obesity and smoking, there is a proven link to early post-operative infections, mainly due to poorer innate immunity. It is conceivable, though, that the occurrence of infectious complications is also contributed to by larger hematomas or hemarthroses which are largely preventable. CONCLUSIONS In the diabetic and obese patients (BMI > 30 kg/m2), the combined topical/intravenous TXA application and two intravenous doses of TXA interventions were shown to be the most effective. However, no evidence of superiority of any of the TXA administration routes was obtained in the smokers. None of the TXA protocols was associated with a higher incidence of complications or early reoperation following TKA surgery. Key words: tranexamic acid, topical application, intravenous application, combined administration, diabetes, obesity, BMI, smoking, blood loss, hidden blood loss, total knee arthroplasty, complications.

• MeSH
• antifibrinolytika * MeSH
• aplikace lokální MeSH
• diabetes mellitus * farmakoterapie   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• obezita komplikace   MeSH
• totální endoprotéza kolene * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: The reliable preoperative identification of patients at a high risk of early reoperations (<2 years after primary surgery) after total knee arthroplasty (TKA) could lead to adjustments of the surgical procedure and counseling, thus lowering the percentage of revision surgeries. METHODS: The unselected cohort consisted of 1885 patients (695 men and 1190 women) who underwent TKA implantation between September 2010 and April 2017 at a single tertiary orthopedic center. Multivariate patient similarity networks were applied to identify patient groups at a high risk of early reoperations based on 25 preoperative parameters. RESULTS: Early reoperations (109 cases, 5.8%) were less frequent in women (4.4%; median time to reoperation, 2.0 months) than in men (8.2%; 7.5 months), reaching the highest incidence in younger men (10.9%; <66 years). Of the tested preoperative parameters, the risk of reoperation in men was more likely associated with smoking or obesity (body mass index [BMI] > 30). In women, low physical activity and high BMI were the most likely risk factors for early reoperations. Other factors did not affect the risk of early reoperations, including the primary diagnosis, comorbidities, and surgeon-implanting TKA. CONCLUSION: This study demonstrates the effect of smoking, physical activity, and BMI on the risk of early reoperation after TKA, with the different contribution in men/women. Identification of patient subgroups with a higher risk of early revision after TKA is needed for clinical implementation of precision medicine in orthopedics.

• MeSH
• cvičení MeSH
• index tělesné hmotnosti MeSH
• kouření škodlivé účinky   epidemiologie   MeSH
• lidé MeSH
• pohlavní dimorfismus MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• totální endoprotéza kolene * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antikoagulancia aplikace a dávkování   klasifikace   MeSH
• artroplastiky kloubů * klasifikace   škodlivé účinky   MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   MeSH
• ortopedické výkony klasifikace   škodlivé účinky   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• totální endoprotéza kolene škodlivé účinky   MeSH
• tromboembolie * epidemiologie   etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY Information that would help physicians make decisions and improve the likelihood of achieving the desired results of medical interventions is sought as part of the concept of the individualized approach to patients. The primary purpose of our study was to identify which features determine the higher/lower likelihood of the need for early reoperation after a TKA (total knee arthroplasty). The successful preoperative identification of high risk patients could lead to the adjustment of the surgical procedure and thus lower the percentage of revision surgeries. MATERIAL AND METHODS In total, 826 patients (296 men and 530 women) were included in our prospective study; these patients underwent TKA implantation at our department between September 2010 and March 2015. The average age of the patients at the time of primary TKA implantation was 68.9 years. Over 60 preoperative and perioperative parameters were tracked and continuously recorded in our arthroplasty register. First, conventional analysis of individual parameters was carried out and odd ratios for their relationship with revision surgeries were set. Subsequently, the data were transformed into a graph and methods of complex network analysis were applied to identify such combinations of features (parameters) that would significantly separate the operated patients into homogeneous subgroups. The observed patient subgroups were then reanalyzed for parameters related to reoperations. RESULTS Thirty-three patients (4% of those studied) required early TKA revision (within 3 years of primary implantation). The most frequent reason for revision surgery was an early postoperative infection. The analysis of observed characteristics proved that the likelihood of revision surgery was by 80% lower in women in comparison with men. Other parameters associated with a higher frequency of reoperations were the level of preoperative activity, smoking and the waiting time for the first operation. Patients waiting for primary TKA implantation for more than 3 months showed a 2.7 times greater likelihood of revision surgery when compared to those who were operated within 3 months after the indication to surgery. Patients declaring medium or high activity levels (assessed by means of the UCLA scale) had a 2.1 times higher likelihood of revision surgery in comparison to patients with low physical activity levels. Smoking meant up to 3.2 times greater likelihood of revision in comparison with non-smokers. Conversely, no correlation between a greater risk of reoperation and age, BMI (body mass index) or the level of comorbidities evaluated by means of the Charlson scale was confirmed. No correlation between the risk of revision and primary diagnosis was found either. DISCUSSION The frequency of early TKA revision surgeries (within 3 years after the primary surgery) in the evaluated sample is relatively high (4%). On the contrary, the reasons for early revisions correspond with recent publications. The risks of TKA infection overlap with the predictors of wound healing disorders to a great extent. Smoking, obesity and comorbidities decreasing the efficiency of the immune system are mentioned most frequently. Patients waiting for TKA implantation longer were more inclined to require early revision surgery too. Awareness of this fact is reflected in the tendency to shorten the waiting time for TKA surgery. A number of studies have pointed out the negative influence of longer waiting times on postoperative results. In our study, it was men who required revision most frequently, specifically the group of those having smoking and higher physical activity in their case histories. The influence of smoking on early postoperative morbidity is also well known. A significant finding is that stopping smoking can decrease the probability of early reoperation. However, we failed to explain the influence of higher physical activity. The influence of patients ́ age, BMI, level of comorbidities or primary diagnosis on the frequency of revision surgeries were not demonstrated. CONCLUSIONS We proved that women definitely show a lower risk of early TKA revision surgeries in comparison with men. A higher frequency of reoperations was related to modifiable factors such as smoking, longer waiting times for the primary operation, and a higher preoperative level of physical activity. A significant finding is that stopping smoking could decrease the probability of early TKA revision. Nonetheless, we do not recommend decreasing preoperative physical activity at this point; it will require further studies and verification of this finding. Also, the potential mechanism of the influence of greater preoperative load on the particular reason for revision is yet to be explained.

PURPOSE OF THE STUDY Our study compared early outcomes of total knee arthroplasty performed in conventional and enhanced perioperative care regimes, i.e. without the use of Redon drain, with intensified perioperative analgesia and more frequent and intensive rehabilitation regime in the latter. MATERIAL AND METHODS The prospective study included 194 patients (76 men and 118 women) implanted with primary knee endoprosthesis. The mean age was 68.8 (44.7 - 88.0 years). The patients were divided into two groups - the "enhanced" and "conventional" procedures. In the first group, Redon suction drain was not inserted at the end of the surgery, and the patients commenced passive knee mobility exercise of the operated knee immediately after being brought back from the operating theatre. The general anaesthesia was supplemented by a combined femoral nerve block and wound infiltration with local anaesthetics. The second group comprised the patients who underwent conventional surgery, i.e. with the use of drain, without femoral nerve block, with no wound infiltration with local anaesthetics, and without immediate post-operative mobilization of the joint. The evaluation was carried out using regular clinical tools (subjective evaluation, objective examination, questionnaire and Knee Society Score (KSS)). Standard statistical methods were applied to data processing. RESULTS The patients under the "conventional regime" showed a significantly sharper drop in haemoglobin and haematocrit levels, higher consumption of blood transfusion and analgesics during the first three days after the surgery. The patients under the "enhanced regime" showed a better range of joint motion at hospital discharge, flexion in particular (p = 0.001). During the hospital stay no frequent swelling, secretion or wound reddening was reported in any of the monitored groups. In the "conventional" group, however, haematomas were more frequently present. The postoperative checks did not reveal any differences in satisfaction of the patients with the surgery. At the first follow-up examination at the outpatient department the "conventional" group patients more often reported knee pain and a feeling of a swollen knee. Nonetheless, their statements did not correspond with the VAS score. In the period between the 6th and 12th months following the surgery, the differences in the range of motion disappeared. The KSS showed a noticeable improvement in both the groups as against the preoperative values. In the "enhanced" group patients, the score increased dramatically at the beginning, whereas in the "conventional" group, the score was growing slowly and gradually until the last follow-up check after the surgery. The "conventional" group patients more frequently reported infectious complications (surface and deep wound infections: 4 vs. 2 patients) requiring a revision surgery (p = 0.024). DISCUSSION Recently, attention has been drawn to the rapid recovery approach, which eliminated postoperative immobilization and enabled the patient to start exercising already on the day of the surgery, with some patients even walking independently. The individual enhanced recovery regimes differ in details but mostly result in achieving the aim much sooner when compared to the conventional approaches. The patients under the enhanced recovery regimes can accomplish better functional outcomes in the first few months after the surgery than the patients undergoing the surgery under the conventional regime. The routine use of Redon drains in TKA is obviously unnecessary; it tends to be associated with a higher blood loss and a higher risk of prosthetic joint infection. CONCLUSIONS The TKA implant without suction drains combined with intensified perioperative analgesia and intensive postoperative rehabilitation is a safe way to earlier recovery of the function of the operated knee, or, by extension, the lower limb. The described approach is not associated with a higher risk of perioperative complications (bleeding, healing disorders or early infections). Patients also benefit from lower blood losses. Based on the results of our study, we recommend performing the TKA surgeries routinely without drains, with perioperative analgesia and immediate postoperative joint mobilization. Key words: total knee arthroplasty; perioperative care; rapid recovery; drainage; active movement; postoperative outcomes; pain; infection.

• MeSH
• anestetika lokální aplikace a dávkování   MeSH
• celková anestezie metody   MeSH
• dospělí MeSH
• kolenní kloub patofyziologie   MeSH
• krevní transfuze MeSH
• lidé středního věku MeSH
• lidé MeSH
• management bolesti metody   MeSH
• nervová blokáda metody   MeSH
• nervus femoralis MeSH
• odsávání škodlivé účinky   metody   MeSH
• pooperační péče metody   MeSH
• prospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• strečink metody   MeSH
• totální endoprotéza kolene metody   rehabilitace   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH