Orthopaedic Articles - Articles for Orthopaedic Practice

Orthopaedic articles on current trends, tips & tricks and best evidence from top orthopaedic specialists.

Blood Management in the Orthopaedic Trauma Patient

Wade Gofton


Blood Management in the Orthopaedic Trauma Patient

Wade Gofton, M.D., FRCSC
Steve Papp, M.D., FRCSC
Ottawa, ON

Trauma is the leading cause of life lost years in North America, and uncontrolled hemorrhage is the leading cause of potentially preventable death. The timing and means of intervention is important, because hemorrhagic death typically occurs very early, usually within the first six hours of admission1. Trauma patients presenting with shock and coagulopathy on admission receive massive transfusions and suffer increased mortality: ranging from 40-70% at leading trauma centres2,3. With increasing experience in both civilian and military trauma, there has been a re-evalaution of transfusion practices and blood conservation techniques have been introduced in the acutely traumatized patients.



Intravenous Tranexamic Acid Use in Elective Total Joint Arthroplasty

James L. Howard


Intravenous Tranexamic Acid Use in Elective Total Joint Arthroplasty

James L. Howard M.D., MSc, FRCSC
Douglas D. Naudie, M.D., FRCSC
London, ON

Patients undergoing major orthopaedic surgery procedures have increased risk of perioperative bleeding leading to transfusion1. In the past, a number of protocols and techniques have been employed to minimize this risk. This has included the use of controlled intraoperative hypotension, hemodilution, blood salvage systems as well as autologous blood donation2-5. Recently, there has been increased interest in the use of antifibrinolytics, such as tranexamic acid, that minimize bleeding through the inhibition of clot degradation. The purpose of the current article is to review intravenous tranexamic use in total joint arthroplasty.



Topical and Intra-articular Tranexamic Acid in Total Knee Arthroplasty

Rajiv Gandhi


Topical and Intra-articular Tranexamic Acid in Total Knee Arthroplasty

Prasad Antapur, MRCS, FRCS(Tr & Orth)
Clinical Arthroplasty Fellow,
Southampton University Hospitals NHS Trust,
Southampton, United Kingdom

Rajiv Gandhi, M.D., MSc, FRCSC
Assistant Professor, Department of Orthopaedics,
Toronto Western Hospital,
Toronto, ON

Nizar N. Mahomed, M.D., ScD, FRCSC
Smith & Nephew Chair in Orthopaedic Surgery, Professor of Surgery,
University of Toronto, Department of Orthopaedics,
Toronto Western Hospital,
Toronto,ON

Total knee arthroplasty (TKA) is associated with postoperative blood loss requiring blood transfusion in up to a third of patients1-2. The reported blood loss ranges from 1450 to 1790 ml leading to anaemia in many patients3-4. Postoperative anaemia in the elderly patient group has increased significance due to the reduced haematopoietic reserve. Adverse effects of anaemia include need for transfusion, longer hospital stay and associated increased costs. With changing demographics worldwide, the demand for TKA is expected to increase exponentially5. Topical application of tranexamic acid (TXA) provides a novel approach for decreasing blood loss after TKA. It is cost-effective compared to preoperative erythropoietin and autologous blood donation6-7.











Role of Autologous Blood Donation

Peter Lewkonia


Role of Autologous Blood Donation

Peter Lewkonia, M.D., FRCSC
Vancouver, BC

Zhi Wang, M.D., FRCSC
Saint-Jerôme, QC

Several techniques have been developed to limit the use of allogeneic blood by perioperative re-infusion of the patient's own red cells. These technologies include cell salvage, acute normovolemic dilution, and preoperative autologous blood donation (PABD)1,2. The popularity of all three techniques grew in the 1980s as public fear over HIV and hepatitis B/C transmission rose3. In PABD, patients donate one or more units of blood within 40-45 days of the planned procedure on a pre-determined schedule. This blood is then processed and retained specifically for that patient at the time of surgery4. The use of PABD has decreased over the last decade in North America because of concerns regarding safety, cost-effectiveness, wastage, and overall patient benefit3.



Erythropoiesis-stimulating Agents

Thomas Turgeon


Erythropoiesis-stimulating Agents

Thomas Turgeon, M.D., MPH, FRCSC
Winnipeg, MB

Blood loss and the potential need for allogeneic transfusion continue to be a significant challenge for orthopaedic patients. Allogeneic blood transfusion continues to carry associated risks. The use of preoperative autologous donation (PAD) in cases at higher risk of blood loss, generally leads to increased anaemia at the time of surgery1. PAD is associated with increased need for transfusion (both PAD and allogeneic), adverse transfusion reactions and wastage of unused units2-6. Erythropoiesis-stimulating agents, developed for anaemia due to a variety of conditions, have been used extensively to assist in the management of patients undergoing elective orthopaedic surgery with preoperative anaemia.


Articles on basic science topics from members of the Orthogate Community.

Articles on bone metabolism and osteoporosis topics from members of the Orthogate Community.

Articles about career planning for orthopaedic surgery residents and orthopaedic surgeons.

Articles about education.
Articles on foot and ankle topics from members of the Orthogate Community.
Articles on hand and wrist topics from members of the Orthogate Community.
Articles on hip and knee topics from members of the Orthogate Community.
Articles about medical informatics.
Articles about orthopedic informatics.
Articles on pediatric orthopaedic topics from members of the Orthogate Community.
Articles on shoulder and elbow topics from members of the Orthogate Community.
Articles on spine topics from members of the Orthogate Community.
Articles on sports medicine topics from members of the Orthogate Community.
Articles on trauma topics from members of the Orthogate Community.
Articles on musculoskeletal tumor topics from members of the Orthogate Community.

Submit Community Content

If you have orthopedic information that you would like to share with the Orthogate Community, please register/login and submit your news, event, job, article, case or workshop from the Submit Content menu under the My Account area. Learn more!