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The Value of Tranexamic Acid in Reducing Blood Loss following Hip Reconstruction in Children with Cerebral Palsy.

Majid I, Alshryda S, Somanchi B, Morakis E, Foster A - J Blood Transfus (2015)

Bottom Line: This did not reach a statistical significance (P = 0.75, 0.5, and 0.71, resp.).The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels.Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated.

View Article: PubMed Central - PubMed

Affiliation: Royal Manchester Children Hospital, Central Manchester University Hospitals, Oxford Road, Manchester M13 9WL, UK.

ABSTRACT
This is a retrospective study of 51 consecutive hip reconstructions in children with cerebral palsy performed between 2011 and 2013. Tranexamic acid (TXA) was used in 14 hip reconstructions only. Transfusion rate was higher, postoperative Hb was lower, and patients stayed longer in the TXA group. This did not reach a statistical significance (P = 0.75, 0.5, and 0.71, resp.). More than half of the patients who had TXA underwent bilateral hip reconstructions in comparison with 27% only in the non-TXA group. Bilateral hip reconstructions mean more surgery, more blood loss, and more blood transfusion. The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels. Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated. Ideally this should be explored further in an adequately powered, randomised controlled trial where risk of bias is minimized.

No MeSH data available.


Related in: MedlinePlus

Preoperative and postoperative X-rays of a dislocated hip in a child with cerebral palsy. The left X-ray showed a dislocated left hip in a child with CP. The acetabulum has become shallow and is not covering the femoral head any more. There is a valgus deformity of the proximal femur. The postoperative pictures showed that the hip is reduced, the proximal femoral deformity is corrected (varus derotation corrective osteotomy), and the acetabulum is corrected by pelvic Dega osteotomy.
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fig1: Preoperative and postoperative X-rays of a dislocated hip in a child with cerebral palsy. The left X-ray showed a dislocated left hip in a child with CP. The acetabulum has become shallow and is not covering the femoral head any more. There is a valgus deformity of the proximal femur. The postoperative pictures showed that the hip is reduced, the proximal femoral deformity is corrected (varus derotation corrective osteotomy), and the acetabulum is corrected by pelvic Dega osteotomy.

Mentions: The initial treatment usually involves a combination of interventions such as medicines, braces, and adaptive and assistive equipment; however, surgery is sometimes warranted to control symptoms and maintain an optimum level of function and appearance. Hip joint dislocation is a common problem in children with CP that can cause significant pain and interference with personal care and hygiene. Surgical hip reconstruction reduces the hip joint through soft tissue releases and bony cuts of the femur and/or pelvis (Figure 1). Blood loss and subsequent blood transfusion are a normal consequence of hip reconstruction [3, 4].


The Value of Tranexamic Acid in Reducing Blood Loss following Hip Reconstruction in Children with Cerebral Palsy.

Majid I, Alshryda S, Somanchi B, Morakis E, Foster A - J Blood Transfus (2015)

Preoperative and postoperative X-rays of a dislocated hip in a child with cerebral palsy. The left X-ray showed a dislocated left hip in a child with CP. The acetabulum has become shallow and is not covering the femoral head any more. There is a valgus deformity of the proximal femur. The postoperative pictures showed that the hip is reduced, the proximal femoral deformity is corrected (varus derotation corrective osteotomy), and the acetabulum is corrected by pelvic Dega osteotomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4664818&req=5

fig1: Preoperative and postoperative X-rays of a dislocated hip in a child with cerebral palsy. The left X-ray showed a dislocated left hip in a child with CP. The acetabulum has become shallow and is not covering the femoral head any more. There is a valgus deformity of the proximal femur. The postoperative pictures showed that the hip is reduced, the proximal femoral deformity is corrected (varus derotation corrective osteotomy), and the acetabulum is corrected by pelvic Dega osteotomy.
Mentions: The initial treatment usually involves a combination of interventions such as medicines, braces, and adaptive and assistive equipment; however, surgery is sometimes warranted to control symptoms and maintain an optimum level of function and appearance. Hip joint dislocation is a common problem in children with CP that can cause significant pain and interference with personal care and hygiene. Surgical hip reconstruction reduces the hip joint through soft tissue releases and bony cuts of the femur and/or pelvis (Figure 1). Blood loss and subsequent blood transfusion are a normal consequence of hip reconstruction [3, 4].

Bottom Line: This did not reach a statistical significance (P = 0.75, 0.5, and 0.71, resp.).The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels.Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated.

View Article: PubMed Central - PubMed

Affiliation: Royal Manchester Children Hospital, Central Manchester University Hospitals, Oxford Road, Manchester M13 9WL, UK.

ABSTRACT
This is a retrospective study of 51 consecutive hip reconstructions in children with cerebral palsy performed between 2011 and 2013. Tranexamic acid (TXA) was used in 14 hip reconstructions only. Transfusion rate was higher, postoperative Hb was lower, and patients stayed longer in the TXA group. This did not reach a statistical significance (P = 0.75, 0.5, and 0.71, resp.). More than half of the patients who had TXA underwent bilateral hip reconstructions in comparison with 27% only in the non-TXA group. Bilateral hip reconstructions mean more surgery, more blood loss, and more blood transfusion. The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels. Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated. Ideally this should be explored further in an adequately powered, randomised controlled trial where risk of bias is minimized.

No MeSH data available.


Related in: MedlinePlus