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This comprehensive review was conducted to assess the effects of tranexamic acid (TXA) on blood loss, venous thromboembolism (VTE) risk, and wound complications following total hip arthroplasty (THA). Additionally, it sought to evaluate the effects of various TXA dosages, modes of administration, and combinations with other antifibrinolytic drug. In search of systematic reviews and meta-analyses on the use of TXA in THA patients, we searched extensively through databases including Scopus, the Cochrane Library, Embase, Medline, the Web of Science, PubMed, and Google Scholar. We discovered 23 meta-analyses covering 32,442 patients overall that fulfilled our study criteria, spanning the period from the creation of these databases until May 2023. This comprehensive review's meta-analyses, which together examined over 35,000 patients, repeatedly demonstrated how TXA administration during THA successfully lowers perioperative blood loss and the need for transfusions. TXA reduced total blood loss by an average of 151–370 ml, postoperative hemoglobin levels by 0.5–1.1 g/dL, and transfusion rates by 19–26% on average when compared to control groups. The information gathered did not indicate that using TXA significantly increased the risk of VTE or wound complications. When comparing different TXA doses, administration techniques, or its use in conjunction with other anti-fibrinolytic therapies, no discernible differences were found in terms of efficacy or safety outcomes. The comprehensive review clearly indicates that TXA improves THA outcomes without increasing the risk of adverse events by lowering blood loss and the requirement for transfusions. This insightful information can help surgeons decide whether to use TXA during THA procedures. [ABSTRACT FROM AUTHOR]

There is a growing trend towards using femoral stems with a medial calcar collar during total hip arthroplasty (THA). Systematically review the literature comparing a femoral collared stem and femoral collarless stem on subsidence, patient-reported outcomes (PROs), and revision rate. Systematic Review, Level of Evidence 1. A literature search of Pubmed and Medline was according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that evaluated collared and collarless stems, subsidence and PROs for adult patients undergoing total hip arthroplasty (THA) were included. Additional data collection included patient demographics, stem-calcar contact, canal-fill ratio (CFR), stem orientation, surgical approach, Dorr Type, complications, and revisions. Five studies met inclusion criteria. 674 patients (704 hips) were included. Mean patient ages ranged 58.5–72.4 years old, and mean BMI ranged 26.6–29.8 kg/m2. Mean reported follow-up of the included clinical trials ranged 1–9.6 years. Two studies reported mean early subsidence at two weeks postoperatively, which was 0.36, 0.99 mm for collared stems and 0.52, 3.22 mm for collarless stems, proving to be statistically significant (P = 0.023), (P = 0.05). All studies demonstrated improved PROs at most recent follow-up. Revision rates ranged from 4 to 11.3 %, but these were not statistically significant. Implantation of collared stems compared to collarless may reduce early post-operative subsidence, while no substantial effect on aseptic loosening, thigh pain, proximal femoral fracture, and revision is seen. When measuring patient-reported outcomes, the collared femoral stem was not superior to the collarless femoral stem as both resulted in similar improvement preoperatively to postoperative state. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic femur fracture (PFF) is an important complication to consider in total hip arthroplasty (THA). The purpose of this systematic review was to compare outcomes of conventional metallic versus modern non-metallic cerclage systems for PFFs and proximal femoral osteotomy. Methods: The PubMed, MEDLINE, and Google Scholar databases were searched for clinical studies reporting PFFs or extended trochanteric osteotomy (ETO) in THA patients and cerclage fixation techniques. Results: Eight studies with 1362 patients (1366 hips) were included. The mean age ranged from 48.2 to 81.7 years, and the study population was 79.4 % female. The infection rate at the site of the PFF or ETO was 0.22 % (3 of 1366 hips), all occurring in patients with non-metallic cerclage fixation. Sixteen of 18 (88.9 %) cases of stem subsidence occurred following metallic cerclage fixation. Significant stem subsidence was substantially higher in hips with metallic device fixation compared to those with non-metallic fixation, at rates of 5.1 % and 0.19 %, respectively. Hips with non-metallic fixation had a clinical or radiologic healing rate of 93.9 %. Loss of fixation was only seen in hips with metallic fixation, at a rate of 0.6 %. Postoperative outcome scores were comparable across both groups. Conclusion: The findings of this systematic review suggest that available non-metallic cerclage fixation methods demonstrate similar clinical success as conventional metallic fixation methods when utilized in hip arthroplasty. The current use of novel materials appears to be safe and reliable for these surgeries and can be considered a dependable option for surgeons. [ABSTRACT FROM AUTHOR]

Background: Rigorous haemostatic control and careful rehabilitation are essential for haemophilic patients undergoing total hip arthroplasty (THA). Aim: to examine the current literature regarding THA in patients with haemophilia in order to determine clinical outcomes and complication rates. Methods: We included 11 case reports/series and 9 original articles. There was a total of 206 patients who underwent 226 THAs. Findings: The number of patients enrolled in the selected articles varied from 1 in case reports to 34 in the original articles. Gender was documented in 10. Mean age at surgery was 41 years. Mean follow-up was 73 months (standard deviation [SD] 35 months). All but 4 articles specified whether implants were cemented or uncemented, with 95% being uncemented, 3.5% being cemented, and 1.5% being hybrid (uncemented acetabular component, cemented femoral stem). Conclusion: Controlled hypotensive anaesthesia (to reduce preoperative blood loss), consult with haematologist, precise control of haemostasis status per the guidelines defined by the World Federation joint replacement, can improve the success rate and hip replacement surgery can be performed safely. [ABSTRACT FROM AUTHOR]