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Introduction: The optimal route and dosing regimen of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains unclear. This study aims to explore if there was a synergistic effect of intravenous (IV) and topical TXA on blood loss and risk of complications. Materials and methods: From Jan 2019 to June 2021, medical records of patients aged 65 years or older who underwent primary unilateral TKA for primary osteoarthritis were retrospectively reviewed. The included patients were divided into 3 groups according to the methods of TXA application: Intravenous (IV) group, topical group, or combined group. Propensity-score match was used to reduce the bias and imbalance of confounding variables. The primary outcome was total blood loss. Results: The total blood loss, hidden blood loss, and the reduction of Hb concentration in the combined group were significantly lower than in the IV group and topical group (all P < .01). There is no significant difference in the transfusion rate, length of hospital stay, and incidence of thromboembolic events (both P > .05). Conclusions: Combined administration of IV and topical TXA is the most effective approach to decrease blood loss and postoperative Hb drop in the treatment of TKA without increasing any risk of complications.

Objective • To compare and analyze the effects of proximal femoral nail anti-rotation (PFNA) and femoral head replacement in treating elderly patients with femoral intertrochanteric fracture. Methods • A retrospective analysis was performed on clinical data of elderly patients with femoral intertrochanteric fractures from February 2019 to February 2021 in the hospital. Patients were divided into a control group (PFNA) and a study group (femoral head replacement) based on surgical methods after propensity score matching. Perioperative indicators, hematocrit (HCT), hemoglobin (Hb), hip function, and complications one year after surgery were compared between the two groups after excluding confounding factors. Result • Both groups had complete follow-ups without any cases lost. The study group had longer surgical time, higher intraoperative blood loss, and greater postoperative drainage volume compared to the control group, while the hospital stay and weight-bearing starting time were shorter in the study group (P<.05). There were statistically significant differences in HCT and Hb after surgery between the two groups (P < .05). One year after surgery, the excellent and good rate of hip function was 90.28% in the study group and 76.39% in the control group (P<.05). The total incidence rate of postoperative early complications was higher in the study group, while the total incidence rate of late postoperative complications was lower in the study group compared to the control group (P<.05). Conclusion • PFNA and femoral head replacement have their respective advantages in treating elderly patients with femoral intertrochanteric fractures. PFNA causes less trauma to patients but has poorer postoperative hip function recovery, while femoral head replacement causes greater trauma to patients but has better postoperative hip function recovery. Therefore, the appropriate surgical method can be selected based on the patient’s specific conditions. [ABSTRACT FROM AUTHOR]