METHODS
From August 2012 to March 2013, 239 patients were included, who underwent primary unilateral THA or TKA, postoperative fluid replacement for 1 day, applied same method of postoperative anticoagulation, and removed drainage tubes 24 h postoperatively. Sixteen patients quit this research for postoperative transfusion.
This study included 106 men and 133 women, age 53-82 years old (mean 68.5 years). Of these, 168 patients underwent THA, including 26 cases of femoral neck fracture, 101 cases of femoral head necrosis, 16 cases of osteoarthritis, 25 cases of congenital hip dysplasia, and 6 cases of intraoperative subtrochanteric osteotomy. The remaining 71 patients underwent TKA for osteoarthritis exclusively. Thirteen patients received preoperative phlebotomy for blood-thinning (extraction of 2-4 units before anesthesia) and autologous blood transfusion immediately postoperatively, and 21 patients received intraoperative allogeneic blood transfusion. THA of 168 patients was performed using a bio-based acetabular cup, with eight receiving a cemented femoral stem and 160 a bio-based stem. For TKA, all femoral and tibial components were fixed with cement.
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The same group of physicians completed the surgeries. For TKA, patients under general anesthesia were placed in a supine position and the lower extremity sterilely prepared and draped. The antibiotics were utilized before one-half an hour before operation. The leg was exsanguinated, and a pneumatic tourniquet applied, in which pressure was synchronized with systolic blood pressure for 1 h. A standard midline incision was made on the knee, followed by a parapatellar incision to expose the joint. Twenty-nine patients underwent patellar replacement, and 42 patients received cemented fixation of the prosthesis without patellar replacement. The incision was sutured after the placement of a drainage tube, and the lower limb was bandaged postoperatively. For THA, patients under general anesthesia were placed in a lateral position to make a posterolateral incision. The incision was sutured after the placement of a drainage tube. After TKA and THA, the drainage tube was clamped for 2 h before opening.
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From the 1st postoperative day (POD), all patients were given one tablet of rivaroxaban once daily for anticoagulation. The drainage tube was removed 24 h postoperatively. Patients in the TKA group wore elastic stockings after surgery. After THA and TKA, all patients started doing rehabilitation exercises on the first POD and walked with the aid of a walker on POD 2. Sutures were removed during postoperative week 2.
Routine blood tests were performed on POD 1, 2, 3, 4, 5, 7, and 14 days.
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