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OBJECTIVE To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P

Resumen Introduccion Una complicacion frecuente tras una artroplastia total de cadera es el sangrado, y para reducirlo se utiliza el acido tranexamico (TXA) intravenoso. Recientemente se han publicado los beneficios de su aplicacion topica. Consideramos necesario realizar un estudio que justifique que via de administracion resulta superior. Material y metodo Estudio prospectivo, controlado, aleatorizado en 2 brazos realizado entre febrero de 2017 a febrero de 2018. En el grupo A se administro 15 mg/kg TXA intravenoso y en el B 2 g TXA intraarticular. Se evaluo los valores de hemoglobina y hematocrito a las 24-72 horas, volumen de sangre drenado, volumen de sangre perdida, transfusiones y complicaciones. Resultados Fueron incluidos 78 pacientes, 31 con tratamiento intravenoso y 47 intraarticular. La hemoglobina descendio 3,15 ± 1,64 g/dl en 24 horas y 3,75 ± 1,56 g/dl en 72 horas en el grupo intravenoso, el hematocrito descendio un 10,4% ± 4,17% en 24 horas y 11,85% ± 4,15% en 72 horas. En el intraarticular se observo una caida de hemoglobina de 3,03 ± 1,30 g/dl en 24 horas y de 3,22 ± 1,2 g/dl en 72 horas y el hematocrito descendio 10,66% ± 3,6% y 12,11% ± 3,29% en 24 y 72 horas (p > 0,05). El drenaje medio en 24 horas fue 195,80 ml en el grupo A frente a 253,93 ml en el grupo B (p > 0,05) y a las 48 horas 225,33 ml en el grupo A y de 328,19 ml en el grupo-B (p = 0,009). En el grupo intravenoso perdieron una media de 1.505 ml de sangre frente a 1.280 ml del grupo intraarticular. Fueron necesarias un 5,1% de transfusiones. No tuvimos complicaciones secundarias. Conclusiones Las diferentes vias de administracion del TXA en la artroplastia total de cadera tienen un efecto similar en la reduccion del sangrado postoperatorio sin evidenciar un incremento de complicaciones.

Introduction One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior. Material and method Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15 mg/kg of intravenous TXA were administered in group A and 2 g of intra-articular TXA in group B. The values of haemoglobin and haematocrit were evaluated at 24 h-72 h, blood loss volume, drained blood volume, transfusions and complications. Results 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15 ± 1.64 g/dl in 24 h and 3.75 ± 1.56 g/dl in 72 h, the haematocrit decreased by 10.4 ± 4.17% in 24 h and 11.85 ± 4.15% in 72 h. In the intra-articular group there was a haemoglobin fall of 3.03 ± 1.30 g/dl in 24 h and 3.22 ± 1.2 g/dl in 72 h and the haematocrit fell by 10.66 ± 3.6% and 12.11 ± 3.29% in 24 and 72 h (p > .05). The mean drainage in 24 h was 195.80 ml in group A versus 253.93 ml in group B (p > .05) and in 48 h it was 225.33 ml in group A and 328.19 ml in group B (p = .009). The intravenous group lost an average of 1505 ml of blood compared to the 11,280 ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications. Conclusions The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications.