Background: Hip fractures are a major health concern, especially among older adults. The conventional treatment for this condition involves surgery, but it carries the risk of excessive blood loss and complications. Tranexamic acid (TXA) has emerged as a possible solution for reducing bleeding during surgery. This study aims to evaluate the safety and efficacy of topical TXA compared to systemic TXA and a placebo in adult patients undergoing surgical treatment for hip fractures. Methods: The literature was reviewed using 3 databases (PubMed, Scopus, and Google Scholar) for studies published up to November 2023. All randomized controlled trials (RCTs) assessing the effectiveness of topical TXA in hip fracture surgery were included for analysis. Two reviewers assessed the quality of studies independently using the Cochrane-recommended risk-of-bias tool. Statistical analysis was performed on Comprehensive Meta-Analysis Software (version 2.0). Results: Nine RCTs with 1,024 patients assessed topical TXA in hip fracture surgery. Topical TXA significantly reduced hemoglobin loss (mean difference [MD], 1.004 g/dL; 95% CI, 0.096–1.911; p = 0.03) and transfused blood units (relative risk, 0.640; 95% CI, 0.487–0.841; p = 0.001) versus placebo, but there was no significant difference in hematocrit loss, total blood loss, deep vein thrombosis (DVT) rates, mortality, hospital stays, or surgery duration compared to placebo. Moreover, the meta-analysis revealed no significant differences between local and intravenous TXA administration in blood transfusion rates, total blood loss, incidence of DVT, and surgery duration. The results of the subgroup analysis that compared topical TXA to placebo in the arthroplasty group showed that TXA significantly reduced hemoglobin drop (MD, 1.500 g/dL; 95% CI, 0.324–2.676; p = 0.012) and total blood loss (MD, –322.3 mL; 95% CI, –566.6 to –78.0; p = 0.010). Conclusions The available evidence suggests that local TXA can significantly reduce hemoglobin loss and the number of transfused blood units without the risk of DVT compared to a placebo. Furthermore, local TXA demonstrated comparable effectiveness and safety to intravenous TXA following hip fracture surgery. Subgroup analysis revealed that topical TXA significantly decreased the hemoglobin drop and total blood loss in the arthroplasty group, as compared to the placebo.

Background: Hip fractures are a major health concern, especially among older adults. The conventional treatment for this condition involves surgery, but it carries the risk of excessive blood loss and complications. Tranexamic acid (TXA) has emerged as a possible solution for reducing bleeding during surgery. This study aims to evaluate the safety and efficacy of topical TXA compared to systemic TXA and a placebo in adult patients undergoing surgical treatment for hip fractures. Methods: The literature was reviewed using 3 databases (PubMed, Scopus, and Google Scholar) for studies published up to November 2023. All randomized controlled trials (RCTs) assessing the effectiveness of topical TXA in hip fracture surgery were included for analysis. Two reviewers assessed the quality of studies independently using the Cochrane-recommended risk-of-bias tool. Statistical analysis was performed on Comprehensive Meta-Analysis Software (version 2.0). Results: Nine RCTs with 1,024 patients assessed topical TXA in hip fracture surgery. Topical TXA significantly reduced hemoglobin loss (mean difference [MD], 1.004 g/dL; 95% CI, 0.096–1.911; p = 0.03) and transfused blood units (relative risk, 0.640; 95% CI, 0.487–0.841; p = 0.001) versus placebo, but there was no significant difference in hematocrit loss, total blood loss, deep vein thrombosis (DVT) rates, mortality, hospital stays, or surgery duration compared to placebo. Moreover, the meta-analysis revealed no significant differences between local and intravenous TXA administration in blood transfusion rates, total blood loss, incidence of DVT, and surgery duration. The results of the subgroup analysis that compared topical TXA to placebo in the arthroplasty group showed that TXA significantly reduced hemoglobin drop (MD, 1.500 g/dL; 95% CI, 0.324–2.676; p = 0.012) and total blood loss (MD, –322.3 mL; 95% CI, –566.6 to –78.0; p = 0.010). Conclusions The available evidence suggests that local TXA can significantly reduce hemoglobin loss and the number of transfused blood units without the risk of DVT compared to a placebo. Furthermore, local TXA demonstrated comparable effectiveness and safety to intravenous TXA following hip fracture surgery. Subgroup analysis revealed that topical TXA significantly decreased the hemoglobin drop and total blood loss in the arthroplasty group, as compared to the placebo.

Background: Hip fractures are a major health concern, especially among older adults. The conventional treatment for this condition involves surgery, but it carries the risk of excessive blood loss and complications. Tranexamic acid (TXA) has emerged as a possible solution for reducing bleeding during surgery. This study aims to evaluate the safety and efficacy of topical TXA compared to systemic TXA and a placebo in adult patients undergoing surgical treatment for hip fractures. Methods: The literature was reviewed using 3 databases (PubMed, Scopus, and Google Scholar) for studies published up to November 2023. All randomized controlled trials (RCTs) assessing the effectiveness of topical TXA in hip fracture surgery were included for analysis. Two reviewers assessed the quality of studies independently using the Cochrane-recommended risk-of-bias tool. Statistical analysis was performed on Comprehensive Meta-Analysis Software (version 2.0). Results: Nine RCTs with 1,024 patients assessed topical TXA in hip fracture surgery. Topical TXA significantly reduced hemoglobin loss (mean difference [MD], 1.004 g/dL; 95% CI, 0.096–1.911; p = 0.03) and transfused blood units (relative risk, 0.640; 95% CI, 0.487–0.841; p = 0.001) versus placebo, but there was no significant difference in hematocrit loss, total blood loss, deep vein thrombosis (DVT) rates, mortality, hospital stays, or surgery duration compared to placebo. Moreover, the meta-analysis revealed no significant differences between local and intravenous TXA administration in blood transfusion rates, total blood loss, incidence of DVT, and surgery duration. The results of the subgroup analysis that compared topical TXA to placebo in the arthroplasty group showed that TXA significantly reduced hemoglobin drop (MD, 1.500 g/dL; 95% CI, 0.324–2.676; p = 0.012) and total blood loss (MD, –322.3 mL; 95% CI, –566.6 to –78.0; p = 0.010). Conclusions The available evidence suggests that local TXA can significantly reduce hemoglobin loss and the number of transfused blood units without the risk of DVT compared to a placebo. Furthermore, local TXA demonstrated comparable effectiveness and safety to intravenous TXA following hip fracture surgery. Subgroup analysis revealed that topical TXA significantly decreased the hemoglobin drop and total blood loss in the arthroplasty group, as compared to the placebo.

Background: Hip fractures are a major health concern, especially among older adults. The conventional treatment for this condition involves surgery, but it carries the risk of excessive blood loss and complications. Tranexamic acid (TXA) has emerged as a possible solution for reducing bleeding during surgery. This study aims to evaluate the safety and efficacy of topical TXA compared to systemic TXA and a placebo in adult patients undergoing surgical treatment for hip fractures. Methods: The literature was reviewed using 3 databases (PubMed, Scopus, and Google Scholar) for studies published up to November 2023. All randomized controlled trials (RCTs) assessing the effectiveness of topical TXA in hip fracture surgery were included for analysis. Two reviewers assessed the quality of studies independently using the Cochrane-recommended risk-of-bias tool. Statistical analysis was performed on Comprehensive Meta-Analysis Software (version 2.0). Results: Nine RCTs with 1,024 patients assessed topical TXA in hip fracture surgery. Topical TXA significantly reduced hemoglobin loss (mean difference [MD], 1.004 g/dL; 95% CI, 0.096–1.911; p = 0.03) and transfused blood units (relative risk, 0.640; 95% CI, 0.487–0.841; p = 0.001) versus placebo, but there was no significant difference in hematocrit loss, total blood loss, deep vein thrombosis (DVT) rates, mortality, hospital stays, or surgery duration compared to placebo. Moreover, the meta-analysis revealed no significant differences between local and intravenous TXA administration in blood transfusion rates, total blood loss, incidence of DVT, and surgery duration. The results of the subgroup analysis that compared topical TXA to placebo in the arthroplasty group showed that TXA significantly reduced hemoglobin drop (MD, 1.500 g/dL; 95% CI, 0.324–2.676; p = 0.012) and total blood loss (MD, –322.3 mL; 95% CI, –566.6 to –78.0; p = 0.010). Conclusions The available evidence suggests that local TXA can significantly reduce hemoglobin loss and the number of transfused blood units without the risk of DVT compared to a placebo. Furthermore, local TXA demonstrated comparable effectiveness and safety to intravenous TXA following hip fracture surgery. Subgroup analysis revealed that topical TXA significantly decreased the hemoglobin drop and total blood loss in the arthroplasty group, as compared to the placebo.

Zoledronic acid has been used for prevention of osteolytic and osteoblastic bone metastasis. This case report illustrates an undesirable consequence from prolonged usage of zoledronic acid in bone metastasis prevention. Periprosthetic acetabular fracture in a patient treated with zoledronic acid for 7 years was reported. The clinical presentation, radiographic and pathological results were described. This is a rare complication after total hip arthroplasty which should not be ignored especially in patients who received long term bisphosphonate.
Acetabulum/*injuries/pathology/surgery ; Aged ; Arthroplasty, Replacement, Hip/*adverse effects ; Bone Density Conservation Agents/*adverse effects/pharmacology ; Bone Neoplasms/prevention & control/secondary ; Bone Remodeling/drug effects ; Breast Neoplasms/pathology ; Diphosphonates/*adverse effects/pharmacology ; Female ; Fractures, Spontaneous/chemically induced/etiology ; Hip Prosthesis ; Humans ; Imidazoles/*adverse effects/pharmacology ; Osteoarthritis, Hip/*surgery ; Periprosthetic Fractures/*chemically induced/etiology ; Prosthesis Failure ; Reoperation

Osteoarthritis (OA) is a degenerative articular disorder manifested by cartilage destruction, subchondral sclerosis, osteophytes, and synovitis, resulting in chronic joint pain and physical disability in the elderly. The purpose of this study was to investigate mitochondrial DNA copy number (mtDNA_CN) and inflammatory cytokines in primary knee OA patients and healthy volunteers. A total of 204 knee OA patients and 169 age-matched healthy volunteers were recruited. Their relative blood leukocyte mtDNA_CN was assessed by quantitative real-time polymerase chain reaction (qRT-PCR), and ten inflammatory cytokines in their plasma were detected by multiplex immunoassay. Blood leukocyte mtDNA_CN in the OA group was significantly lower than that in the control group. Leukocyte mtDNA_CN in the control group was negatively correlated with their age (r=-0.380, P<0.0001), whereas mtDNA_CN in the OA group was positively correlated with their age (r=0.198, P<0.001). Plasma interleukin-4 (IL-4) and IL-6 were significantly higher in the knee OA group than in the control group. The plasma IL-6 level was positively correlated with blood leukocyte mtDNA_CN in the OA group (r=0.547, P=0.0014). IL-5 showed as a major factor (coefficient 0.69) in the second dimension of principle components analysis (PCA)-transformed data and was significantly higher in the OA group (P<0.001) as well as negatively correlated with mtDNA_CN (r=-0.577, P<0.001). These findings suggest that elevation of plasma IL-4 and IL-6 and a relative reduction in mtDNA_CN might be effective biomarkers for knee OA. IL-5 is a plausible factor responsible for decreasing blood leukocyte mtDNA_CN in knee OA patients.
Age Factors ; Aged ; Aged, 80 and over ; Cytokines/blood* ; DNA, Mitochondrial/blood* ; Female ; Gene Dosage ; Humans ; Leukocytes/metabolism* ; Male ; Middle Aged ; Osteoarthritis, Knee/metabolism* ; Principal Component Analysis