Plasma rico em plaquetas e ácido tranexâmico aplicados na artroplastia total do joelho
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Data
2017-12-04
Autores
Guerreiro, João Paulo Fernandes
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivos: avaliar, através de estudo clínico randomizado e cego, a eficácia do plasma rico em plaquetas (PRP) e do ácido tranexâmico (ATX) na artroplastia total do joelho com relação à queda do nível da hemoglobina, ao controle da dor pós-operatória, ao ganho de flexão do joelho e ao ganho de função do membro inferior. Metodologia: foram selecionados 84 pacientes que seriam submetidos à prótese total do joelho e randomizados. Em 23 desses pacientes foi aplicado o ATX, em 20 pacientes o PRP, em outros 20 pacientes o PRP associado ao ATX e em 21 pacientes apenas o soro fisiológico antes do fechamento da cápsula articular. Foram realizadas dosagens de hemoglobina sérica (mg/dL) no pré-operatório, e 24 e 48 horas após a cirurgia, aplicado o questionário Western Ontario and McMaster Universities (WOMAC), a escala numérica (EN) da dor e medido o ganho de flexão do joelho até o segundo ano pós-operatório. A análise estatística comparou os resultados a fim de comprovar haver diferença entre os grupos em cada um dos momentos da avaliação. Resultados: houve diferença estatística significante (p < 0,01) na medida da queda da hemoglobina com 48 horas de pós-operatório entre os grupos em que o ATX foi utilizado em comparação ao grupo controle e ao grupo PRP, sem diferença entre os grupos com ATX isolado ou associado ao PRP. Na mensuração da dor houve significativa vantagem nos grupos que utilizaram o ATX nas avaliações com 24 e 48 horas de pós-operatório e no grupo que utilizou o PRP isolado na avaliação com 48 horas de pós-operatório em relação ao grupo controle (p < 0,01). O ganho de flexão nas primeiras 24 horas de pós-operatório foi melhor nos grupos que utilizaram o ATX em comparação aos grupos PRP e controle (p < 0,05), sem diferença entre os grupos com ATX isolado ou associado ao PRP. Nas avaliações da queda de hemoglobina nas primeiras 24 horas, da dor desde a primeira semana, do ganho de flexão desde as primeiras 48 horas e nos questionários de função WOMAC a partir do segundo mês não houve nenhuma diferença entre os quatro grupos até os dois anos de pós-operatório. Conclusões: foi demonstrado que o ATX aplicado localmente na cirurgia de artroplastia total do joelho foi efetivo em reduzir a queda da hemoglobina nas primeiras 48 horas de pós-operatório e reduzir a dor. Possibilitou melhor ganho de movimento nas primeiras 24 horas após o procedimento. O PRP não se mostrou efetivo para reduzir sangramento ou melhorar a função do joelho após a artroplastia. Houve melhor controle de dor pós-operatória medida pela escala de dor nas primeiras 48 horas pós-operatórias. A associação das duas substâncias não demonstrou vantagem ou potencialização dos seus efeitos.
Purpose: to evaluate, through a randomized and blinded clinical study, the efficacy of platelet-rich plasma (PRP) and tranexamic acid (TXA) in total knee arthroplasty in relation to hemoglobin level decrease, postoperative pain control, knee flexion gain and lower limb function gain. Methods: we selected 84 patients who were submitted to total knee prosthesis and randomized. In 23 of these patients, TXA was applied, in 20 patients the PRP, in 20 others patients the PRP associated with TXA and in 21 patients only the saline solution before the closure of the joint capsule. Hemoglobin dosages (mg/dL) were performed preoperatively, 24 and 48 hours after surgery. The Western Ontario and McMaster Universities Index (WOMAC) questionnaire was applied, the pain scale and the knee flexion gain was measured until the second postoperative year. The statistical analysis compared the results in order to prove that there was a difference between the groups at each moment of the evaluation. Results: there was a statistically significant difference (p < 0,01) in the measurement of hemoglobin drop with 48 postoperative hours between groups in which TXA was used in comparison to the control and PRP groups, with no difference between groups with TXA alone or associated with PRP. In the evaluation of pain, there was a significant advantage in the groups that used the TXA in the evaluations with 24 and 48 hours of postoperative and in the group that used PRP alone in the evaluation with 48 postoperative hours in relation to the control group (p < 0,01). Knee flexion gain in the first 24 hours postoperatively was better in the groups that used the TXA compared to the PRP and control groups (p < 0,05), with no difference between the groups with TXA alone or associated with PRP. In evaluations of hemoglobin drop in the first 24 hours, pain from the first week, flexion gain from the first 48 hours and WOMAC function questionnaires from the second month there was no difference between the four groups up to two years postoperative period. Conclusions: it was demonstrated that the TXA applied locally in total knee arthroplasty surgery was effective in reducing hemoglobin decrease in the first 48 postoperative hours and reduced pain. Allowed better movement gain in the first 24 hours after the procedure. PRP was not effective in reducing bleeding or improving knee function after arthroplasty. There was better control of postoperative pain measured by pain scale in the first 48 hours postoperatively. The association of the two substances did not demonstrate advantage or potentialization of its effects.
Purpose: to evaluate, through a randomized and blinded clinical study, the efficacy of platelet-rich plasma (PRP) and tranexamic acid (TXA) in total knee arthroplasty in relation to hemoglobin level decrease, postoperative pain control, knee flexion gain and lower limb function gain. Methods: we selected 84 patients who were submitted to total knee prosthesis and randomized. In 23 of these patients, TXA was applied, in 20 patients the PRP, in 20 others patients the PRP associated with TXA and in 21 patients only the saline solution before the closure of the joint capsule. Hemoglobin dosages (mg/dL) were performed preoperatively, 24 and 48 hours after surgery. The Western Ontario and McMaster Universities Index (WOMAC) questionnaire was applied, the pain scale and the knee flexion gain was measured until the second postoperative year. The statistical analysis compared the results in order to prove that there was a difference between the groups at each moment of the evaluation. Results: there was a statistically significant difference (p < 0,01) in the measurement of hemoglobin drop with 48 postoperative hours between groups in which TXA was used in comparison to the control and PRP groups, with no difference between groups with TXA alone or associated with PRP. In the evaluation of pain, there was a significant advantage in the groups that used the TXA in the evaluations with 24 and 48 hours of postoperative and in the group that used PRP alone in the evaluation with 48 postoperative hours in relation to the control group (p < 0,01). Knee flexion gain in the first 24 hours postoperatively was better in the groups that used the TXA compared to the PRP and control groups (p < 0,05), with no difference between the groups with TXA alone or associated with PRP. In evaluations of hemoglobin drop in the first 24 hours, pain from the first week, flexion gain from the first 48 hours and WOMAC function questionnaires from the second month there was no difference between the four groups up to two years postoperative period. Conclusions: it was demonstrated that the TXA applied locally in total knee arthroplasty surgery was effective in reducing hemoglobin decrease in the first 48 postoperative hours and reduced pain. Allowed better movement gain in the first 24 hours after the procedure. PRP was not effective in reducing bleeding or improving knee function after arthroplasty. There was better control of postoperative pain measured by pain scale in the first 48 hours postoperatively. The association of the two substances did not demonstrate advantage or potentialization of its effects.
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Palavras-chave
artroplastia de joelho, ácido tranexâmico, plasma rico em plaquetasma, hemorragia, dor, total knee arthroplasty, tranexamic acid, platelet-rich plasma, bleeding, pain