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We investigated the feasibility of estimating living stature in Japanese subjects using femoral length and pelvic dimensions measured on three-dimensional (3D) pelvic models reconstructed from cross-sectional computed tomography (CT) images. For this cross-sectional study, we recruited 106 healthy Japanese subjects. Maximum and bicondylar femoral length, as well as pelvic width, depth, and height, were measured on 3D bone models reconstructed from multi-slice CT images. The correlation of stature with each parameter was evaluated, and multiple regression equations were derived as formulae for living stature estimation. Prediction accuracy was evaluated as the mean absolute difference (MAD) between the measured and estimated statures. Maximum and bicondylar femoral lengths were similar and showed strong correlations with stature (> 0.8 in both males and females). Among the pelvic dimensions, height (craniocaudal length) showed the strongest correlation with stature in both males (r = 0.649) and females (r = 0.684). Formulae using femoral length plus pelvic height provided the best estimation of living stature in both males and females (MAD, 25-26 mm). Among the studied pelvic dimensions, height provided the best estimation of living stature when used alone (MAD, 34-36 mm) in both males and females. The intraclass correlation coefficients were high (> 0.9) for both intraobserver and interobserver reliability. Femoral length and pelvic height measured on CT images are reliable predictors of living stature in the Japanese population. Such tools are particularly useful in disaster victim identification, when the long bones are often not intact but the pelvic bones are.

DOI： 10.1127/homo/2020/1116

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<sec><title>Purpose:</title> Anatomical sacral slope (a-SS), a pelvic anatomical parameter that does not require the center of the femoral head, strongly correlates with pelvic incidence (PI) during three-dimensional measurements in normal subjects. Sagittal alignment of spinal and pelvic parameters is typically evaluated using two-dimensional radiographs; however, the relationship between a-SS and PI has not been evaluated using radiographs. This study aimed to evaluate the correlation between a-SS and other spinal and pelvic parameters using radiographs.

</sec><sec><title>Methods:</title> We evaluated 144 healthy women. Using sagittal radiographs, we measured lumbar lordosis (LL), thoracic kyphosis, PI, SS, pelvic tilt, and a-SS, which were defined as the angle between the superior end plate of S1 and a line perpendicular to the anterior pelvic plane. Pearson coefficients were used to determine correlations, and intraobserver and interobserver intraclass correlation coefficients (ICCs) were used for validation.

</sec><sec><title>Results:</title> There was a strong correlation between PI and a-SS ( r = 0.756). Moreover, correlations between a-SS and LL and between PI and LL were similar ( r = 0.661 and r = 0.554, respectively). The intraobserver ICCs were 0.884 for a-SS and 0.840 for PI. The interobserver ICCs were 0.856 for a-SS and 0.653 for PI.

</sec><sec><title>Conclusion:</title> a-SS was strongly correlated with PI. The correlation between a-SS and LL was equivalent to the correlation between PI and LL. Moreover, the ICC for a-SS was larger than that of PI. This study suggests that a-SS is a useful new pelvic anatomical parameter that can be used instead of PI.

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DOI： 10.1177/2309499019888809

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BACKGROUND: It was previously reported that pelvises with developmental dysplasia of the hip are tilted anteriorly, which increases bony coverage of the femoral head. This study aimed to investigate the correlation between anatomical parameters of the pelvis such as pelvic incidence and anatomical pelvic tilt and functional parameters of the spine and pelvis such as tilt of the anterior pelvic plane. METHODS: We examined 84 female patients with bilateral developmental dysplasia of the hip who had undergone curved periacetabular osteotomy at author's institution. Radiographs of the thoracic to lumbar spines and the pelvis were obtained in the standing position to measure spino-pelvic parameters before surgery. Morphological parameters of the acetabulum such as the anterior center-edge (CE) angle, posterior CE angle, lateral CE angle, and acetabular anteversion were measured using a preoperative three-dimensional pelvic model reconstructed from computed tomography images. Pearson's correlation analysis was conducted to evaluate the relationship of these parameters. RESULTS: With regard to correlations between pelvic incidence (PI) and other parameters, the sacral slope (SS) value (r = 0.666) was the highest among functional parameters and the anatomical-SS value (r = 0.789) was the highest among morphological parameters. There were moderate correlations of the anterior pelvic plane angle (APPA) with pelvic tilt (PT) (r = - 0.594) and anatomical-PT (r = 0.646). With regard to correlations between spino-pelvic parameters and bony morphological parameters of the acetabulum, there was a moderate correlation between anatomical-PT and acetabular anteversion (AA) (r = 0.424). There were moderate correlations of APPA with the anterior CE angle (r = - 0.478), posterior CE angle (r = 0.432), and AA (r = 0.565). APPA had a stronger correlation with anatomical-PT (r = 0.646) than with AA. CONCLUSIONS: The tilt of the pelvis may be more dependent on anatomical-PT, a morphological parameter of the pelvis, than the lateral CE angle, anterior CE angle, posterior CE angle, and acetabular anteversion on bony coverage of the acetabulum. This study is the first to investigate the correlation between functional parameters of the pelvis and spine and morphological parameters of the pelvis and acetabulum besides PI.

DOI： 10.1186/s13018-019-1382-8

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BACKGROUND: We assessed the morphological differences in the knee joint related to knee rotation angle in patients with hip dysplasia. These results may explain the anatomy of the knee in patients with hip dysplasia and aid in planning knee surgery. METHODS: We enrolled 73 women (146 legs, 35.6 ± 9.0 years) with bilateral hip dysplasia and 45 healthy women (90 legs, 49.0 ± 18.9 years) without lumbago, knee symptoms, or osteoarthritic findings of the knee or spine on plain radiographs. We examined the parameters affecting knee rotation angle, such as the condylar twist angle and femoral condyle measurements with a three-dimensional bone model using the correlation coefficients of each parameter. RESULTS: The condylar twist angle and the length of the posterior part of the lateral femoral condyle were statistically positively correlated with knee rotation angle in both the normal (condylar twist angle: r = 0.286, p = 0.007, posterolateral: r = 0.429, p < 0.001) and developmental dysplasia of the hip groups (condylar twist angle: r = 0.230, p = 0.033, posterolateral: r = 0.272, p = 0.005). Knee rotation angle had no statistical correlation with femoral neck anteversion in the developmental dysplasia of the hip group (r = 0.094, p = 0.264), but had a statistical correlation with femoral neck anteversion in the normal group (r = 0.243, p = 0.039). CONCLUSIONS: Knee joint morphology is affected by hip dysplasia. We found that the length of the posterior part of the lateral femoral condyle was significantly positively correlated with knee rotation angle in both the normal and developmental dysplasia of the hip groups, and this finding indicates that a greater posterolateral dimension was associated with a greater knee rotation angle. These morphological knee joint differences in patients with hip dysplasia may help determine the alignment of prostheses in total knee arthroplasty.

DOI： 10.1186/s12891-019-2737-3

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BACKGROUND: Sagittal spinal balance and standing posture are affected by pelvic morphology, especially pelvic incidence (PI). However, it is not difficult to identify the hip center because of overlap of the pelvis, image contrast, and soft tissue artifacts. Measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is nonspherical, subluxed, or dislocated. We measured PI, pelvic tilt (PT), and sacral slope (SS) as anatomical parameters using a novel three-dimensional measurement in order to compare the pelvic morphology between normal, healthy men and women. METHODS: In this cross-sectional study, we evaluated 108 Japanese subjects (55 men, 53 women) without low back or knee pain. We used the three-dimensional pelvis model adjusted to the anterior pelvic plane and measured the pelvic parameters. The subjects were stratified by age (< 50 versus ≥ 50 years) and sex. Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients. RESULTS: There was no significant difference in PI, anatomical-PT, and anatomical-SS between sexes. There was a strong correlation between PI and anatomical-SS in men and women (R = 0.790 and 0.715, respectively). Values of anatomical-PT were lower, and values of anatomical-SS were greater among older subjects than among younger subjects; the value of PI was similar between younger and older subjects. Intraobserver and interobserver mean absolute differences were about 2 mm and 2°, respectively; the intraclass correlation coefficient was > 0.87. CONCLUSIONS: We found a strong correlation between PI and anatomical-SS in men and women. This novel measurement concept may be useful to estimate PI from anatomical-SS because the measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is not spherical or whose femoral head is subluxed or dislocated. This is the first report to describe the relationship between PI, anatomical-PT, and anatomical-SS as morphologic parameters with a high interclass correlation coefficient for intraobserver and interobserver reliabilities.

DOI： 10.1186/s13018-019-1165-2

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BACKGROUND: In obese patients, malpositioning of the acetabular cup increases the risk of dislocation in total hip arthroplasty (THA). The aim of this study was to determine whether obesity affects the accuracy of acetabular cup positioning using a computed tomography (CT)-based navigation system. METHODS: We retrospectively evaluated 226 consecutive patients who underwent cementless primary THAs assisted by the CT-based hip navigation system. We divided the patients into three groups according to body mass index (BMI) and examined the difference between preoperative planning and postoperative implantation angles from CT data. RESULTS: There was no significant correlation between BMI and both inclination and anteversion differences (R = 0.028 and R = 0.045, respectively). There were no significant differences among the BMI < 25, 25 ≦ BMI < 30, and BMI ≧ 30 groups (p value: 0.725, 0.934, respectively); between the BMI < 25 and BMI ≧ 25 groups (p value: 0.542, 0.697, respectively); and between the BMI < 30 and BMI ≧ 30 groups with regard to inclination and anteversion (p value: 0.859, 0.456, respectively). Moreover, similar findings were observed with regard to the distance between the preoperative planning and postoperative cup positioning for the transverse, anteroposterior, and craniocaudal axes of the pelvis. CONCLUSION: We found that the accuracy of acetabular cup placement using CT based-navigation in THA was not affected in obese patients. Therefore, THAs with a CT-based navigation system are considered useful in obese patients.

DOI： 10.1016/j.jos.2018.11.007

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The aim of this study was to survey the incidence of osteoporotic fragility fractures, which include vertebral, hip, distal radius, and proximal humerus fractures, in patients ≥ 50 years of age, from 2004 to 2015, in Sado City, Japan. We examined temporal changes in the incidence of these fractures from 2010 through 2015. The incidence of vertebral (p < 0.001) and radius fractures (p = 0.001) was lower in 2015 than in 2010, with only the incidence of hip fracture (p = 0.013) being lower in 2015 than in 2004. With regard to age-specific incidences, there was a sharp increase in vertebral and hip fractures among the segment of the population 70-89 years old, with no remarkable change in the incidence of radial and humeral fractures. Pre-existing vertebral fractures were identified in 69.6% of patients with a hip fracture, 35.6% of patients with a distal radius fracture, and 55% of patients with a humeral fracture. Among patients with pre-existing vertebral fractures, 42.5% had a single fracture, whereas 57.5% had 2 or more fractures. The proportion of patients on anti-osteoporotic agents before the occurrence of fractures increased to 14.5% in 2015, compared to 4% in 2004 and 7.6% in 2010. We speculate that the increase in the use of anti-osteoporotic agents is the main reason for the declining incidence of fractures. Therefore, considering the sharp increase in hip and vertebral fractures among individuals in their mid-1970s and older, judicious use of anti-osteoporotic agents among these individuals could be useful for lowering the occurrence of these fractures.

DOI： 10.1007/s00774-018-0937-9

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BACKGROUND: The purpose of this study is to measure pelvic morphology with respect to the pelvic incidence, pelvic tilt, and sacral slope using 3-dimensional measurement and to compare the pelvic morphology between the normal population and women with developmental dysplasia of the hip (center-edge angle, <25°). We hypothesized that the relationship between pelvic incidence, anatomical pelvic tilt, and anatomical sacral slope would be different between normal subjects and patients with developmental dysplasia of the hip. METHODS: We evaluated 61 healthy women without low back or knee pain and 71 patients with developmental dysplasia of the hip. We used the 3-dimensional pelvis model adjusted to the anterior pelvic plane and measured the pelvic parameters. To determine correlation, we used Pearson's coefficients. To evaluate variation, we used intraclass correlation coefficients. RESULTS: Pelvic incidence and anatomical pelvic tilt were significantly greater by 4° in the group with developmental dysplasia of the hip than in the normal group (p = 0.026 and < 0.001, respectively). The vertical distance from hip axis to the center of the S1 endplate was significantly greater in the group with developmental dysplasia of the hip than in normal group, that is, by 8 mm (p < 0.001). There was a strong correlation between pelvic incidence and anatomical sacral slope in both groups (R = 0.707 and 0.897, respectively). The intraobserver and interobserver mean absolute differences were about 2 mm and 2°, respectively, and the intraclass correlation coefficient was >0.88. CONCLUSION: Pelvic incidence and anatomical-pelvic tilt were significantly greater in patients with developmental dysplasia of the hip. We found a strong correlation between the pelvic incidence and anatomical sacral slope in both groups. Therefore, anatomical-sacral slope may be useful for estimating pelvic incidence because it is not easily measured, especially in patients with osteoarthritis of the hip joint.

DOI： 10.1016/j.jos.2018.05.004

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We investigated the incidence of hip fracture in patients aged ≥50 years in 2015 in Niigata Prefecture, Japan. We also determined the long-term trend in hip fracture incidence from 1985 to 2015. In 2015, 3214 hip fractures occurred in Niigata Prefecture. The crude incidence rate of hip fracture was 282.7 per 100,000 persons per year (122.9 in men and 416.4 in women). The incidence of hip fracture decreased from 2010 to 2015 in all age groups except in men aged 65-69 years and women aged 60-64 years. The percentage of patients who took anti-osteoporotic medication before their hip fractures increased from 10.2% in 2010 to 14.9% in 2015. The age-specific incidence in women tended to increase until 2010, but significantly decreased from 2010 to 2015 (p < 0.001). Similarly, the incidence in men decreased from 2010 to 2015 but was not significantly different from that in 1994 (p = 0.633); this incidence had been increasing since 1999. In conclusion, a generally increasing trend was observed in the incidence of hip fractures for 30 years in both men and women in Niigata Prefecture; however, it turned into a descending trend beginning in 2010.

DOI： 10.1007/s00774-017-0863-2

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BACKGROUND: We previously described that the anteroposterior (AP) axis of the tibia is approximately perpendicular to the transverse axis of the anterior pelvic plane (APP) in the standing position in healthy subjects. The purpose of this study was to investigate the rotational alignment between the APP and clinical epicondylar axis and the AP axis of the tibia relative to pelvic coordination in the standing position in normal subjects and in women with developmental dysplasia of the hip (DDH) to aid decision making for surgeons in the alignment of implants in total hip or knee arthroplasty. METHODS: This study included 77 Japanese women. Twenty-nine in the DDH group underwent curved periacetabular osteotomy; 48 women without lumbago and knee pain were included in the normal group. Femoral neck anteversion (FNA), condylar twist angle, and knee rotation angle were measured in femoral coordination. The angle between the femoral neck axis and clinical epicondylar axis (CEA) was measured, the transverse axis of the APP was also measured, and the angle between the AP axis of the tibia and transverse axis of the APP was calculated. RESULTS: There was a moderate negative correlation between FNA and CEA relative to the APP. This finding indicated a trend towards greater FNA leading to more internal rotation. Knee rotation angle (KRA) relative to the APP was 1.65° ± 5.58° in the normal group and - 2.65° ± 7.57° in the DDH group. This finding indicated that the tibia AP axis was approximately perpendicular to the APP in the standing position both in the normal and DDH groups. CONCLUSION: We found that the tibia AP axis was at approximately a right angle to the transverse axis of the APP in the standing position in both the normal and DDH groups, while the KRA was different in the normal and DDH groups. These findings may prove helpful for positional alignment investigations needed for implantation in total hip or knee arthroplasty and gait analysis.

DOI： 10.1186/s13018-018-0816-z

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BACKGROUND: We previously reported that the clinical epicondylar axis (CEA) was approximately parallel to the transverse axis of the anterior pelvic plane (APP) in the standing position in normal subjects. The purpose of this study was to investigate the rotational alignment between APP in the standing position and the anteroposterior (AP) axis of the tibia relative to pelvic coordination in normal subjects. METHODS: This study included 68 healthy Japanese, 24 males and 44 females, without lumbago and knee pain. Femoral neck anteversion (FNA), condylar twist angle, and knee rotation angle were measured in femoral coordination. The angle between the femoral neck axis and CEA transverse axis of APP was also measured, and the angle between the AP axis of the tibia and the transverse axis of APP was calculated. The mean value of knee rotation angle was 0.23° and 2.06° in male and female subjects, respectively. RESULTS: There was a moderate positive correlation between FNA and the femoral axis angle relative to the transverse axis of APP. The knee rotation angle relative to APP was 0.33° and 1.56° in male and female subjects, respectively, and the tibia AP axis was approximately perpendicular to the transverse axis of APP in the standing position. Regarding validation, we obtained high interclass correlation coefficients for both intraobserver and interobserver reliability. CONCLUSION: We found that the knee rotation angle was almost 0° and that the tibia AP axis was approximately perpendicular to the CEA. The tibia AP axis was also approximately perpendicular to the transverse axis of the APP in standing position.

DOI： 10.1186/s13018-017-0642-8

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BACKGROUND: Venous thromboembolism is one of the general complications following total hip arthroplasty, wherein various preventive treatments have been recommended. Several studies reported that venous thromboembolism incidence after total hip arthroplasty was similar in patients who were administered prophylaxis with a conventional mechanical procedure alone, and those who were administered pharmacological anticoagulation therapy. Therefore, the optimum methods of prophylaxis are still controversial. The purpose of this study was to investigate whether manual calf massage and passive ankle motion could lower the risk for venous thromboembolism after total hip arthroplasty. METHODS: We retrospectively reviewed the data of 126 consecutive patients undergoing elective primary unilateral total hip arthroplasty wherein manual calf massage and passive ankle motion were performed after the surgery at our hospitals between January and October 2014. The 138 patients of the control group underwent total hip arthroplasty using the same surgical approach and pre- and postoperative protocols without this mechanical prophylaxis between January and December 2013. This mechanical prophylaxis was performed simultaneously 30 times during approximately 10 s; these procedures were repeated thrice immediately after total hip arthroplasty. Duplex ultrasonography was performed to observe the veins of both legs in all the patients on postoperative day 7. RESULTS: The incidence of deep vein thrombosis was 6.52% and 0.79% in the control and manual calf massage and passive ankle motion groups, respectively. The odds ratio for the manual calf massage and passive ankle motion groups was 8.72. Performing this mechanical prophylaxis reduced the incidence of venous thromboembolism after total hip arthroplasty. This mechanical prophylaxis is not only simple and easy, but is also safe and inexpensive. CONCLUSIONS: We therefore recommend that manual calf massage and passive ankle motion be performed in patients who will undergo total hip arthroplasty, if deep vein thrombosis does not exist before the surgery.

DOI： 10.1016/j.jos.2017.03.006

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Plasma D-dimer level is clinically useful for diagnosing patients with suspected deep vein thrombosis (DVT). However, the cut-off value for the D-dimer level remains controversial and undetermined with regard to total hip arthroplasty (THA). The objective of this study was to estimate the efficacy of an age- and D-dimer-based index for diagnosing DVTs in asymptomatic cases before THA. We enrolled 224 patients with no symptoms associated with DVT before THA. All the patients underwent ultrasonography, and the plasma D-dimer level was recorded about 1 month preoperatively. The optimal cut-off value was calculated using multiple logistic regression and receiver operating curve analyses. DVTs were detected in 13 patients (5.8%) using ultrasonography. Multiple logistic regression analysis demonstrated that age (odds ratio [OR]: 1.13; p = 0.007) and D-dimer value (OR: 1.74; p = 0.003) were related to the existence of preoperative DVT. A DVT index (0.12 × age + 0.45 × the D-dimer value) of 8.15 was the most reasonable cut-off value according to the receiver operating curve analysis. This value caused 100% sensitivity and 70.1% specificity, with an area under the curve (AUC) of 0.905 (range, 0.836-0.975). For age and D-dimer value, the AUCs were 0.828 (0.749-0.907) and 0.716 (0.522-0.910), respectively. This study demonstrated that age and D-dimer index can be useful in screening patients for DVTs before THA. This DVT index is also easy to calculate and may be clinically significant.

DOI： 10.1371/journal.pone.0172849

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Due to the increasing elderly population, the prevalence of osteoporotic hip fractures in Japanese patients continues to rise. It is well established that patients with either hip fracture or both symptomatic and asymptomatic morphometric vertebral compression fracture (VCF) have a poor health prognosis compared with the general population. The purpose of this study was to retrospectively investigate vertebral fracture rates among patients with hip fracture and their influence on mortality. We examined 182 cases of osteoporotic hip fracture in patients admitted to our institution between January 2009 and May 2011. The average age at the time of fracture was 85 years. Radiographs of the lumbar spine were obtained from all of the participants and the lateral spinal radiographs were examined for evidence of VCF. The patients were classified into two groups, those with VCF and those without. A VCF was identified in approximately 78 % of the patients. The mortality rate 1 year after the hip fracture was approximately 22 % and it was significantly higher in patients with VCF. Through multivariate statistics we found that VCF, post-operative complication, loss of ambulation after operation and medication for osteoporosis were statistically significant. In other words, VCF, post-operative complication and loss of ambulation were considered to be poor prognostic factors and medication for osteoporosis was likely to improve the prognosis. We concluded that the risk of mortality after hip fracture is significantly greater in patients who also have VCF compared to patients without VCF, and that medication for osteoporosis is likely to improve prognosis.

DOI： 10.1007/s00774-014-0640-4

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We investigated the incidence of hip fracture in a population of patients ≥50 years old in 2004 and 2010 in Niigata City, Niigata Prefecture, Japan. We also investigated the long-term trends in the incidence of hip fracture from 1985 to 2010, using our previously reported survey results obtained from 1985 to 1999. In 2004 and 2010, the survey found 2,368 and 3,218 proximal femur fractures, respectively. The crude hip fracture incidence rates in 2004 and 2010 were 215.8 and 281.5 per 100,000 of population per year, respectively. For males, the incidence rates were 99.9 in 2004 and 126.3 in 2010; for females, the incidence rates were 311.0 and 410.7, respectively. In males aged 80-84 years, the incidence rate since 1999 has been decreasing, while that for males >85 years peaked in 2004. In females of all ages, the incidence rate was higher in 2010 than in all other survey periods, and in females >85 years, the incidence has increased the fastest. Additionally, the long-term changes in the age- and sex-standardized incidence each year using the 1985 population structure in Japan in females has been increasing, although it decreased in 1999. However, in males, the incidence in 2010 was not significantly different from that in 1994, although it has been increasing since 1999. Our study findings indicate that the age-specific incidence of hip fractures in the Niigata Prefecture of Japan has not plateaued in females, but that it may have done so in males; in addition, the number and incidence of hip fractures has been increasing.

DOI： 10.1007/s00774-015-0648-4

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BACKGROUND: Pelvic flexion affects orientation of the acetabular cup; however, pelvic position is not static in daily activities. During THA it is difficult to know the degree of pelvic flexion with the patient in the lateral position and that position is static. However, surgeons need to appropriately determine pelvic tilt to properly insert the acetabular component. QUESTIONS/PURPOSES: We investigated the reliability of pelvic flexion angle that was measured by manually identifying the location of the pubic symphysis and bilateral anterior superior iliac spines using synthesized lateral radiographs. METHODS: We synthesized 49 lateral radiographs based on CT data. Each of the 49 radiographs had a unique position: 7° of varying lateral tilt and rotation in each of seven selected pelvic flexion angles. The pelvic flexion angle was measured three times by three independent observers in each position and determined the accuracy (based on the true value from the reconstructions) and reliability of the measures. RESULTS: The measurement error was 0.1° (range, -4.8° to 4.0°). There was a tendency for errors when the pelvic flexion angle was 0° or ±5°; the errors were less when the pelvic flexion angle was ±10° or ±20°. Lateral tilt was associated with greater error than rotation. The intraclass correlation coefficient (ICC) of the average value was 0.967. For one observer, more than two measurements are necessary for the ICC to be greater than 0.8, and only one measurement was needed for two of the three observers. CONCLUSIONS: Our data suggest measurement of pelvic flexion angle using lateral radiographs is reliable. We recommend the measurement be performed once by two observers for better reliability.

DOI： 10.1007/s11999-012-2700-1

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In this study, we evaluated the hemostatic effects of tranexamic acid (TNA), an antifibrinolytic drug, by examining the timing of its administration during total hip arthroplasty. One hundred seven patients being treated for osteoarthritis of the hip joint were randomly divided into 5 groups based on the timing of TNA administration. The intraoperative blood loss, postoperative blood loss, and hemoglobin of these patients who received TNA at different times during the procedure were monitored. We found that the intraoperative blood loss in the preoperative TNA administration groups was significantly lower than both control and postoperative TNA administration groups. Furthermore, 1 g TNA 10 minutes before surgery and 6 hours after the first administration was most effective for the reduction of blood loss during total hip arthroplasty.

DOI： 10.1016/j.arth.2012.04.024

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