New Medications in Joint Replacement

While joint replacement surgery is becoming more and more common, there are constantly changes to the procedures used to make the surgery better, with fewer complications, and less side effects.  New medications are being administered to patients to reduce pain, prevent bleeding, avoid blood clots, and limit the chance of infection. 

Most of the medications listed have only been used with joint replacement surgery in the last few years.  Learn about some of these new medications, and if you should be discussing their use with your surgeon.  There are many risks of joint replacement surgery, and it's in your interest to do everything possible to avoid these potential problems.

1
TXA - Tranexamic Acid

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Tranexamic acid (abbreviated TXA) is a medication used during joint replacement to prevent blood loss.  TXA has long been used in cardiac surgery and other types of procedures.  The medication can be given by IV or it can be applied topically, directly to the site of the surgery.  TXA works by binding to molecules that break up clotted blood.

TXA has been shown in studies to reduce the need for blood transfusions after hip or knee replacement surgery. 

Source:

Memtsoudis SQ, et al. "Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety" BMJ 2014;349:g4829.

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2
Exparel

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Experal is a new type of injected local anesthetic that can provide pain relief for up to 3 days following surgery.  Most local anesthetics last for a few hours, and then wear off.  Exparel is a commonly used local anesthetic that is combined with a special molecular delivery method so that the anesthetic slowly releases for several days.

Exparel is becoming a commonly used treatment given the good pain relief combined with the fact that it is a non-narcotic medication that lasts for several days.

Source:

Barrington JW, et al. "Perioperative pain management in hip and knee replacement surgery" Am J Orthop. 2014 Apr;43(4 Suppl):S1-S16.

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3
Mupirorcin

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Mupirocin is an antibacterial medication that is applied directly to the body to eradicate bacterial colonization that naturally occurs on the surface of the body.  Most often used to treat Staph bacteria in the nasal passages, Mupirocin is shown in some studies to lower the chance of developing an infection after joint replacement surgery.

Typically patients are tested a few weeks before surgery to determine if they are colonized with specific bacteria (MRSA), and if so, they are treated with antibiotic ointment to rid the body of the bacteria.

Source:

Moroski N, et al. "Is Preoperative Staphylococcal Decolonization Efficient in Total Joint Arthroplasty" Journal of Arthroplasty, October 23, 2014.

McKee J. "Preop screening reduces SSI rates after TJA" AAOSNow April 2011.

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4
Xarelto

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New medications are being developed to help prevent blood clots in the large veins of the legs (DVTs) after surgery.  The most commonly used medication for a long time was Coumadin.  This is an oral medication that is easy to take, but required regular blood tests to monitor for effective levels of the medication in the bloodstream.  An injected medication called lovenox became popular because it required no monitoring, but it had to be injected every day--something many patients were uncomfortable doing.  New medications, like Xarelto, are gaining interest because they don't require monitoring and can be taken by mouth.

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5
Ofirmev

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Ofirmev is another name for Tylenol, or acetaminophen. However, Ofirmev is given through an IV, and is effective as a pain relieving medication after surgery.  Side-effects of Tylenol are minimal, and the Ofirmev can often be very helpful when used in combination with other narcotic and non-narcotic pain medications after surgery.  Care must be taken to ensure too much Ofirmev is not administered, as this can be harmful to the liver.

Source:

Barrington JW, et al. "Perioperative pain management in hip and knee replacement surgery" Am J Orthop. 2014 Apr;43(4 Suppl):S1-S16.

More »

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