Role of intra-articular tranexamic acid in reducing blood loss in total knee arthroplasty

Abstract

Abstract Background Total knee arthroplasty (TKA) is associated with postoperative blood loss. Tranexamic acid (TXA) administration is an effective strategy used to reduce the blood loss. This study aimed to evaluate the effect of intra-articular injection of TXA on blood loss and transfusion rate after an elective TKA. Patients and methods This was a randomized controlled clinical trial adopted to fulfill the purpose of this study. The study was conducted at Benha Health Insurance Hospital and Benha University Hospitals. It was conducted on 42 adult patients who underwent an elective primary unilateral total knee arthroplasty (TKA) through midline incision with medial parapatellar approach after tourniquet application. Patients were categorized into two groups: control group (without TXA), and intra-articular (IA) group who received 1.5 gm of TXA in 10 ml of normal saline injected into the joint after packing, lavage, hemostasis and closure of the muscle layer just before the deflation of the tourniquet to guarantee maintenance of the injected fluid inside the joint. Demographic data and age, sex, comorbidities, and preoperative hemoglobin levels were collected. The maximum hemoglobin decline was the primary outcome, while the drain’s blood amount (cc/day), the rate of blood transfusion, and the duration of hospital stay were secondary outcomes. Results Patients who received Intra-articular TXA had statistically significant lower drop in hemoglobin level (0.99 + 0.45 mg/dl) compared to their control group (2.14 + 1.07 mg/dl) (P<0.001). Conclusion TXA is a safe and efficient way to reduce overall blood loss in TKA patients, according to data from this study and the literature. Administration intraarticular seems to be significantly effective in reducing postoperative blood loss without increasing the risk of thrombotic events.