Does Multiple Intravenous Tranexamic Acid Doses in Patients Undergoing Total Knee Arthroplasty using Kinematic Alignment without Tourniquet Application show any Difference in Blood Loss, Transfusion Requirements and Hospital Stays: A Randomized Controlled Study.

Abstract

Introduction: Total knee arthroplasty (TKA) is a highly effective treatment for patients with severe knee osteoarthritis, but it often results in significant blood loss, which can lead to complications. Tranexamic acid (TXA) is widely used to reduce blood loss during surgeries, including TKA. However, its effectiveness in the context of kinematic alignment without a tourniquet has not been well-studied, particularly within the Indian population.

Objective: This study aimed to evaluate the impact of multiple intravenous doses of TXA on blood loss, transfusion requirements, and hospital stays in patients undergoing TKA with kinematic alignment without a tourniquet.

Materials and methods: A randomized controlled trial was conducted with 60 patients aged 50-75 years undergoing unilateral primary TKA. Participants were randomly assigned to three groups: Group A (single dose of TXA and two doses of saline), Group B (single dose of TXA and two doses of TXA), and Group C (three doses of TXA). Blood loss, hemoglobin (Hb) levels, packed cell volume (PCV), and length of hospital stay were measured preoperatively and on post-operative days 1 and 3.

Results: The results showed a significant reduction in blood loss across all groups, with Group C (multiple doses of TXA) showing the greatest reduction in Hb and PCV levels, though no significant differences were found between groups. The total blood loss and maximum Hb drop were similar between groups. No patients required blood transfusions, and there were no major complications such as deep vein thrombosis or pulmonary embolism. Length of hospital stay was not significantly different between groups.

Conclusion: Multiple intravenous doses of TXA in patients undergoing TKA with kinematic alignment and without a tourniquet reduced blood loss, but the reduction was less than reported in studies involving conventional TKA with tourniquet use. Additional doses of TXA did not significantly affect blood loss, transfusion requirements, or hospital stay. Further research with larger sample sizes is needed to confirm these findings and explore optimal strategies for blood management in TKA.