EFFECT OF THE DRAINED-CLAMPED METHOD WITH INTRA-ARTICULAR INFUSION OF TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY - A RANDOMIZED PROSPECTIVE STUDY

Abstract

Objective The purpose of this study was to evaluate the efficacy and safety of the drained-clamped method with intra-articular infusion of tranexamic acid (TA) for reducing blood loss in total knee arthroplasty (TKA). Material and Methods From November 2011 to July 2014 inclusive, 72 patients with a diagnosis of osteoarthritis underwent unilateral primary TKA using a computed tomography (CT) free navigation system. Patients were randomly divided into two groups: group T (n=40) was given 2000 mg (40 ml) of TA and group W (n=32) was given 40 ml sterile saline only. All operations were performed under total anaesthesia through the medial mid-vastus approach. Cemented posterior stabilised or cruciate retaining prostheses were used. The patella was resurfaced. After tourniquet release and wound suture, TA or saline was infused into the knee joint in addition to the drained-clamped method for 2 hours. For VTE prophylaxis, all patients received bilateral intermittent pneumatic calf compressors, thromboembolic deterrent stockings, and subcutaneous injection of enoxaparin (4000IU daily). We evaluated the hematocrit, hemoglobin and the postoperative estimate of bleeding. At postoperative days 4, extremity venous ultrasonography was performed for the investigation of venous thromboembolism in the latest 40 patients and contrast-enhanced CT was performed in the latest 34 patients without a previous history of asthma and diminished renal function. The present study received institutional review board approval, and informed consent was obtained from all patients. Results Group T had lower hematocrit and hemoglobin levels at postoperative day 1. Group T had higher hemoglobin levels at postoperative days 3 and 7, respectively. The postoperative estimate of bleeding in group T was 739.2 ± 318.9 ml on average, which was significantly less than group W which was 999.8 ± 414.1 ml (p The rate of asymptomatic deep vein thrombosis and pulmonary embolism was 57.1% and 29.4% in group T, and 36.8% and 11.8% in group W, respectively. There were no significant differences between the two groups. Conclusion The drain-clamped method with intra-articular infusion of TA was safe and effective for reducing the amount of blood loss in TKA, without increasing the risk of VTE.