Efficacy of combined use of intravenous and intra-articular versus intra-articular tranexemic acid in blood loss in primary total knee arthroplasty: A randomized controlled study

Purpose/objectives

This study was conducted to compare the efficacy of preoperative intravenous (IV) and intraoperative topical administration of tranexamic acid versus intraoperative topical administration of tranexamic acid along in reducing blood loss in primary total knee arthroplasty (TKA) subjects. The hypothesis of this study was the combined use of intravenous and Intra-articular injection of Tranexamic acid will be more efficacious than intra-articular administration alone in reducing blood loss in Primary Total Knee Arthroplasty.

Materials and method

A total of 31 subjects were selected and randomized into intervention and control group. The intervention group received both intravenous and intra articular tranexamic acid i.e. Trenexamic acid 1 gm IV injection 15 min before skin incision and Trenexamic acid 1 gm intra articular application intraoperatively after joint capsule closure. Subjects in the control group received only intra articular tranexamic acid i.e. Trenexamic acid 1 gm in 20 ml normal saline using intra articular application after joint capsule closure. Outcome measurements included postoperative surgical site drain output, drop in haemoglobin levels and transfusion rate. Ethics approval was taken from the Medical Research Unit, Armed Forces Medical College, Pune.

Results

The mean total blood (drain output) in the intervention group was 354.5 (±208.22) ml vs. 397.65 (±125.00) ml in the control group. T-test between the two groups on the volume drained post-operatively was not significant (p = 0.482). No subjects in the intervention group required post-operative blood transfusion but one subject from the control group required blood transfusion.

Conclusion

Combined use of intravenous and intraarticular injection tranexamic acid had lesser surgical site bleeding compared to only topical administration, however this was not statistically significant.