Abstract
Background:The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. Bleeding may cause local complications consequently greater pain and reduced function postoperatively. No study has related the use of TXA to these facts.Objective:The aim was to evaluate the effects of TXA haemoglobin, Western Ontario and McMaster Universities Index (WOMAC), pain intensity and flexion gain after TKA.Methods:43 patients were randomized and then underwent TKA. TXA was applied to 22 of these patients before closure of the joint capsule. Haemoglobin measurements (mg/dL) were taken preoperatively and 24 and 48 hours after surgery. The WOMAC questionnaire and pain visual analogue scale (VAS) were applied, and flexion gain was measured up to the second postoperative month. Statistical analysis compared the results to determine whether there were differences between the groups for each of the evaluated times.Results:There were differences in favour of the drug 48 hours postoperatively for the haemoglobin variable (p = 0.01), in pain evaluation, 24 and 48 hours, postoperatively (p < 0.01) and in flexion gain, 24 hours after surgery (p = 0.03). There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively, in pain assessment 7 days, 21 days and 2 months, postoperatively, in flexion gain 48 hours, 7 days, 21 days and 2 months, postoperatively and in WOMAC after 2 months.Conclusion:In addition to reducing bleeding, topical TXA improved pain and increased flexion gain in the first hours after TKA.Trial Registration:RBR-9b4qgq
Highlights
Total knee arthroplasty (TKA) is the ideal surgical option for treating severe pain in the arthritic knee [1]
There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively, in pain assessment 7 days, 21 days and 2 months, postoperatively, in flexion gain 48 hours, 7 days, 21 days and 2 months, postoperatively and in WOMAC after 2 months
Calculation of the statistical power of the sample was achieved using the sampsi command of the STATA software package, version 11, based on the method proposed by Frison and Pocock [29] for a group comparison design with repeated measures. 5% significance level was adopted, and upon varying the test power, we found that 20 patients per group would guarantee a power of at least 95% for comparisons [29]
Summary
Total knee arthroplasty (TKA) is the ideal surgical option for treating severe pain in the arthritic knee [1]. Approximately 20% of patients with surgical indications have preoperative anaemia and, are at a relatively higher risk of requiring blood transfusion [2, 3]. Intraoperative homeostatic control is important and can avoid possible procedural and transfusion complications in patients with anaemia in the postoperative period [2, 4]. TXA is a synthetic product that is inexpensive and accessible [8, 10 - 12], with good results in cardiac surgery. It has attenuated haemostatic disorders for over 20 years [20]. The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. No study has related the use of TXA to these facts
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