Effect of intra-articular injection of tranexamic acid on the effectiveness and safety after blood loss and functional recovery of knee joint arthroplasty

Abstract

Objective To analyze the impact of blood loss and postoperative functional rehabilitation of primary unilateral total knee arthroplasty (TKA) with application of intra-articular traneamic acid (TXA) injection and clamping the drainage tube for 3 h. Methods From February 2014 to Augest 2015, 110 patients with knee osteoarthritis undergoing primary unilateral TKA were randomly divided into TXA group, first control group and second control group. There were 30 patients in the TXA group, 39 patients in the first control group and 41 patients in the second control group. TXA (2.0 g dissolved in 100 ml normal saline) or placebo (100 ml normal saline) was prepared. Patients in TXA group were injected with TXA (2.0 g dissolved in 100 ml normal saline) into intra-articular by drainage tube before deflation of the tourniquet. Patients in first control group and second control group were injected with normal saline (100 ml) into intra-articular by drainage tube before deflation of the tourniquet. In the TXA group and first control group, the drainage tube was clamped for 3 h immediately after injection. In the second control group, the drainage tube was not clamped. Gender, age, and body mass index (BMI) showed no significant differences among the three groups. Results There was statistically significant difference among the three groups in postoperative drainage volume, hidden blood loss, total blood loss, transfusion volume and rate, degree of knee joint swelling, the incidence of postoperative lower extremity ecchymosis area >1%, ROM and knee association score (KSS) function scores on the fifth day and first month after operation, but postoperative venous thrombus embolism showed no statistically significant difference (P=0.971). Conclusion Injection of TXA (2.0 g dissolved in 100 ml normal saline) into intra-articular by drainage tube before deflation of the tourniquet significantly reduced hidden blood loss and transfusion volume and rate in primary TKA and did not increase the risk of venous thromboembolisms or other adverse events, and it is beneficial to the early functional recovery of knee joint after operation. Key words: Tranexamic acid; Arthroplasty; Knee joint; Blood loss; Functional rehabilitation