Abstract
BackgroundThere are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA.MethodsRandomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared.ResultsTotally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best.ConclusionsOur meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.
Highlights
There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA)
TKA leads to excessive perioperative blood loss, which can result in anemia and blood transfusions [3]
The search range extended from the establishment to December 2019, with the use of combinations of keywords, i.e., total knee replacement, tourniquet, tranexamic acid, total knee arthroplasty, and randomized controlled trial (RCT)
Summary
There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). We studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Total knee arthroplasty (TKA) remains one of the most successful orthopedic operations to relieve pain and improve function in patients with arthritis [1]. Allogenic transfusion is the standard method for managing acute blood loss following TKA [4]. Many blood preservation strategies have been proposed to reduce the operation-related blood loss and minimize the risk of postoperative blood transfusion, such as the use of the antifibrinolytic medication tranexamic acid (TXA) and application of a tourniquet [6, 7]
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