Percutaneous intra-articular tranexamic acid following total knee arthroplasty without drainage to reduce blood loss

E Gericke,J De Beer,M Deacon,Lc Marais

doi:10.17159/2309-8309/2020/v19n2a3

E Gericke, J De Beer + Show 2 more

Open Access

https://doi.org/10.17159/2309-8309/2020/v19n2a3

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Abstract

Background: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect of a combination of these two strategies on total blood loss associated with TKA. Methods: This is a retrospective study conducted on a single surgeon’s data gathered over a two-year period. This study compares the blood loss in two groups of patients. The control group received no antifibrinolytic agents and a drain was inserted, while the study group received TXA and the drain was omitted. Results: A total of 109 patients were included in the analysis, with 86 patients in the study group and 23 patients in the control group. The two groups were compared in terms of pre-operative haemoglobin, American Society of Anesthesiologists (ASA) score and body mass index (BMI). The mean age of the study group was lower than that of the control group (64±8 years vs 68±9 years; p=0.03). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2–312.2; p=0.01). Duration of hospital stay was also reduced in the study group (2.4 days vs 3.1 days; p=0.003). There was, however, no difference in the functional outcome according to the Knee injury and Osteoarthritis Outcome Score (KOOS). Conclusion: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Larger, well-designed studies are required to determine the optimal TXA administration strategy. Level of evidence: Level 4

Highlights

Blood loss is a common and challenging complication in total knee arthroplasty (TKA), which has been reported as ranging from 700 ml to 1 700 ml.[1,2] Substantial blood loss could lead to allogeneic blood transfusion, which in itself may be associated with complications and risks to the patient
The main aim of this study is to assess the effect of the combination of these two strategies, namely, injecting tranexamic acid (TXA) intra-articularly and omitting negative pressure draining post-operatively, on total blood loss associated with TKA
The mean total blood loss was lower in the study group in comparison to the control group

Summary

Introduction

Blood loss is a common and challenging complication in total knee arthroplasty (TKA), which has been reported as ranging from 700 ml to 1 700 ml.[1,2] Substantial blood loss could lead to allogeneic blood transfusion, which in itself may be associated with complications and risks to the patient. Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2–312.2; p=0.01). Conclusion: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Well-designed studies are required to determine the optimal TXA administration strategy

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