Document Type : RESEARCH PAPER
Mediclinic City Hospital, Dubai Healthcare City, Dubai, UAE
Background: This study aimed to determine whether combined intravenous (IV) and intraarticular (IA) Tranexamic
acid (TXA) reduces blood loss and the requirement of blood transfusion, compared to IA use alone in the middle eastern
patients undergoing primary cemented unilateral Total knee arthroplasty (TKA).
Methods: The present study is a double-blind randomized controlled trial (RTC) comparing the efficacy of IA alone
to combined IA and IV routes of TXA administration in patients undergoing primary cemented TKA using a tourniquet
performed by two senior surgeons. There were 21 patients in the IA alone and 29 in the combined group. The primary
outcome measure was a blood transfusion requirement, hemoglobin drop, and the total estimated blood loss on day
three postoperative period. The secondary outcomes were complications, including thromboembolic events, wound
complications, periprosthetic infection, patient-reported outcomes (PROs) of pain visual analog scale (VAS), Western
Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and EuroQol 5-dimension (EQ-5D), as well as the
range of motion (ROM), at one-year follow-up.
Results: None of the patients in either comparison group required blood transfusion in the perioperative period. The
drop in hemoglobin levels (2.1±1.0 vs. 2.2±1.1, P=0.84) and the total estimated blood loss (884±489 vs. 877±324,
P=0.96) on the third postoperative day in the IA alone group showed no statistically significant difference compared
to that in the combined group. Moreover, there were no complications noted in patients of either group. At one-year
follow-up, there was no significant difference between the two comparison groups regarding the mean PROs of pain
VAS, WOMAC, and EQ-5D, as well as ROM.
Conclusion: According to the obtained results, this RCT in the middle eastern patient population found no additional
benefit of TXA administration through combined IV and IA route over the IA alone in reducing the requirement of blood
transfusion and the total blood loss. Further similar studies with larger sample sizes are needed to ascertain the ideal
route of TXA administration in patients undergoing primary TKA.
Level of evidence: I