The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Comparison of Combined Intraarticular and Intravenous Administration of Tranexamic Acid with Intraarticular and Intravenous Alone in Patients Undergoing Total Knee Arthroplasty without Drainage Catheter: A Clinical Trial Study

Document Type : RESEARCH PAPER

Authors
Nima Bagheri
Mohammad Amin Amini
Arezu Pourahmad
Farzad Vosoughi
Alireza Moharrami
SM Javad Mortazavi
Joint Reconstruction Research Center, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2022.64446.3097
Abstract
Objectives: We aimed to assess the most effective route for Tranexamic acid (TXA) administration 
among Intraarticular (IA), Intravenous (IV), and combined IA/IV for Total Knee Arthroplasty (TKA) 
surgeries.
Methods: A double-blinded clinical trial was run on 147 TKA candidates. Blood loss and hemoglobin (Hb) drop were 
evaluated using the Gross and Nadler formula in three matched case groups administered TXA during the TKA 
through IV, IA, or combined IA/IV route. Tourniquet was used on all operations for controlling intraoperative blood 
loss. No drainage catheter was used for the cases. 
Results: The combined group showed an average blood loss of 630±252 ml, which was significantly lower than 
that in the IV group (878±268 ml, P<0.01) and the IA group (774±288 ml, P=0.03). Furthermore, the mean Hb and 
hematocrit drop were significantly lower in the combined group, compared to the other two groups, 48 and 72 h 
postoperatively (P<0.05).
Conclusion: The combined IA/IV route had a 28% and 19% reduction of blood loss, compared to the IV or IA 
methods, respectively. Therefore, using TXA via the combined IA/IV route may be more effective for reducing 
perioperative blood loss following TKA surgery using a tourniquet without drain placement.
 Level of evidence: I
Keywords
Blood loss
Surgical
Total knee arthroplasty
Tranexamic acid
Subjects
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The Archives of Bone and Joint Surgery
Volume 11, Issue 9
September 2023
Pages 570-576

  • Receive Date 10 April 2022
  • Revise Date 01 October 2022
  • Accept Date 02 October 2022