Intraarticular Administration of Tranexamic Acid Following Total Knee Arthroplasty: A Case-control Study

Document Type : RESEARCH PAPER


1 Tehran university of medical sciences,Tehran, Iran

2 Yazd university of medical sciences, Yazd, Iran


 Tranexamic acid (TXA) has received extensive attention in management of blood loss in orthopedic surgeries. However, the ideal method of TXA administration is still controversial. This study aims to determine whether intraarticular injection of TXA reduces blood loss after total knee arthroplasty (TKA).  
 Through a retrospective case-control study consecutive TKA patients receiving intraarticular TXA (Case group) were compared with similar patients undergoing TKA using traditional blood management strategy (Control group). Hemoglobin levels (Hb) before and after the surgery, need for transfusion, and reoperation due to massive blood loss were compared between the two groups.  
 Fifty TXA patients were compared with 50 patients of the control group. There was no significant difference between the two groups in terms of age, gender, and preoperative Hb. Postoperative blood loss and transfusion rate were significantly reducedin TXA patients compared to the control group (P<0.05).
 Our study revealed that intraarticular administration of TXA reduces postoperative blood loss as well as need for blood transfusion in patients undergoing TKA.


  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-5.

  2. Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006; 452:35-43.

  3. Giesinger K, Hamilton DF, Jost B, Holzner B, Giesinger JM. Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthritis Cartilage. 2014; 22(2):184-9.

  4. Sasaki E, Tsuda E, Yamamoto Y, Meada S, Otsuka H, Ishibashi Y. Relationship between patient-based outcome score and conventional objective outcome scales in post-operative total knee arthroplasty patients. Int Orthop. 2014; 38(2):373-8.

  5. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011; 35(11):1639-45.

  6. Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am. 2004; 86(7):1479-84.

  7. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011; 93(12):1577-85.

  8. Mantilla CB, Wass CT, Goodrich KA, Johanns CJ, Kool ML, Zhu X, et al. Risk for perioperative myocardial infarction and mortality in patients undergoing hip or knee arthroplasty: the role of anemia. Transfusion. 2011; 51(1):82-91.

  9. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007; 31(1):39-44.

  10. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010; 113(2):482-95.

  11. Bolton-Maggs PH, Cohen H. Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety. Br J Haematol. 2013; 163(3):303-14.

  12. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011; 1:CD001886.

  13. Banerjee S, Issa K, Kapadia BH, Khanuja HS, Harwin SF, McInerney VK, et al. Intraoperative nonpharmacotherapeutic blood management strategies in total knee arthroplasty. J Knee Surg. 2013; 26(6):387-93.

  14. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999; 57(6):1005-32.

  15. Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee. 2013; 20(5):300-9.

  16. Zhang H, Chen J, Chen F, Que W. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012; 20(9):1742-52.

  17. Krivokuca I, Lammers JW. Recurrent pulmonary embolism associated with a hemostatic drug: tranexamic acid. Clin Appl Thromb Hemost. 2011; 17(1):106-7.

  18. Taparia M, Cordingley FT, Leahy MF. Pulmonary embolism associated with tranexamic acid in severe acquired haemophilia. Eur J Haematol. 2002; 68(5):307-9.

  19. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003; 90(5):596-9.

  20. Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic Acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 2010; 468(7):1905-11.

  21. Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V. Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty. 2013; 28(10):1888-91.

  22. MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty. 2011; 26(1):24-8.

  23. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion. 2005; 45(8):1302-7.

  24. Rosencher N, Bellamy L, Chabbouh T, Arnaout L, Ozier Y. Blood conservation approaches in orthopedic surgery. Transfus Clin Biol. 2008; 15(5):294-302.

  25. Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res. 2009; 123(5):687-96.

Volume 2, Issue 3 - Serial Number 3
September 2014
Pages 141-145
  • Receive Date: 17 August 2014
  • Revise Date: 27 August 2014
  • Accept Date: 01 September 2014
  • First Publish Date: 01 September 2014