Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty

Abstract

Purpose: This is a randomised controlled trial to examine whether intra-articular injection of tranexamic acid (TXA) decreases blood loss, as well as reducing leg swelling after total knee arthroplasty (TKA).

Methods: We performed 100 TKA in osteoarthritis patients. At closure, a total of 2,000 mg/20 ml TXA was injected into the knee joint through a closed suction drain (TXA group). For the control group, the same volume of physiological saline was injected. The pre-operative condition of the patients, post-operative haemoglobin (Hb) levels, discharge volumes from drain, D-dimer and needs for transfusion were compared between these two groups. Furthermore, leg diameters (thigh, suprapatellar portion and calf girth) were measured pre- and post-operatively to investigate whether TXA has an influence on leg swelling after surgery.

Results: The results revealed that post-operative decrease in Hb level was significantly reduced in the TXA group. Furthermore, knee joint swelling after operation was significantly suppressed in the TXA group compared to the control group.

Conclusions: The results revealed intra-articular administration of TXA decreased not only blood loss, but also knee joint swelling after TKA.

Fig. 1

The mean post-operative reduction in the Hb level for the two groups. In both groups, the Hb level had its minimum peak at 1 week post-operation and recovered gradually. The reduction in Hb levels was significantly decreased in the TXA group compared to the control group by 2 weeks post-operation (*p < 0.01; +p < 0.05) (solid line control group, broken line TXA group)

Fig. 2

The mean post-operative reduction in the Hb level at the different time points. A significantly decreased reduction in Hb level was seen from pre-operation to 1 day post-operation (*p < 0.01) (solid line control group, broken line TXA group)

Fig. 3

The mean discharge volumes from the drain. The discharge volumes from the drain in the TXA group had significantly diminished compared to the control group by 24 h post-operation. The volume in the TXA group increased thereafter, and finally, the total volumes of the drain fluid were approximately the same among these two groups (*p < 0.001; +p < 0.01) (solid line control group, broken line TXA group)

Fig. 4

The mean discharge volume increment from the drain. The drain volumes in the TXA group were remarkably diminished at between 0–1, 1–3 and 3–6 h post-operation; however, the volume increment in the TXA group had significantly increased at between 12 and 24 h, and thereafter in contrast (*p < 0.01; +p < 0.05) (solid line control group, broken line TXA group)