Efficacy and safety evaluation of intra-articular injection of tranexamic acid in total knee arthroplasty operation with temporarily drainage close

Abstract

Objective: To investigate the efficacy and safety of tranexamic acid (TXA) injection during primary total knee arthroplasty (TKA) for reducing postoperative hemorrhage.

Methods: 100 cases of patients admitted to our hospital and underwent primary unilateral TKA from January 2012 to December 2014 were enrolled in this study and they were divided randomly into two groups. For the TXA group, 1 g TXA was dissolved in 50 ml 0.9% sodium chloride solution and injected after prosthesis implantation but before cavity close. Conventional drainage clamping was carried for 4 h and the drainage tube was removed 48 h postoperative. For the control group, similar measures were taken except for that no TXA was dissolved in 0.9% sodium chloride solution. Postoperative hemoglobin, blood coagulation index, total blood loss volume, drainage volume, blood transfusion rate and lower extremity deep vein thrombosis (DVT) rate in both groups were observed and the efficacy and safety of this surgical treatment were evaluated.

Results: There were no significant differences in operation time, postoperative platelet and APPT, D-dimer, lower limb venous thrombosis incidence rate 1 week after operation between the two groups. Postoperative drainage volume, hemoglobin, total blood loss and blood transfusion rate in the TXA group were significantly lower than those of the control group. Ecchymosis of lower extremity peripheral incision and its surroundings was significantly milder than that of the control group.

Conclusion: Intraoperative intra-articular injection of TXA in TKA can significantly reduce the initial postoperative hemorrhage and blood transfusion rate at the early stage after operation.

Keywords: Arthroplasty; hemorrhage; knee; replacement; tranexamic acid; venous thrombosis.

Figure 1

Preoperative and postoperative ultrasonography of patients in TXA and control groups. Preoperative ultrasonography of patients in TXA group (A) and control group (C). Ultrasonography of 1 week after surgery in patients of TXA group (B) and control group (D).

Figure 2

General condition of wound healing after operation. Ecchymosis surrounding incision (A) and in the thigh (B) was found in patients of control group while no ecchymosis was found in patients in TXA group (C).