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Should We Use Intra-articular Tranexamic Acid Before or After Capsular Closure During Total Knee Replacement? A Study of 100 Knees

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Intraarticular (IA) administration of tranexamic acid (TXA) is a proven way of reducing blood loss in total knee replacement (TKR). However, different methods of administration have been described in literature such as placement of an intra-articular swab soaked in TXA before capsular closure or injecting TXA intraarticularly after capsular closure. We decided to compare these two methods.

Materials and Methods

One hundred consecutive patients planned for unilateral TKR between December 2018 and March 2019 were selected for the study and divided into 2 groups of 50 patients each. All patients received IV and oral TXA identically—15 mg/kg TXA IV preoperatively, 10 mg/kg IV TXA at 3 and 6 h postoperatively, and 1 g oral TXA for the next 2 days. Group A was given IA TXA via swab soaked with 1 g TXA in 100 ml normal saline (NS) before closure of arthtrotomy, while Group B was given 1 g of IA TXA via injection in the knee after capsular closure. Preoperative haemoglobin (Hb) and postoperative day 4 Hb values were measured. Blood loss was calculated and compared in both groups using Mann Whitney test.

Result

The mean blood loss was 652.23 ± 64.36 ml in Group A and 542.68 ± 266.23 ml in Group B. The difference in blood loss between both groups was found to be clinically significant with a p-value of 0.03236 (significant, p < 0.05).

Conclusion

Injecting TXA intraarticularly after capsular closure is more effective than using an intra-articular swab containing TXA.

Level of Evidence

Level III Retrospective Comparative study.

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Abbreviations

TKR:

Total knee replacement

TXA:

Tranexamic acid

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

IV:

Intra-venous

IA:

Intra-articular

tPA:

Tissue plasminogen activator

Hb:

Haemoglobin

BMI:

Body mass index

PBV:

Patient’s blood volume

DM:

Diabetes mellitus

HTN:

Hypertension

CABG:

Coronary Artery Bypass Graft

ACB:

Adductor Canal Block

TED:

Thrombo Embolic Deterrent

SC:

Subcutaneous

LMWH:

Low molecular weight heparin

GI:

Gastro-intestinal

NS:

Normal saline

ROM:

Range of movement

RBCs:

Red blood cells

Kg:

Kilogram

g:

Gram

mg:

Milligram

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Authors and Affiliations

  1. Orthopedics Department, SR Mehta and KP Institute, Mumbai, India

    Vatsal Khetan, Nilen Shah & Priyank Pancholi

  2. 105 Saraf Residency, Gorakhpur, Uttar Pradesh, 273001, India

    Vatsal Khetan

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  1. Vatsal Khetan
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Contributions

VK: data collection, analysis and paper writing. NS: senior surgeon, paper editing. PP: data collection. This manuscript has been read and approved by all authors. This article is our original work.

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Correspondence to Vatsal Khetan.

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Khetan, V., Shah, N. & Pancholi, P. Should We Use Intra-articular Tranexamic Acid Before or After Capsular Closure During Total Knee Replacement? A Study of 100 Knees. JOIO 56, 103–109 (2022). https://doi.org/10.1007/s43465-021-00380-y

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