Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 20, Issue 12, pp 2494–2501 | Cite as

Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty

  • Shuvendu Prosad RoyEmail author
  • Umair Firdos Tanki
  • Amitabh Dutta
  • Sumit Kumar Jain
  • Onkar Nath Nagi



The surgical stress of total knee arthroplasty (TKA) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity, which contributes significantly to post-operative blood loss. Tranexamic acid, an antifibrinolytic drug, is commonly used to control post-operative blood loss. The recommended mode of administration of tranexamic acid is either oral or intravenous. However, the mechanism of action of the tranexamic acid points towards the possible effectiveness it may have following local/intra-articular application. This prospective, double-blinded, randomized preliminary study evaluated the efficacy of intra-articular tranexamic acid in reducing TKA-associated post-operative blood loss.


Fifty consenting patients with osteoarthritis of the knee scheduled for primary unilateral cemented-TKA were randomly allocated to one of the two groups: Tranexamic Acid (TA) group (n = 25, 500 mg/5 ml tranexamic acid) and the control group (n = 25, 5 ml 0.9% saline). The drug and control solution were administered intra-articularly through the drain tube immediately after the wound closure. Parameters related to blood loss (drop in haemoglobin, haematocrit differential) and the drain output [volume (ml)] were compared between the two groups.


On a comparative basis, TA-group obtained significant reduction in the drain output [95% CI: 360.41–539.59, p < 0.001] at 48 h post-operatively. Even though the control group received sixfold more blood transfusion than TA-group, it showed a greater drop in haemoglobin and haematocrit (p < 0.05).


Local application of tranexamic acid seems to be effective in reducing post-TKA blood loss as well as blood transfusion requirements.

Level of evidence

Therapeutic study, Level II.


TKA Tranexamic acid Blood loss Blood transfusion 



We thank Ms. Parul Takkar Chugh, statistician, for statistical analysis of data and its interpretation.

Conflict of interest

There is no potential conflict of interest of any of the authors in relation to this manuscript.

Ethical standard

The study was conducted after Institutional Ethics Committee approval.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Shuvendu Prosad Roy
    • 1
    Email author
  • Umair Firdos Tanki
    • 2
  • Amitabh Dutta
    • 3
  • Sumit Kumar Jain
    • 1
  • Onkar Nath Nagi
    • 1
  1. 1.Joint Replacement and Reconstruction UnitSir Ganga Ram HospitalNew DelhiIndia
  2. 2.Department of OrthopaedicSir Ganga Ram HospitalNew DelhiIndia
  3. 3.Department of Anaesthesiology, Pain and Perioperative-MedicineSir Ganga Ram HospitalNew DelhiIndia

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