Tranexamic acid and re-infusion drains in total knee arthroplasty


Blood loss following total knee arthroplasty (TKA) can be significant. Re-infusion drains and tranexamic acid (TA) are used to minimise blood loss and need for allogenic blood transfusion in TKA. The effect of TA on re-infusion volume of drained blood has received little attention. The aim of this study was to measure the effect of TA on re-infusion volumes in primary TKA. A cohort of consecutive patients undergoing primary TKA under one surgeon between November 2006 and January 2008 were studied. Patients operated upon before June 2007 did not receive TA, while those who underwent surgery after June 2007 received TA. All patients had a re-infusion drain. Pre- and post-operative haemoglobin, re-infusion volume and total volume drained were recorded. There was significantly lower drainage volume (average 250 v 600 ml; P < 0.05) and subsequent re-infusion volume (100 v 465 ml; P < 0.05) in the TA group compared to non-TA group. There were no cases of thromboembolism or allogenic blood transfusions in either group. TA decreased post-operative blood loss and subsequent re-infusion volumes. TA is cost-effective compared to re-infusion drains in TKA. Drainage volume was so low when TA was used in primary TKA that the need for re-infusion drains is questionable.

This is a preview of subscription content, log in to check access.


  1. 1.

    Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F (2008) Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 48(3):519–525

    Article  PubMed  Google Scholar 

  2. 2.

    Camarasa MA, Ollé G, Serra-Prat M, Martín A, Sánchez M, Ricós P, Pérez A, Opisso L (2006) Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 96(5):576–582

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Orpen NM, Little C, Walker G, Crawfurd EJ (2006) Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 13(2):106–110. Epub 2006 Feb 17

    Google Scholar 

  4. 4.

    Amin A, Watson A, Mangwani J, Nawabi D, Ahluwalia R, Loeffler M (2008) A prospective randomised controlled trial of autologous retransfusion in total knee replacement. J Bone Joint Surg Br 90(4):451–454

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Tripković B, Buković D, Sakić K, Sakić S, Buković N, Radaković B (2008) Quality of the blood sampled from surgical drainage after total hip arthroplasty. Coll Antropol 32(1):153–160

    PubMed  Google Scholar 

  6. 6.

    Cheng SC, Hung TS, Tse PY (2005) Investigation of the use of drained blood reinfusion after total knee arthroplasty: a prospective randomised controlled study. J Orthop Surg 13(2):120–124 (Hong Kong)

    CAS  Google Scholar 

  7. 7.

    Lotke PA, Faralli VJ, Orenstein EM, Ecker ML (1991) Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am 73(7):1037–1040

    CAS  PubMed  Google Scholar 

  8. 8.

    Padala PR, Rouholamin E, Mehta RL (2004) The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration. J Knee Surg 17(1):24–27

    PubMed  Google Scholar 

  9. 9.

    Jones HW, Savage L, White C, Goddard R, Lumley H, Kashif F, Gurusany K (2004) Postoperative autologous blood salvage drains–are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases. Acta Orthop Belg 70(5):466–473

    PubMed  Google Scholar 

  10. 10.

    Dramis A, Plewes J (2006) Autologous blood transfusion after primary unilateral total knee replacement surgery. Acta Orthop Belg 72(1):15–17

    PubMed  Google Scholar 

  11. 11.

    Solem JO, Olin C, Tengborn L, Nordin G, Lührs C, Steen S (1987) Postoperative autotransfusion of concentrated drainage blood in cardiac surgery. Experience with a new autotransfusion system. Scand J Thorac Cardiovasc Surg 21(2):153–157

    CAS  PubMed  Google Scholar 

  12. 12.

    McKenzie FN, Heimbecker RO, Wall W, Robert A, Black L, Barr R (1978) Intraoperative autotransfusion in elective and emergency vascular surgery. Surgery 83(4):470–475

    CAS  PubMed  Google Scholar 

  13. 13.

    Waller DG, Renwick AG, Hillier K (2001) Medical pharmacology and therapeutics. WB Saunders, London

    Google Scholar 

  14. 14. (27/07/2008)

  15. 15.

    Senthil Kumar G, Von Arx OA, Pozo JL (2005) Rate of blood loss over 48 hours following total knee replacement. Knee 12(4):307–309

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Camarasa Godoy MA, Serra-Prat M, Palomera Fanegas E (2008) Effectiveness of tranexamic acid in routine performance of total knee replacement surgery. Rev Esp Anestesiol Reanim 55(2):75–80

    CAS  PubMed  Google Scholar 

  17. 17.

    Moonen AF, Knoors NT, van Os JJ, Verburg AD, Pilot P (2007) Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial. Transfusion 47(3):379–384

    Article  PubMed  Google Scholar 

  18. 18.

    Strümper D, Weber EW, Gielen-Wijffels S, Van Drumpt R, Bulstra S, Slappendel R, Durieux ME, Marcus MA (2004) Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty. Transfusion 44(11):1567–1571

    Article  PubMed  Google Scholar 

  19. 19.

    Mengal B, Aebi J, Rodriguez A, Lemaire R (2001) A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 87(1):29–39

    CAS  PubMed  Google Scholar 

  20. 20. (02/07/2008)

Download references


Statistical analysis performed by Data Solutions Services, Ormskirk, Lancashire.

Conflict of interest statement

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information



Corresponding author

Correspondence to Lorcan McGonagle.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

McGonagle, L., Hakkalamani, S. & Carroll, F.A. Tranexamic acid and re-infusion drains in total knee arthroplasty. Eur J Orthop Surg Traumatol 20, 553–555 (2010).

Download citation


  • Tranexamic acid
  • Re-infusion
  • Total knee replacement
  • Drain