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Blood loss reduction: effect of different knee prosthesis designs and use of tranexamic acid—a randomized controlled trial

  • Original Article • KNEE - ARTHROPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

In regard to blood loss in total knee arthroplasty (TKA), the effect of either knee prosthesis designs or bone preparation is still unclear. While the benefit of using tranexamic acid (TXA) is well demonstrated, our study aims to determine the effect of different knee prosthesis designs uses and efficacy of blood loss reduction by different routes of TXA administration.

Methods

The 228 patients undergone primary TKA were randomized to determine between open-box and closed-box prosthesis. Among each group, a second randomization was applied to categorize the patients into (1) no use of TXA (No-TXA), (2) intra-articular TXA use (IA-TXA) and (3) intravenous TXA use (IV-TXA). The calculated blood loss (CBL), drain volume (DV) and an average number of units of blood transfused (ANUBT) were blindly evaluated.

Results

The open-box TKA had 85.60 and 63.29 ml (p = 0.02 and p < 0.01) more CBL and DV compared to closed-box TKA. The IA-TXA and IV-TXA significantly reduced CBL by 190.75 and 162.01 ml (p < 0.01 and p < 0.01) and reduced DV by 129.07 and 61.04 ml (p < 0.01 and p = 0.01), respectively, when compared to No-TXA. Patients who received IA and IV-TXA had ANUBT of 0.21 and 0.23 unit, which was significantly lower than 0.42 unit of No-TXA group (p = 0.03).

Conclusions

Use of the different prosthesis designs could significantly affect CBL and DV following TKA. However, the use of either design resulted in a comparable ANUBT. Regardless of prosthetic type, either IA- or IV-TXA could significantly reduce the CBL and ANUBT when compared to No-TXA.

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Acknowledgements

We thank Atthakorn Jarusriwanna, MD, Kongpob Reosanguanwong, MD, Pariphat Chompoonutprapa, MD, Tawan Sunathvanichkul, MD, Waykin Nopanitaya, Ph.D., and Edward B. Rasor for their technical assistance.

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Authors and Affiliations

  1. Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand

    Artit Laoruengthana, Piti Rattanaprichavej, Nattharut Chaibhuddanugul, Panapol Varakornpipat & Monton Galassi

  2. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Krit Pongpirul

  3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Krit Pongpirul

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  1. Artit Laoruengthana
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Correspondence to Piti Rattanaprichavej.

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Laoruengthana, A., Rattanaprichavej, P., Chaibhuddanugul, N. et al. Blood loss reduction: effect of different knee prosthesis designs and use of tranexamic acid—a randomized controlled trial. Eur J Orthop Surg Traumatol 29, 1519–1524 (2019). https://doi.org/10.1007/s00590-019-02450-2

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  • DOI: https://doi.org/10.1007/s00590-019-02450-2

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