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Published in: MUSCULOSKELETAL SURGERY 3/2017

01-12-2017 | Original Article

A comparative analysis of the role of Tranexamic acid as an independent variable in reducing intraoperative blood loss in patients undergoing conventional total knee arthroplasty versus computer-assisted total knee arthroplasty

Authors: K. K. Eachempati, A. V. Gurava Reddy, S. Apsingi, S. R. Sankineani, J. Shaheed, C. Dannana

Published in: MUSCULOSKELETAL SURGERY | Issue 3/2017

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Abstract

Background

Blood loss in total knee arthroplasty (TKA) is an area of significant concern as it has an effect on patient morbidity and hospital stay. Among many different modalities to reduce blood loss, the use of Tranexamic acid has become a standard procedure nowadays. The aim of our study was to determine if Tranexamic acid alone decreases blood loss as an independent variable irrespective of other blood loss preserving measures.

Method

This prospective non-randomized study included patients undergoing unilateral TKA by conventional method (Group 1) and computer-assisted TKA (Group 2). All the patients in both groups received Tranexamic acid in a dose of 10 mg/kg body weight prior to inflation of tourniquet. Blood loss in both the groups was calculated using Nadler’s formula, and haemoglobin (Hb) level was calculated on day one and day three after surgery.

Results

The mean drop of Hb in Group 1 was 1.608 and 1.56 g/dl in Group 2 which was statistically significant (p < 0.001); however, none of the patients in either of the groups actually required any blood transfusion postoperatively. Although there was a significant drop in haemoglobin and haematocrit in both the groups, on comparison, there was no significant difference in blood loss and fall in Hb levels between the groups (p > 0.001).

Conclusion

Tranexamic acid decreases blood loss in patients undergoing TKA independent of all the other blood conserving procedures.
Literature
1.
go back to reference Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81(1):2–10CrossRefPubMed Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81(1):2–10CrossRefPubMed
2.
go back to reference Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B (2002) The effect of tourniquet use in total knee arthroplasty. Int Orthop 26(5):306–309CrossRefPubMedPubMedCentral Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B (2002) The effect of tourniquet use in total knee arthroplasty. Int Orthop 26(5):306–309CrossRefPubMedPubMedCentral
3.
go back to reference Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190CrossRef Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190CrossRef
4.
go back to reference Samama CM (2004) A direct antifibrinolytic agent in major orthopedic surgery. Orthopedics 27(6 Suppl):675–680 Samama CM (2004) A direct antifibrinolytic agent in major orthopedic surgery. Orthopedics 27(6 Suppl):675–680
5.
go back to reference Rama KR, Apsingi S, Poovali S, Jetti A (2007) Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 89(4):699–705PubMed Rama KR, Apsingi S, Poovali S, Jetti A (2007) Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 89(4):699–705PubMed
6.
go back to reference Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ (2005) Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br 87-B(11):1480–1482CrossRef Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ (2005) Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br 87-B(11):1480–1482CrossRef
7.
go back to reference Benoni G, Fredin H (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 78:434–440PubMed Benoni G, Fredin H (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 78:434–440PubMed
9.
go back to reference Hynes M, Calder P, Scott G (2003) The use of tranexamic acid to reduce blood loss during total knee arthroplasty. Knee 10:375–377CrossRefPubMed Hynes M, Calder P, Scott G (2003) The use of tranexamic acid to reduce blood loss during total knee arthroplasty. Knee 10:375–377CrossRefPubMed
10.
go back to reference Akgül T, Büget M, Salduz A, Edipoğlu İS, Ekinci M, Küçükay S, Şen C (2016) Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: a prospective clinical study. Acta Orthop Traumatol Turc 50(4):429–431. doi:10.1016/j.aott.2016.06.007 CrossRefPubMed Akgül T, Büget M, Salduz A, Edipoğlu İS, Ekinci M, Küçükay S, Şen C (2016) Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: a prospective clinical study. Acta Orthop Traumatol Turc 50(4):429–431. doi:10.​1016/​j.​aott.​2016.​06.​007 CrossRefPubMed
11.
go back to reference Huang GP, Jia XF, Xiang Z, Ji Y, Wu GY, Tang Y, Li J, Zhang J (2016) Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty: a comparative study and meta-analysis. Med Sci Monit 10(22):797–802CrossRef Huang GP, Jia XF, Xiang Z, Ji Y, Wu GY, Tang Y, Li J, Zhang J (2016) Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty: a comparative study and meta-analysis. Med Sci Monit 10(22):797–802CrossRef
12.
go back to reference Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232PubMed Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232PubMed
13.
go back to reference Friedman R, Homering M, Holberg G, Berkowitz SD (2014) Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am 96:272e8CrossRef Friedman R, Homering M, Holberg G, Berkowitz SD (2014) Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am 96:272e8CrossRef
14.
go back to reference Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer assisted knee arthroplasty versus a conventional jig-based technique: a randomised, prospective trial. J Bone Joint Surg Br 86-B(3):372–377CrossRef Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer assisted knee arthroplasty versus a conventional jig-based technique: a randomised, prospective trial. J Bone Joint Surg Br 86-B(3):372–377CrossRef
15.
go back to reference Petäjä J, Myllynen P, Myllyla G, Vahtera E (1987) Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand 153(11–12):647–651PubMed Petäjä J, Myllynen P, Myllyla G, Vahtera E (1987) Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand 153(11–12):647–651PubMed
16.
go back to reference Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P (2012) A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplast 27(3):331–340CrossRef Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P (2012) A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplast 27(3):331–340CrossRef
17.
go back to reference Roysam GS, Oakley MJ (2001) Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial. J Arthroplast 16:454–457CrossRef Roysam GS, Oakley MJ (2001) Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial. J Arthroplast 16:454–457CrossRef
Metadata
Title
A comparative analysis of the role of Tranexamic acid as an independent variable in reducing intraoperative blood loss in patients undergoing conventional total knee arthroplasty versus computer-assisted total knee arthroplasty
Authors
K. K. Eachempati
A. V. Gurava Reddy
S. Apsingi
S. R. Sankineani
J. Shaheed
C. Dannana
Publication date
01-12-2017
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue 3/2017
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-017-0477-9

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