Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2021

01-02-2021 | Care | KNEE

Topical co-delivery of platelet rich fibrin and tranexamic acid does not decrease blood loss in primary total knee arthroplasty compared to the standard of care: a prospective, randomized, controlled trial

Authors: Reha N. Tandogan, Metin Polat, Tahsin Beyzadeoglu, Erdem Karabulut, Kerem Yildirim, Asim Kayaalp

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2021

Login to get access

Abstract

Purpose

The purpose of this study was to evaluate the efficacy of intra-operative co-administration of tranexamic acid (TA) and platelet rich fibrin (PRF) using a proprietary co-delivery system on the amount of blood loss, early functional outcomes and wound complications after primary total knee arthroplasty (TKA). The intervention was compared to the standard of care (combined intravenous & topical TA) in a prospective, randomized, blinded setting.

Methods

80 patients undergoing primary cemented TKA without tourniquet were prospectively randomized into control (combined intravenous and topical TA) and PRF (intra-venous TA and co-delivery of topical PRF and TA) groups after informed consent. Total blood loss, drainage blood loss, knee range of motion, VAS pain scores, length of stay and wound complications were analysed. Data collection was performed in a double blind manner on days 1, 3 and 21.

Results

There was no statistically significant difference in drainage blood loss (550 ml vs. 525 ml, p = 0.643), calculated total blood loss on day 1 (401 ml vs. 407 ml, p = 0.722), day 3 (467 ml vs 471 ml, p = 0.471) and day 21 (265 ml vs. 219 ml, p = 0.082) between the PRF and control groups respectively. The PRF group had a small but statistically significant increase in median knee extension in the early post-operative period, however this difference evened out at 3 weeks. No significant difference could be demonstrated between the PRF and control groups in length of stay, VAS pain scores, narcotic usage, wound complications and knee flexion at all time points.

Conclusions

The topical co-delivery of PRF and TA does not significantly decrease blood loss in primary TKA compared to the standard of care. Slightly better active knee extension in the first 3 postoperative days can be achieved, however this benefit is not clinically relevant.

Level of evidence

I, Therapeutic study.
Appendix
Available only for authorised users
Literature
1.
Abdel MP, Chalmers BP, Taunton MJ, Pagnano MW, Trousdale RT et al (2018) Intravenous versus topical tranexamic acid in total knee arthroplasty: both effective in a randomized clinical trial of 640 patients. J Bone Joint Surg Am 100:1023–1029CrossRef
2.
Antuña S, Barco R, Martínez Diez JM, Sánchez Márquez JM (2013) Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial. Acta Orthop Belg 79:25–30PubMed
3.
Bayer A, Lammel J, Rademacher F, Groß J, Siggelkow M et al (2016) Platelet-released growth factors induce the antimicrobial peptide human beta-defensin-2 in primary keratinocytes. Exp Dermatol 25:460–465CrossRef
4.
Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE et al (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81:2–10CrossRef
5.
Buda R, Vannini F, Castagnini F, Cavallo M, Ruffilli A et al (2015) Regenerative treatment in osteochondral lesions of the talus: autologous chondrocyte implantation versus one-step bone marrow derived cells transplantation. Int Orthop 39:893–900CrossRef
6.
Cai DF, Fan QH, Zhong HH, Peng S, Song H (2019) The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res 14:348CrossRef
7.
Chen TP, Chen YM, Jiao JB, Wang YF, Qian LG et al (2017) Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res 12:11CrossRef
8.
Dallari D, Rani N, Sabbioni G, Mazzotta A, Cenacchi A et al (2016) Radiological assessment of the PRF/BMSC efficacy in the treatment of aseptic nonunions: a retrospective study on 90 subjects. Injury 47:2544–2550CrossRef
9.
Dan M, Martos SM, Beller E, Jones P, Randle R et al (2015) Blood loss in primary total knee arthroplasty–body temperature is not a significant risk factor—a prospective, consecutive, observational cohort study. J Orthop Surg Res 10:97CrossRef
10.
Fillingham YA, Darrith B, Calkins TE, Abdel MP et al (2019) Hip society research group. 2019 mark coventry award: a multicentre randomized clinical trial of tranexamic acid in revision total knee arthroplasty: does the dosing regimen matter? Bone Joint J 101-B(7-Supple-C):10–16CrossRef
11.
Gao FQ, Li ZJ, Zhang K, Sun W, Zhang H (2015) Four methods for calculating blood-loss after total knee arthroplasty. Chin Med J 128:2856–2860CrossRef
12.
Goel R, Rondon AJ, Sydnor K, Blevins K, O'Malley M et al (2019) Tourniquet use does not affect functional outcomes or pain after total knee arthroplasty: a prospective, double-blinded, randomized controlled trial. J Bone Joint Surg Am 101:1821–1828CrossRef
13.
Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280CrossRef
14.
Huang Z, Xie X, Li L, Huang Q, Ma J et al (2017) Intravenous and topical tranexamic acid alone are superior to tourniquet use for primary total knee arthroplasty: a prospective, randomized controlled trial. J Bone Joint Surg Am 99:2053–2061CrossRef
15.
16.
Li J, Li HB, Zhai XC, Qin-Lei JXQ et al (2016) Topical use of topical fibrin sealant can reduce the need for transfusion, total blood loss and the volume of drainage in total knee and hip arthroplasty: a systematic review and meta-analysis of 1489 patients. Int J Surg 36:127–137CrossRef
17.
Lin C, Qi Y, Jie L, Li HB, Zhao XC et al (2016) Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty: a meta-analysis. Medicine (Baltimore) 95:e5344CrossRef
18.
19.
Lu Q, Peng H, Zhou GJ, Yin D (2018) Perioperative blood management strategies for total knee arthroplasty. Orthop Surg 10:8–16CrossRef
20.
Lundquist R, Dziegiel MH, Agren MS (2008) Bioactivity and stability of endogenous fibrogenic factors in platelet-rich fibrin. Wound Repair Regen 16:356–363CrossRef
21.
Mi B, Liu G, Zhou W, Lv H, Liu Y et al (2017) Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 137:997–1009CrossRef
22.
Moher D, Schulz KF, Altman D (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194CrossRef
23.
Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG et al (2013) Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 95:1777–1783CrossRef
24.
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD et al (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994CrossRef
25.
Pierce GF, Mustoe TA, Altrock BW, Deuel TF, Thomason A (1991) Role of platelet-derived growth factors in wound healing. J Cell Biochem 45:319–326CrossRef
26.
Ryan SP, Klement MR, Green CL, Blizzard DJ, Wellman SS et al (2019) Preoperative hemoglobin predicts postoperative transfusion despite antifibrinolytics during total knee arthroplasty. Orthopedics 42:103–109CrossRef
27.
Shin YS, Yoon JR, Lee HN, Park SH, Lee DH (2017) Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 25:3585–3595CrossRef
28.
Themistoklis T, Theodosia V, Konstantinos K, Georgios D (2017) Perioperative blood management strategies for patients undergoing total knee replacement: where do we stand now? World J Orthop 8:441–454CrossRef
29.
Verra WC, van Hilten JA, Honohan Á, van Zwet EW, van der Bom JG et al (2018) The effect of a fibrin sealant on knee function after total knee replacement surgery. Results from the FIRST trial. A multicenter randomized controlled trial. PLoS ONE 13:e0200804CrossRef
30.
Wang F, Zhao KC, Zhao MM, Zhao DX (2018) The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a meta-analysis. Medicine (Baltimore) 97:e12270CrossRef
31.
Wang H, Shan L, Zeng H, Sun M, Hua Y et al (2014) Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials. J Orthop Surg Res 9:36CrossRef
32.
Xiong H, Liu Y, Zeng Y, Wu Y, Shen B (2018) The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 19:321CrossRef
33.
Yang TQ, Geng XL, Ding MC, Yang MX, Zhang Q (2015) The efficacy of fibrin sealant in knee surgery: a meta-analysis. Orthop Traumatol Surg Res 101:331–339CrossRef
Metadata
Title
Topical co-delivery of platelet rich fibrin and tranexamic acid does not decrease blood loss in primary total knee arthroplasty compared to the standard of care: a prospective, randomized, controlled trial
Authors
Reha N. Tandogan
Metin Polat
Tahsin Beyzadeoglu
Erdem Karabulut
Kerem Yildirim
Asim Kayaalp
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05938-1

Other articles of this Issue 2/2021

Knee Surgery, Sports Traumatology, Arthroscopy 2/2021 Go to the issue

KNEE

Threshold values for stress radiographs in unstable knees after total knee arthroplasty

KNEE

Varus inclination of the tibia is related to patellofemoral osteoarthritis in Japanese female patients with moderate knee osteoarthritis

KNEE

High intra- and inter-observer reliability of planning implant size in MRI-based patient-specific instrumentation for total knee arthroplasty

KNEE

Validation of a new topographic classification of bone marrow lesions in the knee: the six-letter system

KNEE

A cruciate-retaining implant can treat both knees of most windswept deformities when performed with calipered kinematically aligned TKA

KNEE

A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues