The reduction in blood loss with intra-articular injection of tranexamic acid in unilateral total knee arthroplasty without operative drains: a randomized controlled trial

The objective of this randomized controlled trial was to evaluate the efficacy and safety of intra-articular injections of tranexamic acid (TXA) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty (TKA) without drainage. Primary TKA was performed on a total of 80 patients (80 knees) affected to various degrees by knee osteoarthritis. The patients were randomized to receive 500 mg of TXA in 20 mL of normal saline solution (n = 40) or an equivalent volume of normal saline solution (n = 40), applied into the joint for 5 min at the end of surgery. Data on routine blood examination, blood loss and blood transfusion after TKA were compared between the two groups. The results showed no significant difference between the two groups in intra-operative blood loss (P = 0.136). The mean postoperative visible blood loss, hidden blood loss and transfusion requests were significantly different between the two groups (P < 0.05). The values of postoperative hemoglobin and hematocrit were lower in the control group compared with those in the treatment group (P < 0.05). No deep vein thrombosis was detected through Doppler ultrasound examination. Three hour postoperative D-dimer in the control group was higher than the treatment group (P = 0.02). There was no statistically significant difference between the coagulation indicators and range of motion in the two groups. We conclude that intra-articular TXA in patients undergoing unilateral TKA could significantly reduce postoperative blood loss and blood transfusion and avoid perioperative anemia-related complications without increased risk of venous thrombosis.

Level I. Therapeutic study.