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.