Intra-Articular Injection of Tranexamic Acid to Reduce Blood Loss after Total Knee Arthroplasty

Purpose. To evaluate the effect of intra-articular tranexamic acid (TXA) on blood loss after total knee arthroplasty (TKA). Methods. Medical records of 73 men and 93 women (mean age, 68 years) who underwent primary TKA for osteoarthritis and received intra-articular TXA 1500 mg (n=56) or 3000 mg (n=56) or not at all (n=54) were reviewed. Reduction in haemoglobin levels on days 1 and 2 was measured, as were the rates of venous thromboembolism (VTE) and blood transfusion. Results. Reduction in haemoglobin levels on day 2 was significantly greater in controls (35±11 g/dl) than the 1500 mg TXA group (29±9 g/dl, p=0.005) and the 3000 mg TXA group (23±10 g/dl, p±0.001). The difference between the 2 TXA groups was also significant (p=0.002). There was a dose-dependent effect of TXA on blood loss. The rates of VTE and blood transfusion did not differ significantly between groups. Conclusion. Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.