Comparison of intra-articular versus intravenous application of tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

There is much controversy about the optimal application of tranexamic acid (TXA) in total knee arthroplasty (TKA). The purpose of this meta-analysis was to compare the efficacy of the intra-articular and intravenous regimens of TXA in TKA. A literature search of the PubMed, Embase and Cochrane Library databases was performed. Randomized controlled trials comparing the result of intra-articular and intravenous application of TXA during TKA were included. The focus was on the outcomes of blood loss, transfusion requirement and thromboembolic complications. Six studies were eligible for data extraction and meta-analysis. We found no statistically significant difference between intra-articular and intravenous administration of tranexamic acid in terms of total blood loss (WMD, 6.01; 95% CI: -96.78 to 108.79; = 0.91), drain output (WMD = -20.26; 95% CI: -51.34 to 10.82; = 0.20), hemoglobin drop (WMD = 0.33; 95% CI: -0.31 to 0.98; = 0.31), or the incidences of transfusion (RR = 0.98; 95% CI: 0.56-1.70; = 0.93) as well as deep vein thrombosis (RR = 0.49; 95% CI: 0.09-2.73; = 0.42). In comparison with intravenous application of TXA, intra-articular application had a comparable effect on reducing blood loss and the transfusion rate without increasing the complication rate.