Summary

Is combined use of intravenous and intraarticular tranexamic acid better than intravenous or intraarticular tranexamic acid alone in bilateral single stage total knee arthroplasty? single centre, prospective, double blinded randomised controlled study

Abstract

Background

One of the major concerns against single-stage bilateral TKA is blood loss in the perioperative period and complications associated with it. Tranexamic acid (TA) is an antifibrinolytic agent routinely administered IV or topically (intraarticular or IA) that helps in reducing blood loss by inhibiting plasminogen activation. However, the evidence of combined administration(IV+IA) especially in single-stage bilateral TKA is very limited. The primary of our study is to evaluate the efficacy and safety of combined administration of IV and topical TA in reducing blood loss, transfusion rates, and incidence of deep vein thrombosis and thromboembolism. The secondary objective is whether that transforms to less postoperative pain, better patient satisfaction, and shorter hospital stay.

Methods

This single-center, prospective, double-blinded randomized controlled study consists of 98 patients undergoing Bilateral TKA were randomly divided by computer software into 3 groups depending on the route of administration. Group IV received 2g IV TA at the time of induction, Group IA received 2g of TA mixed with 30ml saline intrarticularly after the closure of capsule whereas Group C received both. All surgeries were done under tourniquet using the medial parapatellar approach and perioperative data like total blood loss( intraoperative blood loos + drain output), the blood volume of drainage, Hb drop, transfusion rate were recorded. Also postoperative knee pain(VAS), short-term patient satisfaction, length of hospital stays, and complications like DVT, thromboembolism were noted. Data management and statistical analysis were performed with SPSS version 20 software (SPSS Inc., Chicago, IL, USA). Independent t-tests were used for continuous variables such as
Hb drop, Bood volume, etc. Person chi-square test or Fisher exact test were used to analyzing the categorical variables. The level of significance was set at p<0.05.

Results

There was a statistically significant difference in total blood loss, the blood volume of drainage, mean Hb drop, transfusion rate when compared combined TA group with IV TA group or IA TXA group (P < 0.05). There was no difference in thromboembolic complications when comparing combined TXA with IV TXA or IA TXA alone (P > 0.05). Moreover, patients in the combined group had lesser postoperative knee pain, shorter length of hospital stays, and higher short-term satisfaction (p< 0.05).

Conclusion

The combined use of IV and IA TXA provided significantly better results compared with use TA IV or IA alone with respect to not only all variables related to postoperative blood loss in TKA, but also lead to a shorter hospital stay and higher patient satisfaction with no added risk of complications.