Background

Tranexamic acid (TXA) is an antifibrinolytic, commonly utilized in orthopedic procedures for the purpose of reducing perioperative bleeding and need for transfusion.

Purpose

To evaluate if IV TXA for tibial tubercle osteotomy (TTO) could reduce perioperative blood loss or postoperative intra-articular hemarthrosis without postoperative drains.

Methods

A double-blind randomized controlled trial was conducted in patients who underwent TTO. Forty patients were randomized equally to the control and experimental groups. The experimental group received two 1-gram boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. The following outcomes were documented: perioperative blood loss (cc), postoperative hemarthrosis (cc), Visual Analog Scale (VAS) on postoperative days (POD) 1-7 and postoperative visits (POV) 1-3, postoperative opioid consumption POD 1-7 (morphine mg equivalents), range of motion (ROM) and ability to straight leg raise (SLR) at POV 1-3, and pre- and post-operative thigh circumference ratio (TCR).
Study Design: Randomized Controlled Trial

Results

There was no significant difference found in perioperative blood loss between experimental and control groups (64.25cc v. 60cc, p=0.38). No statistical significance was observed in patient demographic characteristics. All patients were available at the first POV for hemarthrosis evaluation. There were 3 knees aspirated in each of the groups; no significant difference was found in postoperative hemarthrosis with use of IV TXA (3.3cc v. 14cc, p=0.09). Significantly reduced levels of pain were seen throughout the first postoperative week in both the experimental and control groups (p=0.022, p<0.0001), but no significant reduction in VAS score between the two groups (p=0.15). No significant difference was noted in post-operative opioid consumption by the end of the first week (120.21mg v. 120.58mg, p=0.5). No significant difference in ROM or ability to SLR at all three postoperative visits. No significant difference in pre- nor post-operative TCR (p=0.15, p=0.70).

Conclusion

In patients undergoing TTO, intravenous TXA does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain control. Additionally, IV TXA did not impact ROM, ability to SLR, or TCR following TTO.