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Comparative effectiveness of combined peri-articular and intra-articular injection versus intravenous and intra-articular injection of tranexamic acid in total knee arthroplasty: a randomized controlled trial study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tranexamic acid (TXA) administration is supported by numerous evidence in reducing blood loss after total knee arthroplasty (TKA). The combination of intravenous (IV) and intra-articular (IA) TXA administration revealed good result in blood loss reduction with less evidence of venous thromboembolism event (VTE). Several literature reviews portray that peri-articular (PA) administration yields similar hemostasis in comparison to IV route. However, there is no report on the clinical effect of combining PA + IA TXA in blood loss reduction and its complications, compared to combining IV + IA TXA after TKA.

Materials and methods

We conducted a double-blind, randomized controlled trial comparing the use of PA + IA TXA administration and IV + IA TXA administration in 70 patients who were scheduled for unilateral primary TKA. Thirty-five patients were assigned for PA + IA injection (Group 1) and anoter 35 patients were assigned for IV + IA injection (Group 2). Primary outcomes included total blood loss at 48 h, and the need for blood transfusion. Secondary outcomes included thigh and leg circumference, degree of knee flexion, and postoperative complications.

Results

The calculated blood loss at 48 h showed no difference between Groups 1 and 2 (617 ml vs. 632 ml, p = 0.425). The total hemoglobin and hematocrit changes were not different (1.89 g/dL vs. 1.97 g/dL, p = 0.371 and 5.66% vs. 5.87%, p = 0.391). There was no need for blood transfusion in either group. However, lower thigh swelling was significant in Group 1 (2.15 cm vs. 2.79 cm, p = 0.04). Leg circumferences at 48 h was also lower in Group 1 (42.12 cm vs. 42.77 cm, p = 0.04). There was no significant difference in knee flexion decrease between the two groups (38° vs. 37°, p = 0.425). There were no VTE complications or infections found in either group.

Conclusions

Combined PA + IA TXA administration had similar efficacy in blood loss reduction and blood transfusion when compared to combined IV + IA TXA. The first group displayed less soft tissue swelling. The combination of PA + IA TXA administration can be used as an alternative regimen to avoid IV TXA administration.

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Acknowledgements

We thank Mr. Michael Everts for reviewing the article and language help. We also thank all participants for providing the data used in this study.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Thammasat University, 99 Moo 18 Phaholyothin Rd, Khlong Luang, Pathum Thani, 12120, Thailand

    Piya Pinsornsak, Ranet Thaveekitikul & Yot Tanariyakul

  2. Kasetsart University Laboratory School Center for Educational Research and Development, 50 Ngamwongwan Rd, Chatuchak, Bangkok, 10900, Thailand

    Prem Pinsornsak

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Piya Pinsornsak, Ranet Thaveekitikul and Prem Pinsornsak. The first draft of the manuscript was written by Yot Tanariyakul and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yot Tanariyakul.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Thammasat University (MTU-EC-OT-1-277/61).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1.

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Pinsornsak, P., Thaveekitikul, R., Pinsornsak, P. et al. Comparative effectiveness of combined peri-articular and intra-articular injection versus intravenous and intra-articular injection of tranexamic acid in total knee arthroplasty: a randomized controlled trial study. Arch Orthop Trauma Surg 144, 2753–2759 (2024). https://doi.org/10.1007/s00402-024-05337-y

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