Efficacy Efficacy Of Peri-articular Administration Of Tranexamic Acid In Controlling Postoperative Blood Loss After Unilateral Total Knee Arthroplasty

Objective:Intravenous tranexamic acid(TXA)is one of the most effective ways to reduce blood loss after artificial total knee arthroplasty(TKA).However,there is still doubt about the safety of venous thromboembolism(VTE).In contrast to intravenous TXA,local administration of TXA can reduce systemic toxicity and may provide better control over postoperative bleeding.Known intra-articular injection of TXA can effectively reduce blood loss after TKA.However,this method has some disadvantages,such as TXA leakage due to soft tissue release.The aim of this study was to evaluate the effect of TXA injection around the joint cavity to reduce bleeding after TKA.Methods: From June 2015 to June 2017,114 patients with primary knee osteoarthritis were treated with unilateral TKA in our hospital.The cases were divided into three groups: group A(40 cases with TXA injected around articular cavity);group B(with TXA injected into articular cavity)38 cases;group C(control group,without TXA).Recording the general physical condition,preoperative and postoperative hemoglobin(Hb),operation time,intraoperative blood loss,postoperative drainage,total perioperative blood loss,occult bleeding,postoperative blood transfusion rate,postoperative complications occurrence rate.Using SPSS 20.0 software statistical analysis of data.Results: The general data of three groups showed no significant difference(P> 0.05).Compared with the control group(1384.84 ± 234.41 m L),the amount of bleeding in the two TXA groups(A group,917.55 ± 222.23 m L,B group,951.66 ± 227.01 m L)were significantly reduced,postoperative knee drainage(A group 302.28 ± 154.12 m L,318.06 ± 127.89 m L in group B,and 522.62 ± 177.12 m L in group C).Hb of the third day after operation(100.58 ± 12.33 g / L in group A,100.08 ± 11.98 g / L in group B and 90.97 ± 10.32 g / Lin group C)and blood transfusion(10%(4/40)in group A,13.16%(5/38)in group B and 33.33%(12/36)in group C)showed significant difference(P <0.05).The effect of pplying TXA was similar in two groups(A and B)(P> 0.05).No deep vein thrombosis or thromboembolic complications occurred in all three groups.Conclusion: Compared with intra-articular injection of TXA,the injection of TXA(1 g)around the joint cavity can effectively reduce the postoperative hemorrhage of TKA without increasing the risk of TXA leakage,infection,deep venous thrombosis or thromboembolism.The injection around the joint cavity can be used as an alternative to intra-articular injection of a way.