Effect Of Tranexamic Acid Topically Using With Two Different Methods On Blood Loss In Primary Total Knee Arthroplasty

Objective To discuss the effect of tranexamic acid(TXA)topically using with two different methods on blood loss in primary total knee arthroplasty(TKA).Methods From January 2017 to January 2018,patients with primary knee osteoarthritis(OA)who underwent primary total knee arthroplasty in our department were retrospectively invovled.They were divided into two groups which were then named peripheral-articular injection group(2g TXA averagely injected to capsule,patellar tendon,quadriceps tendon,subperiosteum of the femoral condyle and tibial plateau before osteotomy)while the perfusion group(same dose of TXA perfused into the joint before suture)according to the different application modes.Both groups did not use tourniquet and drainage.The primary outcomes were hemoglobin(Hb)level,Hb drop and total blood loss on postoperative day 1 and day 3.The second outcomes were length of stay after surgery,the rate of transfusion and the rate of complications(Deep venous thrombosis(DVT),pulmonary embolism(PE),infection and hematoma on Incision).Results A total of 62 patients were collected.32 patients were in peripheral-articular injection group and 30 patients were in perfusion group.The Hb level on postoperative day 1 and 3 in injection group were both higher than perfusion group with significant differences(P<0.05).The mean total blood loss in injection group(647.27 ± 227.01)mL was reduced significantly compared to perfusion group(876.34 ± 183.16)mL(P=0.016).There were only 2 patients had intermuscular venous thrombosis in perfusion group and no episode of DVT,PE,infection and hematoma on Incision in all patients.No significant difference was found in the Visual analogue scale(VAS)and The Western Ontario and McMaster Universities(WOMAC)Osteoarthritis Index in two groups at 6 weeks and 3 months after the operation.Conclusions Compared with perfusion of TXA,peripheral-articular injection is more effective on blood loss during the perioperative period in TKA.But there was no significant difference in length of stay,complication,VAS and WOMAC in two groups.