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Background  Patients undergoing cementless total knee arthroplasty (TKA) sometimes suffer large blood loss. In a retrospective study, we explored whether postoperative intra-articular retrograde injection of tranexamic acid (TA) and leaving a drain clamp in place for 1 h reduced blood loss.    Patients and methods  Patients ( n  = 140) treated with unilateral primary cementless TKA (posterior cruciate ligament retained) were divided into two groups: those who had an intra-articular injection of TA (1000 mg) and drain clamping for 1 h postoperatively (study group,  n  = 70) and those who were not given TA and did not undergo clamping of their drains (control group,  n  = 70). Postoperative total blood loss, volume of drainage, hemoglobin level, transfusion amounts and rates, D-dimer level at postoperative day (POD) 7, and complications were recorded.    Results  Total blood loss, total drainage, mean transfusion volume, and transfusion rates were lower in the study group than in controls ( P  < 0.001). Hemoglobin levels on PODs 1 and 14 were similar in the groups, but on POD 7 the hemoglobin level was higher in the study group than in controls ( P  < 0.001). D-dimer level on POD 7 was lower in the study group than in controls ( P  < 0.05). There were no complications in either group.    Conclusions  Immediately postoperative intra-articular retrograde injection of TA and 1 h of drain-clamping effectively reduced blood loss and blood transfusion after cementless TKA. We believe that this method is simple, easy, and suitable for these patients.

Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty