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Objective: Perioperative bleeding during total knee arthroplasty (TKA) is a lasting problem for surgeons. Intravenous or intra-articular administration of tranexamic acid (TXA) can effectively stop bleeding, but there is still no uniform standard for the best administration and dosing. Method: Between October 2017 and September 2019, ninety patients with unilateral primary knee osteoarthritis requiring knee replacement were retrospectively evaluated and investigated in three groups according to the route of TXA administration: Group 1 (n=30) intravenous (IV) injection, Group 2 (n=30) intra-articular injection (IAI), and Group 3 (n = 30) combined IV and IAI. Demographic characteristics, hematological indices, and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were studied. Results: Of the patients included in the study, 86% were female (n=78), and 14% were male (n=12). The gender distribution of the groups was homogeneous (p=0.749). The mean h emoglobin values of Group 2 were significantly lower than those of Group 1 and Group 3 (p=0.002 and p=0.045, respectively). Less postoperative blood loss was observed in the group receiving combined IV and IA TXA. The mean blood loss from the drain in Group 3 was significantly lower than that in Group 1 and Group 2 (p=0.001). Postoperative infection, DVT, and PE were not seen in any group. Conclusion: This study demonstrated that the use of intraarticular and intravenous tranexamic acid in primary unilateral TKA significantly reduced postoperative blood loss and consequently decreased the need for blood transfusion without an increase in adverse events, particularly thromboembolic complications.

Decreased blood loss with systemic and intraarticular tranexamic acid administration after total knee arthroplasty