Aditya - Is local infiltration of tranexamic acid efficacious in reducing blood loss after simultaneous bilateral total knee arthroplasty? A prospective randomized study

Background: Simultaneous bilateral Total Knee Arthroplasty (TKA) results in substantial perioperative blood loss with increased associated morbidity of blood loss. Despite various studies proving the efficacy of Tranexamic Acid (TXA), no consensus exists on the routes of administration. Aim: Aim of present study was to compare the efficacy of local infiltration versus intravenous TXA in reducing perioperative blood loss. Methods: Seventy consecutive ages, sex and BMI-matched patients of knee arthritis undergoing simultaneous bilateral TKA were randomly allocated either to have received intravenous TXA (IVTXA) (Group 1) or topical TXA (TTXA) (Group 2) in a prospective, double blinded study. The primary outcome measures were: Total blood loss and total drain output. The secondary outcome measures were: Number of blood unit’s transfused and clinical and functional outcomes as evaluated by Knee Society Score (KSS), WOMAC score, visual analogue score and wound score. Results: All 70 patients were included in the study. Perioperative blood loss in group2 (561.42 ± 248.99) was reduced significantly as compared to group1 (1037.04 ± 506.65) with a p-value of <0.001. Postoperative Hb in group2 (10.30 ± 1.11) was also significantly higher as compared to group1 (9.66 ± 1.47; p <0.001). Total drain output in group2 (269.14 ± 120.98) was significantly reduced as compared to group1 (574.14 ± 269.03; p <0.001). Statistically significant difference was observed in allogenic blood transfusion between the two groups (p=0.000). No complication was observed in either group. Significant difference was observed in WOMAC score at 12weeks and 6months (p=0.015, 0.007) and KSS score at 6 and 12months (p=0.050, 0.045) respectively. However no significant difference was found at 6 weeks. Conclusion: Local infiltration of tranexamic acid significantly decreases the blood loss and improves clinical outcome following simultaneous bilateral total knee arthroplasty as compared to intravenous administration, with a mean reduction by about 45% with respect to intravenous group.

Author(s): Aditya Aggarwal

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