Effect of Injecting Tranexamic Acid from a Drain to the Joint and Drain-Clamping to Reduce Blood Loss during Bilateral Cementless Total Knee Arthroplasty

Abstract

Only a few papers have evaluated the effect of TA for bilateral cemented TKA [9,10]. The effect of injecting TA from the drain to the knee joint on reducing postoperative bleeding after bilateral cementless TKA has not been reported. Our hypothesis was that intra-articular administration of TA via the drain would reduce postoperative bleeding and the need for allogeneic blood transfusion after bilateral cementless TKA. The purpose of this study was to determine if injecting TA from the drain to the knee joint and drain clamping reduces postoperative bleeding and the need for allogeneic blood transfusion in patients undergoing bilateral cementless TKA. Methods This study, conducted from July 2007 through October 2012, was nonrandomized and retrospective. It included 50 patients (100 knees) undergoing simultaneous bilateral primary cementless TKA. The patients gave written informed consent for publication of this report and any accompanying images. Exclusion criteria were a known allergy to TA, cemented TKA, unilateral TKA, and posterior stabilized TKA. After these exclusions, 50 patients remained. They were divided into two groups. The study group underwent injection of TA from the drain to knee joint at the end of the operation but before tourniquet release, followed by clamping the drain for 1 hour (n=25). The control group did not undergo this treatment (n=25). The preoperative characteristics, including age, sex, knee disease, height, weight, preoperative femorotibial angle, range of motion of the knee, and hemoglobin levels 1 day before surgery were comparable in the two groups (Table 1). The backgrounds of the patients in the groups were not significantly different except for their height and the femorotibial angle of the right knee. All surgery was performed or supervised by two surgeons (H.M. for the right knees, K.I. for the left knees).