Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty?

The use of tourniquet in total knee arthroplasty (TKA) has resulted in negligible intra-operative blood loss but notable post-operative blood loss, creating the ideal scenario for using topical haemostatic agents intra-operatively. Recently, medical adjuvants including tranexamic acid (TXA) and hydrogen peroxide (H2O2) have been introduced. The aim of this study was to evaluate the effectiveness of intra-articular TXA and H2O2 in reducing blood loss during TKA.

Fifty patients, who underwent a primary TKA with 1,500 mg of intra-articular TXA between May 2011 and December 2011, were compared with two matching cohorts of 50 patients each who underwent TKA with 100 ml of 3 % H2O2 wash and TKA without any TXA or H2O2. All surgeries were performed by two senior surgeons. The total blood loss was calculated by the hemoglobin balance method.

The pre-operative serum hemoglobin levels were 13.1 ± 1.3, 13.1 ± 1.3 and 13.0 ± 1.2 g/dl (p > 0.05); while the drop in serum hemoglobin levels post-operatively was 2.0 ± 0.7, 2.4 ± 0.9 and 2.7 ± 0.8 g/dl for the TXA, H2O2 and Control groups, respectively (p < 0.001). The total amount of blood loss was 596 ± 449, 710 ± 279 and 760 ± 228 ml, respectively (p = 0.046). There was no difference in the duration of surgery between the three groups (p > 0.05).

This study showed that intra-articular TXA reduced blood loss during TKA without significantly increasing the duration of surgery. We cannot justify H2O2 wash as an alternative to intra-articular TXA to reduce blood loss during TKA.