Topical Tranexamic Acid May Improve Early Functional Outcomes of Primary Total Knee Arthroplasty

The use of tranexamic acid (TXA) reduces postoperative anemia and blood transfusion requirements. We investigated if these beneficial effects improve the early outcomes of primary total knee arthroplasty (TKA).

We retrospectively studied 166 consecutive patients (179 TKAs) who received topical TXA (3 g before tourniquet deflation). This "study group" was compared with a "control group" of 197 consecutive patients (209 TKAs) in whom no TXA was used. We captured outcomes during the first 4 postoperative months. Knee Society score (KSS) was determined preoperatively, 6 weeks, and 4 months postoperatively. The outcomes were compared using univariate analysis. Multiple logistic regressions were calculated to assess differences between groups in KSS at 6 weeks and 4 months, controlling for age, sex, body mass index, and preoperative KSS.

Postoperative hemoglobin was significantly higher in the study than that in the control group on day 1, day 2, and at discharge (P < .0001). Blood transfusions were required in 5% and 22% of patients (P < .001), respectively. Six weeks postoperatively, the functional KSS and its 5 categories (ability to walk, negotiate stairs up and down, stand up from a chair, and the use of support) were significantly higher in the study than those in the control group (P ≤ .001). Four months postoperatively, there was no difference in the KSS between the groups.

Our study suggests that the clinical benefit of topical TXA administration extends beyond the hospitalization period. Its use may improve knee function during the first 6 postoperative weeks. This beneficial clinical effect seems to be negligible afterward.