Using intra-articular tranexamic acid in total knee replacement surgery with and without bleeding control: a...

Area of Science:

• Orthopedic Surgery
• Surgical Hemorrhage Control
• Pharmacological Interventions

Background:

• Tourniquet use in orthopedic surgery can lead to significant blood loss.
• Tranexamic acid (TA) is a known antifibrinolytic agent used to reduce bleeding.
• Optimizing TA application timing is crucial for maximizing its efficacy.

Purpose of the Study:

• To evaluate the effectiveness of tranexamic acid (TA) in two distinct surgical techniques.
• To compare TA application before versus after tourniquet release and wound closure.
• To determine the optimal method for reducing surgical hemorrhage.

Main Methods:

• A comparative study involving four patient groups.
• Groups received either TA or placebo, with or without tourniquet release before wound closure.
• Hemorrhage was quantified by measuring blood in hemovac drains and assessing hemoglobin/hematocrit levels.

Main Results:

• The group receiving TA with wound closure before tourniquet release (TA + TNR) exhibited significantly less hemorrhage (217.4 ± 99.6 ml) compared to all other groups.
• This TA + TNR group also showed significantly better hemoglobin and hematocrit values.
• Other groups (TA - TNR, TA + TR, TA - TR) demonstrated higher blood loss and lower hematological values.

Conclusions:

• Applying tranexamic acid (TA) to the suprapatellar space before tourniquet release and wound closure significantly reduces postoperative hemorrhage.
• This technique offers a superior method for bleeding control in orthopedic procedures involving tourniquets.
• The findings support the use of TA in conjunction with early wound closure for enhanced hemostasis.