Topical use of tranexamic acid in primary total knee arthroplasty: a comparative study

Perioperative blood management represents a major issue in knee arthroplasty. The aim of the present observational study is to compare two different methods of topical tranexamic acid (TXA) administration (periarticular and intraarticular) in primary knee arthroplasty.

The present is an observational comparative study. A total of 66 consecutive patients receiving topical injection of TXA after unilateral primary knee arthroplasty due to osteoarthritis were recorded. Patients were divided into two groups: group 1; periarticular injection of TXA and group 2; intraarticular injection.

Transfusion rate in group 1 was found to be 15%, compared to 44% in group 2 (p-value= 0.015). In transfused patients the mean received blood units were 1.2 (SD=0.44) in group 1, compared to 1.06 (SD=0.24; p-value=0.34) in group 2. The mean hospital stay of group 1 patients was 7.94 days (SD=2.79), compared to 9.58 days (SD=3.26; p-value=0.03) in group 2.

The main findings of the study are that statically significant higher transfusion rates, as well as longer in-hospital stay were found in the intraarticular group, when compared to the periarticular group. According to these two parameters the present study has shown that the topical periarticular TXA injection is superior to the intraarticular one. Further research is of utmost importance in order to conclude to the optimum combination of knee arthroplasty perioperative blood management.