Percutaneous intra-articular tranexamic acid following total knee arthroplasty without drainage to reduce blood loss

Background: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect of a combination of these two strategies on total blood loss associated with TKA. Methods: This is a retrospective study conducted on a single surgeon’s data gathered over a two-year period. This study compares the blood loss in two groups of patients. The control group received no antifibrinolytic agents and a drain was inserted, while the study group received TXA and the drain was omitted. Results: A total of 109 patients were included in the analysis, with 86 patients in the study group and 23 patients in the control group. The two groups were compared in terms of pre-operative haemoglobin, American Society of Anesthesiologists (ASA) score and body mass index (BMI). The mean age of the study group was lower than that of the control group (64±8 years vs 68±9 years; p=0.03). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2–312.2; p=0.01). Duration of hospital stay was also reduced in the study group (2.4 days vs 3.1 days; p=0.003). There was, however, no difference in the functional outcome according to the Knee injury and Osteoarthritis Outcome Score (KOOS). Conclusion: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Larger, well-designed studies are required to determine the optimal TXA administration strategy. Level of evidence: Level 4