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We studied 99 patients who were undergoing total knee arthroplasty (TKA) to determine the optimum protocol for the administration of tranexamic acid (TNA) in order to reduce blood loss. It decreased by more than 40% after the administration of TNA. The haemostatic effect was greatest when TNA was given preoperatively and on deflation of the tourniquet. There was no increase in the incidence of adverse affects in the patients receiving TNA, compared with a control group. We conclude that two injections of TNA, one given preoperatively and one on deflation of the tourniquet, significantly reduce blood loss without increasing the risk of thromboembolic complications.

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To determine whether the risk of infectious complications after total joint arthroplasty is increased in rheumatoid arthritis patients who are treated continuously with leflunomide, the incidences of infectious complications in 41 rheumatoid arthritis patients who received continuous leflunomide treatment (leflunomide group) and in 41 patients who did not receive leflunomide within 4 weeks of surgery (nonleflunomide group) were compared. The incidence (6.1%) of local infection after surgery in the leflunomide group (82 procedures) was slightly lower than that (6.3%) in the nonleflunomide group (79 procedures). There were no systemic or deep infections. None of the other variables analyzed were identified as risk factors for postoperative complications. The results indicate that there is no dramatically increased risk of postoperative infectious complications in rheumatoid arthritis patients who continue to be treated with low doses of leflunomide perioperatively.