Effects of local infiltration of analgesia and tranexamic acid in total knee replacements: safety and efficacy in reducing blood loss and comparability to intra-articular tranexamic acid

Abstract

Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

Comparison between peri-articular injection and intra-articular injection of tranexamic acid during total knee arthroplasty: A meta-analysis

“…After carefully reviewing the titles and abstract, 40 studies were excluded. Finally, two RCTs [17,18] and four non-RCTs [14,[19][20][21] were included for data extraction and meta-analysis. The detailed search process is summarized in Figure 1.…”

“…Sivasubramanian et al [21] 2021 for units of blood transfused, of whom 69 and 69 in the PAI and IAI groups, respectively. The units of blood transfused in the PAI group were similar to those transfused in the IAI group (MD=0.08; 95% CI -0.06 to 0.21; p=0.26) (Figure 7).…”

Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis

“…One case series was removed [28]. Thus, ten studies (5 RCTs, 1 prospective comparative study and 4 retrospective studies) were finally included in the meta-analysis [29][30][31][32][33][34][35][36][37][38] (Fig. 1).…”

“…There were six good-methodological-quality studies [29,32,33,[36][37][38] and four fair-quality studies [30,31,34,35]. Eight out of ten studies achieved a perfect score on study size [30][31][32][33][35][36][37][38]. Only two studies received two points on the follow-up part [31,38].…”

“…Four studies were conducted in China [30,32,34,37], two in Thailand [29,36], and one each in Japan [31], Greece [33], Singapore [35], and Korea [38]. Three studies included a comparison of PAI versus IV injection [29,37,38], and six studies included a comparison of PAI versus IA [30,[32][33][34][35][36]. One study only compared PAI versus no TXA injection [31] (Table 1).…”