Tranexamic Acid Reduces Total Blood Loss and Inflammatory Response in Computer-Assisted Navigation Total Knee Arthroplasty

Introduction. Tranexamic acid (TXA) is an effective blood salvage agent that reduces perioperative blood loss in conventional total knee arthroplasty (TKA). As computer-assisted surgery for TKA (CAS-TKA) results in a lower perioperative blood loss than conventional TKA, the additional effect of blood conservation by TXA might be mitigated. This study aimed to evaluate the efficacy of TXA in CAS-TKA. Methods. We retrospectively reviewed 222 consecutive patients who underwent CAS-TKA. Intravenous TXA was administered in 103 patients (TXA group) at a dosage of 20 mg/kg 15 min before deflation of the tourniquet. The other 119 patients did not receive TXA (control group). Patient demographic data including age, gender, BMI, DM, and hypertension were collected. The primary outcomes were the estimated total blood loss (ETBL) and perioperative data, including tourniquet duration, preoperative and postoperative day 1 (POD1) and day 3 (POD3) serum D-dimer, CRP, hemoglobin (Hb), and hematocrit (Hct) levels. Secondary outcomes including transfusion rate and 90-day complications were recorded. Results. The ETBL was lower in the TXA group on both POD1 (404.34 ± 234.77 vs. 595.47 ± 279.04, p<0.001) and POD3 (761.39 ± 260.88 vs. 987.79 ± 326.58, p<0.001). The TXA group also demonstrated a lower level of CRP on POD1 (p=0.02) and lower levels of CRP and serum D-dimer on POD3 (p=0.008 and p<0.001). Consumption of fibrinogen was higher in the control group on both POD1 (p=0.013) and POD3 (p<0.001). Length of hospital stay was lower in the TXA group (5.42 ± 1.21 vs. 6.25 ± 1.49, p<0.001). The transfusion rate and perioperative complications were not significantly different between the two groups. Conclusion. Administration of TXA is not only effective in reducing perioperative blood loss and length of hospital stay but also exerts an anti-inflammatory effect following CAS-TKA without causing major complications.

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Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203710 ◽

2020 ◽

Vol 6 (5) ◽

pp. 884

Author(s):

Rui Viegas ◽

Abhishek Kumar ◽

Maria M. Carvalho ◽

João Vide ◽

Ana P. Fontes ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Normal Weight ◽

Control Group ◽

Transfusion Rate ◽

Perioperative Blood Loss ◽

Significant Difference ◽

Total Knee

Background: Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA.Methods: We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared.Results: Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml).Conclusions: TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.

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Bipolar Sealers Do not Improve Blood Loss or Functional Outcomes of Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1676516 ◽

2018 ◽

Vol 33 (01) ◽

pp. 062-066

Author(s):

Stefano Pasqualotto ◽

Guillaume Demey ◽

Aude Michelet ◽

Luca Nover ◽

Mo Saffarini ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Control Group ◽

Transfusion Rate ◽

Significant Difference ◽

Functional Scores ◽

Bipolar Sealer ◽

Total Knee ◽

Without Tourniquet

AbstractSeveral methods were introduced to limit perioperative blood loss in total knee arthroplasty (TKA). By transcollation of soft tissues below 100°C, bipolar sealers intend to reduce bleeding and tissue damage, compared with conventional electrocautery. Existing studies report contradictory findings about the performance of bipolar sealers. The purpose of this study was to evaluate the effect of a bipolar sealer on blood loss, transfusions, hospital length of stay (LOS), and functional scores in primary TKA. In this single-center prospective study, 101 patients, undergoing primary TKA in a fast-track setting without tourniquet use, were randomly assigned to either (1) the study group which was operated with a bipolar sealer or (2) the control group operated with conventional electrocautery. The study cohort comprised 49 men and 52 women, aged 71.1 ± 8.8 years. There was no significant difference between the bipolar sealer group and the control group in terms of blood loss at day 3 (1,240 ± 547.4 vs. 1,376 ± 584.4 mL; p = ns [not significant]), transfusion rate (10 vs. 4%; p = ns), surgery time (48.2 ± 10.8 vs. 46.6 ± 9.1 minute; p = ns) or LOS (4.1 ± 2.7 vs 4.3 ± 2.0 days; p = ns). At a mean follow-up of 63.3 ± 4.9 days, there was no significant difference between the bipolar sealer group and the control group in terms of net improvement of Knee Society Score (KSS) knee (26.0 ± 16.7 vs. 23.7 ± 12.3; p = ns) and KSS function (20.4 ± 19.3 vs. 20.8 ± 19.9; p = ns). Compared with the use of conventional electrocautery in primary TKA without tourniquet, we found no effect of bipolar sealer use on blood loss, transfusion rates, LOS, or functional recovery. This is a Level II, prospective cohort study.

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One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-015-2189-7 ◽

2015 ◽

Vol 135 (4) ◽

pp. 573-588 ◽

Cited By ~ 32

Author(s):

Hamidreza Shemshaki ◽

Sayed Mohammad Amin Nourian ◽

Niloofaralsadat Nourian ◽

Masoudhatef Dehghani ◽

Masoud Mokhtari ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Transfusion Rate ◽

Total Blood ◽

One Step ◽

Total Knee ◽

Acid Administration

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Tranexamic Acid Reduces Occult Blood Loss, Blood Transfusion, and Improves Recovery of Knee Function after Total Knee Arthroplasty: A Comparative Study

The Journal of Knee Surgery ◽

10.1055/s-0037-1602248 ◽

2017 ◽

Vol 31 (03) ◽

pp. 239-246 ◽

Cited By ~ 1

Author(s):

Chunmei Yang ◽

Xiujun Huang ◽

Ruizhong Liu ◽

Wei Liu

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Knee Joint ◽

Intravenous Infusion ◽

Occult Blood ◽

Knee Function ◽

Control Group ◽

Transfusion Rate ◽

Total Knee

AbstractThis study intends to explore the effects of tranexamic acid (TA) on occult blood loss, blood transfusion, and recovery of knee function in patients undergoing total knee arthroplasty (TKA). From October 2013 to April 2015, 224 patients undergoing TKA were enrolled in this study. These patients were randomly assigned into the control group (intravenous infusion of normal saline), 10 mg/kg TA group (intravenous infusion of 10 mg/kg TA) and 15 mg/kg TA group (intravenous infusion of 15 mg/kg TA). Compared with the control group, the 10 and 15 mg/kg TA groups were lower in postoperative blood loss, occult blood loss, blood transfusion rate, and volume. In comparison to the control group, hemoglobin levels were lower and the number of red blood cells was higher at 7 days after surgery in the 10 and 15 mg/kg TA groups. Higher fibrinogen levels and lower prothrombin time (PT), activated partial thromboplastin time, D-dimer levels, thrombin time, lower the visual analog scale/score, and circumference diameter of knee joint were observed in the 10 and 15 mg/kg TA groups compared with the control group at 7 and 14 days after surgery. At 1 and 3 months after surgery, the knee joint range of motion scores, Hospital for Special Surgery scores, and Knee Society Score were increased in 10 and 15 mg/kg TA groups in comparison to the control group. TA could reduce occult blood loss and blood transfusion rate and improve recovery of knee function in patients undergoing TKA.

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Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

10.21203/rs.2.23655/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Lijia Pei ◽

Xiaoyang Li ◽

Yang Liu ◽

Xuyi Wang ◽

Hai Ding ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Visual Analog Scale Score ◽

Drainage Tube ◽

Control Group ◽

Total Blood ◽

Total Knee

Abstract Background: Intraoperative injections of ropivacaine and tranexamic acid have an increasing role as part of analgesia and haemostasis for enhanced recovery after Total Knee Arthroplasty. However, drug efficiency gradually disappears one day after surgery. Drainage tube placed for too long can cause various complications. This study evaluates whether the postoperative injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day would promote recovery after TKA. Methods: A total of 80 participants were randomly assigned to two groups. One group was treated with additional intra-articular injections at 08:30 on postoperative day 1 and the removal of drainage tube simultaneously (Trial Group). Another group was dealt with no injection and removal of the drainage tube responding to the amount of drainage fluid (Control Group). The multi-drug solution included 100 mg ropivacaine, and 1 g tranexamic acid, and 10 mL saline. The primary outcomes assessed included visual analog scale score, length of hospital stay after surgery, the circumference of the knee, total blood loss volume. Results: The group that received an additional intra-articular injection of ropivacaine had a significantly lower area under the curve for visual analog scale score than the no injection group at rest (424 ± 32 compared with 515 ± 39, p = 0.003). The Trial Group can reduce the length of hospital stay after surgery over the Control Group (7.1 ± 3.1 days compared with 8.7 ± 3.2 days, p = 0.003). The group that received an additional intra-articular injection of tranexamic acid have no difference in total blood loss volume & the circumference of knee joint over the no additional intra-articular injection group (910.6 ± 385.3 mL compared with 974.8 ± 408.2 mL, p=0.47 & 38.9 ±5.4cm compared with 38.8±2.4cm，p=0.91). Conclusions: Intra-articular injection of ropivacaine, and tranexamic acid and removal of the drainage tube one day after TKA can further promote recovery after TKA. Keywords: enhanced recovery after surgery, total knee arthroplasty, tranexamic acid, ropivacaine

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The Role of Knee Position in Blood Loss and Enhancement of Recovery after Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1708042 ◽

2020 ◽

Author(s):

Le Cao ◽

Haitao Yang ◽

Kai Sun ◽

Hanbang Wang ◽

Haitao Fan ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Postoperative Blood Loss ◽

Transfusion Rate ◽

Analgesic Drugs ◽

Extension Group ◽

Total Knee

AbstractThe study aimed to investigate the effects of postoperative position of knee on blood loss and functional recovery after total knee arthroplasty (TKA). We enrolled patients who underwent TKA from 2017 to 2019 in our department with osteoarthritis of the knee in this prospective and randomized study. The patients were randomly allocated to flexion or extension group. In the flexion group, the affected leg was elevated by 30 degrees at the hip and the knee was flexed by 30-degree, postoperatively, while in the extension group, the affected knee was fully extended postoperatively. Patients' data related to postoperative blood loss, Hospital for Special Surgery scores, pain intensity, usage of analgesic drugs, circumference of knee, and range of motion (ROM) of knee were recorded to assess the influence of postoperative leg position on clinical outcomes. Although the transfusion rate was similar between the two groups (p > 0.05), other parameters related to blood loss (including total blood loss, hidden blood loss, usage of analgesic drugs, and postoperative circumference of knee) were significantly lower in the flexion group than those in the extension group (p < 0.05). After 6 weeks and 6 months of rehabilitation, patients gained a similar ROM in the affected knee in both groups (p > 0.05). The length of hospital stay and medical expenses were similar in both groups. Incidence of wound infection and other complications was also similar in both groups (p > 0.05). Elevation of the hip by knee flexion of 30 degrees is an effective and simple method to reduce blood loss after TKA, and contributes to reduction of the dosage of analgesic drugs in the early postoperative period. The routine application of the present protocol also did not increase medical costs and length of hospital stay after TKA.

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Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid

Reconstructive Review ◽

10.15438/rr.6.3.151 ◽

2016 ◽

Vol 6 (3) ◽

Author(s):

Tyler Steven Watters ◽

Daniel L Levy ◽

Raymond H Kim ◽

Todd M Miner ◽

Douglas A Dennis ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Transfusion Requirement ◽

Total Blood Loss ◽

Total Blood ◽

Perioperative Blood Loss ◽

Estimated Blood Loss ◽

Total Knee

AbstractBackground: The use of a tourniquet during total knee arthroplasty (TKA) continues to be a matter of debate. Advantages of tourniquet use include improved visualization, decreased intraoperative and total blood loss, and possibly decreased transfusion requirement. However, the recent widespread adoption of antifibrinolytic therapy with tranexamic acid (TXA), may negate these benefits. The purpose of this study was to evaluate perioperative blood loss and transfusion requirement with two different tourniquet application strategies, and surgery without the use of a tourniquet during routine, primary cemented TKA.Methods: A retrospective cohort study was performed of 300 patients undergoing TKA at a single institution after the implementation of a routine intravenous TXA administration protocol and consisted of three groups based on tourniquet usage: tourniquet inflation before incision and deflation following cement hardening (TQ), tourniquet inflation prior to cement application and deflation following hardening (Partial TQ), and no tourniquet usage (No TQ). Each group consisted of 100 consecutive patients. Perioperative blood loss, change in hematocrit and transfusion requirement were compared between groups. Results: Total blood loss (estimated blood loss and drain output) was lowest in the TQ group, however this was only due a slight decrease in intraoperative estimated blood loss. There was no difference in post-operative drain output, or change in hematocrit levels from preoperative values. There were no transfusions in the Partial TQ and No TQ groups, whereas there were 5 transfusions in the TQ group.Conclusions: In the era of routine TXA administration during TKA, tourniquet usage does not appear to have a benefit in regards to perioperative blood loss or transfusion requirement.

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Blood Loss Control with Two Doses of Tranexamic Acid in a Multimodal Protocol for Total Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001105010044 ◽

2011 ◽

Vol 5 (1) ◽

pp. 44-48 ◽

Cited By ~ 19

Author(s):

Miguel Ortega-Andreu ◽

Hanna Pérez-Chrzanowska ◽

Reyes Figueredo ◽

Enrique Gómez-Barrena

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Disease Transmission ◽

Length Of Hospital Stay ◽

Transfusion Rate ◽

Postoperative Blood Transfusion ◽

Transfusion Requirements ◽

Total Knee

Average blood loss after total knee arthroplasty (TKA) usually ranges from 1500 to 1900 cc, including both the postoperative drain and hidden blood loss. This represents about 46% of TKA patients requiring postoperative blood transfusion. Not only the risks of disease transmission but also those of ABO incompatibility, infection due to immunosupression, increased procedure costs, and increased length of hospital stay, are potential problems that foster blood saving strategies. In this study, 71 unilateral TKAs using a multimodal protocol to decrease blood loss were compared to 61 historical cases. Patients in both groups underwent cemented TKA with the same system, surgical technique, and multimodal protocol (MIS approach, plug in the femoral canal, tourniquet removal after wound closure and compressive bandage, analgesic periarticular infiltration with vasoconstrictor, postoperative drain at atmospheric pressure, opened 2 hours after the end of the surgical procedure and removed after 24 hours). The study series incorporated intravenous tranexamic acid (TXA) infusion in 2 doses of 10-15 mg/kg, 15 minutes before tourniquet release and 3 hours later. Results showed no transfusion requirements in the TXA series (0%), with 23/61 (37.7%) transfusions in the control, with an average cost decrease of 240 euros per patient. Visible bleeding in 24h significantly decreased from 553.36 cc (range 50-1500) to 169.72 cc (range 10-480) in the TXA series. As a conclusion, implementing a TXA-based multimodal protocol produced significant decrease in the transfusion rate, visible blood loss, and cost per patient, thus proving effectiveness and efficiency in the surgical management of TKA.

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Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-hour clamp drain: a prospective triple-blinded randomized controlled trial

Orthopedic Reviews ◽

10.4081/or.2011.e12 ◽

2011 ◽

Vol 3 (2) ◽

pp. 12 ◽

Cited By ~ 53

Author(s):

Paphon Sa-ngasoongsong ◽

Thanaphot Channoom ◽

Viroj Kawinwonggowit ◽

Patarawan Woratanarat ◽

Pongsthorn Chanplakorn ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Controlled Trial ◽

Computer Assisted Surgery ◽

Postoperative Blood Loss ◽

Control Group ◽

Computer Assisted ◽

Total Blood ◽

Acid Injection ◽

Total Knee

A high-dose local tranexamic acid has been introduced in total knee arthroplasty for bleeding control. We are not sure about the systemic absorption and side effects. The aim of this study was to evaluate the effect of low dosage of intra-articular tranexamic acid injection combined with 2-hour clamp drain in minimally bleeding computer-assisted surgery total knee replacement (CAS-TKR). A prospective randomized controlled trial was conducted in a total of 48 patients underwent CAS-TKR. The patients were randomly assigned to receive either of a mixed intra-articular solution of tranexamic acid 250 mg with physiologic saline (TXA group), or physiologic saline (control group) and then followed by clamp drain for 2 hours. Postoperative blood loss was measured by three different methods as drainage volume, total hemoglobin loss and calculated total blood loss. Transfusion requirement and postoperative complications were recorded. All patients were screened for deep vein thrombosis and the functional outcomes were evaluated at 6 months after surgery. The mean postoperative drainage volume, total hemoglobin loss and calculated total blood loss in TXA group were 308.8 mL, 2.1 g/dL and 206.3 mL compared to 529.0 mL, 3.0 g/dL and 385.1 mL in the control group (P=0.0003, 0.0005 and <0.0001 respectively). Allogenic blood transfusion was needed for one patient (4.2%) in TXA group and for eight patients (33.3%) in the control group. Postoperative knee scores were not significantly different between groups. No deep vein thrombosis, infection or wound complication was detected in both groups. In this study, low dose intra-articular tranexamic acid injection combined with 2-hour clamping drain was effective for reducing postoperative blood loss and transfusion requirement in CAS-TKR without significant difference in postoperative complications or functional outcomes.

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Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without

Acta Orthopaedica Belgica ◽

10.52628/87.3.11 ◽

2021 ◽

Vol 87 (3) ◽

pp. 461-468

Author(s):

Simon Joufflineau ◽

Emmanuel Thienpont

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Low Pressure ◽

Total Blood Loss ◽

Transfusion Rate ◽

Total Blood ◽

Hidden Blood Loss ◽

Total Knee ◽

No Tourniquet

Tourniquet-use has been described in litera- ture as a surgical factor leading to increased post-operative hidden blood loss in total knee arthroplasty (TKA). The hypothesis for this retro- spective study was that low-pressure tourniquet TKA would offer the benefits of tourniquet surgery without the potential negative effects on late blood loss after the procedure. Therefore, this study evaluated total (TBL) and hidden blood loss (HBL) in TKA with or without a tourniquet. We retrospectively compared two groups : one group (n= 54) undergoing TKA without a tourniquet and one group with a low-pressure tourniquet (n= 110). The outcomes compared were hemoglobin levels 2 weeks before surgery and at days 2 and 4 after surgery to calculate total and hidden blood loss, transfusion rate, and functional outcome. A higher total blood loss was observed in the no tourniquet group with a mean loss of 1073 mL against 890 mL in the tourniquet group (p-value = 0,003). Hidden blood loss values between both groups were statistically not significant : in the no-tourniquet group, Hb drop between D2 and D4 was 0.5 g/dL against 0.4 g/ dL in the low-pressure tourniquet group. The tourniquet-less group did not present with better functional scores. This study showed that low- pressure tourniquet use reduces TBL without increasing HBL in TKA.

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