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Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The use of tourniquet in total knee arthroplasty (TKA) has resulted in negligible intra-operative blood loss but notable post-operative blood loss, creating the ideal scenario for using topical haemostatic agents intra-operatively. Recently, medical adjuvants including tranexamic acid (TXA) and hydrogen peroxide (H2O2) have been introduced. The aim of this study was to evaluate the effectiveness of intra-articular TXA and H2O2 in reducing blood loss during TKA.

Materials and methods

Fifty patients, who underwent a primary TKA with 1,500 mg of intra-articular TXA between May 2011 and December 2011, were compared with two matching cohorts of 50 patients each who underwent TKA with 100 ml of 3 % H2O2 wash and TKA without any TXA or H2O2. All surgeries were performed by two senior surgeons. The total blood loss was calculated by the hemoglobin balance method.

Results

The pre-operative serum hemoglobin levels were 13.1 ± 1.3, 13.1 ± 1.3 and 13.0 ± 1.2 g/dl (p > 0.05); while the drop in serum hemoglobin levels post-operatively was 2.0 ± 0.7, 2.4 ± 0.9 and 2.7 ± 0.8 g/dl for the TXA, H2O2 and Control groups, respectively (p < 0.001). The total amount of blood loss was 596 ± 449, 710 ± 279 and 760 ± 228 ml, respectively (p = 0.046). There was no difference in the duration of surgery between the three groups (p > 0.05).

Conclusions

This study showed that intra-articular TXA reduced blood loss during TKA without significantly increasing the duration of surgery. We cannot justify H2O2 wash as an alternative to intra-articular TXA to reduce blood loss during TKA.

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Acknowledgments

The authors thank Yanni Xu for her technical support.

Conflict of interest

The authors did not receive any outside funding or Grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 169608, Singapore

    Jerry Yongqiang Chen, Inderjeet Singh Rikhraj, Zhihong Zhou, Darren Keng Jin Tay, Pak Lin Chin, Shi-Lu Chia, Ngai Nung Lo & Seng Jin Yeo

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  1. Jerry Yongqiang Chen
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Correspondence to Jerry Yongqiang Chen.

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Chen, J.Y., Rikhraj, I.S., Zhou, Z. et al. Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty?. Arch Orthop Trauma Surg 134, 997–1002 (2014). https://doi.org/10.1007/s00402-014-1958-z

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  • DOI: https://doi.org/10.1007/s00402-014-1958-z

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