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Comparing the efficacy of intravenous or intra-articular tranexamic acid in reducing blood loss in simultaneous bilateral knee replacement surgery without the use of tourniquet

  • Original Article • KNEE - ARTHROPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To compare the effect of intravenous or intra-articular route of administration of tranexamic acid in reducing the blood loss in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquets.

Methods

Prospective cohort study of 30 consecutive patients grouped into two groups; Group 1: intravenous group and group 2: intra-articular group. Two outcome measures were studied; mean drop in post-operative haemoglobin and need for blood transfusion in both groups.

Results

No significant difference in mean drop of haemoglobin and need for blood transfusion in both groups.

Conclusion

Route of administration of tranexamic acid does not influence on the mean drop of haemoglobin and need for blood transfusion in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquet.

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References

  1. Lee YS (2017) Comprehensive analysis of pain management after total knee arthroplasty. Knee Surg Relat Res 29(2):80–86

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fu Y, Shi Z, Han B et al (2016) Comparing efficacy and safety of two methods of tranexamic acid administration in reducing blood loss following total knee arthroplasty: a meta-analysis. Medicine 95(50):e5583

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Hao W, Bin S, Yi Z (2014) Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee 21(6):987–993

    Article  Google Scholar 

  4. Themistoklis T, Theodosia V, Konstantinos K, Georgios DI (2017) Perioperative blood management strategies for patients undergoing total knee replacement: where do we stand now? World J Orthop 8(6):441–454

    Article  PubMed  PubMed Central  Google Scholar 

  5. Henry DA, Carless PA, Moxey AJ et al (2007) Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 17(4):CD001886

    Google Scholar 

  6. Schwarzkopf R, Dang P, Luu M, Mozaffar T, Gupta R (2015) Topical tranexamic acid does not affect electrophysiologic or neurovascular sciatic nerve markers in an animal model. Clin Orthop Relat Res 473(3):1074–1082

    Article  PubMed  PubMed Central  Google Scholar 

  7. Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM (2014) A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 96B(8):1005–1015

    Article  Google Scholar 

  8. Huang Z, Ma J, Shen B, Pei F (2014) Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplast 29(12):2342–2346

    Article  Google Scholar 

  9. Holmström B, Laugaland K, Rawal N, Hallberg S (1993) Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery. Can J Anaesth 40(7):601–606

    Article  PubMed  Google Scholar 

  10. Zhanxia Yu, Yao Lulan, Yang Qin (2017) Tranexamic acid plus diluted-epinephrine versus tranexamic acid alone for blood loss in total joint arthroplasty: a meta-analysis. Medicine 96(24):e7095

    Article  CAS  Google Scholar 

  11. Bakovic D, Pivac N, Eterovic D et al (2013) The effects of low-dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets. Clin Physiol Funct Imaging 33:30–37

    Article  PubMed  CAS  Google Scholar 

  12. Niki Y, Matsumoto H, Otani T, Tomatsu T, Toyama Y (2007) How much sterile saline should be used for efficient lavage during total knee arthroplasty? Effects of pulse lavage irrigation on removal of bone and cement debris. J Arthroplast 22(1):95–99

    Article  Google Scholar 

  13. Maheshwari A, Blum Y, Shekhar L, Ranawat A, Ranawat C (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467(6):1418–1423

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kayamori S, Tsukada S, Sato M, Komata K, Isida Y, Wakui M (2016) Impact of postoperative compression dressing using polyethylene foam pad on the multimodal protocol for swelling control following total knee arthroplasty: a randomized controlled trial. Arthroplast Today 2(4):199–204

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dobbelaere A, Schuermans N, Smet S, Van Der Straeten C, Victor J (2015) Comparative study of innovative postoperative wound dressings after total knee arthroplasty. Acta Orthop Belg 81(3):454–461

    PubMed  Google Scholar 

  16. Turun S, Banghua L, Yuan Y, Zhenhui L, Ying N, Jin C (2011) A systematic review of rivaroxaban versus enoxaparin in the prevention of venous thromboembolism after hip or knee replacement. Thromb Res 127(6):525–534

    Article  PubMed  CAS  Google Scholar 

  17. Pua Y, Ong P, Chong H, Lo N (2011) Sunday physiotherapy reduces inpatient stay in knee arthroplasty: a retrospective cohort study. Arch Phys Med Rehabil 92(6):880–885

    Article  PubMed  Google Scholar 

  18. Rogers BA, Johnstone DJ (2006) Audit on the efficient use of cross-matched blood in elective total hip and total knee replacement. Ann R Coll Surg Engl 88:199–201

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Dennis DA, Kittelson AJ, Yang CC, Miner TM, Kim RH, Stevens-Lapsley JE (2016) Does tourniquet use in TKA affect recovery of lower extremity strength and function? A randomized trial. Clin Orthop Relat Res 474(1):69–77

    Article  PubMed  Google Scholar 

  20. Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L (2014) The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res 9(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY (2011) Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19(7):1121–1130

    Article  PubMed  Google Scholar 

  22. Weng K, Zhang X, Bi Q, Zhao C (2016) The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty: a meta-analysis. Medicine 95(39):e4960

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Jansen AJ, Andreica S, Claeys M, D’Haese J, Camu F, Jochmans K (1999) Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth 83(4):596–601

    Article  PubMed  CAS  Google Scholar 

  24. May JH, Rieser GR, Williams CG, Markert RJ, Bauman RD, Lawless MW (2016) The assessment of blood loss during total knee arthroplasty when comparing intravenous vs intracapsular administration of tranexamic acid. J Arthroplast 31(11):2452–2457

    Article  Google Scholar 

  25. Chen JY, Chin PL, Moo IH, Pang HN, Tay DK, Chia SL, Lo NN, Yeo SJ (2016) Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: a double-blinded randomised controlled noninferiority trial. Knee 23(1):152–156

    Article  PubMed  Google Scholar 

  26. Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL (2014) Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplast 29(8):1528–1531

    Article  Google Scholar 

  27. Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V (2013) Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 28(10):1888–1891

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hiranandani Orthopaedic Medical Education (HOME), Dr L H Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Powai, Mumbai, 400076, India

    Mridul Arora, Singh Saurabh, Varun Gupta, Ashutosh Dongre & Vijay Shetty

Authors
  1. Mridul Arora
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  2. Singh Saurabh
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  3. Varun Gupta
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  4. Ashutosh Dongre
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  5. Vijay Shetty
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Corresponding author

Correspondence to Singh Saurabh.

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The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Arora, M., Singh, S., Gupta, V. et al. Comparing the efficacy of intravenous or intra-articular tranexamic acid in reducing blood loss in simultaneous bilateral knee replacement surgery without the use of tourniquet. Eur J Orthop Surg Traumatol 28, 1417–1420 (2018). https://doi.org/10.1007/s00590-018-2194-y

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  • DOI: https://doi.org/10.1007/s00590-018-2194-y

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