An additional intra-operative peri-articular tranexamic acid decreases the drain output but does not benefit in total blood loss conservation during bilateral Total Knee Arthroplasty: A retrospective observation

Arghya Kundu Choudhury; Anil Regmi; Bishwa Bandhu Niraula; Tushar Gupta; Souvik Paul; Roop Bhusan Kalia

doi:10.1016/j.jcot.2024.102770

An additional intra-operative peri-articular tranexamic acid decreases the drain output but does not benefit in total blood loss conservation during bilateral Total Knee Arthroplasty: A retrospective observation

J Clin Orthop Trauma. 2024 Oct 16:57:102770. doi: 10.1016/j.jcot.2024.102770. eCollection 2024 Oct.

Authors

Arghya Kundu Choudhury¹, Anil Regmi², Bishwa Bandhu Niraula², Tushar Gupta³, Souvik Paul⁴, Roop Bhusan Kalia³

Affiliations

¹ Department of Robotics and Joint Replacement, Sarvodaya Health and Research Centre.
² Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India.
³ Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
⁴ Department of Orthopaedics, AMRI, Mukundapur, Kolkata, India.

PMID: 39525859
PMCID: PMC11541940 (available on 2025-10-16)
DOI: 10.1016/j.jcot.2024.102770

Abstract

Background: The preferred procedure for end-stage arthritic knees is Total Knee Arthroplasty (TKA). Hidden blood loss during and after surgery is one of the most frequent side effects of TKA. This study aims to assess the impact of an extra intraoperative dosage of local periarticular tranexamic acid (TXA) on total blood loss and drain output following bilateral TKA in comparison to conventional triple dose IV TXA.

Methods: Patients who had bilateral simultaneous TKA between January 2021 and November 2022 were the subjects of a single centre based retrospective observational analysis. In group 1 and group 2, 80 knees (IV TXA with periarticular TXA) were compared to a matched paired control set of 80 knees (3 dose IV TXA).

Results: In all, 80 patients having 160 TKAs performed were included in the study. When the two groups' total and concealed blood losses were compared, they were found to be statistically insignificant; nevertheless, first group's drain output was considerably lower than the second group due to the use of an additional dose of periarticular TXA. Comparable declines in Hb, HCT, and platelet count were observed among the two groups. The secondary goal indicated that although there was no significant difference in range of motion between the groups 72 h after surgery, group 2 had a higher rate of hospital re-admissions within 30 days compared to group 1.

Conclusion: The study demonstrated that peri-articular TXA administration during bilateral simultaneous TKA resulted in no additional benefit to the total or hidden blood loss conservation, except reducing the drain amount. However, a unique finding of the current study suggests decreased chances of wound complications and lesser 30-day readmission rate among patients receiving peri-articular TXA. Present study thus advocates the use of TXA as an effective peri-articular adjunct after TKA when a negative suction drain is being used post-operatively.

Level of evidence: Level III, Retrospective comparative study.

Keywords: Blood loss; Knee arthroplasty; Tranexamic acid.