• Yusuke Kamatsuki, Shinichi Miyazawa, Takayuki Furumatsu, Yuya Kodama, Tomohito Hino, Yoshiki Okazaki, Shin Masuda, Yuki Okazaki, and Toshifumi Ozaki.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
• Eur J Orthop Surg Tr. 2019 Dec 1; 29 (8): 1737-1741.

IntroductionThe effect of tranexamic acid (TXA) on the incidence of venous thromboembolic events (VTEs) in total knee arthroplasty (TKA) as assessed by contrast-enhanced computed tomography (CT) is unclear. Thus, we investigated the efficacy and safety profiles of TXA administration during TKA. We hypothesised that intra-articular 1 g TXA administration would have a sufficient effect on the reduction of blood loss and transfusion rates without increasing VTE risk.Materials And MethodsWe retrospectively analysed 86 patients who underwent primary TKA from January 2014 to September 2017. The study comprised control (n = 45) and TXA (n = 41) groups. All patients underwent navigation-assisted TKA via the medial parapatellar approach. In those who received TXA, 1 g of intra-articular TXA was injected via a drain immediately following wound closure. The drain was clamped for 2 h and then reopened. Contrast-enhanced CT was performed 5-6 days after surgery to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). Blood loss was calculated using the haemoglobin balance method.ResultsThe mean postoperative volume of blood loss was 900 ± 296 mL vs 1216 ± 445 mL in the TXA vs control group (p < 0.01). Allogeneic blood transfusion was required for 0 (0%) vs 6 (13.3%) patients in the TXA vs control group (p = 0.013). There were no significant inter-group differences regarding DVT and PE incidence (p > 0.05). No case of symptomatic PE occurred.ConclusionsThis study demonstrated that intra-articular 1 g TXA administration during TKA is safe and effective for reducing blood loss and blood transfusion without increasing VTE risk.

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