A comparative study between intravenous alone and combined intravenous and intra-articular administration of tranexamic acid in primary total knee replacement patients

Background: With the better understanding of the total knee arthroplasty, the number of patients with extremes of ages and advanced comorbidities undergoing total knee arthroplasty are increasing. The most common post-operative complication remains the blood loss. The intravenous use of tranexamic acid was initially thought to decrease the blood loos. Over the past years, intra-articular administration of Tranexamic acid is also being used to reduce the blood loss. Now there is an increasing trend to combine the intravenous and intra-articular route for tranexamic acid in patients undergoing total knee arthroplasty. There are very few studies that evaluates or compares the intravenous and combination of intravenous and intra-articular route of tranexamic acid in total knee arthroplasty patients. Methods: Two Hundred and two patients with severe knee osteoarthrosis planned for total knee arthroplasty were selected in accordance to inclusion and exclusion criteria. Patients were divided into Group A and B and was administered with combination of intravenous and intra-articular tranexamic acid for Group A patients and intravenous tranexamic acid for Group B patients .The outcome was measured in terms of blood loss in post-operative day one calculated using classical Nadir Method. Results: The blood loss were found to be 328.04±178.9 ml in Group A and 362.88±220.408 ml in Group B. The p value was found to be greater than 0.005 and hence the difference in post-operative blood loss in both group was not statistically significant. Conclusions: There is no difference between the combination of Intra-venous Transexmic and Intra-articular Tranexamic acid when compared with intravenous Tranexamic acid in reducing blood loss in patients undergoing total knee arthroplasty.