The Efficacy of Tranexamic Acid when added Locally in Joint Arthroplasty

Purpose: The reduction in intra-operative blood loss leads to a reduced rate of blood transfusion, faster recovery and a more stable hemodynamic status in joint arthroplasty. In this study, the authors examined the added effects of TXA when injected locally in joint replacement.

Methods: A total of 169 patients were examined in two consecutive series ( intravenous TXA only, intravenous TXA + Local TXA). 83 patients in the IV only (63 THA, 20 TKA), 86 in the locally added TXA (72 THA, 20 TKA). In The beginning of each case 15mg/kg TXA were administered IV for all patients. Durning wound closure 3g mixed in 150cc saline where injected locally. The amount of blood loss, transfusion and haemoglobin levels followed up and documented accordingly.

Results: The mean blood loss in the intravenous & intra-articular were 1027 ± 374 ml, 865 ± 354 ml respectively. When broken to groups by joint – the mean blood loss for THJR was 1008± 374, 928 ± 349 ml, for TKJR it was 1087 ± 378 ml and 579 ± 218 ml for the local TXA group. 4 transfusions were required in the IV TXA Group, 1 transfusion was required in the local TXA group.

Discussion: TXA is a good method for bleeding control in joint replacement. Addition of local TXA seems to have no added effect in THJA but it appears to be beneficial in TKJA hence more studies are required in this field.