Clinical Outcomes of Intra-Operative Soak with Tranexamic Acid in Total Knee Replacement Surgery

Main Article Content

ศักรินทร์ ธนเกียรติสกุล


The major problem of total knee arthroplasty for the degenerative knee is blood loss after the operation. This retrospective study aimed to survey the clinical outcomes especially blood loss after total knee arthroplasty in Buddhachinaraj Phitsanulok hospital, from January 2010 to March 2018. Fifty osteoarthritic patients who had total knee arthroplasty were enrolled. They had received tranexamic acid 250 mg. plus normal saline 50 mL. soak intra-operation within 10 minutes period. The amounts of blood loss after operation in all the patients were recorded by vacuum drainage volume until the drainage were removed. The number of patients who required blood replacement, length of stay in hospital and the complications were also recorded. The descriptive statistics were analyzed by percentage, mean, standard deviation and range. The results showed that, the post-operative blood loss in the drainage was average 613 +/- 262.06 mL. Only one patient required blood transfusion. The hospital length of stay was average 7 days (7.290+/-6.23 days) and there was no complication found. In conclusion, the total knee arthroplasty with intra-operative soak with tranexamic acid can reduce blood loss and safe for patients


Article Details

Research Article


1. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81(1):2-10.

2. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 2004;19(3):281-7.

3. Krohn CD, Sørensen R, Lange JE, Riise R, Bjørnsen S, Brosstad F. Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg Suppl 2003;(588):57-61.

4. i JJ, Yang ZQ, Zhao YL, Tan L. [Research progress on tranexamic acid application strategy in total knee arthroplasty]. Zhongguo Gu Shang 2016;29(10):963-967.

5. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemel HM, M?ntyl SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997;84(4):839-44.

6. Veien M, Sørensen JV, Madsen F, Juelsgaard P. Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study. Acta Anaesthesiol Scand 2002;46(10):1206-11.

7. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 2001;83(5):702-5.

8. Charoencholvanich K, Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res 2011 ;469(10):2874-80.

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

10. Zhang F, Gao Z, Yu J. [Clinical comparative studies on effect of tranexamic acid on blood loss associated with total knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007 ;21(12):1302-4.

11. Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg Br 2007;89(3):306-9.

12. Zhang H, Chen J, Chen F, Que W. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012;20(9):1742-52.

13. Kakar PN, Gupta N, Govil P, Shah V. Efficacy and Safety of Tranexamic Acid in Control of Bleeding Following TKR: A Randomized Clinical Trial. Indian J Anaesth 2009;53(6):667-71.

14. Cid J, Lozano M. Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion 2005;45(8):1302-7.

15. Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res 2009;123(5):687-96.

16. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 2003;90(5):596-9.

17. Kovesi T, Royston D. Pharmacological approaches to reducing allogeneic blood exposure. Vox Sang 2003;84(1):2-10.

18. Lin PC, Hsu CH, Chen WS, Wang JW. Does tranexamic acid save blood in minimally invasive total knee arthroplasty? Clin Orthop Relat Res 2011;469(7):1995-2002.

19. Roy SP, Tanki UF, Dutta A, Jain SK, Nagi ON. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012;20(12):2494-501.

20. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 2011;35(11):1639-45.

21. Xiong H, Liu Y, Zeng Y, Wu Y, Shen B. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2018;19(1):321.

22. Gao F, Ma J, Sun W, Guo W, Li Z, Wang W. Topical fibrin sealant versus intravenous tranexamic acid for reducing blood loss following total knee arthroplasty: A systematic review and meta-analysis. Int J Surg 2016;32:31-7.

23. Li J, Li HB, Zhai XC, Qin-Lei, Jiang XQ, Zhang ZH. Topical use of topical fibrin sealant can reduce the need for transfusion, total blood loss and the volume of drainage in total knee and hip arthroplasty: A systematic review and meta-analysis of 1489 patients. Int J Surg 2016;36(Pt A):127-37.

24. Li ZJ, Fu X, Tian P, Liu WX, Li YM, Zheng YF, Ma XL, Deng WM. Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2015;23(7):2019-25.

25. Plangsiri K. Periarticular soft tissue injection of tranexamic acid around knee joint can reduce postoperative blood loss in total knee arthroplasty. J Med Health Sci 2016;23:2:8-15.