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Effectiveness of Intra-Articular Tranexamic Acid Versus Intravenous Tranexamic Acid in Reducing Blood Loss for Total Knee Replacement: A Randomized Control Trial

Ralph August Manaois, MD

Introduction: Intra-articular TXA administration during TKR has only began to gain popularity in recent years. The drug may be given as an intra-articular wash or into the joint after wound closure with a drain. Advocates of intra-articular Tranexamic acid believes in the advantages of it which includes easy administration, and the achievement of maximum concentration at the bleeding site with minimal systemic absorption as compared to IV administration.

Objective: To determine the effectiveness of intra-articular administration of Tranexamic acid in TKR patients compared with Intravenous Tranexamic Acid

Methods: A Randomized Control Trial Open Label Non-inferiority Study Design was utilized to describe the outcomes of patients who were subjected to Intra-articular and Intravenous TXA during surgery. Total sample size was computed at 20. The primary outcome was the decrease in blood loss after administration of Intra-articular Tranexamic Acid as compared with Intravenous Tranexamic Acid intra-operatively and post-operatively. The secondary outcome was the decrease or absence of complications, pain, cost effectiveness and improvement of function.

Results: There was lesser amount of blood noted in the suction bottle and weight of operative sponges in the IA-TXA group than the IV-TXA group. The estimated blood loss at 48th hour was 673.5mL in the experimental group and 634.7 mL in the control group, no blood transfusion was performed in either group and post-operative Hgb level at the 48th hour post-operative period was 113.3 mL in the experimental group and 115.7 mL in the control group was not clinically significant confirming the noninferiority for the efficacy. Complication rates and Functional outcome have no significant difference suggesting equivalence. 

Conclusion: Intra-articular administration of TXA demonstrated non-inferiority compared with intravenous TXA, with no safety concerns. This randomized controlled trial supports the intra-articular administration of TXA in primary total knee replacement with cemented implants.

Keywords: Total Knee Replacement, Tranexamic Acid, Blood Loss, Intra-articular, Transfusion

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