A STUDY ON THE USE OF TOPICAL VERSUS INTRAVENOUS TRANEXAMIC ACID IN MINIMIZING BLOOD LOSS IN PRIMARY TOTAL KNEE REPLACEMENT IN A TERTIARY CARE HOSPITAL
DOI:
https://doi.org/10.54112/bcsrj.v2024i1.1020Keywords:
Total knee replacement, topical tranexamic acid, intravenous tranexamic acid, blood lossAbstract
Significant blood loss during total knee replacement (TKR) surgery is a major concern, with tranexamic acid (TXA) commonly used to reduce it. This study compares the efficacy of topical versus intravenous TXA in minimizing blood loss in primary TKR. Objective: To compare the efficacy of topical versus intravenous tranexamic acid in minimizing blood loss in primary total knee replacement surgery. Methods: This prospective randomized controlled trial was conducted at the Department of Orthopedics, CMH Rawalpindi, Pakistan in the duration from December 2023 to May 2024 to compare the efficacy of intravenous and intra-articular Tranexamic Acid (TXA) in primary total knee replacement (TKR) patients. 120 adult patients with primary knee osteoarthritis were randomly assigned to two groups: Group A (IV TXA) received 15 mg/kg TXA intravenously twice, and Group B (IA TXA) received 2 grams of TXA intra-articularly. Exclusion criteria included conditions like hepatitis B or C, TXA allergy, and severe medical histories such as thromboembolic events. Surgeries were performed by a single consultant orthopedic surgeon using a mid-vastus approach and cemented prosthesis, with standardized postoperative care, including drain management and rehabilitation exercises. Data on drain output, hemoglobin levels, and transfusion requirements were collected and analyzed using SPSS version 23, with statistical significance set at p < 0.05. Ethical approval and informed consent were obtained before the study. Results: In this study involving 120 patients undergoing total knee replacement (TKR), participants were evenly divided into Group A (Intravenous TXA) and Group B (Topical TXA). Both groups were comparable in demographics, procedural characteristics, and co-morbidities, ensuring balanced baseline conditions. Results showed that while Group B exhibited significantly less blood loss on Day 1 post-surgery (p = 0.15), there were no significant differences in immediate post-surgery blood loss, hemoglobin levels, or the need for transfusions. Postoperative complications, hospital stay length, and patient satisfaction were similar between the groups. Group B showed a trend towards a shorter hospital stay and better range of motion at six weeks. Conclusion: Our research demonstrates that topical and intravenous Tranexamic Acid (TXA) is equally effective in reducing intraoperative and postoperative blood loss in primary total knee replacement (TKR). No significant differences were observed between the two methods regarding hemoglobin level changes, transfusion rates, blood loss, complications, hospital stay duration, patient satisfaction, or functional outcomes. However, topical TXA offers advantages such as local application, enhanced safety, and ease of administration. These findings support the TXA delivery method based on patient preferences and characteristics, providing flexibility in clinical practice for managing blood loss in TKR.
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References
Dantas LO, de Fátima Salvini T, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian journal of physical therapy. 2021;25(2):135-46.
Kim D-J. A study on the physical activities, mental health, and health-related quality of life of osteoarthritis patients. Osong Public Health and Research Perspectives. 2019;10(6):368.
Steinhaus ME, Christ AB, Cross MB. Total knee arthroplasty for knee osteoarthritis: support for a foregone conclusion? HSS Journal®. 2017;13(2):207-10.
Kumar D, Sharma A, Sharma G, Trivedi A. A Comparative Study of Blood Loss With and Without Infusion of Tranexamic Acid in Total Knee Replacement. Cureus. 2022;14(8).
Al-Turki AA, Al-Araifi AK, Badakhan BA, Al-Nazzawi MT, Alghnam S, Al-Turki AS. Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia. Saudi Medical Journal. 2017;38(6):598.
Allain J-P, Stramer SL, Carneiro-Proietti A, Martins M, Da Silva SL, Ribeiro M, et al. Transfusion-transmitted infectious diseases. Biologicals. 2009;37(2):71-7.
Lam T, Medcalf RL, Cloud GC, Myles PS, Keragala CB. Tranexamic acid for haemostasis and beyond: does dose matter? Thrombosis Journal. 2023;21(1):94.
Mortazavi SJ, Sattartabar B, Moharrami A, Kalantar SH. Intra-articular versus intravenous tranexamic acid in total knee arthroplasty: a randomized clinical trial. Archives of Bone and Joint Surgery. 2020;8(3):355.
Franchini M, Mengoli C, Marietta M, Marano G, Vaglio S, Pupella S, et al. Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials. Blood Transfusion. 2018;16(1):36.
Furqan A, Hafeez S, Khan F, Orakzai SH, Nur AN, Khan MA. Intra-articular Versus Intravenous Tranexamic Acid in Primary Total Knee Replacement. Cureus. 2022;14(1).
Maniar RN, Singhi T, Patil A, Kumar G, Maniar P, Singh J. Optimizing effectivity of tranexamic acid in bilateral knee arthroplasty—a prospective randomized controlled study. The knee. 2017;24(1):100-6.
Kim DH, Lee GC, Lee SH, Pak C-H, Park SH, Jung S. Comparison of blood loss between neutral drainage with tranexamic acid and negative pressure drainage without tranexamic acid following primary total knee arthroplasty. Knee surgery & related research. 2016;28(3):194.
Park JH, Rasouli MR, Mortazavi SJ, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. JBJS. 2013;95(19):1777-83.
Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. JBJS. 2014;96(23):1937-44.
Fu D-J, Chen C, Guo L, Yang L. Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Chinese Journal of Traumatology. 2013;16(02):67-76.
Chen Y, Chen Z, Cui S, Li Z, Yuan Z. Topical versus systemic tranexamic acid after total knee and hip arthroplasty: a meta-analysis of randomized controlled trials. Medicine. 2016;95(41):e4656.
Pispati A, Garg P, Patil N, Savedekar A, Jaiswal N, Kumar A. Is intraarticular administration of tranexamic acid better than its intravenous administration in reducing blood loss after total knee arthroplasty? Journal of Orthopaedics and Spine. 2013;1(2):28-32.
Balasubramanian N, Natarajan G. Prospective study to compare intra-articular versus intravenous tranexemic acid in reducing post-operative blood loss in staged bilateral total knee arthroplasty. Malaysian Orthopaedic Journal. 2016;10(3):7.
Pinsornsak P, Phunphakchit J, Boontanapibul K. Efficacy and systemic absorption of peri-articular versus intra-articular administration of tranexamic acid in total knee arthroplasty: a prospective randomized controlled trial. Arthroplasty Today. 2021;11:1-5.
Ribed-Sánchez B, González-Gaya C, Varea-Díaz S, Corbacho-Fabregat C, Pérez-Oteyza J, Belda-Iniesta C. Economic analysis of the reduction of blood transfusions during surgical procedures while continuous hemoglobin monitoring is used. Sensors. 2018;18(5):1367.
Seo J-G, Moon Y-W, Park S-H, Kim S-M, Ko K-R. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21:1869-74.
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