Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (6): 873-877.doi: 10.3969/j.issn.2095-4344.2390

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Hemostatic effect of topical tranexamic acid infiltration in cementless total knee arthroplasty

Yuan Jun, Yang Jiafu   

  1. Department of Orthopedics, Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • Received:2020-02-10 Revised:2020-02-20 Accepted:2020-04-11 Online:2021-02-28 Published:2020-12-03
  • About author:Yuan Jun, Attending physician, Department of Orthopedics, Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou 646000, Sichuan Province, China

Abstract: BACKGROUND: Topical tranexamic acid in cemented total knee arthroplasty has been shown to significantly reduce perioperative blood loss, thereby reducing the need for blood transfusion. However, few studies have focused on whether the hemostatic effect of topical tranexamic acid is still effective under the mixed fixation mode (femoral prosthesis compression fixation, tibial prosthesis bone cement fixation). 
OBJECTIVE: To investigate the effect of topical tranexamic acid on blood loss after total knee arthroplasty using hybrid fixation.
METHODS: From January 2017 to December 2018, 208 patients receiving primary total knee arthroplasty were retrospectively collected. Among these patients, 132 patients in the hybrid fixation group (First Affiliated Hospital of the Fourth Military Medical University) underwent total knee arthroplasty using hybrid fixation, and 76 patients in the cemented fixation group (Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University) received total knee arthroplasty with cemented fixation. These patients were sub-classified based on whether or not receiving topical tranexamic acid. The 24-hour drainage volume, blood transfusion rate, the difference in preoperative and postoperative hemoglobin levels, and complications were taken into account for assessing the hemostatic effect of topical tranexamic acid. 
RESULTS AND CONCLUSION: (1) Among all the patients and patients having hybrid fixation, there was no significant difference in age, gender, body mass index, and operation duration between the patients treated with and without tranexamic acid (P > 0.05). (2) Topical tranexamic acid significantly decreased drainage volume, blood loss, and blood transfusion rate whether patients received hybrid fixation or cemented fixation (P < 0.05). In the hybrid fixation group, patients receiving topical tranexamic acid had remarkably lower drainage volume, blood loss, and blood transfusion rate than patients without topical tranexamic acid. Meanwhile, overall blood loss in the hybrid fixation group was a little higher than that in the cemented fixation group. (3) No severe complications such as thrombosis or rejection were reported in both groups. (4) In conclusion, topic tranexamic acid is as effective in decreasing blood loss and blood transfusion rate for total knee arthroplasty with hybrid fixation as with cemented fixation.

Key words: bone, joint, total knee arthroplasty, tranexamic acid, bone cement, fixation, blood loss

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