BACKGROUND: Tranexamic acid is a synthetic amino acid, and can block the lysine binding site of plasminogen to reduce fibrinolysis and blood loss. It is widely used to reduce perioperative bleeding in total knee arthroplasty.

OBJECTIVE: To evaluate the effect of intra-articular infusion combined with peri-articular injection versus intra-articular infusion of tranexamic acid on blood loss after total knee arthroplasty.  

METHODS: Totally 75 patients with unilateral knee osteoarthritis who underwent total knee arthroplasty were randomly divided into two groups. Both groups were intravenously injected with normal saline 250 mL+tranexamic acid 1 g 30 minutes before surgery. For the intra-articular infusion group, peri-articular injection with 100 mL cocktail was performed after the closure of articular capsule and intra-articular infusion with tranexamic acid (3.0 g+normal saline 50 mL) was also performed after surgery. For the intra-articular infusion combined with peri-articular injection group, peri-articular injection with 100 mL cocktail+1.5 g tranexamic acid was performed after the closure of articular capsule and intra-articular infusion with normal saline 50 mL+3.0 g tranexamic acid was also performed after surgery. Patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 24-hour drainage, blood loss, coagulation function, visual analogue scale score, knee joint mobility, blood transfusion rate, incision infection rate, pulmonary embolism and deep vein thrombosis were recorded on the third day after operation.  

RESULTS AND CONCLUSION: (1) The intra-articular infusion combined with peri-articular injection group resulted in less postoperative 24-hour drainage volume and 3^rd day’s blood loss postoperatively (P < 0.05). (2) There was no obvious statistical difference in range of motion, visual analogue scale score, and coagulation function between two groups (P > 0.05). (3) There was only one patient who received the transfusion treatment in intra-articular infusion group. There was no wound infection, deep venous thrombosis or pulmonary embolism in the two groups. (4) These findings demonstrated that intra-articular infusion combined with peri-articular injection of tranexamic acid can significantly reduce the postoperative blood loss in total knee arthroplasty without increasing the risk of thrombosis.