Role of Tranexamic Acid and Drainless Closure in Decreasing Blood Loss in Primary Total Knee Arthroplasty
Total knee arthroplasty is one of the most successful orthopaedic surgeries to be performed and osteoarthritis is its leading indication. There are various methods advocated to limit the amount of blood loss in this surgery. In our study we have used tranexamic acid and a drainless closure together to decrease the blood loss in primary total knee replacements done for osteoarthritis over a period of one year. This is one of the first studies to use tranexamic acid and a drainless closure together to limit the fall in post operative haemoglobin after a primary total knee replacement for osteoarthritis.
Of the 71 patients who were included in the study, 49 of them had undergone bilateral replacement in the same sitting. All cases received 15 mg/kg of tranexamic acid intravenously 10 minutes before surgery. All cases were done by the same surgeon following similar techniques and similar implants. Prior to closure, tourniquet was released and haemostasis was attained. Closure was done without any suction drain. The haemoglobin level after 24 hours was checked and the difference in preoperative and post operative haemoglobin levels was calculated and was compared with a known standard of 2.39 mg/dl fall in haemoglobin level per knee after total knee replacement. The average fall in haemoglobin per knee was found to be 1.81 mg/dl per knee.
On statistical analysis it was found that there is significant reduction in the fall of haemoglobin levels when a single dose of tranexamic acid given preoperatively was combined with drainless closure.