Study On The Use Of Tranexamic Acid In Total Knee Arthroplasty

Part ? Study on the use of tranexamic acid in fully cemented total knee arthroplastyObjective:The perioperative bleeding of total knee arthroplast(TKA)has always been a problem for surgeons.Studies have shown that intravenous injection and local injection of tranexamic acid(TXA)alone or in combination can effectively stop bleeding,but the optimal dosage and route of administration are still controversial.This study aims to explore a better using method of TXA in fully cemented TKA.Methods:From October 2016 to March 2019,218 patients with primary knee osteoarthritis who needed to underwent unilateral TKA were randomly divided into 4 groups.On the basis of intravenous TXA 20 mg/kg in all patients,group 1(n=55)received intra-articular injection(IAI)of 1 g TXA and peri-articular injection(PAI)of placebo,group 2(n=55)received IAI of placebo and PAI of 1 g TXA,group 3(n=51)received IAI and PAI of 1 g TXA,and group 4(n=57)received IAI and PAI of placebo.The placebo operation was to inject the same dose of normal saline at the same site.The blood loss,blood transfusion demand,postoperative and follow-up score of pain and function were compared.Results:Eight cases were lost to follow-up and 210 cases were included in the analysis.The median of total blood loss(TBL)in group 1 and 2 were significantly higher than those in group 3(P<0.001),but significantly lower than those in group 4(P<0.001).Compared with other groups,patients in group 4 had more blood transfusion rates(P=0.013).In the short term after surgery,visual analogue scale(VAS)score was higher and range of motion(ROM)was lower in group 4(P=0.011 and P=0.001,respectively).There was no significant difference in 6-month follow-up results among groups.Conclusion:The combination of intravenous injection,IAI and PAI can make the advantages of various methods complement each other and has further hemostasis,which is superior to the currently reported hemostatic methods of TXA.It can also significantly reduce VAS score and improve ROM in the short term after surgery.Part ? Study on the use of tranexamic acid in reverse hybrid total knee arthroplastyObjective:Due to the short time of clinical application of mixed fixation total knee arthroplasty(TKA),there is no research on the strategy of TXA.Surgeons still use strategy of fully cemented TKA according to the past experience.The validity and efficiency of the method are questionable.This study aims to explore a better using method of TXA in reverse hybrid TKA.Methods:From September 2018 to November 2020,233 patients with primary knee osteoarthritis who needed to undergo unilateral TKA and meet the Monoblock prosthesis(reverse hybrid)indications were randomly divided into 4 groups:group 1(n=54)underwent fully cemented TKA+intra-articular injection(IAI)of 1g TXA,group 2(n=60)underwent fully cemented TKA+IAI of 2g TXA,group 3(n=56)underwent reverse hybrid TKA+IAI of 1g TXA,and group 4(n=56)underwent reverse hybrid TKA+IAI of 2 g TXA.In addition,TXA(20 mg/kg)was injected intravenously in all patients.The blood loss and blood transfusion demand of the four groups were compared.Results:The postoperative hemoglobin(Hb)and hematocrit(Hct)in group 1,2 and 3 were lower than those in group 4(all P<0.05),while the total blood loss(TBL)and hidden blood loss(HBL)were higher than those in group 4(all P<0.0001).Although there was no significant difference in blood transfusion demand among all four groups(P>0.05),the number of anaemic patients who did not meet the standard of blood transfusion in group 4 decreased significantly(P<0.0001).Conclusion:For reverse hybrid TKA,on the basis of intravenous injection of TXA(20 mg/kg),IAI of 2 g TXA is better than 1 g.Although this method does not reduce the need for blood transfusion,it can significantly reduce the incidence of postoperative anemia.