Efficacy of Peri-Operative Intra-Articular Compared with Intravenous Tranexamic Acid in Reducing Blood Loss after Primary Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) is an established and reliable surgical procedure but it is associated with substantial perioperative blood loss. Tranexamic acid (TXA) reduces blood loss in this type of surgery. Aim of the Work The main primary outcome of this study is to investigate and compare the clinical effectiveness of intra-articular (IA) topical TXA with intravenous (IV) TXA in patients undergoing primary TKA regarding the efficacy in reducing blood loss. The other secondary targets for this study is to compare and discuss the efficacy of both regimens regarding the level of hemoglobin drop, reducing the need of blood transfusion, checking the safety of both interventions regarding the patient population and possible accompanying comorbidities, and the reduction of length of hospital stay and costs. Materials and Method The electronic search strategy included the following databases: PubMed, and Cochrane Library from January 2010 to January 2020. Published accessible completed studies on the use of tranexamic acid TXA via the intra-articular IA route or the intravenous IV route in patients undergoing primary total knee arthroplasty TKA were identified through searching PubMed, and Cochrane Library using this specific set of keywords: (((((total knee arthroplasty) AND (tranexamic acid)) AND (intravenous)) OR (intraarticular)) AND (primary)) AND (tourniquet). Results This meta-analysis demonstrates the statistically significant favoring of IA-TXA over IV-TXA in reducing blood loss and it demonstrates the statistically significant favoring of IV-TXA over IA-TXA in postoperative hemoglobin level drop. Conclusion Both IV-TXA and IA-TXA are equivalent effectively in reducing the need for postoperative blood transfusion and consequently helps reduce the possible accompanying complications of blood transfusion.