Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial

• One hundred patients were randomised to receive intravenous or intra-articular tranexamic acid.
• Both routes of administration had similar effect on transfusion during total knee arthroplasty.
• Perioperative blood loss was comparable between both routes of administration.
• There was no difference in postoperative limb swelling between both routes of administration.
• Intra-articular tranexamic acid is an alternative to intravenous administration.

BackgroundDespite the proven efficacy of both intravenous (IV) and intra-articular (IA) tranexamic acid (TXA) in reducing blood loss during total knee arthroplasty (TKA), the ideal route of administration remained debatable. This study aimed to compare the effect of IV versus IA TXA on transfusion incidences, perioperative blood loss and postoperative lower limb swelling during TKA.MethodsOne hundred patients were prospectively randomised into two groups: 1) IV TXA; and 2) IA TXA. In both groups, TXA was administered intraoperatively after cementing the prostheses. The perioperative blood loss was calculated using the haemoglobin balance method. The thigh, suprapatellar, and calf girths were measured preoperatively and on postoperative day (POD) 4.ResultsTwo patients in the IV group and one patient in the IA group required blood transfusion (p = 0.500). The median and interquartile range (IQR) of perioperative blood loss on POD1 and POD4 was 530 (IQR 386,704) and 730 (IQR 523,925) ml for the IV group, compared with 613 (IQR 506,703) and 799 (IQR 563,1067) ml for the IA group (p = 0.090 and p = 0.232 respectively). The median increment in thigh, suprapatellar, and calf girths were 1.5 (IQR 0, 3.0), 2.0 (IQR 0.5, 4.0) and 0 (IQR 0, 1.0) cm for the IV group, compared to 2.0 (IQR 1.0, 4.0), 2.0 (IQR 0, 4.5) and 0 (IQR 0, 1.5) cm for the IA group (p = 0.246, p = 0.562, and p = 0.937 respectively).ConclusionsBoth IV and IA TXA had comparable effect on transfusion incidences, perioperative blood loss, and postoperative lower limb swelling during TKA. IA TXA is an alternative to IV TXA.Level of evidence: I.