A Prospective Double-Blind Placebo Controlled Trial of Topical Tranexamic Acid in Total Knee Arthroplasty

Tranexamic acid (TNA) reduces postoperative blood loss in general and obstetrical surgery but there is limited orthopaedic literature regarding its use in the topical setting. To study the effect of topical TNA after primary total knee arthroplasty (TKA), 101 patients were randomized to topical administration of 2.0 g TNA in 75 mL of normal saline (50 patients) or placebo (51 patients). Operative technique, drug administration, and venous thromboembolism prophylaxis were standardized. All patients underwent screening ultrasound of the operative extremity. Total blood loss was lower in the TNA group (940.2 ± 327.1 mL) than the placebo group (1293.1 ± 532.7 mL)(P < 0.001), and four patients in the placebo group and none in the TNA group received postoperative transfusion (P = 0.118). We recommend administration of topical TNA in primary TKA in healthy patients to decrease perioperative blood loss.