Skip to main content
Erschienen in: International Orthopaedics 11/2011

01.11.2011 | Original Paper

Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty

verfasst von: Kazunari Ishida, Nobuhiro Tsumura, Atsushi Kitagawa, Sayaka Hamamura, Koji Fukuda, Yoshihiro Dogaki, Seiji Kubo, Tomoyuki Matsumoto, Takehiko Matsushita, Takaaki Chin, Tetsuhiro Iguchi, Masahiro Kurosaka, Ryosuke Kuroda

Erschienen in: International Orthopaedics | Ausgabe 11/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This is a randomised controlled trial to examine whether intra-articular injection of tranexamic acid (TXA) decreases blood loss, as well as reducing leg swelling after total knee arthroplasty (TKA).

Methods

We performed 100 TKA in osteoarthritis patients. At closure, a total of 2,000 mg/20 ml TXA was injected into the knee joint through a closed suction drain (TXA group). For the control group, the same volume of physiological saline was injected. The pre-operative condition of the patients, post-operative haemoglobin (Hb) levels, discharge volumes from drain, D-dimer and needs for transfusion were compared between these two groups. Furthermore, leg diameters (thigh, suprapatellar portion and calf girth) were measured pre- and post-operatively to investigate whether TXA has an influence on leg swelling after surgery.

Results

The results revealed that post-operative decrease in Hb level was significantly reduced in the TXA group. Furthermore, knee joint swelling after operation was significantly suppressed in the TXA group compared to the control group.

Conclusions

The results revealed intra-articular administration of TXA decreased not only blood loss, but also knee joint swelling after TKA.
Literatur
3.
Zurück zum Zitat Groh GI, Buchert PK, Allen WC (1990) A comparison of transfusion requirements after total knee arthroplasty using the Solcotrans autotransfusion system. J Arthroplasty 5:281–285PubMedCrossRef Groh GI, Buchert PK, Allen WC (1990) A comparison of transfusion requirements after total knee arthroplasty using the Solcotrans autotransfusion system. J Arthroplasty 5:281–285PubMedCrossRef
4.
Zurück zum Zitat Gannon DM, Lombardi AV Jr, Mallory TH, Vaughn BK, Finney CR, Niemcryk S (1991) An evaluation of the efficacy of postoperative blood salvage after total joint arthroplasty. A prospective randomized trial. J Arthroplasty 6:109–114PubMedCrossRef Gannon DM, Lombardi AV Jr, Mallory TH, Vaughn BK, Finney CR, Niemcryk S (1991) An evaluation of the efficacy of postoperative blood salvage after total joint arthroplasty. A prospective randomized trial. J Arthroplasty 6:109–114PubMedCrossRef
5.
Zurück zum Zitat Clements DH, Sculco TP, Burke SW, Mayer K, Levine DB (1992) Salvage and reinfusion of postoperative sanguineous wound drainage. A preliminary report. J Bone Joint Surg Am 74:646–651PubMed Clements DH, Sculco TP, Burke SW, Mayer K, Levine DB (1992) Salvage and reinfusion of postoperative sanguineous wound drainage. A preliminary report. J Bone Joint Surg Am 74:646–651PubMed
6.
Zurück zum Zitat Sinha A, Sinha M, Burgert S (2001) Reinfusion of drained blood as an alternative to homologous blood transfusion after total knee replacement. Int Orthop 25:257–259PubMedCrossRef Sinha A, Sinha M, Burgert S (2001) Reinfusion of drained blood as an alternative to homologous blood transfusion after total knee replacement. Int Orthop 25:257–259PubMedCrossRef
7.
8.
Zurück zum Zitat Juelsgaard P, Larsen UT, Sørensen JV, Madsen F, Søballe K (2001) Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med 26:105–110. doi:10.1053/rapm.2001.21094 PubMed Juelsgaard P, Larsen UT, Sørensen JV, Madsen F, Søballe K (2001) Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med 26:105–110. doi:10.​1053/​rapm.​2001.​21094 PubMed
9.
Zurück zum Zitat Ryu J, Sakamoto A, Honda T, Saito S (1997) The postoperative drain-clamping method for hemostasis in total knee arthroplasty. Reducing postoperative bleeding in total knee arthroplasty. Bull Hosp Jt Dis 56:251–254PubMed Ryu J, Sakamoto A, Honda T, Saito S (1997) The postoperative drain-clamping method for hemostasis in total knee arthroplasty. Reducing postoperative bleeding in total knee arthroplasty. Bull Hosp Jt Dis 56:251–254PubMed
10.
11.
Zurück zum Zitat Kiely N, Hockings M, Gambhir A (2001) Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. Knee 8:325–327PubMedCrossRef Kiely N, Hockings M, Gambhir A (2001) Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. Knee 8:325–327PubMedCrossRef
12.
Zurück zum Zitat Tsumara N, Yoshiya S, Chin T, Shiba R, Kohso K, Doita M (2006) A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty. J Bone Joint Surg Br 88:49–53. doi:10.1302/0301-620X.88B1.16653 PubMedCrossRef Tsumara N, Yoshiya S, Chin T, Shiba R, Kohso K, Doita M (2006) A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty. J Bone Joint Surg Br 88:49–53. doi:10.​1302/​0301-620X.​88B1.​16653 PubMedCrossRef
13.
Zurück zum Zitat Stucinskas J, Tarasevicius S, Cebatorius A, Robertsson O, Smailys A, Wingstrand H (2009) Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial. Int Orthop 33:1275–1278. doi:10.1007/s00264-008-0662-4 PubMedCrossRef Stucinskas J, Tarasevicius S, Cebatorius A, Robertsson O, Smailys A, Wingstrand H (2009) Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial. Int Orthop 33:1275–1278. doi:10.​1007/​s00264-008-0662-4 PubMedCrossRef
14.
Zurück zum Zitat Wang GJ, Hungerford DS, Savory CG, Rosenberg AG, Mont MA, Burks SG, Mayers SL, Spotnitz WD (2001) Use of fibrin sealant to reduce bloody drainage and hemoglobin loss after total knee arthroplasty: a brief note on a randomized prospective trial. J Bone Joint Surg Am 83-A:1503–1505PubMed Wang GJ, Hungerford DS, Savory CG, Rosenberg AG, Mont MA, Burks SG, Mayers SL, Spotnitz WD (2001) Use of fibrin sealant to reduce bloody drainage and hemoglobin loss after total knee arthroplasty: a brief note on a randomized prospective trial. J Bone Joint Surg Am 83-A:1503–1505PubMed
15.
Zurück zum Zitat Levy O, Martinowitz U, Oran A, Tauber C, Horoszowski H (1999) The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Joint Surg Am 81:1580–1588PubMed Levy O, Martinowitz U, Oran A, Tauber C, Horoszowski H (1999) The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Joint Surg Am 81:1580–1588PubMed
16.
Zurück zum Zitat Gibbons CE, Solan MC, Ricketts DM, Patterson M (2001) Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop 25:250–252PubMedCrossRef Gibbons CE, Solan MC, Ricketts DM, Patterson M (2001) Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop 25:250–252PubMedCrossRef
18.
Zurück zum Zitat Astedt B (1987) Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl 137:22–25PubMedCrossRef Astedt B (1987) Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl 137:22–25PubMedCrossRef
19.
Zurück zum Zitat Benoni G, Carlsson A, Petersson C, Fredin H (1995) Does tranexamic acid reduce blood loss in knee arthroplasty? Am J Knee Surg 8:88–92PubMed Benoni G, Carlsson A, Petersson C, Fredin H (1995) Does tranexamic acid reduce blood loss in knee arthroplasty? Am J Knee Surg 8:88–92PubMed
20.
Zurück zum Zitat Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599PubMedCrossRef Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599PubMedCrossRef
21.
Zurück zum Zitat Akizuki S, Yasukawa Y, Takizawa T (1997) A new method of hemostasis for cementless total knee arthroplasty. Bull Hosp Jt Dis 56:222–224PubMed Akizuki S, Yasukawa Y, Takizawa T (1997) A new method of hemostasis for cementless total knee arthroplasty. Bull Hosp Jt Dis 56:222–224PubMed
22.
24.
Zurück zum Zitat McMaster WC, Liddle S (1980) Cryotherapy influence on posttraumatic limb edema. Clin Orthop Relat Res 150:283–287PubMed McMaster WC, Liddle S (1980) Cryotherapy influence on posttraumatic limb edema. Clin Orthop Relat Res 150:283–287PubMed
25.
Zurück zum Zitat Healy WL, Seidman J, Pfeifer BA, Brown DG (1994) Cold compressive dressing after total knee arthroplasty. Clin Orthop Relat Res 299:143–146PubMed Healy WL, Seidman J, Pfeifer BA, Brown DG (1994) Cold compressive dressing after total knee arthroplasty. Clin Orthop Relat Res 299:143–146PubMed
26.
Zurück zum Zitat Hecht PJ, Bachmann S, Booth RE Jr, Rothman RH (1983) Effects of thermal therapy on rehabilitation after total knee arthroplasty. A prospective randomized study. Clin Orthop Relat Res 178:198–201PubMed Hecht PJ, Bachmann S, Booth RE Jr, Rothman RH (1983) Effects of thermal therapy on rehabilitation after total knee arthroplasty. A prospective randomized study. Clin Orthop Relat Res 178:198–201PubMed
28.
Metadaten
Titel
Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty
verfasst von
Kazunari Ishida
Nobuhiro Tsumura
Atsushi Kitagawa
Sayaka Hamamura
Koji Fukuda
Yoshihiro Dogaki
Seiji Kubo
Tomoyuki Matsumoto
Takehiko Matsushita
Takaaki Chin
Tetsuhiro Iguchi
Masahiro Kurosaka
Ryosuke Kuroda
Publikationsdatum
01.11.2011
Verlag
Springer-Verlag
Erschienen in
International Orthopaedics / Ausgabe 11/2011
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-010-1205-3

Weitere Artikel der Ausgabe 11/2011

International Orthopaedics 11/2011 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.