Post-operative blood loss in total knee arthroplasty: knee flexion versus pharmacological techniques.
OBJECTIVE
To compare the blood loss and the blood transfusion between a control group and a group of patients following either a local administration of tranexamic acid or a mechanical post-operative knee flexion, a controlled randomized study was performed.


METHODS
Sixty patients affected by primary knee osteoarthritis and candidates to receive a primary unilateral total knee arthroplasty were enrolled in a prospective, randomized, controlled study. Exclusion criteria were the following: tranexamic acid allergy, the use of pharmacological anticoagulant therapy, previous knee surgery and renal failure. For each patient, the following parameters were investigated: the blood loss volume, the haemoglobin and haematocrit concentrations and the blood transfusion needs.


RESULTS
Compared to the control group, the administration of systemic tranexamic acid significantly reduces (p < 0.05) both the blood loss (average reduction 39.8%) and the blood transfusion needs (64%). Furthermore, the tranexamic acid group shows a significant reduction (p < 0.05) compared to the knee flexion group of the blood loss (average reduction 31.8%) and the transfusion needs (65%). However, even if the knee flexion technique slightly reduces the blood loss (average reduction 11.6%) compared to the control group, this difference is not statistically significant (n.s.). Moreover, this treatment did not reduce the transfusion needs compared to the control group (n.s.). Incidence of complications was not influenced by any of the treatments.


CONCLUSIONS
The use of tranexamic acid compared to knee flexion and to control group significantly reduces blood loss and transfusion needs, without wound complications or symptomatic deep vein thrombosis.


METHODS
Prospective therapeutic study, Level I.
Orthopedic and Traumatology Clinic, S. Maria della Misericordia Hospital, Via G. Dottori, 06100, Perugia, Italy, pantinolfi@gmail.com.
Pierluigi
P
Antinolfi
Bernardo
B
Innocenti
Auro
A
Caraffa
Giuseppe
G
Peretti
Giuliano
G
Cerulli
D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D056888:Patient Positioning; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid