title: Intra-articular tranexamic acid wash during bilateral total knee arthroplasty.
abstract: OBJECTIVE
  To compare the outcome after simultaneous bilateral total knee arthroplasty (TKA) with or without an intra-articular tranexamic acid (TXA) wash in terms of blood loss, haemoglobin change, and transfusion requirement.
  
  
  METHODS
  35 women and 10 men (mean age, 67.5 years) who underwent primary simultaneous bilateral TKA by a single senior surgeon were compared with 45 matched controls. In the TXA group, 1500 mg of TXA diluted in 100 ml of 0.9% sodium chloride was administered as a wash after cementing of implant and before closure of the retinaculum. At least 5 minutes of contact time was allowed before wound closure and tourniquet deflation. No drain was used.
  
  
  RESULTS
  No patients had thromboembolic complication. Compared with controls, the TXA group had lower perioperative blood loss (920 vs. 657 ml, p=0.001), total blood loss (997 vs. 679 ml, p<0.001), blood transfusion rate (60% vs. 37.8%, p=0.035), percentage of patients requiring more than one blood unit (24.4% vs. 8.9%, p=0.048), and length of hospitalisation (6 vs. 4 days, p<0.001). Nonetheless, the 2 groups were comparable in blood units and volume transfused.
  
  
  CONCLUSIONS
  An intra-articular TXA wash during simultaneous bilateral TXA reduced total blood loss and resulted in a difference of 22.2% in blood transfusion rate and a 2-day reduction in the length of hospital stay.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Meng
authors.initials: M
authors.lastname: Zhu
authors.forename: Jerry Yongqiang
authors.initials: JY
authors.lastname: Chen
authors.forename: Andy Khye Soon
authors.initials: AK
authors.lastname: Yew
authors.forename: Shi-Lu
authors.initials: SL
authors.lastname: Chia
authors.forename: Ngai Nung
authors.initials: NN
authors.lastname: Lo
authors.forename: Seng Jin
authors.initials: SJ
authors.lastname: Yeo
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007270:Injections, Intra-Articular; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid
keywords: arthroplasty, replacement, knee; blood loss, surgical; blood transfusion; tranexamic acid