title: Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial.
abstract: BACKGROUND
  Despite 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.
  
  
  METHODS
  One 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.
  
  
  RESULTS
  Two 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).
  
  
  CONCLUSIONS
  Both 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.
  
  
  METHODS
  I.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. Electronic address: yqjchen@gmail.com.
authors.forename: Jerry Yongqiang
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Pak Lin
authors.initials: PL
authors.lastname: Chin
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Ing How
authors.initials: IH
authors.lastname: Moo
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Hee Nee
authors.initials: HN
authors.lastname: Pang
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Darren Keng Jin
authors.initials: DK
authors.lastname: Tay
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Shi-Lu
authors.initials: SL
authors.lastname: Chia
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Ngai Nung
authors.initials: NN
authors.lastname: Lo
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Seng Jin
authors.initials: SJ
authors.lastname: Yeo
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D004487:Edema / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Blood loss; Lower limb swelling; Total knee arthroplasty; Tranexamic acid; Transfusion