title: Combined Administration of IV and Topical Tranexamic Acid is Not Superior to Either Individually in Primary Navigated TKA.
abstract: In this study, we tried to assess if combined method (intravenous [IV] and topical) of tranexamic acid (TXA) administration, which has been shown to be superior in conventional arthroplasty, has similar effect in navigational arthroplasty compared to administration of drug either individually.
  
  
  
  In present randomized control trial, 200 patients were randomly divided in one of the 4 groups using computer-generated tables-control, IV, intraarticular, and combined. We studied evident loss through drain, total loss based on Gross method and hemoglobin balance method, hidden losses, hemoglobin and hematocrit drop, functional scores, and all possible complications related to TXA.
  
  
  
  Evident loss in combined group was 535.55 mL, not significantly less than IV (585 mL, P = .15) and intraarticular group (514 mL, P = .74). However, these were significantly less than control group (696 mL, P = .000). Functional scores and recovery rates were, however, comparable in all 4 groups. No patients in any group developed symptomatic deep vein thrombosis.
  
  
  
  Tranexamic use decreases blood loss in navigation-assisted arthroplasty, however, less than that observed for conventional arthroplasty in literature. Further, combined group has no added advantage over other methods of drug administration. We believe that additional amount of TXA administered in combined regimen may not be clinically useful. Further TXA group did not have any advantage in terms of functional recovery over control group.
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea.
authors.forename: Eun-Kyoo
authors.initials: EK
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea.
authors.forename: Jong-Keun
authors.initials: JK
authors.lastname: Seon
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea.
authors.forename: Jatin
authors.initials: J
authors.lastname: Prakash
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Young-Jun
authors.initials: YJ
authors.lastname: Seol
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea.
authors.forename: Cheng
authors.initials: C
authors.lastname: Jin
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004322:Drainage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: IV; combined; primary navigation total knee arthroplasty; randomized control trial; topical; tranexamic acid