Effects of intraarticular tranexamic acid injection combined with 3-hour drainage tube occlusion postoperatively on blood loss in unicompartmental knee arthroplasty / 中国组织工程研究

ABSTRACT

BACKGROUND:Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee, but unicompartmental knee arthroplastystil has some problems, such as excessive bleeding-induced postoperative blood transfusion, increased blood transfusion rate, hospitalization expense and complication of blood transfusion. As tranexamic acid for total knee arthroplasty has achieved good effects. It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty. OBJECTIVE:To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty. METHODS:122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplastyinthe Department of Orthopedics, the Second Affiliated Hospital ofDalian Medical University from January 2014 to August 2015wereenroled in this study. Al patients were randomly divided into two groups. Patients in the tranexamic acid group were injected with 10 mL of tranexamic acid (containing 1000 mg) + 10 mL of sodium chloride injection in the articular cavity before loosening the tourniquet. Patients in the control group received 20 mL of sodium chloride injection in the articular cavity. In both groups, the drainage tube was clipped for 3 hours after injection.At 48 hours after replacement, the drainage tube was puled out. We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively, total blood loss and drainage volume at 2 days postoperatively, the number of patients receiving blood transfusion, Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively, and thrombosis at 1 week postoperatively, and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty. RESULTS AND CONCLUSION:(1) Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively (P 0.05). (2) Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). (3) The number of patients receiving blood transfusion was significantly less in the tranexamic acid group (0 case) than in the control group (6 cases) (P< 0.05). (4) Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively (P< 0.05). No significant difference in above socres was identified between the two groups at 1 month postoperatively. (5) No venous thrombosis was found at 1 week postoperatively in both groups. (6) These results confirm that during knee medial unicompartmental arthroplasty, intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume, perioperative blood loss, blood transfusion, is beneficial to the early recovery of knee jointfunction after replacement, and does not increase the risk of lower extremity deep venous thrombosis.