The use of tranexamic acid to reduce blood loss during total knee arthroplasty

Hypothesis: The fall in haemoglobin following unilateral total knee arthroplasty is reduced by tranexamic acid administration. Methods: 60 patients were studied in total, 30 received tranexamic acid 10 mg/kg on induction and a further dose shortly before the release of the tourniquet. Surgery was performed by the senior author in a standardised fashion using the Freeman Samuelson cemented total knee replacement. Haemoglobin levels were measured 2 weeks pre and 3 days post operatively. Any complications were noted. A control group was matched using the Bone and Joint Research Unit database for age, sex, disease and pre-operative haemoglobin level. This group had been monitored in the same way as the group treated with tranexamic acid. Results: In the group receiving no tranexamic acid the mean fall in haemoglobin was 2.8 g/dl (95% CI of mean 2.5–3.2) and in the group treated with tranexamic acid 1.7 g/dl (95% CI of mean 1.3–2) P<0.01. There were no complications in either group. Conclusions: The administration of tranexamic acid is an effective method of reducing the haemoglobin fall following knee arthroplasty.