Effect of Intra-articular Tranexamic Acid and Epinephrine on Blood Loss after Total Knee Arthroplasty

Abstract：Objective To explore the effect and safety of intra-articular tranexamic acid (TXA) and epinephrine on blood loss after primary unilateral total knee arthroplasty (TKA).Methods 136 cases of severe knee arthritis patients scheduled to undergo TKA were divided randomly into group A (n=68) and group B (n=68) according to the number list method.Before the release of the tourniquet, TXA 3 g was injected into the articular cavity in group A, and TXA 3 g and epinephrine 0.25 mg were injected in group B.Operation time, tourniquet application time, hospital stay time, straight leg lifting time, change rate of longitude of large (small) leg postoperative 3 d, postoperative knee joint activity (1 week, 1 month, 3 months after surgery), hospital for special surgery (HSS) knee score at 3 months after surgery, total blood loss, intraoperative blood loss, hidden blood loss, hemoglobin decline value postoperative 3 d, hematokrit decline value postoperative 3 d, allogeneic blood transfusion rate, incidence of subcutaneous ecchymosis area＞ 1％ were compared between the two groups.The adverse reactions in the two groups were recorded.Results Operation time, tourniquet application time, length of hospital stay, straight leg lifting time, change rate of longitude of thign and lower3 dafter surgery, postoperative knee joint activity (1 week, 1 month, 3 months after surgery), HSS knee score at 3 months after surgery were statistically different between the two groups (P＜0.05).Total blood loss, hidden blood loss, hemoglobin decline value 3 dafter surgery, hematokrit decline value 3 dafter surgery, incidence of subcutaneous ecchymosis area＞ 1％in group B were lower than those in group A (P＜0.05).Serious adverse reactions including incision infection and necrosis, deep vein thrombosis and symptomatic pulmonary embolism, rise of blood pressure and arrhythmia did not happen in the two groups.Conclusion The effect of intra-articular TXA and epinephrine to reduce blood loss after TKA operation is significantly better than that of TXA alone and has certain safety.