Topical Tranexamic Acid in Addition To Intravenous Tranexamic Acid in Primary Total Knee Arthroplasty Does Not Change Length of Hospital Stay or Rate of Prosthetic Joint Infections

Alex Denning, Fadi Hindi, Harry Smeeden, Leonidas Vachtsevanos

Salisbury District Hospital NHS Foundation Trust

Evidence shows both intravenous and topical tranexamic acid (TXA) in primary total knee arthroplasty (TKA) reduces post operative haematoma formation and blood loss. Blood loss is associated with increased length of stay and prosthetic joint infection (PJI). Our work looked at whether addition of topical TXA to intravenous use increased total length of stay and incidence of PJI following TKA.

We retrospectively looked at 100 patients who underwent primary TKA from 2019. Outcomes measured were length of stay and revision for infection in the 2 years following the procedure. All patients were required to have TXA at induction and the groups were then split into those who had topical intraarticular TXA and those who did not at the end of the procedure.

97 patients met the inclusion criteria. Of those patients, 51 had TXA given topically and 46 did not. Average age for TXA group was 73.1 and non-TXA 73.2. Average BMI for the TXA group was 33.0 and non-TXA 32.6. The TXA group lost on average 12g/L of haemoglobin and non-TXA group lost 15G/L between pre and post op bloods. The TXA group had an average inpatient stay of 4.1 days, whereas the non-TXA group was 3.9 days. There were no PJI in either group.

There appears to be little advantage to giving topical TXA as well as intravenous TXA. Although there appeared to be a small reduction in Intra-operative blood loss, this had no effect on length of stay or likelihood of developing PJI within 2 years.