Reducing Blood Loss in Simultaneous Bilateral Total Knee Arthroplasty

Objectives: We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of different method of tranexamic acid administration in TKA. Methods: The study enrolled 81 patients who underwent simultaneous bilateral total knee replacement in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group received both intravenous and intra-articular TXA. The control group did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 min before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 min before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 h. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion (BT). Results: Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (509.39 ± 224.97mL) than in control subjects (961.37 ± 427.99mL). The mean hemoglobin decrease 12 hours postoperatively was lower in patients receiving tranexamic acid (2.07 ± 1.11g/dL) than in control subjects (3.21 ± 1.05g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects. Conclusion: This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss and helped to reduce the BT amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for BT associated with bilateral simultaneous total knee replacement without enhancing the risk of deep vein thrombosis.