Background and Goal of Study: Patients undergoing total knee arthroplasty (TKA) are at risk of significant perioperative blood loss. Surgical site infection (SSI, including prosthetic joint infection) is one of the causes of TKA failure, and it is associated with significant morbidity. Intravenous tranexamic acid (TXA) has been recommended to decrease associated blood loss, and it has not been shown to increase adverse events such as venous thromboembolic disease (VTD). Intra-articular TXA (IA-TXA) is also recommended, but there are not enough studies about regional associated complications (surgical site infections-SSI-, aseptic mobilization-AM-, or periprosthetic fracture-PF-). Our hypothesis is that IA-TXA is a useful preventive treatment to reduce hemorrhage associated with TKA without increasing the risk of thrombotic or regional complications.
Materials and Methods: With the authorization of our institutional investigation committee, an observational retrospective cohort was performed to study the effect of 2 different preventive blood loss programs. Not exposed group (group A) and exposed group (group B), differed only at exposition at 3 grams of IA-TXA, developed during different years. Groups were operated by the same team with large TKA experience and with the same prosthetic model. Perioperative hemorrhage (hemoglobin loss > 2 g/dl, and transfusion rates), VTD and arterial thrombosis (stroke, ischemic cardiopathy…) until 1st postoperative year, and regional complications till 3rd postoperative year were analyzed.
Results and Discussion: A total of 200 patients were analyzed, 100 randomized outpatients per group. ASA III and IV were more frequent at group B (RR 1,3; p=0,032), so this group had more basal preoperative risk of general complications. Basal hemoglobin was similar (13,8 g/dl at group A Vs 13,9 at group B). Hemoglobin loss > 2 g/dl was more frequent at group A (RR 0,81; p< 0,001), as transfusional rates (RR 0,12; p< 0,001). VTD and arterial thrombosis were similar (0% & 2% respectively at group A Vs 1% & 1% at group B). Regional complications were similar (7% SSI at group A Vs 4% at group B; 1% AM at group A Vs 3% at group B; 2% PF at group A Vs 0% at group B).
Conclusions: IA-TXA reduces hemorrhage and transfusion associated with TKA, and it does not seem to increase the risk of associated regional complications neither vascular thrombotic events. More studies about regional IA-TXA associated complications are needed.

Regional complications, vascular thrombosis and prevention of hemorrhage associated with intra-articular tranexamic acid in total knee arthroplasty: a cohort study