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Hidden Blood Loss, Infection and Cost-Effectiveness of Tranexamic Acid Protocol in Primary Total Knee Arthroplasty

Objective: The purpose was to evaluate the effect of combined administration of TXA on total blood loss, hidden blood loss, drain output, cost effectiveness and periprosthetic infection rate in patients undergoing unilateral primary knee arthroplasty. Materials and Methods: We enrolled fifty-eight patients with primary gonarthrosis undergoing unilateral primary knee arthroplasty between May 2014 and December 2014. We compared 29 cases performed without the application of TXA to 29 cases performed with the application of TXA. Our TXA protocol consisted of three stages. Results: Postoperative hemoglobin and hematocrit levels were found to be significantly lower in the non-TXA group. Estimated blood loss, hidden blood loss, and drain output were found to be higher in the non-TXA group. Transfusion rate was lower in TXA group. The blood bank costs were found to be higher in the non-TXA group. The total direct cost was also higher in the non-TXA group. This was average 29.9$ savings per case in the TXA group. No complication such as infection or thromboemboli was detected among the study groups. Conclusion: Combined topical and continuous up to 24 hours intravenous administration of TXA reduced the total blood loss and decreased drainage volume, as well as reducing hidden blood loss. Level of evidence III.