Aslam Farhan, Arshad Hafiz Usman, Qammar Bilal, Shakeel Izzah, Sidhu Zia, Shakeel Zunaira, Arbaz Hafiz Muhammad, Rashid Tariq, Ishfaq Muhammad Ahsan, Zafar Muhammad Naveed, Raza Mohsin
Trauma and Orthopedic Surgery Department, Sir Ganga Ram Hospital/Fatima Jinnah Medical University, Lahore, PAK.
Trauma and Orthopedic Surgery Department, Sir Ganga Ram Hospital, Lahore, PAK.
Cureus. 2024 Sep 3;16(9):e68593. doi: 10.7759/cureus.68593. eCollection 2024 Sep.
Total knee arthroplasty (TKA) may result in significant blood loss, but it is an effective and affordable treatment for severe osteoarthritis in the knees. While intravenous (IV) tranexamic acid (TXA) is a commonly used technique, intraarticular (IA) TXA has just recently started to gain traction in joint replacement procedures. The purpose of this research was to examine the mean postoperative hemoglobin concentration in order to assess the effectiveness of TXA administered IV vs IA after TKA.
To assess the effectiveness of intraarticular TXA against intravenous administration.
The six-month randomized controlled experiment was started from October 5, 2022, to April 4, 2023, at "the Orthopedics Department of Sir Ganga Ram Hospital in Lahore". The experiment included 60 patients undergoing TKA, ranging in age from 30 to 70. All members of the surgical team, including the supervisor (a consultant surgeon), assistants, and researchers, were present throughout the surgery. A high, thigh tourniquet was employed in every case, and a medial parapatellar technique was performed as well. Before the tourniquet was inflated, individuals in the intravenous group received 1 g of TXA intravenously 15-30 minutes beforehand. In the IA group, the "patient received an injection of 2 g of TXA in a 20 mL solution" straight into the joint after the prosthesis was implanted and secured. Data were analyzed using SPSS (version 26), with numerical data (age, BMI, surgical length, and hemoglobin levels) presented as mean ± SD and categorical factors (gender, American Society of Anesthesiologists (ASA) class, anatomical side) shown as frequency and percentage. The mean postoperative hemoglobin levels were compared between groups using an independent sample t-test, with data stratified by various factors and p ≤ 0.05 considered significant.
There were 60 patients in this study, ranging in age from 30 to 70. The mean±SD age was 48.73±10.35 years. Patients' mean BMI was 25.51±4.48 kg/m², with representation across underweight, normal, overweight, and obese categories. The procedure took 173.10±32.61 minutes. The overall postoperative hemoglobin concentration was significantly higher in the IA TXA group (12.12±1.32 g/dL) compared to the IV TXA group (11.11±1.10 g/dL), with a p-value of 0.02. Additionally, when stratified by age, the IA TXA group consistently demonstrated higher postoperative hemoglobin levels across all age brackets, with significant differences observed in the 51-60 years (p = 0.001) and 61-70 years (p = 0.011) groups. Gender-based comparisons showed that IA TXA was associated with higher postoperative hemoglobin levels for both males (p < 0.05) and females (p < 0.05) compared to IV TXA.
This study demonstrates that IA administration of TXA is more effective in maintaining higher postoperative hemoglobin concentrations compared to IV TXA in patients undergoing TKA. The IA TXA group consistently achieved significantly higher hemoglobin levels across various age groups and both genders, indicating superior efficacy in reducing blood loss associated with TKA. These findings suggest that IA TXA could be a preferable alternative to IV TXA for enhancing postoperative hemoglobin recovery and potentially improving patient outcomes in knee arthroplasty procedures.
全膝关节置换术（TKA）可能导致大量失血，但它是治疗重度膝关节骨关节炎的一种有效且经济实惠的方法。虽然静脉注射（IV）氨甲环酸（TXA）是一种常用技术，但关节内（IA）注射TXA最近才开始在关节置换手术中受到关注。本研究的目的是检查术后平均血红蛋白浓度，以评估TKA术后静脉注射与关节内注射TXA的有效性。
评估关节内注射TXA与静脉注射的有效性。
这项为期六个月的随机对照实验于2022年10月5日至2023年4月4日在“拉合尔甘加拉姆爵士医院骨科”开展。实验纳入了60例接受TKA的患者，年龄在30至70岁之间。手术团队的所有成员，包括主管（一名顾问外科医生）、助手和研究人员，在整个手术过程中都在场。每例患者均使用高位大腿止血带，并采用内侧髌旁技术。在止血带充气前，静脉注射组的患者在15 - 30分钟前静脉注射1 g TXA。在关节内注射组，患者在假体植入并固定后，将“2 g TXA溶于20 mL溶液中”直接注射到关节内。使用SPSS（26版）进行数据分析，数值数据（年龄、体重指数、手术时长和血红蛋白水平）以均值±标准差表示，分类因素（性别、美国麻醉医师协会（ASA）分级、解剖部位）以频率和百分比表示。使用独立样本t检验比较两组术后平均血红蛋白水平，数据按各种因素分层，p≤0.05被认为具有统计学意义。
本研究共有60例患者，年龄在30至70岁之间。平均年龄±标准差为48.73±10.35岁。患者的平均体重指数为25.51±4.48 kg/m²，涵盖体重过轻、正常、超重和肥胖类别。手术耗时173.10±32.61分钟。与静脉注射TXA组（11.11±1.10 g/dL）相比，关节内注射TXA组术后总体血红蛋白浓度显著更高（12.12±1.32 g/dL），p值为0.02。此外，按年龄分层时，关节内注射TXA组在所有年龄组中术后血红蛋白水平均持续较高，在51 - 60岁组（p = 0.001）和61 - 70岁组（p = 0.011）中观察到显著差异。基于性别的比较显示，与静脉注射TXA相比，关节内注射TXA在男性（p < 0.05）和女性（p < 0.05）中均与较高的术后血红蛋白水平相关。
本研究表明，在接受TKA的患者中，与静脉注射TXA相比，关节内注射TXA在维持较高的术后血红蛋白浓度方面更有效。关节内注射TXA组在各个年龄组和男女两性中均持续达到显著更高的血红蛋白水平，表明在减少与TKA相关的失血方面具有卓越疗效。这些发现表明，在膝关节置换手术中，关节内注射TXA可能是静脉注射TXA的更优替代方法，可增强术后血红蛋白恢复并潜在改善患者预后。
