Lee Kun-Han, Chen Cheng-Fong, Tsai Shang-Wen, Wu Po-Kuei, Lin Yu-Kuan, Chen Wei-Ming
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Beitou District, 112, Taipei, Taiwan (R.O.C.).
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Orthop Surg Res. 2025 Aug 30;20(1):806. doi: 10.1186/s13018-025-06242-9.
Perioperative blood loss and the need for transfusion are significant concerns in total knee arthroplasty (TKA). Topical tranexamic acid (TXA) is commonly used to reduce bleeding and is administered either via intra-articular (IAI) or peri-articular injection (PAI). This study aimed to compare the efficacy of PAI and IAI of TXA in reducing the postoperative drainage volume and blood transfusion rates in patients undergoing TKA.
One hundred patients who underwent simultaneous bilateral TKA were included in this retrospective cohort study. The patients were divided into two groups: Group A received 1 g TXA via PAI and 1 g TXA via IAI in one knee, with 2 g TXA via IAI in the other knee; and Group B received 2 g TXA via PAI in one knee and 2 g TXA via IAI in the other knee. Postoperative outcomes, including blood loss, hemoglobin (Hb) levels, transfusion rates, and surgical duration, were collected and analyzed.
Group A demonstrated a significantly greater decrease in postoperative Hb levels (-2.03 ± 0.15 mg/dL) than Group B (-1.29 ± 0.11 mg/dL). Knees treated with PAI (391.10 ± 25.45 mL) or PAI + IAI (412.80 ± 26.76 mL) had significantly lower drainage volumes than those treated with IAI alone (523.50 ± 17.47 mL, p < 0.001). No significant differences were observed between the PAI and PAI + IAI subgroups. No major complications such as deep vein thrombosis or wound infections were noted.
PAI of TXA, either alone or in combination with IAI, is more effective in reducing postoperative blood loss in TKA procedures than IAI alone. These findings support the use of PAI, particularly with a higher dose of 2 g TXA, as a safe and effective method for minimizing drainage output in patients undergoing TKA.
围手术期失血和输血需求是全膝关节置换术（TKA）中的重要问题。局部应用氨甲环酸（TXA）常用于减少出血，可通过关节内注射（IAI）或关节周围注射（PAI）给药。本研究旨在比较TXA的PAI和IAI在减少TKA患者术后引流量和输血率方面的疗效。
本回顾性队列研究纳入了100例行同期双侧TKA的患者。患者分为两组：A组在一侧膝关节通过PAI给予1g TXA，另一侧膝关节通过IAI给予1g TXA，同时在另一侧膝关节通过IAI给予2g TXA；B组在一侧膝关节通过PAI给予2g TXA，另一侧膝关节通过IAI给予2g TXA。收集并分析术后结果，包括失血量、血红蛋白（Hb）水平、输血率和手术时长。
A组术后Hb水平的下降幅度（-2.03±0.15mg/dL）显著大于B组（-1.29±0.11mg/dL）。采用PAI（391.10±25.45mL）或PAI+IAI（412.80±26.76mL）治疗的膝关节引流量显著低于单纯采用IAI治疗的膝关节（523.50±17.47mL，p<0.001）。PAI组和PAI+IAI亚组之间未观察到显著差异。未发现深静脉血栓形成或伤口感染等重大并发症。
TXA的PAI单独使用或与IAI联合使用，在减少TKA手术术后失血方面比单纯IAI更有效。这些发现支持将PAI，特别是2g TXA的高剂量PAI，作为减少TKA患者引流量的一种安全有效的方法。
