Comparison of Intraarticular Versus Combined Intravenous and Intraarticular Tranexamic Acid Administration in Patients Undergoing Primary Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial in the Middle Eastern Patient Population

Background: This study aimed to determine whether combined intravenous (IV) and intraarticular (IA) Tranexamicacid (TXA) reduces blood loss and the requirement of blood transfusion, compared to IA use alone in the middle easternpatients undergoing primary cemented unilateral Total knee arthroplasty (TKA).Methods: The present study is a double-blind randomized controlled trial (RTC) comparing the efficacy of IA aloneto combined IA and IV routes of TXA administration in patients undergoing primary cemented TKA using a tourniquetperformed by two senior surgeons. There were ۲۱ patients in the IA alone and ۲۹ in the combined group. The primaryoutcome measure was a blood transfusion requirement, hemoglobin drop, and the total estimated blood loss on daythree postoperative period. The secondary outcomes were complications, including thromboembolic events, woundcomplications, periprosthetic infection, patient-reported outcomes (PROs) of pain visual analog scale (VAS), WesternOntario and McMaster Universities Osteoarthritis Index (WOMAC), and EuroQol ۵-dimension (EQ-۵D), as well as therange of motion (ROM), at one-year follow-up.Results: None of the patients in either comparison group required blood transfusion in the perioperative period. Thedrop in hemoglobin levels (۲.۱±۱.۰ vs. ۲.۲±۱.۱, P=۰.۸۴) and the total estimated blood loss (۸۸۴±۴۸۹ vs. ۸۷۷±۳۲۴,P=۰.۹۶) on the third postoperative day in the IA alone group showed no statistically significant difference comparedto that in the combined group. Moreover, there were no complications noted in patients of either group. At one-yearfollow-up, there was no significant difference between the two comparison groups regarding the mean PROs of painVAS, WOMAC, and EQ-۵D, as well as ROM.Conclusion: According to the obtained results, this RCT in the middle eastern patient population found no additionalbenefit of TXA administration through combined IV and IA route over the IA alone in reducing the requirement of bloodtransfusion and the total blood loss. Further similar studies with larger sample sizes are needed to ascertain the idealroute of TXA administration in patients undergoing primary TKA.Level of evidence: I