Do We Concern Ourselves with Blood Loss and Blood Transfusions of the Peri-articular Injection of Tranexamic Acid after Unilateral Total Knee Arthroplasty?

Yıl 2022, Cilt: 11 Sayı: 2, 184 - 193, 31.08.2022

Aziz Çataltepe Kadir Öznam

https://doi.org/10.47493/abantmedj.1016189

Öz

Objective: The means of peri-articular (PA) administration of tranexamic acid (TXA) is not examined sufficiently in unilateral total knee arthroplasty (TKA). The primary purpose of this study was to evaluate postoperative blood loss and transfusions rates after the administration of PA injection of TXA in TKA. In addition, PA TXA may decrease pain owing to reduced hemarthrosis after TKA.

Materials and Methods: In this retrospective study, 113 patients who underwent a primary unilateral TKA with or without a PA injection of TXA were included. A total of 1500 mg/50 ml TXA was injected into the extra-articular soft tissue around the medial, lateral capsules and muscular soft tissue around the quadriceps tendon immediately after cementation the prothesis, but before capsular closure and 15 minutes before the deflation of the tourniquet. A total of 56 patients in the control group did not receive TXA. The surgical procedure was standardized in all of the patients.

Results: There was a statistically significant reduction in hidden blood loss, estimated blood loss, and receiving a postoperative allogeneic blood transfusion in the TXA group compared with the control group (p=0.0001). We found a significant correlation between blood transfusion and the length of hospital stay (p=0.0001). No significant difference was found regarding pain VAS score after postoperative 1st day and postoperative 3rd day (p=0.597 and p=0.183, respectively). 1500 mg/50 ml (30 mg/ml) TXA was a relatively optimal dose to minimize the cytotoxic effects on the soft tissue around the knee compared with 50 mg/ml. No patients encountered any thromboembolic and wound complications.

Conclusion: The PA administration of TXA may offer a significant reduction in postoperative blood loss and transfusions rates as well as the length of hospital stay without increasing the risk of thromboembolic complications and cytotoxic effects on cartilage and peri-articular soft tissue. However, we did not observe a significant reduction in postoperative pain VAS score.

Anahtar Kelimeler

Total Knee Arthroplasty, Tranexamic Acid, Peri-Articular Injection, Blood Loss

Tek Taraflı Total Diz Artroplastisi Sonrası Traneksamik Asit Peri-artiküler Enjeksiyonunun Kan Kaybı ve Kan Transfüzyonları ile İlgili Endişemiz Var mı?

Öz

Amaç: Tek taraflı total diz artroplastisinde (TDA) traneksamik asidin (TXA) peri-artiküler (PA) uygulama şekli yeterince incelenmemektedir. Bu çalışmanın birincil amacı, TDA'da TXA'nın PA enjeksiyonunun uygulanmasından sonra postoperatif kan kaybı ve transfüzyon oranlarını değerlendirmekti. Ek olarak, PA TXA, TDA sonrası hemartrozun azalması nedeniyle ağrıyı azaltabilir.

Gereç ve Yöntemler: Bu retrospektif çalışmaya TXA PA enjeksiyonu olan veya olmayan primer tek taraflı TDA uygulanan 113 hasta dahil edildi. Protezin simante edilmesinden sonra, ancak kapsül kapanmadan ve turnike indirilmeden 15 dakika önce, medial, lateral kapsüller ve kuadriseps tendonu çevresindeki kas yumuşak doku çevresindeki eklem dışı yumuşak dokuya toplam 1500 mg/50 ml TXA enjekte edildi. Kontrol grubundaki toplam 56 hasta TXA almadı. Tüm hastalarda cerrahi prosedür standardize edildi.

Bulgular: Kontrol grubuna kıyasla TXA grubunda gizli kan kaybında, tahmini kan kaybında ve postoperatif allojenik kan transfüzyonu almada istatistiksel olarak anlamlı bir azalma vardı (p=0,0001). Kan transfüzyonu ile hastanede kalış süresi arasında anlamlı bir ilişki bulduk (p=0,0001). Postoperatif 1. gün ve postoperatif 3. günden sonra ağrı VAS skoru açısından anlamlı bir fark bulunmadı (p=0,597 ve p=0,183, sırasıyla). 1500 mg/50 ml (30 mg/ml) TXA, 50 mg/ml. ile karşılaştırıldığında diz çevresindeki yumuşak doku üzerindeki sitotoksik etkileri en aza indirmek için nispeten optimal bir dozdu. Hiçbir hastada herhangi bir tromboembolik ve yara komplikasyonu görülmedi.

Sonuç: TXA'nın PA uygulaması, tromboembolik komplikasyon ve kıkırdak ve periartiküler yumuşak doku üzerinde sitotoksik etki riskini artırmadan, postoperatif kan kaybı ve transfüzyon oranlarında ve hastanede kalış süresinde önemli bir azalma sağlayabilir. Ancak postoperatif ağrı VAS skorunda anlamlı bir azalma gözlemlemedik.

Anahtar Kelimeler

Total Diz Artroplastisi, Traneksamik Asit, Periartiküler Enjeksiyon, Kan Kaybı

Kaynakça

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