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J Knee Surg 2023; 36(05): 515-523
DOI: 10.1055/s-0041-1739197
Original Article

Synergistic Effect of a Prolonged Combination Course of Tranexamic Acid and Dexamethasone Involving High Initial Doses in Total Knee Arthroplasty: A Randomized Controlled Trial

Hong Xu   *
1   Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
,
Jinwei Xie   *
1   Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
,
Jingli Yang   *
2   College of Earth and Environmental Sciences and School of Public Health, Lanzhou University, Lanzhou, Gansu, China
,
Zeyu Huang
3   Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
,
Duan Wang
3   Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
,
Fuxing Pei
3   Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
› Author Affiliations Funding The research was supported by Post-Doctor Research Project, West China Hospital, Sichuan University (2018HXBH073); National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B11).
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Abstract

The optimal regimes of tranexamic acid (TXA) and dexamethasone (DXM) in total knee arthroplasty (TKA) are still uncertain. The aim of this study was to assess the efficacy and safety of a prolonged course of intravenous TXA and DXM involving a high initial dose in TKA. Patients who underwent primary TKA at our center were randomized to receive one of four regimes: control (group A), prolonged course of TXA (B), prolonged course of DXM (C), or the combination of a prolonged course of TXA and DXM (D). The four groups were compared in primary outcomes (fibrinolytic and inflammatory markers, knee function, postoperative pain levels, and consumption of opioids) and secondary outcomes (blood loss, maximal drop in hemoglobin, coagulation, fasting blood glucose, and complications). A total of 162 patients were enrolled. On postoperative days 2 and 3, fibrinolytic markers were lower in groups B and D than in groups A and C; inflammatory markers were lower in groups C and D than in groups A and B. Inflammatory markers were lower in group B than in group A on postoperative day 3. Postoperative pain levels and oxycodone consumption were lower, and knee function was better in groups C and D. The four groups did not differ in any of the secondary outcomes. A prolonged course of intravenous TXA and DXM involving high initial doses can effectively inhibit postoperative fibrinolytic and inflammatory responses, reduce pain, and improve knee function after TKA.

Keywords

arthroplasty - replacement - knee - tranexamic acid - dexamethasone - inflammation - fibrinolysis

Note

This study was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR1900026092).


Ethical Approval

The study protocol was approved by clinical trials and biomedical ethics committee, West China Hospital, Sichuan University.


Authors' Contributions

H.X. and J.W. X. performed the study design, data collection, writing and revision of the manuscript. J.L. Y. and Z.Y. H. analyzed and interpreted data for the work. D.W. participated in final approval of the version to be published. F.X. P. contributed to the conception and design of the work and revised the manuscript. All authors read and approved the final manuscript.


* Hong Xu, Jinwei Xie, and Jingli Yang are co-first authors. They equally contributed to this article.


Supplementary Material



Publication History

Received: 07 January 2021

Accepted: 21 September 2021

Article published online:
18 November 2021

© 2021. Thieme. All rights reserved.

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