Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study

Mark Hood Jr.; Julian E. Dilley; Mary Ziemba-Davis; R. Michael Meneghini

doi:10.1055/s-0039-1695796

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2021; 34(04): 351-356
DOI: 10.1055/s-0039-1695796

Original Article

Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study

Mark Hood Jr.

¹Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Julian E. Dilley

¹Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

,

Mary Ziemba-Davis

²Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana

,

R. Michael Meneghini

¹Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

› Institutsangaben

Abstract

The purpose of this retrospective study was to assess whether tranexamic acid (TXA) reduces blood loss in cementless total knee arthroplasty (TKA) comparable to levels observed with cemented fixation. After exclusions from 109 consecutive TKAs, 76 cementless knees were matched to 78 cemented knees of identical implant and surgeon. Blood loss with and without TXA was compared. There was no difference between cohorts in sex, age, body mass index, American Society of Anesthesiologists Physical Status classification, or preoperative hemoglobin (p ≥ 0.119). Use of TXA reduced median drain output by only 205 mL in cementless knees compared to 470 mL in cemented knees (p < 0.001). Median drain output per hour was highest in cementless knees without TXA (39.5 mL) followed by cemented knees without TXA (38.2 mL), cementless knees with TXA (28.5 mL), and cemented knees with TXA (12.7 mL; p < 0.001). Hemoglobin drop and total blood loss did not differ between cohorts regardless of TXA use. Cementless fixation in TKA resulted in greater intra-articular blood loss as measured by drain output, despite the use of TXA. Further research is warranted to examine whether a higher TXA dose, TXA delivery method, or the application of bone wax sealant would mitigate blood loss in cementless TKA, and subsequently whether intra-articular blood accumulation resulting in postoperative hemarthrosis affects recovery, function, and clinical outcomes.

Keywords

total knee arthroplasty - cementless - blood loss - tranexamic acid

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