Chaiyachet Paradeevisut¹

Background: There are advantages of simultaneous bilateral total knee arthroplasty (TKA), including reduced leg length discrepancy (LLD), better gait balance, and affordability. However, the main issue is excessive blood loss. Systemic effects are lessened by peri-articular injection of tranexamic acid (PA-TXA). Compared to the intravenous method (IV-TXA), it is claimed to produce better results.

Objective: To evaluate the efficacy of IV-TXA + PA-TXA compared to IV-TXA alone in reducing blood loss during simultaneous bilateral TKA.

Materials and Methods: Between December 2022 and April 2024, 60 simultaneous bilateral TKA procedures were enrolled at Charoenkrung Pracharak Hospital. The control group, which was IV alone, and the study groups, which was IV-TXA plus PA-TXA, were randomly assigned, and postoperative follow-up was conducted to monitor 24 hours blood draining and total blood loss at 72 hours, blood transfusion, and complications over a 3-month period.

Results: The mean age was 68.28±6.97 years, and 95.0% of the participants were female. A body mass index (BMI) of 26.09±4.70 was the average. The data were evaluated by blood transfusion, complications, total blood loss at 72 hours, and 24-hour blood draining, respectively. Although there was no significant difference between the control and study groups (p=0.227 and 0.773, respectively), there was a decrease in 24-hour blood draining and total blood loss after 72 hours. The operating time and postoperative transfusion did not differ significantly. Neither group experienced infection or deep vein thrombosis (DVT).

Conclusion: Although not statistically significant, the combination of IV-TXA and PA-TXA appears to have lower total blood loss in simultaneous TKA as compared to the IV-TXA route alone.

Received 3 September 2024 | Revised 30 October 2024 | Accepted 11 November 2024

DOI: 10.35755/jmedassocthai.2024.12.963-971-01605