The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty

Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1869-74. doi: 10.1007/s00167-012-2079-2. Epub 2012 Jun 24.


Purpose: Reduction in blood loss during surgery stabilizes hemodynamic status and aids in recovery after total knee arthroplasty (TKA). In this study, the authors examined whether different administration routes of tranexamic acid (TNA) might affect the amount of blood loss after TKA.

Methods: A total of 150 patients were prospectively allocated to each of the three groups (intravenous, intra-articular, and placebo group) and underwent unilateral TKA. During closing the operative wound, TNA (1.5 g mixed in 100 cc of saline) was administered intravenously or intra-articularly according to the enrolled group, and an equivalent volume of normal saline was administered into the knee joint cavity and intravenously in the placebo group, respectively. The amount of blood loss and transfusion, and changes in haemoglobin levels were documented accordingly.

Results: The mean blood loss in the intravenous, intra-articular, and placebo groups were 528 ± 227, 426 ± 197, and 833 ± 412 ml, respectively. About 66 % (intravenous), 80 % (intra-articular), and 6 % (placebo) of each group did not require transfusion for any reason, and the mean amount of transfusion was 273.6, 129.6, and 920.8 ml, respectively. Preoperative haemoglobin values decreased by 1.6 ± 0.8, 1.8 ± 0.8, and 2.0 ± 0.9 mg/dl, respectively.

Conclusion: Compared to intravenous administration, intra-articular administration of TNA seems to be more effective in terms of reducing blood loss and transfusion frequency. TNA may improve the general conditions of patients given TKA by maintaining a hemodynamically stable state, aiding in recovery, and reducing the chance of transfusion-associated side effects and complications.

Level of evidence: II.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antifibrinolytic Agents / administration & dosage*
  • Arthroplasty, Replacement, Knee*
  • Atrial Fibrillation / etiology
  • Blood Loss, Surgical / prevention & control*
  • Blood Transfusion / statistics & numerical data
  • Female
  • Hemoglobins / analysis
  • Humans
  • Injections, Intra-Articular
  • Injections, Intravenous
  • Male
  • Postoperative Complications
  • Prospective Studies
  • Tranexamic Acid / administration & dosage*
  • Venous Thrombosis / etiology


  • Antifibrinolytic Agents
  • Hemoglobins
  • Tranexamic Acid