An evaluation of the use of topical tranexamic acid in total knee arthroplasty

J Arthroplasty. 2013 Sep;28(8 Suppl):74-7. doi: 10.1016/j.arth.2013.06.037.


The purpose of this study was to evaluate the effectiveness of topical tranexamic acid in primary TKA from a clinical and economic standpoint. We retrospectively reviewed 683 primary total knee arthroplasties performed at a single institution over a 2-year period. We compared 373 cases performed in 2010 without tranexamic acid to 310 cases performed in 2011 with tranexamic acid. Demographic data, hemoglobin levels, transfusion rates, hospital length of stay, cost, and perioperative complications during the first 3 months were collected. Statistical analysis was performed using two sample t-tests and Fisher's exact tests. There was no difference in age, sex, height, or pre-operative hemoglobin between the two groups. The tranexamic acid group had significantly higher post-operative hemoglobin (P<0.0001), lower transfusion rate (P<0.0001), decreased length of stay (P<0.0001), decreased blood bank costs (P<0.0001), increased pharmacy cost (P<0.0001), and decreased total direct cost to the hospital (P<0.0001). The average savings was approximately $1500 per patient. There were no differences in thromboembolic events or infection. The use topical tranexamic acid in primary TKA is safe, effective, and results in significant cost savings.

Keywords: blood product management; economics; knee replacement; morbidity; transfusion.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Administration, Topical
  • Aged
  • Antifibrinolytic Agents / administration & dosage
  • Antifibrinolytic Agents / therapeutic use
  • Arthroplasty, Replacement, Knee / methods*
  • Blood Loss, Surgical / prevention & control*
  • Blood Transfusion / statistics & numerical data
  • Female
  • Hemoglobins / metabolism
  • Humans
  • Incidence
  • Length of Stay
  • Male
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Tranexamic Acid / administration & dosage*
  • Tranexamic Acid / therapeutic use*


  • Antifibrinolytic Agents
  • Hemoglobins
  • Tranexamic Acid