Effects of different administration routes of tranexamic acid during primary total knee arthroplasty

doi:10.3877/ cma.j.issn.1674-134X.2025.02.007

Abstract

Abstract:

Objective

To observe the clinical application effect on patients with primary total knee arthroplasty (tKA) receiving different administration routes of tranexamic acid combined with cold compress.

Methods

A total of 148 patients with TKA in Chengdu Nuclear Industry 416 Hospital were enrolled from December 2021 to December 2023. The patients were all adult patients who were treated with primary TKA,and there was no contraindication of tranexamic acid nor important organ lesions or diseases. The patients were divided into four groups according to the stratified randomization method by random number table method,including intravenous group (IV group), intra-articular group (IA group), combined group and oral group, 37 cases in each group. The coagulation indicators, inflammatory indicators, total blood loss volume and drainage volume, pain degree, joint range of motion (ROM) and incidence rates of complications were observed among the four groups after medication.One-way analysis of variance was used for measurement data among multiple groups, and chi square or Fisher exact test was used for enumeration data.

Results

The differences were statistically significant in neutrophil to lymphocyte ratio (nLR), monocyte to lymphocyte ratio (MLR), fibrinogen(FIB) and D-dimer (D-D) among the four groups (F=14.580, 19.180, 4.391, 7.974, all P<0.05). FIB (q=6.808,6.407, 8.810), D-D (q=8.055, 7.048, 10.070), NLR (q=3.963, 3.699, 4.668) and MLR (q=4.978, 4.418,6.637) were significantly lower in the combined group than those in the IV group, IA group and oral group（all P<0.05）. The differences were statistically significantin total blood loss volume and drainage volume among the four groups (F=5.27, 4.959, both P<0.05). Total blood loss volume (q=4.262, 4.060, 5.157) and drainage volume (q=3.095, 4.135, 5.012) were significantly lower in the combined group than those in the IV group, IA group and oral group (all P<0.05). The visual analogue scale scores at three and seven days after surgery and knee ROM at three days after surgery revealed no statistically significant differences among the four groups (all P>0.05), but there was a statistically significant difference in knee ROM at seven days after surgery (F=6.083,P<0.05). The ROM in the combined group at seven days after surgery was significantly higher than that in oral group (q=6.030, P<0.05). The incidence rates of complications exhibited no statistically significant differences among the four groups (P>0.05).

Conclusions

Different administration routes combined with cold compress for TKA patients can help to improve coagulation function, inflammatory response and perioperative blood loss.Intravenous medication combined with intra-articular medication may have certain advantages in improving inflammation, inhibiting FIB and D-D levels and improving knee ROM.

Key words: Arthroplasty, replacement, knee, Tranexamic acid, Infusions, intravenous, Injections, intra-articular

Yuhao Yan, Xuanze Liu, Lishuai Bao, Mingliang He, Guoqing Xiao. Effects of different administration routes of tranexamic acid during primary total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(02): 178-184.

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Figures/Tables 6

Table 1 Comparison of general data

组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ± s ）］Age（year）	身体质量指数［kg/m²，（ $\overset{ˉ}{x}$ ± s ）］Body mass index	高血压（例）Hypertension	高脂血症（例）Hyperlipidemia
静脉组Intravenous group	37	63. 5±5. 4	23. 1±2. 4	5	6
关节腔组Intra-articular group	37	63. 1±5. 6	23. 1±2. 5	3	5
联合组Combined group	37	63. 4±5. 9	23. 0±2. 5	5	4
口服组Oral group	37	63. 2±5. 4	23. 0±2. 5	4	4
统计值Statistic al values		F=0. 045	F=0. 022	χ ²=0. 731	χ ²=0. 664
P值		>0. 05	>0 . 05	>0. 05	>0. 05

Table 1 Comparison of general data

组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ± s ）］Age（year）	身体质量指数［kg/m²，（ $\overset{ˉ}{x}$ ± s ）］Body mass index	高血压（例）Hypertension	高脂血症（例）Hyperlipidemia
静脉组Intravenous group	37	63. 5±5. 4	23. 1±2. 4	5	6
关节腔组Intra-articular group	37	63. 1±5. 6	23. 1±2. 5	3	5
联合组Combined group	37	63. 4±5. 9	23. 0±2. 5	5	4
口服组Oral group	37	63. 2±5. 4	23. 0±2. 5	4	4
统计值Statistic al values		F=0. 045	F=0. 022	χ ²=0. 731	χ ²=0. 664
P值		>0. 05	>0 . 05	>0. 05	>0. 05

Table 2 Comparison of general data

组别Groups	例数Number of cases	FIB（g/L）		D-D（mg/L）
组别Groups	例数Number of cases	术前Before surgery	术后24 h24 h after surgery	术前Before surgery	术后24 h24 h after surgery
静脉组Intravenous group	37	2. 63±0. 47	4. 22±0. 65^ab	0. 24±0. 04	0. 50±0. 07^ab
关节腔组Intra-articular group	37	2. 58±0. 42	4. 18±0. 62^ab	0. 23±0. 05	0. 49±0. 06^ab
联合组Combined group	37	2. 65±0. 47	3. 54±0. 51^a	0. 24±0. 03	0. 42±0. 05^a
口服组Oral group	37	2. 57±0. 45	4. 42±0. 64^ab	0. 22±0. 04	0. 52±0. 06^ab
F值		0. 269	14. 580	2. 056	19. 180
P值		>0. 05	＜0. 001	>0. 05	＜0. 001

Table 3 Comparison of inflammatory indicators

组别Groups	例数Number of cases	NLR		MLR
组别Groups	例数Number of cases	术前Before surgery	术后24 h24 h after surgery	术前Before surgery	术后24 h24 h after surgery
静脉组Intravenous group	37	1. 98±0. 46	2. 98±0. 73^ab	0. 23±0. 03	0. 37±0. 07^ab
关节腔组Intra-articular group	37	2. 02±0. 41	2. 95±0. 69^ab	0. 24±0. 05	0. 36±0. 07^ab
联合组Combined group	37	2. 00±0. 43	2. 53±0. 58^a	0. 23±0. 05	0. 31±0. 06^a
口服组Oral group	37	1. 97±0. 43	3. 06±0. 75^ab	0. 24±0. 03	0. 39±0. 09^ab
F值		0. 097	4. 391	0. 725	7. 974
P值		>0. 05	0. 006	>0. 05	＜0. 001

Table 4 Comparison of total blood loss and drainage volume

组别Groups	例数Number of cases	总失血量［ml，（ $\overset{ˉ}{x}$ ± s ）］Total blood loss volume	引流量［ml，（ $\overset{ˉ}{x}$ ± s ）］Drainage volume	输血率［例（%）］Transfusion rate［ n（%）］
静脉组Intravenous group	37	286. 4±59. 6^a	134. 3±29. 5^a	1（2. 7）
关节腔组Intra-articular group	37	284. 6±58. 4^a	135. 4±30. 3^a	1（2. 7）
联合组Combined group	37	248. 6±43. 8	115. 3±26. 8	0（0）
口服组Oral group	37	294. 3±52. 5^a	139. 6±31. 3^a	3（8. 1）
统计值Statistical values		F=5. 274	F=4. 959	-
P值		0. 002	0. 003	0. 400^*

Table 4 Comparison of total blood loss and drainage volume

组别Groups	例数Number of cases	总失血量［ml，（ $\overset{ˉ}{x}$ ± s ）］Total blood loss volume	引流量［ml，（ $\overset{ˉ}{x}$ ± s ）］Drainage volume	输血率［例（%）］Transfusion rate［ n（%）］
静脉组Intravenous group	37	286. 4±59. 6^a	134. 3±29. 5^a	1（2. 7）
关节腔组Intra-articular group	37	284. 6±58. 4^a	135. 4±30. 3^a	1（2. 7）
联合组Combined group	37	248. 6±43. 8	115. 3±26. 8	0（0）
口服组Oral group	37	294. 3±52. 5^a	139. 6±31. 3^a	3（8. 1）
统计值Statistical values		F=5. 274	F=4. 959	-
P值		0. 002	0. 003	0. 400^*

Table 5 Postoperative pain and ROM

组别Groups	例数Number of cases	VAS（分）		ROM（°）
组别Groups	例数Number of cases	术后3 dThree days after surgery	术后7 dSeven days after surgery	术后3 dThree days after surgery	术后7 dSeven days after surgery
静脉组Intravenous group	37	3. 52±0. 43	1. 96±0. 30	49. 26±4. 62	69. 58±4. 26
关节腔组Intra-articular group	37	3. 49±0. 46	1. 94±0. 29	50. 53±4. 59	69. 35±4. 08
联合组Combined group	37	3. 53±0. 45	1. 87±0. 26	48. 38±4. 66	71. 56±3. 82
口服组Oral group	37	3. 52±0. 48	2. 02±0. 31	50. 15±4. 82	67. 52±4. 13^a
F值		0. 053	1. 676	1. 564	6. 083
P值		>0. 05	>0. 05	>0. 05	0. 001

Table 6 Incidences of complications［ n（%）］

组别Groups	例数Number of cases	感染Infection	胃肠道反应Gastrointestinal reaction	下肢血栓Lower extremity thrombosis	总发生率Total incidence rate
静脉组Intravenous group	37	2（5. 4）	0（0）	3（8. 1）	5（13. 5）
关节腔组Intra-articular group	37	1（2. 7）	1（2. 7）	1（2. 7）	3（8. 1）
联合组Combined group	37	0（0）	2（5. 4）	0（0）	2（5. 4）
口服组Oral group	37	2（5. 4）	2（5. 4）	2（5. 4）	6（16. 2）
χ ²值					-
P值					0. 490^*

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