J Knee Surg 2019; 32(02): 160-164
DOI: 10.1055/s-0038-1636914
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Improved Early Postoperative Range of Motion in Total Knee Arthroplasty Using Tranexamic Acid: A Retrospective Analysis

Matthew A. Dorweiler
1   Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio
,
Michael A. Boin
1   Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio
,
Andrew W. Froehle
2   Department of Kinesiology and Health, Wright State University, Dayton, Ohio
,
Matthew W. Lawless
3   Premier Orthopaedics, Dayton, Ohio
,
Jedediah H. May
4   Department of Orthopaedic Surgery, University of Otago, Christchurch, New Zealand
› Author Affiliations
Funding None.
Further Information

Publication History

15 September 2017

28 January 2018

Publication Date:
13 March 2018 (online)

Abstract

The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has become common practice. Recent literature has demonstrated a reduction in postoperative knee swelling and drain output while using TXA. Our purpose is to analyze the range of motion (ROM) following TKA in patients who received TXA compared with a control group. We hypothesize that patients treated with TXA will have improved early postoperative ROM when compared with controls. A retrospective chart review was performed for patients who underwent TKA from 2010 to 2012 performed by a single orthopaedic surgeon. Patients were stratified into three cohorts by route of TXA administration including intravenous (IV), topical, and a control group. Dependent variables analyzed included extension, flexion, and total arc ROM on each postoperative day (POD), average ROM across all three postoperative days, as well as pre-to-postoperative differences in ROM. Demographic data were recorded for each patient. A total of 174 patients were included for analysis, 75 controls and 99 receiving TXA. A significant difference was found between the treatment groups and the control for all variables (for each, p ≤ 0.002). There were no significant differences in ROM between the IV and topical TXA treatment groups (for each, p ≥ 0.558). A multivariate analysis demonstrated no significant difference between the groups in complication rate or demographic variables. The use of TXA may improve early postoperative ROM following TKA.

 
  • References

  • 1 National and regional estimates on hospital use for all patients from the HCUP Nationwide Inpatient Sample (NIS): U.S. Department of Health and Human Services
  • 2 Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999; 57 (06) 1005-1032
  • 3 Alshryda S, Mason J, Vaghela M. , et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg Am 2013; 95 (21) 1961-1968
  • 4 May JH, Rieser GR, Williams CG, Markert RJ, Bauman RD, Lawless MW. The assessment of blood loss during total knee arthroplasty when comparing intravenous vs intracapsular administration of tranexamic acid. J Arthroplasty 2016; 31 (11) 2452-2457
  • 5 Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty 2013; 28 (07) 1080-1083
  • 6 Wong J, Abrishami A, El Beheiry H. , et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 2010; 92 (15) 2503-2513
  • 7 Sepah YJ, Umer M, Ahmad T, Nasim F, Chaudhry MU, Umar M. Use of tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement. J Orthop Surg 2011; 6: 22
  • 8 Slover J, Bosco J. Cost analysis of use of tranexamic acid to prevent major bleeding complications in hip and knee arthroplasty surgery. Am J Orthop 2014; 43 (10) E217-E220
  • 9 Ishida K, Tsumura N, Kitagawa A. , et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 2011; 35 (11) 1639-1645
  • 10 Naylor JM, Ko V, Rougellis S. , et al. Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 1. J Eval Clin Pract 2012; 18 (03) 644-651
  • 11 Naylor JM, Ko V, Rougellis S. , et al. Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2. J Eval Clin Pract 2012; 18 (03) 652-658
  • 12 Wied C, Thomsen MG, Kallemose T. , et al. The risk of manipulation under anesthesia due to unsatisfactory knee flexion after fast-track total knee arthroplasty. Knee 2015; 22 (05) 419-423
  • 13 Sharareh B, Le NB, Hoang MT, Schwarzkopf R. Factors determining discharge destination for patients undergoing total joint arthroplasty. J Arthroplasty 2014; 29 (07) 1355-1358
  • 14 Bini SA, Fithian DC, Paxton LW, Khatod MX, Inacio MC, Namba RS. Does discharge disposition after primary total joint arthroplasty affect readmission rates?. J Arthroplasty 2010; 25 (01) 114-117