Abstract
Background
Tourniquets and tranexamic acid (TXA) are commonly used in total knee arthroplasty (TKA), but there is not consensus on how these interventions affect blood transfusion rates and total blood loss. Few studies examine the combined use of both interventions. We compared outcome measures and transfusion rates following TKA, with and without the use of tourniquet and TXA.
Methods
Retrospective cohort study of 477 consecutive patients undergoing primary TKA at a single center between 2008 and 2013. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquet-unassisted (TU) group. Subanalysis was performed on those patients receiving TXA.
Results
Mean operative duration was 66.4 minutes (30–135) in the TA group and 87.5 minutes (43–162) in the TU group (p<0.0001). Mean post-operative drop in hemoglobin was significantly greater in TU group (3.1g/dl vs. 2.8g/dl, p=0.002). The transfusion rate was 9.5% in TA compared to 11.5% in TU patients (p=0.46) with comparable mean units transfused (2.6 vs. 2.2, p=0.30). There was no significant difference in rate of wound infection (2% vs. 1.7%, p = 0.82) and total complication rate (4.1% vs. 2.5%, p=0.19) between groups. Mean length of stay was 5.8 days in TA and 7 days in the TU group (p=0.07). Those patients given TXA had a lower hemoglobin drop (2.6g/dl vs. 3.3g/dl, p=0.04) with similar transfusion (10.9% vs. 13.3%, p=0.61) and complication (3.3% vs. 5.2%, p=0.95) rates.
Discussion
Tourniquet-unassisted TKA had a greater operative duration and post-operative drop in hemoglobin than tourniquet-assisted TKA. However, transfusion rates were similar between groups. TXA use reduced the operative decrease in hemoglobin with no effect on complication or transfusion rates.
Key words
TKA, tourniquet, tranexamic acid, transfusion rates, outcomes
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