الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Total knee arthroplasty is one of the most successful orthopaedic surgeries that has a key role to play in relieving pain and restoring knee function and improve the patient quality of life. Despite being a very successful surgery, there are a bunch of complications that may accompany this operation. Perioperative bleeding is one of the serious complications that associated with it. Total knee arthroplasty usually results in blood loss between 1000 mL and 1500 mL which increase the need of blood transfusion. The major cause of postoperative blood loss following to TKA can be attributed to surgical trauma that leads to activation of both the coagulation cascade and local fibrinolysis.There are several methods to reduce postoperative blood loss and blood transfusion one of these methods is the use of TXA. Tranexamic acid is a synthetic derivative of the amino acid lysine that acts by reversible blockade of the lysine-binding sites on plasminogen, thus reducing the blood loss and requirement for blood transfusion. It is available in different forms: IV, IM, and oral.The aim of the work: The purpose of this work is to compare the effect of topical versus intravenous tranexamic acid in decreasing postoperative bleeding and blood transfusion after TKA.Materials and Methods: This is a randomized double blinded controlled study which included (70) patients. The study included all patients who were admitted to Mansoura University Hospital to have primary TKA.
The study subjects were randomly allocated into two groups using randomization.com website.1. group A received an IV injection of TXA (1000mg) 15 minutes before inflation of tourniquet followed by (1000 mg) TXA 15 minutes before deflation of tourniquet.2. group B received Intra-articular injection of TXA (1000mg) in 20 ml saline injected into the drain at the end of the operation followed by clamping the drain for 2 hours.with assesement of the following:The amounts of blood collected in the drainage 24 hour after the operation.Preoperative and Postoperative Hb and HCT levels. Postoperative blood transfusion.Results:In this clinical study a total of 70 patients with primary OA knee, randomized in two groups, group A received IV TXA, while group B received local TXA, we found that there was no significantly difference between the studied groups as regarding their preoperative and postoperative Hb, HCT and amount of drain output.This study went through demographic data of our patients to predict the risk factors for postoperative bleeding. It was found that BMI, diabetes mellitus and hypertension were a positive significant predictor in our study, On the contrary age, sex, duration of surgery and anesthesia were found to be insignificant.Conclusion:Total knee arthroplasty has become one of the most commonly performed orthopaedic operations for the treatment of end-stage knee arthritis. Perioperative blood loss is a significant concern for patients undergoing TKA, controlling blood loss during and after surgery is important to improve the patient outcome. Tranexamic acid is one of the several modalities employed to minimize blood loss in patients undergoing TKA. Tranexamic acid present in several forms IV, IM and oral.In this study, we found that there was no difference between IV and topical TXA as regarding postoperative bleeding, postoperative Hb and postoperative HCT between the study groups. We found also a significant correlation between body mass index, diabetes mellitus, hypertension and postoperative bleeding.