A retrospective audit to evaluate the effectiveness of Tranexamic Acid (TXA) in reducing blood transfusion requirements in primary total knee and hip joint replacements operated on by a single surgeon (SMD).

A survey is being sent to all Fellows of the New Zealand Orthopaedic Association who are currently in clinical practice to evaluate the strategies currently in use for reducing blood transfusion requirements in joint replacement surgery.

All primary total knee and hip joint replacements are included in this trial since February 2003. Two doses of TXA (Cyclokapron) are given at a dose of 10mg/kg intravenously. The first dose is given 10 minutes before the skin incision and the second dose 10 minutes before wound closure in the case of hip replacements and just before tourniquet release in total knee replacements. Haemostasis is secured by diathermy in the case of total knee joint replacements after tourniquet release. One deep suction drain is used.

The use of Tranexamic acid was continued until September when the numbers were collated and compared to a six-month period prior to the use of TXA. Blood loss (both measured and calculated ) and the need for transfusion were the major outcome measures. Complications related to the use of TXA were recorded.

The response rate was 89%. Various strategies to reduce blood loss were used. The mean calculated blood loss in the control group and TXA group were 1196 and 948 ml respectively. The mean measured blood loss in the control group and TXA were 595 ml and 468 ml respectively. This small number of cases – (control 8 and TXA 13) did not reach statistical significance but there was a trend in favour of reduced blood loss with the use of TXA. There was one wound haematoma in the TXA group.

A wide variety of blood conservation strategies are used by New Zealand Orthopaedic Surgeons. The use of TXA in knee joint replacements is a promising strategy.