Efficacy of tranexamic acid with/without drain in knee arthroplasty: a randomized prospective clinical study from Northwest Syria.

PURPOSE: This study evaluated the outcomes of intra-articular tranexamic acid (TXA) and/or suction drainage in patients undergoing total knee arthroplasty (TKA).

MATERIALS AND

METHODS

Following approval from the institutional review board, a prospective, randomized, and blinded clinical study was conducted in Northwest Syria, including 192 patients who underwent unilateral TKA between August 2023 and April 2025. Patients were randomly assigned to three groups: TXA with suction drainage, TXA only, or suction drainage only. Patients with coagulopathies, active infections, previous knee surgeries, or contraindications to TXA were excluded. All procedures followed a standardized surgical and postoperative protocol. Outcome measures included total and hidden blood loss (HBL), drainage volume, transfusion rate, limb swelling, and wound complications.

RESULTS

Total blood loss was lowest in Group 2 (710 mL) compared to Group 1 (891 mL) and Group 3 (1391 mL) (P < 0.0001). No transfusions were required in Group 2, whereas 7.8% of Group 1 and 36% of Group 3 received transfusions (P < 0.0001). No wound complications occurred in Group 2. HBL and early swelling were higher in Group 2 but resolved within 6 weeks. Knee range of motion at 2 months showed no significant differences among groups (p = 0.0789).

CONCLUSION

Intra-articular TXA without suction drainage appears to be the safest and most effective method to reduce perioperative blood loss in TKA. Larger multicenter studies are recommended.