Optimal Release Timing of Temporary Drain Clamping to Reduce Postoperative Bleeding After Total Knee Arthroplasty With an Intraarticular Injection of Tranexamic Acid

Background: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus had been reached regarding the timing of clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA.Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 minutes (Group A, 60 patients), 2 hours (Group B, 42 patients), or 3 hours (Group C, 49 patients). Total drained volumes, hematocrit (Hct) reductions, estimated blood losses (EBLs), transfusion rates, and wound complications were reviewed.Results: Mean total drained volume, Hct reduction, EBL, and transfusion rate were significantly less in group C than in groups A or B (p < 0.01). No significant intergroup difference was found for wound-related complications. No surgical site infection or deep vein thrombosis was observed.Conclusion: IA-TXA plus drain-clamping for 3 hours is optimal for reducing blood loss with minimal complications after TKA.