Transamin

All surgeries were performed by one of the 2 surgeons (S.T. and M.W.). Neither a pneumatic tourniquet nor drain was used in any of the patients undergoing TKA during the study period. A subvastus approach was used in all surgeries except in patients with valgus knees, for whom a lateral approach was used. All patients received a cemented, posterior stabilized prosthesis (Scorpio NRG; Stryker Orthopaedics, Mahwah, NJ).
We administered 1 g of tranexamic acid intravenously (Transamin; Daiichi Sankyo, Tokyo, Japan) just prior to skin incision and again at 6 hours after the first administration.
We subcutaneously administered 1.5 or 2.5 mg of fondaparinux (Arixtra; GlaxoSmithKline, Tokyo, Japan) for thromboprophylaxis once every evening for 10 days, starting from postoperative day 1. The dosage was determined based on the renal function and body weight.
For postoperative pain control, intraoperative periarticular injection including ropivacaine, morphine, epinephrine, ketoprofen, and/or corticosteroid was performed [14] (link), [15] (link). From the day after surgery, oral nonsteroidal anti-inflammatory drug (60 mg of loxoprofen, Surinofen; Aska, Tokyo, Japan) was administered 3 times a day.
An intravenous cefazolin (Cefamezin; Astellas, Tokyo, Japan) was administered perioperatively and every 8 hours for the first 48 hours after surgery.

The same surgical procedures were performed for all patients by 8 surgeons whose career of orthopaedic surgeons ranged 9–34 years (the average was 18 years). The average surgical time was 121 min and average tourniquet time was 95 min. Significant differences of both surgical and tourniquet time among surgeons did not exist. The decision to replace the patella was made by the operating surgeon based on specifics of each case. An air tourniquet was utilized during surgery and was released before skin closure since released tourniquet before skin closure decreases complications compared with released tourniquet after skin closure.¹² Following a midline skin incision, the midvastus approach with measured bone cutting based on anatomic landmarks was used for all knees. An intramedullary alignment rod for the femoral side and an extramedullary guide system for the tibial side were used. After bone cutting, the soft tissues were released on a case-by-case basis to obtain mediolateral balance, and all components were fixed with cement. No drains were utilized in any patients. One ampoule of tranexamic acid (10% Transamin, 10 mL, 1000 mg; Daiichi-Sankyo, Tokyo, Japan) was routinely administered into the joint by an 18-gauge needle after skin closure.

The combined TXA group received 1,000 mg of TXA (Transamin; Daiichi-Sankyo) administered intravenously just before the skin incision in the first knee. After implantation of the prosthesis and a periarticular analgesic injection followed by washing out of the solution (Figs. 1-A and 1-B), we closed the capsule and retinaculum. Then, 1,000 mg of TXA (10 mL of 100 mg/mL TXA) was administered intra-articularly into each knee (Fig. 1-C). Thus, a total of 3,000 mg of TXA was administered in the operating room. Six hours later, another 1,000 mg of TXA was given intravenously.
The intravenous TXA group received 1,000 mg of TXA administered intravenously just before skin incision in the first knee and again 6 hours after the first dose. No intra-articular TXA was given in this group.