Original Research Article DOI: 10.18231/2395-1362.2018.0062 Indian Journal of Orthopaedics Surgery, October-December, 2018;4(4):316-319 316 Comparative study between the hemoprophylaxis provided by intra-articular and intravenous tranexamic acid in total knee arthroplasty K.S. Kushalappa 1,* , Vinay Kumar 2 , Vikram Shetty 3 , Lawerence Mathias 4 1 Junior Resident, 2 Senior Resident, 3,4 Professor, Dept. of Orthopaedics, K.S. Hegde Medical Academy, Mangalore, Karnataka, India *Corresponding Author: K.S. Kushalappa Email: kushalappa.s@gmail.com Abstract Patients undergoing Total knee arthroplasty (TKR) are transfused at the rates of 11-21%. As per ISHKS joint registry, data of 34,478 TKRs was assessed: Average age was 64.4 years These Geriatric patients are exposed to complications as a result of major orthopedic surgery and postoperative anemia, which exposes the patient to the complications associated with transfusion as well as increasing their duration of hospital stay. Geriatric patients are prone to existing comorbidities and are susceptible to risk factors, predisposing to Venous Thromboembolism (VTE). In our single center based short series study, we look to compare the efficacy of hemoprophylaxis provided by intravenous & intra-articular tranexamic acid. Our aim is to find an effective protocol to reduce postoperative anemia whilst minimising risk of VTE’s. Keywords: TKA, Tranexamic acid, Chemoprophylaxis. Introduction A silver tsunami is approaching as the nation’s population progresses towards a top heavy distribution. 1 Life expectancy has increased steadily which points towards a progression towards development. The average Indian now can expect to live well into the 6 th decade of life, however, Geriatric problems are unavoidable and will ensue. As Indians, we come from a culture oriented with activities which quite commonly require us to assume positions such as - squatting and sitting cross legged. From local village meetings to primary rural classrooms, to Indian style commodes which are believed to be good for bowel movements, but over the years; this position has proven to be a strain on the knees of the hard laboring Indian. The country moves towards development and with that comes opportunities. The percentage of home or car loans has gone up year on year. People are more conscious of their lifestyle, health and standard of living than ever before. Protection, security and safety have now become necessities and this has made people aware of the concept and ease of access to insurance. Insurance in the medical world gives a patient a chance, an opportunity, to partake in state of the art elective procedures such as total joint replacement. Joint replacement rates in India have soared in the recent past, the two factors that have primarily driven this increase are, availability of these procedures and acceptance for a culturally, “unpalatable” procedure. The Geriatric population look to live a longer, more productive, pain free life. The advancements in the medical industry in India gives Orthopaedic surgeons adequate support to deliver procedures which will enhance and lengthen one’s productive life. Geriatric patient prove a different challenge to the treating surgeon. From their fragile bony structure to their pre-existing comorbidities. Joint replacement surgery is a major Orthopaedics surgery that takes a toll on the patient. A balance is required to provide the patient with the best outcome at the most minimal collateral damage in terms of duration of hospital stay and financial impact. Through our study, we look to provide an effective protocol in managing the perioperative blood loss that is accustomed by total knee arthroplasty. We aim to look at reducing the patient’s hospital stay, financial burden and most importantly look to alleviate the risks associated with post-operative anemia and blood transfusion. Tranexamic acid has been used to good effect in the past to control bleeding in other major Orthopaedic surgeries of the lower limb and in cardiac surgeries. Here we look to change the route of administration to bring about the same desired outcome at a lower cost to the patient in terms of side effects. Study Our study aimed at comparing the efficacy in hemoprophylaxis provided by intravenously and intra- articular administered tranexamic acid in cases of primary unilateral total knee arthroplasty. We compared the outcomes in terms of hemoglobin variations pre and postoperatively along with close monitoring for thromboembolic complications. We included all patients undergoing primary unilateral total knee arthroplasty at our center from October 2015 to January 2017. Patients were assessed based on total blood loss which was calculated based on an equation factoring hemoglobin variations during hospital stay and calculating the patient's’ blood volume. Patients were divided in two groups: Group A- Patients received 10 mg/kg intravenous