Mutlu Akdoğan1, Alper Öztürk2, Mehmet Faruk Çatma1, Burak Menderes Akdoğan1, Atakan Gülsoy3, Halis Atıl Atilla1

1Department of Orthopedics and Traumatology, Dışkapı Training and Research Hospital, Ankara, Türkiye
2Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Türkiye
3Department of Orthopedics and Traumatology, Anamur Devlet Hastanesi, Mersin, Türkiye

Keywords: Blood loss, pneumatic tourniquet, postoperative pain, total knee arthroplasty, tranexamic acid.


Objectives: The aim of this study was to evaluate the effects of tranexamic acid (TXA) administration on bleeding control and to compare its utilization with and without simultaneous use of conventional pneumatic tourniquets during total knee arthroplasty (TKA).

Patients and methods: Between January 2017 and December 2017, a total of 204 patients (23 males, 181 females; mean age: 66±6.9 years; range, 45 to 86 years) who underwent TKA for Stage 4 gonarthrosis were retrospectively analyzed. The patients were divided into two groups as those with (n=110) and without (n=94) pneumatic tourniquet use. Tranexamic acid (1 g) was administered intravenously to all patients in both study groups. Intra- and postoperative blood loss were calculated, and postoperative pain was evaluated by a Visual Analog Scale. Demographic and clinical data were compared between the study groups.

Results: The amount of total blood loss and postoperative blood loss were significantly higher in the tourniquet group than that in the no-tourniquet group (589.4±69.5 mL vs. 490.8±55.2 mL and 326±56 mL vs. 164±35.5, respectively; p<0.001 for both). Intraoperative blood loss was significantly higher in the no-tourniquet group (326.9±42.9 mL vs. 263.5±53.8 mL, respectively; p<0.001). The pain score at 24 h was significantly higher in the tourniquet group (p<0.001).

Conclusion: Total blood loss and postoperative pain were significantly higher among patients in whom a tourniquet was used during TKA. Therefore, the routine use of tourniquets with TXA should be reconsidered.

Citation: Akdoğan M, Öztürk A, Çatma MF, Akdoğan BM, Gülsoy A, Atilla HA. Use of tranexamic acid may reduce the need for routine tourniquet use in total knee arthroplasty. Jt Dis Relat Surg 2022;33(3):547-552.

Ethics Committee Approval

The study protocol was approved by the Univiersity of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital Ethics Committee (date/ no: 19.03.2018-47/03). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Design: M.A., H.A.A.; Data collection: B.M.A.; Analysis and interpretation of results: A.G., M.F.Ç.; Draft manuscript preparation: A.Ö., M.A.; All authors reviewed the results and approved the final version of the manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.


We would like to express our deepest appreciation to Yalım Ateş MD for encouraging us for no-tourniquet total knee arthroplasty.