Yue Liu1*, Yao-min Li2*, Peng Tian3, Zhi-jun Li4, Gui-jun Xu5, Xin Fu5

1Department of Minimally Invasive Spine Surgery, Tianjin University Tianjin Hospital, Tianjin, China
2Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
3Department of Traumatic Orthopedics, Tianjin University Tianjin Hospital, Tianjin, China
4Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
5Department of Orthopedics, Tianjin University Tianjin Hospital, Tianjin, China

Keywords: Intra-articular injection, meta-analysis, peri-articular injection, total knee arthroplasty, tranexamic acid.


Objectives: In this meta-analysis, we aimed to compare the efficacy and safety of peri-articular injection (PAI) and intraarticular injection (IAI) of tranexamic acid (TXA) in total knee arthroplasty (TKA).

Patients and methods: We performed a comprehensive literature search from electronic databases such as Springer, Web of Science, PubMed, Cochrane Library databases, and ScienceDirect up to October 2021. The language of identified articles was not restricted. The keywords used for the search strategy included: “tranexamic acid”, “total knee arthroplasty”, “peri-articular injection” and “intra-articular injection”.

Results: Two randomized-controlled trials (RCTs) and four non-RCTs with a total of 491 patients met the inclusion criteria. Of the patients, 242 patients were in the PAI group and 249 patients were in the IAI group. No significant difference was observed between the two groups in hemoglobin drop, postoperative drainage volume, total blood loss, blood transfusion requirements, or units of blood transfused. There was no significant difference between the two groups regarding postoperative infection or deep venous thrombosis.

Conclusion: The PAI of TXA is comparable to IAI of TXA in decreasing postoperative blood loss during TKA.

Citation: Liu Y, Li YM, Tian P, Li ZJ, Xu GJ, Fu X. Comparison between peri-articular injection and intra-articular injection of tranexamic acid during total knee arthroplasty: A meta-analysis. Jt Dis Relat Surg 2022;33(3):686-694.

* The first two authors contributed equally to this manuscript

Ethics Committee Approval

No ethical approval was required, as all data in this meta-analysis were derived from previously published research. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Data Sharing Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.

Author Contributions

Contributed to conception and design of this study: Y.L., Y.M.L., P.T., Z.J.L., G.J.X., and X.F.; Study selection and data extraction of the finally included studies were done independently assessed the methodological quality of each included study: by Y.L. and Y.M.L., P.T. and X.F.; Contributed to preparation of the manuscript: Y.L. and Y.M.L., P.T., Z.J.L., G.J.X. and X.F.; The final version of the article was approved by all the authors.

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 are grateful for the support by Tianjin Health Science and Technology Project (No. ZC20096 and RC20120).


The authors are grateful for the support by Tianjin Health Science and Technology Project (No. ZC20096 and RC20120).