Discussion
thrombosis, nonhealing, postoperative pain, blood loss, intraoperative and postoperative blood loss, pain, knee arthroplasty, thrombus, ’ postoperative hypoproteinaemia, cardiovascular or cerebrovascular accidents, coagulation abnormalities, postoperative knee swelling
THROMBOSIS, DEEP VEIN THROMBOSIS, BLOOD LOSS, WOUND INFECTION, ACUTE RENAL FAILURE, THROMBUS, ASYMPTOMATIC PULMONARY EMBOLISM, COMPLICATIONS
TXA administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. There was no statistical significance in the comparison of intraoperative and postoperative blood loss, postoperative haemoglobin, haematocrit or red blood cell count between the two groups of patients in this study, but the data demonstrated that applying TXA before tourniquet pressurisation had a better haemostatic effect. However, the use of an intraoperative tourniquet and the effect of repelling the blood will have a negative impact on the TXA blood concentration in the tissues of the operated area while blocking the blood circulation of the affected limb [Multimodal analgesia was strictly applied to both groups, and active and passive functional exercises of the knee joint were strictly performed in the postoperative period. The results showed that there was no difference in the effect of the two regimens on the postoperative pain and function of the patients. During the follow-up period, the pain of the affected limbs was reduced compared with that in the preoperative period, and the improvement in pain was obvious over time; however, due to the influence of postoperative knee swelling, pain and other comprehensive factors, the knee function score decreased first and then increased later, and the improvement in knee function was satisfactory at 3 months after the operation. There was no significant difference in the incidence of complications between the two groups of patients. In this study, some patients had thrombosis of the intermuscular vein of the calf, but there were no obvious clinical symptoms, and the thrombus disappeared after intensive anticoagulation treatment. There was no deep vein thrombosis of the lower extremities or symptomatic pulmonary embolism. Some patients’ wounds showed oozing blood and fluid, which was related to the patients’ postoperative hypoproteinaemia and slow wound healing factors; the state of the wounds improved after dressing changes. None of the patients had complications such as wound infection, nonhealing, acute renal failure, cardiovascular or cerebrovascular accidents, or coagulation abnormalities.Although this study was well designed, it still has some limitations. First, the study was a single-centre study and the sample size was small. Haemoglobin and blood loss indicators reflected less blood loss and more stable haemoglobin levels in the group of patients who received TXA before loosening the tourniquet, but there was no significant difference in the statistical analysis. Because of the strict inclusion criteria, the sample size may not have been large enough to determine significance for all variables. Second, venography was not used as a standard method to screen for postoperative lower extremity deep vein thrombosis, and Doppler ultrasonography may affect the accuracy of the diagnosis of lower extremity deep vein thrombosis, but the occurrence of lower extremity deep vein thrombosis and symptomatic pulmonary embolism can be determined according to the clinical signs and symptoms at the 1-month postoperative follow-up, and the safety of TXA has been well supported by evidence.