Introduction: Our study compared the effectiveness of tranexamic acid in patients undergoing TKA using the three different administration methods—IV, IA, and combined IV and IA—in terms of total blood loss and the rate of allogeneic transfusion. We also wanted to compare the frequency of wound complications and venous thromboembolism (VTE) among these regimens.

Material and Methods: 66 TKA patients were divided into four groups based on the route of tranexamic acid administration: IV only, IA only, low-dose combined (IV + IA injection of 1 g), and high-dose combined (IV + IA injection of 2 g). This research involved 66 patients who underwent TKA between March 2019 and March 2020. Comparing the groups revealed differences in the estimated total blood loss, allogeneic transfusion rate, hemoglobin loss, frequency of symptomatic deep vein thrombosis and pulmonary embolism, wound complications, and periprosthetic joint infection.

Results: There were no differences between the other three groups, but the combined high and low dose group and the IA only group lost less blood overall than the IV only group did. None of the study groups' patients received an allogeneic transfusion. There were no other symptomatic VTE events in any group, with the exception of one patient in the IV-only group who developed a symptomatic pulmonary embolism.

Conclusion: Regardless of whether it is combined with IV administration, IA tranexamic acid administration further reduces blood loss after unilateral TKA compared to IV use alone. With respect to further reducing blood loss in comparison to IA alone, this study did not find any additional effects of IV combination.