The Knee, ISSN: 1873-5800, Vol: 23, Issue: 2, Page: 310-3

Is there a need for routine post-operative hemoglobin level estimation in total knee arthroplasty with tranexamic acid use?

Goyal, Navendu; Kaul, Ritik; Harris, Ian A; Chen, Darren B; MacDessi, Samuel J


  • Identifies the relationship of pre-operative hemoglobin to post-operative transfusions with the use of tranexamic acid in primary total knee arthroplasty.
  • Study defines an important prospect of cost saving to the patient and the health sector as a whole.
  • Risk of transfusion with a pre-operative Hb > 140 g/L is 0% with the use of intra-articular Tranexamic acid in total knee arthroplasty.
  • Routine post-operative Hb estimation is not recommended.




Total knee arthroplasty (TKA) can result in significant blood loss, leading to a need for blood transfusion. The major indication of transfusion is post-operative hemoglobin (Hb) levels in association with symptomatic anemia. The aim of this study was to determine the possibility of eliminating routine post-operative Hb tests in patients undergoing TKA with intra-articular tranexamic acid (TXA) use based on the predictability of pre-operative factors.


We conducted a retrospective analysis of 487 patients who underwent TKA with intra-articular TXA use. Statistical analysis was done to predict the transfusion risk based on multiple pre-operative parameters.



Post-operative blood transfusions were required in 2.5% of all patients. Pre-operative-Hb was the only significant predictor of post-operative transfusion (p < 0.0001). Age, sex, weight, height and body mass index (BMI) were not related to post-operative transfusion risk. Transfusions were needed in 4.2% of patients with pre-operative Hb levels <14 g/dl. No patient with a pre-operative Hb >14 g/dl required a transfusion (p < 0.0001).


Pre-operative Hb is a strong predictor of post-operative blood transfusion risk. Patients who receive TXA in TKA, with a pre-operative Hb >14 g/dl do not require routine post-operative Hb evaluation.Level of evidence: IV

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