<![CDATA[Background: Total knee arthroplasty (TKA) may be associated with perioperative blood loss and postoperative hemoglobin reduction. Tranexamic acid (TXA) is widely used to reduce perioperative blood loss in total joint arthroplasty, with variation in dose, route, and timing of administration. This case series describes perioperative outcomes following local TXA infiltration and tourniquet application in two patients undergoing primary TKA. Case Presentation: Two men with advanced knee osteoarthritis (Kellgren–Lawrence grade IV) underwent primary TKA under spinal anesthesia. Case 1 was a 41-year-old man with chronic left knee pain and valgus deformity, whereas Case 2 was a 68-year-old man with progressive right knee pain and varus deformity. In both cases, a pneumatic tourniquet was applied at 250 mmHg, and 250 mg of TXA was locally infiltrated into the tissues surrounding the surgical site before wound closure. Hemoglobin concentration decreased from 16.1 to 14.9 g/dL in Case 1 and from 13.3 to 11.8 g/dL in Case 2 at 24 hours postoperatively. Neither patient received an allogeneic blood transfusion. Both patients ambulated with a walker on postoperative day three, had postoperative pain scores of 3–4 on the visual analogue scale, and had no documented surgical wound complications. At six-month follow-up, both were reported to have recovered full knee range of motion. Conclusions: Local TXA infiltration combined with tourniquet application in two primary TKA cases was followed by postoperative hemoglobin reductions without allogeneic blood transfusion and postoperative recovery. Given the descriptive nature of this case series, these observations do not establish the effectiveness of either intervention.]]>
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