Tsukada S, et al. - Since intra-articular tranexamic acid (TXA) as an adjunct to intravenous TXA was reported to reduce perioperative blood loss during unilateral total knee arthroplasty (TKA), researchers conducted this randomized double-blind, placebo-controlled trial to compare intravenous vs combined intravenous and intra-articular TXA administration in individuals undergoing simultaneous bilateral TKA. Seventy-seven patients with 154 involved knees undergoing simultaneous bilateral TKA were randomly assigned to the intravenous TXA group (intra-articular placebo for each knee) or combined TXA group (1,000 mg of intra-articular TXA for each knee) with 1:1 treatment allocation. In patients undergoing simultaneous bilateral TKA, the addition of intra-articular TXA did not decrease perioperative blood loss compared with placebo. No patients needed allogenic blood transfusion.