We appreciate the valuable comments and constructive suggestions regarding our paper. We have carefully considered the comments and respond accordingly. 1. We take more time to surgery for TKA because many Japanese patients have severe varus deformity of osteo-arthritis. The surgical haemostasis after tourniquet deflation was performed before placing the polyethylene. 2. Our study has several limitations. The major limitation was the small sample size. Furthermore, the study was not randomised. 3. In our hospital, anaesthetists perform hypotensive anaesthesia in TKA, but do not use hypothermic anaesthesia. 4. In all groups, we used the principles of transfusion based on the guidelines for postoperative surgical patients suggested by the American Association of Blood Banks (AABB). Transfusion was considered at ahaemoglobin concentration of <=8 g/dl or for symptoms of acute anaemia. In the end, the need for transfusion was decided upon by the orthopaedic surgeon (ST) on the basis of the symptoms of acute anaemia. 5. We stated in our manuscript that the intra-operative blood loss was measured by collected blood and weighed sponges. 6. Administration of TXA twice may eliminate the need for blood transfusion including both autologous donation and postoperative autotransfusion during TKA.
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