Topical Tranexamic Acid Reduces Postoperative Blood Loss in Primary Total Hip and Knee Arthroplasty

Abstract

Context: The purpose of this study was to assess the effectiveness of topical pre-closure application of tranexamic acid (TXA) to reduce postoperative blood loss and blood transfusion rates in primary total hip and knee arthroplasty (THA and TKA) in a private, high-volume orthopedic specialty hospital setting.

Methods: This was a retrospective study examining 140 consecutive patients undergoing primary hip or knee arthroplasty at the sample setting by a single surgeon. The first 70 patients did not receive topical TXA (2 gm./20ml.), the final 70 did receive topical TXA. We compared the postoperative hemoglobin levels of both sample subgroups at postoperative days 1, 2, and 3.

Results: Overall, the postoperative hemoglobin levels were significantly higher in the TXA group on postoperative days 1, 2, and 3 (p < 0.05). When patients who underwent THA (n = 70) were investigated separately, the hemoglobin levels were significantly higher on postoperative days 1, 2, and 3 in the group that received TXA. In the TKA group (n = 70), there was not a significantly higher hemoglobin level in patients who received TXA. There were no blood transfusions in the entire study cohort. Possibly due to the more restrictive transfusion criteria employed in this study, the total estimated prospective cost savings from use of TXA was calculated at about $116 per patient.

Conclusions: Based on these results from a high volume orthopedic specialty hospital, pre-closure topical TXA application may prove effective in reducing postoperative blood loss for some patients but have a relatively small impact on cost outcomes.

Keywords: allogenic blood transfusion; topical tranexamic acid; total hip arthroplasty; total knee arthroplasty.

Figure 1 Total Hip Arthroplasty Cohort. Mean Hemoglobin Levels ± SEM (G/Dl) and Demographics of Patients Who Did (+) or Did Not (-) Receive Topical TXA. This Was Evaluated Pre-Operatively, On Post-Operative Day 1 (POD 1), POD 2, and POD 3. P-Value Considered Statistically Significant if < 0.05.

Figure 2 Total Knee Arthroplasty Cohort. Mean Hemoglobin Levels ± SEM (G/Dl) and Demographics of Patients Who Did (+) or Did Not (-) Receive Topical TXA. This Was Evaluated Pre-Operatively, On Post-Operative Day 1 (POD 1), POD 2, and POD 3. P-Value Considered Statistically Significant if < 0.05.

Figure 3 All patients (THA + TKA). Mean Hemoglobin Levels ± SEM (g/dL) and Demographics of Patients Who Did (+) or Did Not (-) Receive Topical TXA. This Was Evaluated Pre-Operatively, On Post-Operative Day 1 (POD 1), POD 2, and POD 3. P-Value Considered Statistically Significant if < 0.05.