Topical Intra Articular Tranexamic Acid Reduces Packed Blood Cell Consumption in Total Joint Arthroplasty

Introduction: Post-operative blood loss anemia is an undesired event following total joint arthroplasty. Use of tranexamic acid (TXA) has been shown to reduce blood loss after surgery and can be administered intravenously, orally and topically. We assessed the effect of topical intra articular TXA administration at the end of surgery in total joint arthroplasty on post-operative packed blood cell units consumption.

Patients and Methods: This is a retrospective study comparing 2 groups of patients that had either a primary knee or hip arthroplasty during a 4 months' period before and after the beginning of intra articular administration of a solution containing 2 grams of TXA. Pre-operative hemoglobin level, post-operative day 1 hemoglobin level, packed blood cell administration and venous thromboembolism (VTE) events were assessed.

We reviewed 148 records of patients that had a knee arthroplasty and 134 records of patients that had a hip arthroplasty. There were 80 and 68 knee arthroplasties without and with TXA administration, respectively. There were 84 and 50 hip arthroplasties without and with TXA administration, respectively. There was no difference between the groups with regard to preoperative anticoagulation and aspirin treatment and VTE risk assessment. There was also no difference regarding preoperative hemoglobin levels.

Results: Hemoglobin levels difference between pre op and day 1 post op decreased in the patients treated with TXA from 2.77gr% to 2.18gr% in hip arthroplasty (p<0.001) and from 2.92gr% to 1.72gr% in knee arthroplasty (p<0.001).

In the hip arthroplasty group 13 packed blood cell units were administered without TXA compared to 2 units in patients treated with TXA (p<0.001). In the knee arthroplasty group 15 packed blood cell units were administered without TXA compared to 2 units in patients treated with Hexacapron (p<0.001).

There were no VTE events in the hip arthroplasty patients. In the knee arthroplasty patients, pulmonary embolism was diagnosed in 2 patients not treated with TXA and in 3 patients that were treated with intra articular TXA (p=0.66).

Conclusion: Intra articular administration of TXA at the end of surgery significantly reduced need for post-operative packed blood cell units administration without increase in VTE risk in all patients undergoing primary hip and knee arthroplasty.