Tranexamic acid increases early perioperative functional outcomes after total knee arthroplasty

The purpose of this study was to investigate the influence of tranexamic acid (TXA) on functional outcomes in the immediate postoperative period after total knee arthroplasty (TKA). We hypothesized that the known benefits of TXA would confer measurable clinical improvements in physical therapy (PT) performance, decrease pain, and decrease hospital length of stay (LOS).

We retrospectively analyzed 560 TKA patients, including 280 consecutive patients whose surgery was performed before the initiation of a standardized TXA protocol and the first 280 patients who received TXA after protocol initiation. Outcome measurements included postoperative changes in hemoglobin and hematocrit, LOS, pain scores, destination of discharge, and steps ambulated with PT over 5 sessions.

TXA administration resulted in less overall drops in hemoglobin (P < .001) and hematocrit levels (P < .001). Moreover, patients administered TXA ambulated more than their counterparts during every PT session, which was statistically significant during the second (P = .010), third (P = .011), and fourth (P = .024) sessions. On average, the TXA cohort ambulated 20% more per PT session than patients who did not receive TXA (P < .001). TXA administration did not influence pain levels during PT, hospital LOS, or discharge destination in this investigation.

It is well known that TXA reduces postoperative anemia, but this study also demonstrates that it confers early perioperative functional benefits for TKA patients. Potential mechanisms for this benefit include reduced rates of postoperative anemia and reduced rates of hemarthroses.