Primary lower limb joint replacement and tranexamic acid: an observational cohort study

Area of Science:

• Orthopaedic Surgery
• Pharmacology
• Patient Recovery

Background:

• Evaluating the efficacy and safety of routine tranexamic acid (TXA) in elective orthopaedic lower limb joint replacement.
• Assessing TXA's role within enhanced recovery after surgery protocols.

Purpose of the Study:

• To determine the impact of routine tranexamic acid (TXA) administration on postoperative outcomes in elective hip and knee replacement surgeries.
• To evaluate the safety and cost-effectiveness of TXA in this patient population.

Main Methods:

• Retrospective cohort study of 673 primary hip or knee replacement procedures over a 6-year period.
• Comparison of outcomes between patients who received TXA and a control group.
• Multivariate analysis to identify independent associations with TXA use.

Main Results:

• TXA use was associated with a significantly reduced median length of stay (5 vs. 6 days, P < .001).
• Fewer patients receiving TXA required blood transfusions (6.3% vs. 17.6%, P < .001), with a number needed to treat of 9.
• Complication rates were similar between groups; TXA demonstrated cost savings of £67.89-£155.90 per case.

Conclusions:

• Routine prophylactic tranexamic acid (TXA) effectively reduces postoperative transfusions in elective primary hip and knee replacements.
• TXA administration is safe and associated with significant cost savings per case.
• The number needed to treat for TXA to prevent one transfusion is 9.