Related Experiment Video
Updated: Jun 6, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Does Tranexamic Acid Improve Early Postoperative Shoulder Motion After Total Shoulder Arthroplasty?
Logan T Wright1, Robert J Cueto, Kevin A Hao
1From the College of Medicine, University of Florida, Gainesville, FL (L. T. Wright, Cueto, Popp, and Hartman), the Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL (Hao, Hones, J. O. Wright, T. W. Wright, Farmer, LaMonica, and King), and the Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL (Schoch).
Purpose:
Although the hematologic benefits of tranexamic acid (TXA) have been thoroughly evaluated, an additional value demonstrated in knee arthroplasty and rotator cuff repair is improved early postoperative range of motion (ROM). This study aims to evaluate whether TXA given during total shoulder arthroplasty (TSA) confers improved early postoperative ROM or pain.
Methods:
We did retrospective review of 653 TSAs (223 anatomic TSA [aTSA] and 430 reverse TSA [rTSA]) performed in 596 patients at a single institution from 2007 to 2022. Intraoperative TXA use was implemented on a case-by-case basis starting in 2014 then became standard practice in 2016. Pre- to postoperative improvement in ROM was evaluated at 6 weeks, 3 months, 6 months, 1 year, and 2-years of follow-up. Mixed-effects models were used to evaluate whether administration of TXA intraoperatively improved ROM or pain at each follow-up time point.
Results:
TXA was administered to 26% (n = 58) of aTSAs and 43% (n = 179) of rTSAs. Patients with a history of hypertension received TXA at a higher rate for both aTSA ( P = 0.009) and rTSA ( P = 0.005). Intraoperative TXA was not associated with improved ROM or pain for aTSA or rTSA at any time point investigated. Average estimated intraoperative blood loss was markedly less in the TXA group for both aTSA [250 to 300 mL] ( P < 0.001) and rTSA [200 to 300 mL] ( P < 0.001) when compared with the non-TXA groups [300 to 400 mL for both].
Conclusion:
Intraoperative TXA does not improve ROM or pain after TSA. However, intraoperative blood loss was reduced, further supporting the routine use of TXA to reduce hematologic complications and improve intraoperative visibility.
