The Influence of Tranexamic Acid (TXA) on Postoperative Infection Rates Following Total Hip Arthroplasty (THA)-A...

Background: Tranexamic acid (TXA) has become a cornerstone in total hip arthroplasty for reducing blood loss and minimizing transfusion requirements. However, its influence on postoperative infection rates, including surgical site infections and periprosthetic joint infections (PJIs), remains a topic of debate. This systematic review aims to explore the association between tranexamic acid use and infection rates in total hip arthroplasty. Methods: Following PRISMA 2020 guidelines, an electronic search was performed in the PubMed, Scopus, Web of Science, Cochrane, and Epistemonikos databases. A PICO-based question was developed to select relevant studies, which were assessed for quality using the MINORS tool for non-randomized studies and the RoB 2 tool for randomized controlled trials (RCTs). This review critically appraises three studies, including one RCT and two retrospective cohort studies. Results: Of 277 studies identified, 3 met inclusion criteria, totaling 146,227 patients. Findings indicate that tranexamic acid is generally associated with reduced periprosthetic joint infections and surgical site infection rates, with some variability based on administration routes and dosages. Despite these promising results, methodological limitations in the included studies underscore the need for further high-quality research to establish optimal tranexamic acid protocols. Conclusions: In summary, this systematic review indicates that TXA could reduce postoperative infection rates following total hip arthroplasty (THA). Further well-designed randomized controlled trials are required to validate these findings and determine the best dosing and administration strategies. PROSPERO registration: CRD42024589078.