Improved Patient-Reported Outcomes With Extended Oral Tranexamic Acid Following Total Hip and Knee Arthroplasty

Tranexamic acid (TXA) is widely used in total joint arthroplasty (TJA) to reduce perioperative blood loss and transfusion requirements. There is a growing body of literature on the use of extended postoperative TXA following total knee arthroplasty (TKA). This study evaluated the impact of an extended postoperative oral TXA regimen following total hip arthroplasty (THA) and TKA.

After obtaining Institutional Review Board approval, a retrospective chart review was conducted to identify patients who underwent THA/TKA at a single institution. All patients received a standard 1-gram intravenous TXA dose prior to incision and at the time of closure. Those who underwent TJA after formal adoption of an institutional protocol implementing an extended postoperative oral TXA regimen received an additional 1.95-gram dose of oral TXA starting on the day of surgery and continued for three days postoperatively. Patient-reported outcome measures, hospital lengths of stay (LOSs), postoperative complications, 90-day readmissions, and primary TJA-related emergency department visits were compared between the oral TXA group and a historical cohort. All patients included in the analysis had a minimum follow-up of three months. A total of 312 patients were included (153 in the oral TXA group and 159 historical controls). Baseline demographics and preoperative Hip Disability and Osteoarthritis Outcome/Knee Injury and Osteoarthritis Outcome scores were comparable between groups.

Extended TXA use was associated with significantly greater improvement in patient-reported outcome measures (change of 27.7 versus a change of 18.1; P < 0.001) and a significant reduction in TJA-related emergency department visits (odds ratio 0.11; 95% confidence interval 0.02 to 0.49; P = 0.007). There were no significant differences in LOS, 90-day readmissions, or postoperative complications, including infection or thromboembolic events (all P > 0.05).

In this retrospective cohort of primary THA and TKA patients, the use of oral TXA for three days postoperatively was associated with improved early patient-reported function without an increase in complications or LOSs.