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What is the optimal approach for tranexamic acid application in patients with unilateral total hip arthroplasty?

Welcher Weg der Tranexamsäureapplikation ist bei Patienten mit einseitiger Hüfttotalendoprothese optimal?

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Abstract

Purpose

In the total hip arthroplasty (THA), the optimal administration route of tranexamic acid (TXA) remains controversial. This study was designed to investigate the impact of topical injection of TXA on blood loss during primary unilateral THA as well as short-term safety and adverse side effects compared with intravenous administration of TXA.

Material and methods

In this study, 75 patients who underwent unilateral THA were randomly divided into 3 groups receiving intra-articular TXA (IA group), intravenous TXA (IV group) or no TXA (control group C). Blood loss, postoperative drainage, covert blood loss, total blood volume, the number of blood transfusions after surgery and transfusion rate, incidence of deep venous thrombosis and pulmonary embolism were recorded and evaluated in the three groups after 1 week and 1 month.

Results

There were significant differences in the quantity of postoperative drainage, covert blood loss, total blood volume, the number of blood transfusions after surgery and transfusion rates between the three groups (P < 0.05), but blood loss during surgery showed no significant differences among the three groups (P > 0.05). In the IV group, 1 patient suffered from deep venous thrombosis of the lower limbs and in the C group, 2 patients suffered from superficial venous thrombosis of the lower limbs 2 and 4 days after surgery, respectively. In the IA group no complications occurred during the follow-up period.

Conclusion

Preoperative intravenous TXA and postoperative topical TXA significantly reduced postoperative blood loss and transfusion rates among the patients who underwent primary unilateral THA and the short-term safety was good. The data suggest that topical injection of TXA is safer and more effective, without postoperative complications.

Zusammenfassung

Zielsetzung

Der optimale Weg der Tranexamsäure(TXA)-Applikation im Rahmen der Hüfttotalendoprothese ist weiterhin umstritten. In der vorliegenden Studie sollten der Effekt einer topischen TXA-Injektion auf den Blutverlust während einer einseitigen Hüfttotalendoprothese, die kurzfristige Sicherheit und unerwünschte Wirkungen untersucht werden, jeweils im Vergleich zur intravenösen TXA-Applikation.

Material und Methoden

In dieser Studie wurden 75 Patienten, die eine einseitige Hüfttotalendoprothese erhielten, in 3 Gruppen randomisiert. Sie erhielten intraartikulär TXA (i.a.-Gruppe), intravenös TXA (i.v.-Gruppe) oder keine TXA (Kontrollgruppe). Dokumentiert und ausgewertet wurden Blutverluste, die postoperative Drainage, versteckte Blutverluste, das Gesamtblutvolumen, die Zahl der Bluttransfusionen nach chirurgischem Eingriff, die Transfusionsrate sowie die Inzidenz von tiefen Venenthrombosen und Lungenembolien, jeweils nach einer Woche und einem Monat in den drei Gruppen.

Ergebnisse

Es fanden sich signifikante quantitative Unterschiede zwischen den drei Gruppen in postoperativer Drainage, versteckten Blutverlusten, dem Gesamtblutvolumen, der Zahl der Bluttransfusionen nach chirurgischem Eingriff und in der Transfusionsrate (p < 0,05). Keine signifikanten Unterschiede zeigten sich dagegen im Blutverlust während des chirurgischen Eingriffs (p > 0,05). In der i.v.-Gruppe kam es bei einem Patienten zu einer tiefen Venenthrombose der unteren Extremitäten. In der Kontrollgruppe erlitten 2 Patienten eine oberflächliche Venenthrombose der unteren Extremitäten (2 bzw. 4 Tage nach dem Eingriff). Bei den Patienten der i.a.-Gruppe ereigneten sich in der Follow-up-Phase keine Komplikationen.

Schlussfolgerung

Die präoperative i.v.-Applikation und postoperative topische Applikation von TXA reduzierten signifikant den postoperativen Blutverlust und die Transfusionsrate bei Patienten, die einer primären einseitigen Hüfttotalendoprothese unterzogen wurden. Die kurzfristige Sicherheit war gut. Die Ergebnisse deuten darauf hin, dass die topische Injektion von TXA sicherer und wirksamer ist, ohne dass es dabei zu postoperativen Komplikationen kommt.

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Acknowledgements

We thank Xianghao Ma, Yudong Jia, Huichao Wang for assistance in recruitment and data collection during the trial, Yingjie Zhu and Youwen Liu for clinical trials and regulatory expertise in the trial steering committee and data monitoring committee for this trial. The sponsors and funding bodies had no role in the inception or design of the study, data collection and analysis or preparation of this report.

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Authors and Affiliations

  1. Medical Center of Hip, Luoyang Orthopedic Traumatology Hospital, No. 82, South Qiming Road, 471002, Henan, China

    Ying Zhang, Leilei Zhang, Xianghao Ma, Yudong Jia, Huichao Wang, Yingjie Zhu & Youwen Liu

  2. Orthopedics Hospital of Henan Province, Luoyang, China

    Ying Zhang, Leilei Zhang, Xianghao Ma, Yudong Jia, Huichao Wang, Yingjie Zhu & Youwen Liu

Authors
  1. Ying Zhang
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  2. Leilei Zhang
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  3. Xianghao Ma
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  4. Yudong Jia
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  5. Huichao Wang
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  6. Yingjie Zhu
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  7. Youwen Liu
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Corresponding author

Correspondence to Youwen Liu.

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Conflict of interest

Y. Zhang, L. Zhang, X. Ma, Y. Jia, H. Wang, Y. Zhu and Y. Liu state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried outwith the approval of the responsible ethics committee and in accordance with national lawand the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Additional information

Ying Zhang and Leilei Zhang contributed equally to this work.

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Zhang, Y., Zhang, L., Ma, X. et al. What is the optimal approach for tranexamic acid application in patients with unilateral total hip arthroplasty?. Orthopäde 45, 616–621 (2016). https://doi.org/10.1007/s00132-016-3252-y

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  • DOI: https://doi.org/10.1007/s00132-016-3252-y

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