Clinical Efficacy of Intra‐articular Tranexamic Acid Injection in the Management of Hemophilia with Total Hip Arthroplasty: A 24‐month Retrospective Cohort Study

Abstract

Objective Total hip arthroplasty (THA) effectively treats end‐stage hemophilic hip arthropathy. Given hemophilia's unique characteristics, perioperative bleeding remains a significant risk for patients undergoing THA. Tranexamic acid (TXA), an efficient antifibrinolytic agent, may benefit the outcomes of THA for patients with hemophilia (PWH). This study aims to explore the clinical efficacy of intra‐articular injection of TXA in treating perioperative bleeding in PWH and assess its additional clinical benefits. Methods The retrospective study comprised data of PWH who received THA from January 2015 to December 2021 in the research center. A total of 59 individuals were included in the study, divided into a TXA group (n = 31) and a non‐TXA group (n = 28). We compared various parameters, including total blood loss (TBL), visible blood loss (VBL), occult blood loss (OBL), intraoperative coagulation factor VIII (FVIII) consumption, perioperative total FVIII consumption, hemoglobin (HB), erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), length of hospital stay, hospitalization costs, length of surgery, total protein, activated partial thromboplastin time (APTT), D‐dimer, rate of joint swelling, hip joint range of motion (ROM), visual analogue scale (VAS), and Harris hip joint function scale (HHS) between the two groups. Follow‐up assessments were conducted for up to 24 months. A Student's t test was utilized for the statistical analysis. Results This study demonstrated that intra‐articular TXA effectively reduced TBL (1248.19 ± 439.88 mL, p < 0.001), VBL (490.32 ± 344.34 mL, p = 0.003), and OBL (757.87 ± 381.48 mL, p = 0.004) in PWH who underwent THA. TXA demonstrated effectiveness in reducing VAS scores on POD1, POD7, and POD14 and joint swelling rates on POD1, POD7, POD14, and at discharge (p < 0.05). Additionally, the TXA group achieved higher HHS ratings at all follow‐up time points (p < 0.05), showing superior hip joint mobility, lower postoperative inflammation levels, reduced factor VIII consumption during surgery, and less postoperative nutritional loss. No statistically significant differences were observed between the two groups in terms of hospital stay, hospitalization costs, surgery duration, and coagulation indicators. Conclusion Intra‐articular injection of TXA reduces perioperative bleeding in PWH undergoing THA while also improving joint mobility, post‐operative rehabilitation, and quality of life. This may provide value for the future application of TXA in PWH.

Keywords

• Blood loss
• Hemophilia
• Hemophilia hip joint arthritis
• Total hip arthroplasty
• Tranexamic acid