Subgroup Analysis of Topical Tranexamic Acid in Primary Total Hip Arthroplasty

Abstract

Intraarticular or “topical” tranexamic acid (TXA) has increasingly received attention for reducing blood loss following total joint arthroplasty. While our institution has seen transfusion rates drop from 17.5% to 5.5% after administration of topical TXA in total joint replacement, it is still not known which patients will benefit most from TXA administration. Patients undergoing total hip arthroplasty (THA) at our institution continue to have a higher allogeneic transfusion rate compared to total knee arthroplasty (TKA). While THA patients respond to topical TXA, the question remains as to which specific subset of THA patients might benefit most from administration of topical TXA. To answer this question we performed a retrospective cohort study that involved 123 THA patients who received topical TXA, and compared them to 111 controls who did not receive TXA treatment. These patients were subdivided into groups based on gender, age, BMI, preoperative hemoglobin, and surgical approach. Our goal in this investigation is to identify characteristics that will more accurately justify the use of topical TXA in THA; the ultimate goal is for a surgeon to correctly identify patients preoperatively (prospectively) who will most consistently benefit from topical TXA administration. Preoperative identification of patients who would most likely benefit from topical TXA administration would allow for more targeted use of the drug, ideally reducing cost and unnecessary exposure.