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The Efficacy of Tranexamic Acid in Perioperative Bleeding Following Total Hip Arthroplasty Through Different Surgical Approaches: Systematic Review and Meta-Analysis Publisher



Khorram R1 ; Borazjani R2 ; Khavandegar A3 ; Behjat M4 ; Rahmanipour E5 ; Vafadar R6 ; Vali M7 ; Parsa A8 ; Ghorbani M8
Authors
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Authors Affiliations
  1. 1. Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2. Medical Research Fellow, INOV8 Research, Houston, TX, United States
  3. 3. Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Orthopedic Surgery, School of Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  5. 5. Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  6. 6. Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran
  7. 7. Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
  8. 8. Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran

Source: Journal of Orthopaedics Published:2025


Abstract

Introduction: Tranexamic acid (TXA) has been documented to reduce perioperative blood loss following orthopedic surgeries, such as total hip arthroplasty (THA). Previous studies focused on the best applicable dose and administration method to minimize blood loss. Although the surgical approach is another factor that may influence perioperative bleeding, no previous research has examined its concurrent impact alongside TXA. This meta-analysis investigated the effect of intravenous TXA on perioperative bleeding in primary THA, focusing on the surgical approach used. Method: The authors searched PubMed, Web of Science, Scopus, Embase, and the Cochrane Library through November 2022. Fourteen studies, comprising 1358 patients, were identified as suitable for inclusion in this meta-analysis. To assess perioperative bleeding, hemoglobin (Hb) decline, transfused blood products, total blood loss (TBL), and intraoperative blood loss (IOBL) were recorded. Results: The study showed that the lateral approach (LA) maintains the postoperative Hb level more effectively (WMD = 1.081, 95 % CI: 0.620–1.541). Significantly less IOBL was observed with the posterolateral approach (PLA; WMD = −70.578, 95 % CI: [-130.389] – [-10.766]). The posterior approach (PA) was associated with a reduction in TBL (WMD = −392, 95 % CI: [-474.439] – [-310.231], P-value <0.0001). Conclusion: The surgical approach plays a significant role in blood management during surgery. Overall, the PLA resulted in the least IOBL, while the LA was associated with the least blood transfusion and a decline in Hb level. Additionally, the PA was linked to the lowest TBL. © 2024
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