The Journal of Bone and Joint Surgery (American). 2005;87:766-770.
doi:10.2106/JBJS.D.02046
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Tranexamic Acid Reduces Postoperative Blood Loss in Cementless Total Hip Arthroplasty

Satoshi Yamasaki, MD1, Kensaku Masuhara, MD, PhD1 and Takeshi Fuji, MD, PhD1

1 Department of Orthopaedic Surgery, Osaka Kosei-Nenkin Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan. E-mail address for S. Yamasaki: ys8483{at}okn.gr.jp

Investigation performed at the Department of Orthopaedic Surgery, Osaka Kosei-Nenkin Hospital, Osaka, Japan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin, has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip arthroplasty with cement. However, there have been few reports describing the effects of tranexamic acid on blood loss during and following total hip arthroplasty without cement.

Methods: We investigated the effects of tranexamic acid in twenty-one patients who underwent staged bilateral total hip arthroplasty without cement for the treatment of osteoarthritis of the hip. The average interval between the two procedures was 16 ± 16 months. On one side, 1000 mg of tranexamic acid was administered intravenously five minutes before the skin incision. On the other side, tranexamic acid was not administered. Baseline hemoglobin and hematocrit values were obtained three weeks before each arthroplasty. The volume of postoperative blood loss was recorded at two-hour intervals for the first twelve hours and then again at twenty-four hours, and the values were compared between the two groups.

Results: The total intraoperative blood loss in the tranexamic acid group (607 ± 298 mL) was similar to that in the control group (633 ± 220 mL). The postoperative blood loss in the tranexamic acid group was significantly lower than that in the control group at all time-points during the first twenty-four hours (p < 0.001 for all comparisons). The greatest reduction in blood loss was observed during the first four hours after surgery in the tranexamic acid group (p < 0.01).

Conclusions: In patients undergoing total hip arthroplasty without cement, preoperative administration of tranexamic acid is associated with decreased postoperative blood loss during the first twenty-four hours, especially during the first four hours after surgery.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


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