Top

International Orthopaedics

Published in:

23-09-2023 | Tranexamic Acid | Original Paper

Intra-articular injection of tranexamic acid in patients with haemophilia arthritis: retrospective controlled study in total knee arthroplasty

Authors: Si-cheng Xiang, Shao-ning Shen, Rui Wang, Zheng-ming Wang, Zhao-kai Jin, Hai Su, Pei-jian Tong, Shuai-jie Lv

Published in: International Orthopaedics | Issue 3/2024

Abstract

Purpose

Total knee arthroplasty is the main method for the treatment of advanced haemophilic knee arthritis. Due to the particularity of hemophilia, the blood management plan is the focus of the perioperative period for haemophilia patients. This study aimed to investigate the clinical effect and safety of intra-articular injection of tranexamic acid in patients with haemophilia.

Methods

This is a retrospective study. According to whether tranexamic acid is used or not, patients are divided into tranexamic acid group (n=30) and non-tranexamic acid group (n=29). Total blood loss, intraoperative blood loss, complete blood count, total amount of coagulation factor VIII (FVIII) usage, coagulation biomarkers, inflammatory biomarkers, knee range of motion, knee joint function, pain status, complication rate, and patient satisfaction were assessed and compared at a mean follow-up of 16 months.

Results

Injecting tranexamic acid into the knee joint cavity can effectively reduce the hidden blood loss and total blood loss (P<0.001), and reduce the patient’s early postoperative inflammation biomarkers, pain status, and limb swelling. Therefore, the patient can obtain a better range of motion following total knee arthroplasty. In the long run, in terms of joint function and surgical satisfaction, there are no statistically significant differences. In addition, there are no statistically significant differences between the two groups of patients in terms of the total amount of FVIII usage, length of stay, and hospitalization expenses.

Conclusion

In patients with haemophilia, intra-articular injection of tranexamic acid during total knee arthroplasty can effectively reduce postoperative blood loss, early postoperative inflammation levels, pain and limb swelling, and enable patients to receive higher-quality rehabilitation exercises to get better joint function. Previous studies on TKA in haemophilic patients have already demonstrated the efficacy of intra-articular injections of TXA in reducing postoperative blood loss. Our study confirms this efficacy.

Wong T, Recht M (2011) Current options and new developments in the treatment of haemophilia. Drugs 71(3):305–320. https://doi.org/10.2165/11585340-000000000-00000CrossRefPubMed

Rodriguez-Merchan EC (2010) Musculoskeletal complications of hemophilia. HSS J Feb 6(1):37–42. https://doi.org/10.1007/s11420-009-9140-9CrossRef

Liu S et al (2020) Age-related severity and distribution of haemophilic arthropathy of the knee, ankle and elbow among Chinese patients with haemophilia. Haemophilia 26(1):129–135. https://doi.org/10.1111/hae.13858CrossRefPubMed

Rodriguez-Merchan EC (2017) Simultaneous bilateral total knee arthroplasty in hemophilia: is it recommended? Expert Rev Hematol 10(10):847–851. https://doi.org/10.1080/17474086.2017.1358084CrossRefPubMed

Zhao CC et al (2023) Does living at high altitude increase the risk of bleeding events after total knee arthroplasty? A retrospective cohort study. Int Orthop 47(1):67–74. https://doi.org/10.1007/s00264-022-05614-8CrossRefPubMed

Lin ZX, Woolf SK (2016) Safety, Efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics 39(2):119–130. https://doi.org/10.3928/01477447-20160301-05CrossRefPubMed

Pimenta FS et al (2023) Chondrotoxic effects of tranexamic acid and povidone-iodine on the articular cartilage of rabbits. Int Orthop 26. https://doi.org/10.1007/s00264-023-05820-y

Ye S et al (2023) Comparative study of carbazochrome sodium sulfonate and tranexamic acid in reducing blood loss and inflammatory response following direct anterior total hip arthroplasty: a prospective randomized controlled trial. Int Orthop 20. https://doi.org/10.1007/s00264-023-05853-3

Wong J et al (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 92(15):2503–2513. https://doi.org/10.2106/JBJS.I.01518CrossRefPubMed

10.

Bradley KE et al (2019) Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? A randomized controlled trial. Bone Joint J 101-B(9):1093–1099. https://doi.org/10.1302/0301-620X.101B9.BJJ-2018-1096.R1CrossRefPubMed

11.

Tzatzairis T et al (2019) Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg 139(6):859–868. https://doi.org/10.1007/s00402-019-03173-zCrossRefPubMed

12.

Rodriguez-Merchan EC, Romero-Garrido JA, Gomez-Cardero P (2016) Multimodal blood loss prevention approach including intra-articular tranexamic acid in primary total knee arthroplasty for patients with severe haemophilia A. Haemophilia 22(4):e318–e320. https://doi.org/10.1111/hae.12942CrossRefPubMed

13.

Huang ZY et al (2019) Tranexamic acid may benefit patients undergoing total hip/knee arthroplasty because of haemophilia. BMC Musculoskelet Disord 20(1):402. https://doi.org/10.1186/s12891-019-2767-xCrossRefPubMedPubMedCentral

14.

Rodriguez-Merchan EC, Encinas-Ullan CA, Gomez-Cardero P (2020) Intra-articular Tranexamic acid in primary total knee arthroplasty decreases the rate of post-operative blood transfusions in people with hemophilia: a retrospective case-control study. HSS J 16(3):218–221. https://doi.org/10.1007/s11420-019-09711-0CrossRefPubMed

15.

Cai J et al (2020) The many roles of tranexamic acid: an overview of the clinical indications for TXA in medical and surgical patients. Eur J Haematol 104(2):79–87. https://doi.org/10.1111/ejh.13348CrossRefPubMed

16.

Wang SX et al (2017) Retrospectively analysis of the difference of bleeding frequency and hemophilic arthropathy between hemophilia A and hemophilia B patients. Zhonghua Xue Ye Xue Za Zhi 38(5):404–409. https://doi.org/10.3760/cma.j.issn.0253-2727.2017.05.010CrossRefPubMed

17.

Xiao C et al (2023) Medullary cavity application of tranexamic acid to reduce blood loss in tibial intramedullary nailing procedures-a randomized controlled trial. Int Orthop 47(8):2095–2102. https://doi.org/10.1007/s00264-023-05824-8CrossRefPubMed

18.

Kvederas G et al (2013) A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(12):2790–2799. https://doi.org/10.1007/s00167-012-2221-1CrossRefPubMed

19.

Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee 7(3):151–155. https://doi.org/10.1016/s0968-0160(00)00047-8CrossRefPubMed

20.

Bergin PF et al (2011) Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am 93(15):1392–1398. https://doi.org/10.2106/JBJS.J.00557CrossRefPubMedPubMedCentral

21.

Wang K et al (2017) The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 25(9):2849–2857. https://doi.org/10.1007/s00167-015-3964-2CrossRefPubMed

22.

Montroy J et al (2018) The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfus Med Rev. https://doi.org/10.1016/j.tmrv.2018.02.003

23.

Manta N et al (2021) The role of suction drainage in the management of peri-operative bleeding in Total and Unicomcompartmental knee arthroplasty: a retrospective comparative study. BMC Musculoskelet Disord 22(1):1031. https://doi.org/10.1186/s12891-021-04868-4CrossRefPubMedPubMedCentral

24.

Li N et al (2015) Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage. J Orthop Surg Res 10:3. https://doi.org/10.1186/s13018-014-0140-1CrossRefPubMedPubMedCentral

25.

Albasha A et al (2023) Outcomes of drain versus no drain in total knee arthroplasty: a retrospective cohort study. Int Orthop 23. https://doi.org/10.1007/s00264-023-05946-z

26.

Hu Y et al (2018) Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors. J Orthop Surg Res 13(1):325. https://doi.org/10.1186/s13018-018-1038-0ADSCrossRefPubMedPubMedCentral

27.

Wang QR et al (2020) Intravenous tranexamic acid for reducing perioperative blood loss during revision surgery for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty: a retrospective study. Orthop Surg 12(1):100–107. https://doi.org/10.1111/os.12592CrossRefPubMed

28.

Hvas AM et al (2007) Tranexamic acid combined with recombinant factor VIII increases clot resistance to accelerated fibrinolysis in severe hemophilia A. J Thromb Haemost 5(12):2408–2414. https://doi.org/10.1111/j.1538-7836.2007.02755.xCrossRefPubMed

29.

Jimenez JJ et al (2007) Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care 11(6):R117. https://doi.org/10.1186/cc6173CrossRefPubMedPubMedCentral

30.

Jimenez JJ et al (2011) Safety and effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial. J Cardiothorac Surg 6:138. https://doi.org/10.1186/1749-8090-6-138CrossRefPubMedPubMedCentral

31.

Holm B et al (2010) Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil 91(11):1770–1776. https://doi.org/10.1016/j.apmr.2010.07.229CrossRefPubMed

32.

Li JW, Ma YS, Xiao LK (2019) Postoperative pain management in total knee arthroplasty. Orthop Surg 11(5):755–761. https://doi.org/10.1111/os.12535CrossRefPubMedPubMedCentral

33.

Pinho-Ribeiro FA, Verri WA Jr, Chiu IM (2017) Nociceptor sensory neuron-immune interactions in pain and inflammation. Trends Immunol 38(1):5–19. https://doi.org/10.1016/j.it.2016.10.001CrossRefPubMed

34.

Ngaage DL, Bland JM (2010) Lessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies. Eur J Cardiothorac Surg 37(6):1375–1383. https://doi.org/10.1016/j.ejcts.2009.11.055CrossRefPubMed

35.

Hermans C et al (2010) Subclinical deep venous thrombosis observed in 10% of hemophilic patients undergoing major orthopedic surgery. J Thromb Haemost 8(5):1138–1140. https://doi.org/10.1111/j.1538-7836.2010.03829.xCrossRefPubMed

36.

Martin K, Key NS (2016) How I treat patients with inherited bleeding disorders who need anticoagulant therapy. Blood 128(2):178–184. https://doi.org/10.1182/blood-2015-12-635094CrossRefPubMedPubMedCentral

37.

Sander M et al (2010) Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. Crit Care 14(4):R148. https://doi.org/10.1186/cc9216CrossRefPubMedPubMedCentral

38.

Koster A, Schirmer U (2011) Re-evaluation of the role of antifibrinolytic therapy with lysine analogs during cardiac surgery in the post aprotinin era. Curr Opin Anaesthesiol 24(1):92–97. https://doi.org/10.1097/ACO.0b013e32833ff3ebCrossRefPubMed

39.

Wang SH et al (2019) Does hemophilia increase risk of adverse outcomes following total hip and knee arthroplasty? A propensity score-matched analysis of a nationwide, population-based study. J Arthroplasty 34(10):2329–2336 e1. https://doi.org/10.1016/j.arth.2019.05.062CrossRefPubMed

Title: Intra-articular injection of tranexamic acid in patients with haemophilia arthritis: retrospective controlled study in total knee arthroplasty
Authors: Si-cheng Xiang
Shao-ning Shen
Rui Wang
Zheng-ming Wang
Zhao-kai Jin
Hai Su
Pei-jian Tong
Shuai-jie Lv
Publication date: 23-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Tranexamic Acid
Hemophilia
Arthritis
Published in: International Orthopaedics / Issue 3/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-023-05983-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intra-articular injection of tranexamic acid in patients with haemophilia arthritis: retrospective controlled study in total knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2024

Arthroscopy with partial meniscectomy for degenerative tear does not increase the risk of total knee arthroplasty at five year follow up; however, this population undergoes total knee arthroplasty with a lower threshold of osteoarthritis

Anterior radial head subluxation in primary elbow osteoarthritis

The distance between the fibular collateral ligament tunnel and the common peroneal nerve allows a posterolateral corner reconstruction without neurolysis

Is COVID-19 an independent risk factor for the development of avascular necrosis of the hip? A retrospective study to evaluate the factors associated with avascular necrosis of the hip in patients who had COVID-19 infection

Heterotopic hip ossification resection: monocentric experiences of associated factors, outcomes, and complications

Outcomes of Exeter cemented total hip arthroplasty in a county hospital: survivorship of eight hundred and ninety four hips with a minimum ten-year follow up