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Intra-articular versus intravenous administration of tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomised clinical trials

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Abstract

Aim

The ideal route of tranexamic acid (TXA) administration in total hip arthroplasty (THA) or total knee arthroplasty (TKA) remains controversial. This study aims to identify the optima route of TXA administration in THA or TKA.

Methods

PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched until 4 August 2021 for randomised studies that compared intravenous (IV) or intra-articular (IA) administration of TXA in THA or TKA.

Results

Sixty-seven studies enrolling 8335 patients (IA: 4162; IV: 4173) were eligible for quantitative and qualitative analysis. Comparable results were demonstrated in the incidence of venous thromboembolisation (OR:0.96, p = 0.84), total blood loss (MD: − 9.05, p = 0.36), drain output (MD: − 7.36, p = 0.54), hidden blood loss (MD: − 6.85, p = 0.47), postoperative haemoglobin level (MD: 0.01, p = 0.91), haemoglobin drop (MD: − 0.10, p = 0.22), blood transfusion rate (OR: 0.99, p = 0.87), total adverse events (OR: 1.12, p = 0.28), postoperative range of motion (MD: 1.08, p = 0.36), postoperative VAS pain score (MD: 0.13, p = 0.24) and postoperative D-dimer level (MD: 0.61, p = 0.64). IV route of TXA administration was associated with significantly longer length of hospital stay compared to IA route of administration (MD: − 0.22, p = 0.01).

Conclusion

In this meta-analysis, both IV and IA route of TXA administration were equally effective in managing blood loss and postoperative outcomes in lower limb joints arthroplasty.

Level of evidence

Level 1.

PROSPERO Registration CRD42021271355.

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Abbreviations

ASA:

American society of anaesthesia

BMI:

Body mass index

CI:

Confidence interval

DF:

Degree of freedom

I2 :

Heterogeneity

IA:

Intra-articular

IV:

Intravenous

NA:

Not applicable

NR:

Not reported

SD:

Standard deviation

SE:

Standard error

TKA:

Total knee arthroplasty

THA:

Total hip arthroplasty

TXA:

Tranexamic acid group

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Acknowledgements

The authors would like to express their gratitude to Laoruengthana et al. and Arora et al. for providing additional data and information with regards to their studies.

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  1. Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Tze Khiang Tan, Aaron Tay & Markus Kuster

  2. Royal Perth Hospital, Perth, WA, Australia

    Jenn Yuan Lee

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TKT contributed to protocol/project management, data collection or management, data analysis, manuscript writing/editing. DL contributed to data collection or management. AT contributed to manuscript writing/editing. MK contributed to manuscript writing/editing.

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Tan, T.K., Lee, J.Y., Tay, A. et al. Intra-articular versus intravenous administration of tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomised clinical trials. Eur J Orthop Surg Traumatol 33, 709–738 (2023). https://doi.org/10.1007/s00590-022-03241-y

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