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Effectiveness of Primary Total Hip Arthroplasty Combined with Intra-articular and Intravenous Tranexamic Acid: A Retrospective Analysis of Number of Doses and Dose Strength

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Abstract

Introduction

Total hip arthroplasty is a very effective reconstructive surgery but is often associated with massive perioperative bleeding, which leads to anemia. Tranexamic acid (TXA) minimizes bleeding and the need for blood transfusion. However, no universal standard TXA dosing regimen has been established. The objectives of this study were (1) whether there was a difference in the amount of decrease in perioperative mean hemoglobin (Hb) level between a single topical administration of TXA and intravenous and topical combination administration, and we also investigated whether there was a difference in the amount of decrease in the perioperative mean Hb level due to the difference in the local dose of TXA.

Methods

We retrospectively reviewed 292 hips between June 2013 and October 2020. The decrease in Hb level (difference between the preoperative value and the 7-day postoperative value) was used to estimate total perioperative blood loss. The mean perioperative reduction in Hb was compared between hips that received intravenous TXA preoperatively and intra-articular TXA at wound closure (combination administration group) and those that received only intra-articular TXA (single dose group). It was also compared by different local doses of tranexamic acid.

Results

The mean reduction in Hb was significantly smaller in the combination administration group than in the single dose group. However, no significant difference was observed due to the difference in the local dose of TXA administered at the time of wound closure.

Conclusion

Reducing perioperative bleeding decreases the invasiveness of surgery, which is important from the perspective of medical safety.

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Authors and Affiliations

  1. Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812, Japan

    Masaru Nakamura, Tateaki Shimakawa, Shunji Nakano, Ryosuke Sato, Kenji Kondo, Hitoshi Goto, Yuto Sugimine & Tetsuya Enishi

  2. Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-5 Kuramoto, Tokushima, 770-8503, Japan

    Koichi Sairyo

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  1. Masaru Nakamura
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  2. Tateaki Shimakawa
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  3. Shunji Nakano
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  4. Ryosuke Sato
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  6. Hitoshi Goto
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  8. Tetsuya Enishi
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  9. Koichi Sairyo
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Correspondence to Masaru Nakamura.

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This research has been approved by the IRB (approval number: 2017-14) of the authors’ affiliated institution.

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Nakamura, M., Shimakawa, T., Nakano, S. et al. Effectiveness of Primary Total Hip Arthroplasty Combined with Intra-articular and Intravenous Tranexamic Acid: A Retrospective Analysis of Number of Doses and Dose Strength. JOIO 56, 1234–1239 (2022). https://doi.org/10.1007/s43465-021-00595-z

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  • DOI: https://doi.org/10.1007/s43465-021-00595-z

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