Topical Tranexamic Acid Use in Knee Periprosthetic Joint Infection is Safe and Effective

Waddell, Bradford S., Zahoor, Talal, Meyer, Mark, Ochsner, Lock and Chimento, George (2015) Topical Tranexamic Acid Use in Knee Periprosthetic Joint Infection is Safe and Effective. Journal of Knee Surgery, 29 5: 423-429. doi:10.1055/s-0035-1564599

Author Waddell, Bradford S.
Zahoor, Talal
Meyer, Mark
Ochsner, Lock
Chimento, George
Title Topical Tranexamic Acid Use in Knee Periprosthetic Joint Infection is Safe and Effective
Journal name Journal of Knee Surgery   Check publisher's open access policy
ISSN 1938-2480
Publication date 2015-08-08
Year available 2015
Sub-type Article (original research)
DOI 10.1055/s-0035-1564599
Open Access Status Not yet assessed
Volume 29
Issue 5
Start page 423
End page 429
Total pages 7
Place of publication New York, United States
Publisher Thieme Medical Publishers
Collection year 2016
Language eng
Formatted abstract
Introduction Tranexamic acid (TXA) has been shown to decrease hemoglobin loss and reduce the need for transfusions in primary hip and knee arthroplasty. Our study evaluated the safety and efficacy of topical TXA in revision TKA for periprosthetic joint infection (PJI).

Methods We performed a retrospective review of patients who underwent removal of hardware with antibiotic spacer placement (stage 1) and/or revision TKA (stage 2) for PJI at our institution between September 2007 and July 2013. During that time, 49 patients underwent stage-1 procedures (20 knees with TXA, 29 without TXA) and 47 patients underwent stage-2 revisions (28 with TXA, 19 without TXA). We evaluated hemoglobin loss, need for transfusion, reinfection rate, length of stay (LOS), complications, and mortality with and without the use of TXA in these patients. All data sets were analyzed with a two-sample t-test.

Results Average follow-up was 3.15 years (range, 1–7 years). TXA use led to a significantly lower percentage drop in the postoperative lowest hemoglobin compared with the preoperative hemoglobin in stage-1 surgeries (19.8 vs. 30.05%, p = 0.0004) and stage-2 revisions (24.5 vs 32.01%, p = 0.01). In both groups, TXA use was associated with a significant reduction in transfusion rates (stage-1, 25 vs 51.7%, p = 0.04; stage-2, 25 vs. 52.6%, p = 0.05). There was a nonstatistical decreased LOS in both groups in which TXA was used (stage 1, 5.15 vs. 6.72 days, p = 0.055; stage 2, 5.21 vs. 6.84 days, p = 0.09). There was no difference in the reinfection rate (4 vs. 4, p = 0.56) or mortality rate between groups (0 vs. 2 non-TXA group). A single upper extremity deep vein thrombosis occurred in a stage-1 patient who received TXA, and no pulmonary embolism occurred.

Conclusion We show that topical TXA is safe and effective for use in both stages of revision TKA for PJI. Previous studies have shown TXA to aggravate a staphylococcal infection in mice; however, topical TXA doesn't appear to negatively effect on the treatment of PJI in our patients and did not increase the reinfection, complication, or mortality rate.
Keyword Knee revision
Tranexamic acid
Periprosthetic joint infection
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
UQ Diamantina Institute Publications
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