Tranexamic Acid Use Is Associated With Lower Rates of Transfusion in Patients Undergoing Revision Total Hip Arthroplasty for Periprosthetic Joint Infection.

BACKGROUND

While tranexamic acid (TXA) is widely used in primary total hip arthroplasty (THA), it has not been studied extensively during revision THA for periprosthetic joint infection (PJI). Since revision procedures for infection are associated with greater intraoperative blood loss and a higher likelihood of transfusion, investigation of TXA use in first-stage revision THA for PJI is warranted to define its impact on postoperative bleeding risk, transfusion requirements, and safety profile.

METHODS

Querying a large healthcare database, we identified adult patients between 2016 and 2023 undergoing stage-one revision THA for PJI. Patients who received TXA were subsequently identified. Propensity score matching was used to balance cohorts. Mixed-effects logistic regression models were used to assess primary outcome, transfusion. Secondary outcomes included postoperative bleeding outcomes, wound complications, deep vein thrombosis, and pulmonary embolism.

RESULTS

After 1:1 propensity matching, 10,404 patients that had explanation of their THA and placement of an antibiotic spacer were included, with all hospital characteristics, patient demographics, and comorbidities demonstrating standardized mean differences <0.10. TXA-treated patients had significantly lower rates of postoperative transfusion (15.94% vs 17.78%; adjusted odds ratio = 0.86, 95% confidence interval [CI] = 0.76-0.99, P = .030) and wound complications (16.69% vs 22.72%; odds ratio = 0.66, 95% confidence interval = 0.59-0.73). Similar rates were found for aggregate bleeding complications, deep vein thrombosis, and pulmonary embolism in both cohorts.

CONCLUSIONS

TXA is associated with a reduction in postoperative transfusion and wound complications in patients undergoing revision THA for PJI.