Tranexamic Acid Use in Hip Arthroscopy Reduces Bleeding Without Increased Risk of Major Complications: A Systematic Review.

PURPOSE: To critically evaluate the impact of tranexamic acid (TXA) on hip arthroscopy outcomes, including its effects on bleeding, functional recovery, postoperative pain, complications, intraoperative visualization, and surgical efficiency.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted across PubMed, Embase, and Cochrane through March 2025. Inclusion criteria encompassed randomized controlled trials and prospective or retrospective comparative studies evaluating intravenous TXA during hip arthroscopy. Studies were excluded if they lacked original clinical data, involved non-arthroscopic procedures or did not report TXA use. Primary outcomes included blood loss, visual field clarity, operative time, postoperative pain, complications, and functional scores.

RESULTS

Six studies comprising 1034 patients (TXA, 584; control, 450) were analyzed. TXA significantly reduced perioperative bleeding, with postoperative hemoglobin and hematocrit declines consistently smaller in TXA patients compared with controls (P < .01). Intraoperative blood loss was also lower with TXA (0.18 L vs 0.24 L, P = .020). TXA did not consistently improve intraoperative visualization (Likert scores 2.51 to 2.85 vs 2.64 to 2.67, P = .13 to 0.16) or operative time (P > .3). One trial reported lower VAS pain scores at postoperative day 14 (2.3 ± 1.1 vs 3.1 ± 0.7, P < .05), though no long-term functional benefits were observed. A large cohort reported fewer complications with TXA (2.0% vs 6.8%, P < .01), largely driven by reduced lateral femoral cutaneous nerve neuritis (1.8% vs 4.6%, P = 0.02). Given the absence of a plausible mechanism and no difference when neuritis was excluded, this association is likely incidental. No significant differences were observed in thromboembolic events (0.2% vs 0.5%, P = .51), infections (P = .27), or revision rates (P = .68).

CONCLUSIONS

TXA use in hip arthroscopy significantly reduces perioperative bleeding without increasing the risk of major complications. It may offer modest short-term pain relief and early functional improvements, but no consistent long-term functional benefits have been showed. TXA does not reliably enhance intraoperative visualization or reduce operative time. The optimal dosing strategy remains uncertain, though continuous infusion may provide superior hemostatic efficacy compared to single bolus administration.

LEVEL OF EVIDENCE: Level III, systematic review of Level I, II, and III studies.