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Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).

Materials and methods

Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case–control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).

Results

Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49–0.62) (P < 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47–0.59) (P < 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35–0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43–0.71) (P < 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47–0.75) (P < 0.0001), whereas topical administration did not.

Conclusions

Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA.

Level of evidence

Level III.

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Data availability

The data that support the findings of this study are available from the corresponding author, [N.K.], upon reasonable request.

References

  1. Kurtz SM, Lau E, Watson H et al (2012) Economic burden of periprosthetic joint infection in the united states. J Arthroplasty 27:61–65. https://doi.org/10.1016/j.arth.2012.02.022

    Article  PubMed  Google Scholar 

  2. Kurtz SM, Ong KL, Lau E et al (2010) Prosthetic joint infection risk after TKA in the medicare population. Clinical Orthopaedics and Related Research. Springer, New York, pp 52–56

    Google Scholar 

  3. Ong KL, Kurtz SM, Lau E et al (2009) Prosthetic joint infection risk after total hip arthroplasty in the medicare population. J Arthroplasty 24:105–109. https://doi.org/10.1016/j.arth.2009.04.027

    Article  PubMed  Google Scholar 

  4. Johns WL, Layon D, Golladay GJ et al (2020) Preoperative risk factor screening protocols in total joint arthroplasty: a systematic review. J Arthroplasty 35:3353–3363. https://doi.org/10.1016/J.ARTH.2020.05.074

    Article  PubMed  Google Scholar 

  5. Siddiqi A, Forte SA, Docter S et al (2019) Perioperative antibiotic prophylaxis in total joint arthroplasty: a systematic review and meta-analysis. J Bone Joint Surg Am 101:828–842. https://doi.org/10.2106/JBJS.18.00990

    Article  PubMed  Google Scholar 

  6. Kobayashi N, Kamono E, Maeda K, et al (2021) Effectiveness of diluted povidone-iodine lavage for preventing periprosthetic joint infection: an updated systematic review and meta-analysis. J Orthop Surg Res 16:. https://doi.org/10.1186/S13018-021-02703-Z

  7. Kim JL, Park JH, Han SB et al (2017) Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: a meta-analysis. J Arthroplasty 32:320–325. https://doi.org/10.1016/J.ARTH.2016.08.026

    Article  PubMed  Google Scholar 

  8. Saleh K, Olson M, Resig S et al (2002) Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 20:506–515. https://doi.org/10.1016/S0736-0266(01)00153-X

    Article  PubMed  Google Scholar 

  9. Lacko M, Jarčuška P, Schreierova D, Lacková A, Gharaibeh A (2020) Tranexamic acid decreases the risk of revision for acute and delayed periprosthetic joint infection after total knee replacement. Joint Diseases Related Surg 31:8–13

    Article  Google Scholar 

  10. Yazdi H, Klement MR, Hammad M et al (2020) Tranexamic acid is associated with reduced periprosthetic joint infection after primary total joint arthroplasty. J Arthroplasty 35:840–844. https://doi.org/10.1016/j.arth.2019.10.029

    Article  PubMed  Google Scholar 

  11. Drain NP, Gobao VC, Bertolini DM, Smith C, Shah NB, Rothenberger SD, Dombrowski ME, O’Malley MJ, Klatt BA, Hamlin BR, Urish KL (2020) Administration of tranexamic acid improves long-term outcomes in total knee arthroplasty. J Arthroplasty 35:201–206

    Article  Google Scholar 

  12. Klement MR, Padua FG, Li WT et al (2020) Tranexamic acid reduces the rate of periprosthetic joint infection after aseptic revision arthroplasty. J Bone Joint Surg Am 102:1344–1350. https://doi.org/10.2106/JBJS.19.00925

    Article  PubMed  Google Scholar 

  13. Hong GJ, Wilson LA, Liu J, Memtsoudis SG (2021) Tranexamic acid administration is associated with a decreased odds of prosthetic joint infection following primary total hip and primary total knee arthroplasty: a national database analysis. J Arthroplasty 36:1109–1113

    Article  PubMed  Google Scholar 

  14. Lei Y; Xie J; Huang Q; Huang W; Pei F; Journal: Archives of orthopaedic and trauma sur (2021) Is there a role of tranexamic acid in rheumatoid arthritis with total knee arthroplasty? Findings from a multicenter prospective cohort study in China. Arch Orthop Trauma Surg 141:489–496

  15. Prieto HA, Vincent HK, Deen JT et al (2018) Tranexamic acid effectively reduces blood loss and transfusion rates during simultaneous bilateral total knee arthroplasty. J Knee Surg 31:270–276. https://doi.org/10.1055/s-0037-1603333

    Article  PubMed  Google Scholar 

  16. Mehta NGNGAJDCD (2019) A prospective comparative study between intravenous and intraarticular tranexamic acid administration in decreasing the perioperative blood loss in total knee arthroplasty. J Arthrosc Joint Surg 6:70–73

    Article  Google Scholar 

  17. Yozawa S, Ogawa H, Matsumoto K, Akiyama H (2018) Periarticular injection of tranexamic acid reduces blood loss and the necessity for allogeneic transfusion after total knee arthroplasty using autologous transfusion: a retrospective observational study. J Arthroplasty 33:86–89

    Article  PubMed  Google Scholar 

  18. Wang J, Wang Q, Zhang X, Wang Q (2017) Intra-articular application is more effective than intravenous application of tranexamic acid in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 32:3385–3389

    Article  PubMed  Google Scholar 

  19. Yuan X, Li B, Wang Q, Zhang X (2017) Comparison of 3 routes of administration of tranexamic acid on primary unilateral total knee arthroplasty: a prospective, randomized, controlled study. J Arthroplasty 32:2738–2743

    Article  PubMed  Google Scholar 

  20. Liu KL, Chen IH, Wen SH (2017) Low dose tranexamic acid reduces blood transfusion rate after total knee arthroplasty: a population-based study in Taiwan. J Formos Med Assoc 116:24–31

    Article  CAS  PubMed  Google Scholar 

  21. Tzatzairis TK, Drosos GI, Kotsios SE, Ververidis AN, Vogiatzaki TD, Kazakos KI (2016) Intravenous vs topical tranexamic acid in total knee arthroplasty without tourniquet application: a randomized controlled study. J Arthroplasty 31:2465–2470

    Article  PubMed  Google Scholar 

  22. Formby PM, Pickett AM, van Blarcum GS et al (2015) The use of intravenous tranexamic acid in patients undergoing total hip or knee arthroplasty: a retrospective analysis at a single military institution. Mil Med 180:1087–1090. https://doi.org/10.7205/MILMED-D-14-00657

    Article  PubMed  Google Scholar 

  23. Alshryda S, Mason J, Vaghela M et al (2013) Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg 95:1961–1968. https://doi.org/10.2106/JBJS.L.00907

    Article  PubMed  Google Scholar 

  24. Xu X, Jiang J, Liu W, Li X, Lu H (2019) Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res 14:430

    Article  PubMed  PubMed Central  Google Scholar 

  25. Xie J, Zhang S, Chen G, Xu H, Zhou Z, Pei F (2019) Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: results from a multicenter cohort study. Br J Clin Pharmacol 85:2089–2097

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Tavares Sánchez-Monge FJ, Aguado Maestro I, Bañuelos Díaz A et al (2018) Efficacy and safety of the topical application of tranexamic acid in primary cementless hip arthroplasty: prospective, randomised, double-blind and controlled study. Revista Española de Cirugía Ortopédica y Traumatología (English Edition) 62:47–54. https://doi.org/10.1016/j.recote.2017.12.004

    Article  PubMed  Google Scholar 

  27. Zeng Y, Si HB, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX (2017) Intravenous combined with topical administration of tranexamic acid in primary total hip arthroplasty: a randomized controlled trial. Orthop Surg 9:174–179

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kang JS, Moon KH, Kim BS, Yang SJ (2017) Topical administration of tranexamic acid in hip arthroplasty. Int Orthop 41:259–263

    Article  PubMed  Google Scholar 

  29. Hsu CH, Lin PC, Kuo FC, Wang JW (2015) A regime of two intravenous injections of tranexamic acid reduces blood loss in minimally invasive total hip arthroplasty: a prospective randomised double-blind study. Bone Joint J 97:905–910

    Article  PubMed  Google Scholar 

  30. Chen JY, Lo NN, Tay DK, Chin PL, Chia SL, Yeo SJ (2015) Intra-articular administration of tranexamic acid in total hip arthroplasty. J Orthop Surg 23:213–217

    Article  Google Scholar 

  31. Yue C, Kang P, Yang P, Xie J, Pei F (2014) Topical application of tranexamic acid in primary total hip arthroplasty: a randomized double-blind controlled trial. J Arthroplasty 29:2452–2456

    Article  PubMed  Google Scholar 

  32. Viola J, Gomez MM, Restrepo C et al (2015) Preoperative anemia increases postoperative complications and mortality following total joint arthroplasty. J Arthroplasty 30:846–848. https://doi.org/10.1016/J.ARTH.2014.12.026

    Article  PubMed  Google Scholar 

  33. Akonjom M, Battenberg A, Beverland D, et al (2019) General Assembly, Prevention, Blood Conservation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 34:S147–S155. https://doi.org/10.1016/J.ARTH.2018.09.065

  34. Greenky M, Gandhi K, Pulido L et al (2012) Preoperative anemia in total joint arthroplasty: Is it associated with periprosthetic joint infection? hip. Clin Orthop Relat Res 470:2695–2701. https://doi.org/10.1007/S11999-012-2435-Z

    Article  PubMed  PubMed Central  Google Scholar 

  35. Spahn DR (2010) Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology 113:482–495. https://doi.org/10.1097/ALN.0B013E3181E08E97

    Article  PubMed  Google Scholar 

  36. Myers E, Grady PO, Dolan AM (2004) The influence of preclinical anaemia on outcome following total hip replacement. Arch Orthop Trauma Surg 124:699–701. https://doi.org/10.1007/S00402-004-0754-6

    Article  CAS  PubMed  Google Scholar 

  37. Pulido L, Ghanem E, Joshi A et al (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715. https://doi.org/10.1007/S11999-008-0209-4

    Article  PubMed  PubMed Central  Google Scholar 

  38. Taeuber I, Weibel S, Herrmann E, et al (2021) Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression. JAMA Surg 156:. https://doi.org/10.1001/JAMASURG.2021.0884

  39. Cheung E v., Sperling JW, Cofield RH (2008) Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop Relat Res 466:1363–1367. https://doi.org/10.1007/S11999-008-0226-3

  40. Rohde JM, Dimcheff DE, Blumberg N et al (2014) Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 311:1317–1326. https://doi.org/10.1001/JAMA.2014.2726

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Draxler DF, Yep K, Hanafi G et al (2019) Tranexamic acid modulates the immune response and reduces postsurgical infection rates. Blood Adv 3:1598–1609. https://doi.org/10.1182/bloodadvances.2019000092

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Beam E, Osmon D (2018) Prosthetic Joint Infection Update. Infect Dis Clin North Am 32:843–859. https://doi.org/10.1016/J.IDC.2018.06.005

    Article  PubMed  Google Scholar 

  43. Yi S, Tan J, Chen C et al (2014) The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 134:1469–1476. https://doi.org/10.1007/S00402-014-2056-Y

    Article  PubMed  Google Scholar 

  44. Clarke MT, Longstaff L, Edwards D, Rushton N (2001) Tourniquet-induced wound hypoxia after total knee replacement. J Bone Joint Surg Br 83:40–44. https://doi.org/10.1302/0301-620X.83B1.10795

    Article  CAS  PubMed  Google Scholar 

  45. Martin JG, Cassatt KB, Kincaid-Cinnamon KA, Westendorf DS, Garton AS, Lemke JH (2014) Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty 29:889–894

    Article  PubMed  Google Scholar 

  46. Qunn Jid Lee FWYCB and YCWF (2017) Blood sparing efficacy of oral tranexamic acid in primary total knee arthroplasty: a randomized controlled trial. Knee Surg Relat Res 29:57–62

    Article  Google Scholar 

  47. Lee QJ, Chang WY, Wong YC (2017) Blood-sparing efficacy of oral tranexamic acid in primary total hip arthroplasty. J Arthroplasty 32:139–142

    Article  CAS  PubMed  Google Scholar 

  48. Wu KT, Siu KK, Ko JY, et al (2019) Tranexamic acid reduces total blood loss and inflammatory response in computer-assisted navigation total knee arthroplasty. Biomed Res Int 2019:. https://doi.org/10.1155/2019/5207517

  49. Wu J, Feng S, Chen X, Lv Z, Qu Z, Chen H, Xue C, Zhu M, Guo K, Wu P (2019) Intra-articular injection of tranexamic acid on perioperative blood loss during unicompartmental knee arthroplasty. Med Sci Monit 25:5068–5074

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Qiu J, Sun X, Zhang W, Ke X, Yang G, Zhang L (2019) Effect of topical tranexamic acid in total hip arthroplasty patients who receive continuous aspirin for prevention of cardiovascular or cerebrovascular events: a prospective randomized study. Orthop Traumatol Surg Res 105:1327–1332

    Article  PubMed  Google Scholar 

  51. Steinmetz RG, Luick L, Tkach S et al (2020) Effect of tranexamic acid on wound complications and blood loss in total ankle arthroplasty. Foot Ankle Int 41:1117–1121. https://doi.org/10.1177/1071100720934889

    Article  PubMed  Google Scholar 

  52. Goh GS, D’Amore T, Lonner JH, Fillingham YA (2021) Tranexamic acid is associated with decreasing the risk of complications in patients undergoing arthroplasty with preoperative coagulopathy. J Arthroplasty 36:3864–3869

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Japan

    Keiji Imanishi, Naomi Kobayashi, Emi Kamono, Yohei Yukizawa & Shu Takagawa

  2. Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan

    Hyonmin Choe, Ken Kumagai & Yutaka Inaba

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  1. Keiji Imanishi
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  2. Naomi Kobayashi
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Correspondence to Naomi Kobayashi.

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Imanishi, K., Kobayashi, N., Kamono, E. et al. Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis. Arch Orthop Trauma Surg 143, 6883–6899 (2023). https://doi.org/10.1007/s00402-023-04914-x

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