Tranexamic acid (TXA) is known to decrease the risk for postoperative blood transfusion in total hip arthroplasty (THA) patients. However, non-human studies have observed correlations between TXA exposure and increased pain as well as decreased periarticular cell viability and cell death. A new study explored how TXA affects early pain outcomes by comparing THAs that did and did not include TXA exposure.
This comparison included a consecutive series of 213 THAs without TXA exposure and 169 THAs that included topical TXA, all performed by a single surgeon. All operations included the same perioperative medical and pain control protocols. Data collection included inpatient pain scores, time to first opioid, and opioid consumption in morphine milligram equivalents; the relationship between these data and TXA use and 10 additional covariates was examined.
Mean 24-hour pain scores were higher in patients whose surgeries included topical TXA compared to patients who were not given topical TXA (P=0.006). The topical TXA patients also asked for opioids significantly sooner than non-TXA patients (mean 152 minutes vs. 246 minutes; P=0.033). For patients who did receive topical TXA, average morphine milligram equivalents consumed during the first 24 hours after post-anesthesia care unit was 56.07, compared to 31.26 among patients who did not receive topical TXA (P<0.001).
“Topical TXA use was associated with greater early postoperative pain and opioid consumption in primary THA patients,” the study authors concluded. “Findings were supported by the magnitude of observed effects and the likelihood of clinical relevance. Replication and consideration of potential adverse consequences of TXA use in elective settings is encouraged.”
The findings appeared in The Journal of Arthroplasty.
THA Pain: ‘Worse Than Death?’
The present study observed significantly higher pain in THA patients who received topical TXA than those who did not. A previous study found that about 20% of all patients waiting to undergo THA are in significant pain and describe it as “worse than death (WTD).”
The study included 2,073 THAs performed in 2,073 patients (mean age, 67.4 years; mean body mass index [BMI], 28.5 kg/m2; 60% were female). Researchers evaluated any association between a EuroQol five-dimension (EQ-5D) questionnaire score < 0 and the following variables: age, body mass index (BMI), sex, deprivation quintile, comorbidities, and functional outcomes measured by the Oxford Hip Score (OHS). One year postoperatively, 1,555 THAs underwent EQ-5D and OHS again.
In total, 391 THA patients (19%) were WTD prior to surgery. Factors associated with WTD included preoperative OHS, deprivation, and chronic obstructive pulmonary disease, EQ-5D scores significantly improved one year after surgery; the WTD rate fell to 35 (2%). Preoperative WTD had significantly poorer one-year OHS and satisfaction rates compared to patients who were not WTD before surgery.