Topical Tranexamic Acid in Hip and Knee Surgery: A Meta-Analysis of Randomized Controlled Trials

Abstract Tranexamic Acid (TXA) has been widely used in orthopedic operations, including hip and knee surgery, to decrease blood loss. However, the optimal tranexamic acid regimen is still debated between topical or systematic such as oral or intravenous. We conducted a meta-analysis of randomized controlled trials that compare the efficacy and safety of the topical application of transamine in hip and knee surgery with other routes. Outcomes of interest were the comparative aspects of bleeding, hospitality, and morbidity associated with topical TXA, in contrast to alternative administration routes. Eighty RCTs, involving 13,969 patients, assessed the outcomes of topical tranexamic acid in hip fracture surgery, hip arthroplasty, and knee arthroplasty, comparing it with intravenous, oral, and placebo administration. Overall, topical TXA decreased total blood loss [-353 mL (95%CI -395, -311), P<0.001], drainage volume [-239.802 mL (95% CI -298.744, -180.859), P<0,001], intraoperative blood loss [-14.994 mL (95% CI -34.370, 4.382), P<0.001], hidden blood loss [-123.711 mL (95% CI -153.703, -93.719), P<0.001], total hemoglobin loss [-0.970 gr/dL (95% CI -1.289, -0.651), P<0.001], total hematocrit loss [-0.937 (95% CI -1.289, -0.584), P<0.001], and blood transfusion rate [RR diff. 0.480 (95% CI 0.386, 0.597), P<0.001] compared to placebo. Topical TXA administration consistently demonstrated significant reductions in total blood loss, drain volume, intraoperative blood loss, total hemoglobin loss, and the need for blood transfusions compared to the placebo group. Subgroup analysis results also indicated that topical TXA performed better than placebo and was comparable to intravenous and oral routes.