Abstract
The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA.
Highlights
The use of tranexamic acid (TXA) systemically and /or locally in total joint arthroplasties (TJAs) has been a widely established approach in clinical practice
In an experimental study in rats tibiae, vancomycin was able to inhibit the development of osteomyelitis if the treatment was administered locally at the same time as a bacterial inoculum of 6.62 × 107 CFU/mL, when compared to an untreated group. These findings suggest that local intramedullary vancomycin delivery could achieve sufficiently high local concentrations to prevent the development of osteomyelitis while minimising systemic toxicity [10]
The purpose of this study is to assess the efficacy of the intra-articular combined administration of vancomycin powder and TXA inside the joint space, before the wound closure
Summary
The use of tranexamic acid (TXA) systemically and /or locally in total joint arthroplasties (TJAs) has been a widely established approach in clinical practice. TXA can be delivered either intravenously or topically within the joint space prior to the wound closure. A number of studies have been used, both intravenous (IV) and intra-articularly combined. Both ways of administration are effective, but the local application of TXA has the advantage of providing higher doses while minimising any systemic adverse reactions such as seizures or thromboembolic events in high-risk patients [6,7,8]. Local TXA is thought to have anti-inflammatory effects, positively affecting the patient recovery [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
