TRANEXAMIC ACID IN PRIMARY HIP AND KNEE ARTHROPLASTY: ROUTE, DOSE, AND SAFETY ACROSS RANDOMIZED TRIALS

Abstract

By the mid-2010s, tranexamic acid had become standard practice for blood management in hip and knee replacement. Yet debate continued over which route of administration works best and how safe each strategy proves in real-world use. We reviewed randomized controlled trials and meta-analyses appearing between August 2014 and August 2019 that examined TXA in adult primary TKA and THA. Our search of PubMed, Cochrane, and Embase excluded revision cases, trauma, tumor surgery, and pediatric patients. We focused on comparing routes—intravenous, topical, and oral—along with combination protocols, transfusion outcomes, and safety events. Four randomized trials and three meta-analyses met our criteria. The largest trial enrolled 640 patients and found intravenous and topical TXA equally effective in unilateral TKA. Pooled analyses covering both knee and hip procedures showed comparable transfusion reduction and thromboembolic risk across topical and systemic delivery. Early-phase studies of oral TXA and extended postoperative dosing looked promising. Rates of venous thromboembolism, infection, and seizures stayed low regardless of route, though many trials reported these outcomes inconsistently. Evidence from this period confirms that TXA cuts transfusion needs whether given intravenously, topically, or by mouth. Hospitals can choose based on cost, workflow, and local practice patterns. Future trials should adopt uniform definitions for adverse events to sharpen comparative risk assessments.