Tranexamic Acid Reduces the Rate of Periprosthetic Joint Infection After Aseptic Revision Arthroplasty

Abstract

Background: Revision total joint arthroplasty (TJA) has a higher rate of periprosthetic joint infection (PJI) compared with primary TJA, possibly as the result of increased allogeneic blood transfusion. Tranexamic acid (TXA) is gaining popularity in revision TJA to minimize blood loss and the need for transfusion; however, its effect on PJI reduction has yet to be investigated. The hypothesis of this study was that the administration of TXA during revision arthroplasty is protective against subsequent PJI. Methods: A prospectively maintained institutional database was used to identify patients who underwent revision TJA for aseptic failure from 2009 to 2018 and had a minimum follow-up of 90 days. Patients who developed PJI following revision arthroplasty were identified. All patients with PJI met Musculoskeletal Infection Society (MSIS) criteria. A multivariate analysis was performed to identify variables independently associated with PJI after aseptic revision TJA. Results: Overall, 1,731 patients who underwent aseptic revision were identified; of these patients, 83 (4.8%) developed PJI. Patients who received TXA had significantly lower rates (p = 0.029) of PJI postoperatively at 3.30% compared with those who did not receive TXA at 5.73%. After controlling for relevant confounding variables, TXA remained a significant independent factor that protected against PJI (odds ratio [OR], 0.47 [95% confidence interval (CI), 0.23 to 0.90]; p = 0.030). Female sex was also identified as a significant independent factor that protected against PJI (OR, 0.52 [95% CI, 0.30 to 0.88]; p = 0.016). However, preoperative anemia was independently associated with an increased risk of subsequent PJI (OR, 2.37 [95% CI, 1.34 to 4.16]; p = 0.003). Conclusions: Based on this study conducted at a single institution, the use of TXA during aseptic revision arthroplasty was independently associated with a reduced risk of subsequent acute PJI after adjusting for multiple patient characteristics and surgical factors. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intraoperative blood loss as indicated by haemoglobin trend is a predictor for the development of postoperative spinal implant infection—a matched-pair analysis

“…Due to the abovementioned relationship between preoperative anaemia and the development of PJI, more recently, blood conservation strategies have gained attention in the field of arthroplasty. Here, multiple studies have shown that reducing intraoperative blood loss by perioperative application of TXA reduces the risk for PJI after both primary and revision total joint arthroplasty [ 19 , 20 ]. While its effectiveness in reducing blood loss and thereby transfusion rates has been proven by several studies, its exact role in reducing this risk of infection has yet to be studied in depth.…”

Effect of Tranexamic Acid against Staphylococcus spp. and Cutibacterium acnes Associated with Peri-Implant Infection: Results from an In Vitro Study

“…Administration of TXA significantly reduced postsurgery infection rates, as it controls bleeding through its antifibrinolytic effect ( 9 – 13 ). Infection rates were significantly lower among nondiabetic patients who received TXA during surgery ( P = 0.003) ( 5 ).…”

“…It also seems to decrease infectious complication rates. Some authors point out that by reducing local hematoma, TXA could indirectly reduce infection rates ( 9 – 13 ). Whether, in addition to its antifibrinolytic action, TXA has a potential antibiotic effect, as demonstrated for hyaluronic acid ( 7 ), needs to be clarified.…”

Tranexamic acid protects against implant-associated infection by reducing biofilm formation

“…Recently, it was reported to have a potential downregulating effect on postoperative infection. Clinical researchers have found that it reduces the infection rate after total joint arthroplasty 9 , which allows us to recognize the utilization of tranexamic acid in orthopaedic surgeries in addition to haemostasis.…”