Tranexamic Use in the ASC Wins AAHKS Clinical Research Award

The 2023 American Association of Hip and Knee Surgeons (AAHKS) Clinical Research Award goes to the research team of Mateo J. Kirwan, M.D., Zachary R. Diltz, M.D., Derek T. Dixon, B.S., Carlos A. Rivera-Peraza, B.S., Christal J. Gammage, Ph.D., William M. Mihalko, M.D., Ph.D., James W. Harkess, M.D., James L. Guyton, M.D., John R. Crockarell, M.D. and Marcus C. Ford, M.D.

Their study investigated the safety and clinical efficacy of extended postoperative oral perioperative tranexamic acid (TXA) for use in total knee arthroplasty (TKA) performed in the free-standing ambulatory surgery center (ASC) setting.

The research team collected data from 40 patients who had been treated with primary total knee arthroplasty (TKA). The patients were separated into two groups—one group received extended oral TXA and the second group received a placebo.

Both groups received a 1g intravenous TXA dose prior to incision and at the time of closure. The investigators found that those receiving extended TXA showed significantly increased knee flexion at six weeks compared to those who received a placebo.

“Everyone can agree that tranexamic acid has been a game changer in total joint arthroplasty. In addition to minimizing blood loss, its use also exhibits an anti-inflammatory effect that has been safely investigated internationally and across multiple medical disciplines.”

“Through our pilot study, we demonstrated that extended use of oral TXA as a multi-modal adjunct helps improve early recovery after TKA. With additional research and collaboration, extended postoperative TXA can become an important tool for enhanced recovery after TKA. I must thank all my colleagues, residents and research assistants who helped with the study. I also want to acknowledge the Campbell Clinic Foundation for its support in orthopaedic education and research,” said Marcus C. Ford, M.D.

OTW asked if the researchers were surprised at how much more knee flexion patients had at six weeks, Dr. Ford noted, “There has recently been more discussion surrounding swelling control and improved early recovery (including knee flexion). I felt like the TXA protocol would improve early swelling, and thus felt like there would be a good chance that the extended TXA cohort would have significantly better knee flexion compared to the control group. Our data reinforced some of the international data showing improved early recovery and function with the use of extended TXA.”

And what should surgeons do while awaiting further information on long-term outcomes?

“I feel like extended postoperative TXA use is safe and effective for arthroplasty patients,” stated Dr. Ford to OTW. “In addition to our randomized controlled trial, there are multiple international studies that have demonstrated extended TXA use to be safe and effective in the postoperative period. TXA has been used in other subspecialties without long-term safety concerns.”