JOA - 2026-06-22 - Journal Article
Efficacy of Intraosseous Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomized Controlled Trial.
Chen Y, Cao L, Ji B, Li G, Zhang X
Topics
Key Takeaway
IO TXA (20 mg/kg) is noninferior to IV and topical TXA for hemoglobin reduction across POD 0–3, with exploratory data showing lower calculated total blood loss in the IO group on DOS and POD1 (P=0.005 and P=0.016).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This three-arm RCT randomized 126 primary THA patients to IO, IV, or topical TXA (20 mg/kg each) to test noninferiority of IO administration. Primary outcome—hemoglobin reduction on DOS through POD3—was statistically equivalent across all three groups (P=0.431–0.532). Exploratory analysis showed lower calculated total blood loss in the IO group on DOS and POD1 (P=0.005 and P=0.016), though transfusion rates were similar (IO 2.3%, IV 7.1%, topical 2.3%; P=0.434) and the authors acknowledge uncertain clinical relevance.
Key Limitation
The study is underpowered for transfusion rate as an endpoint (n=42 per arm), and the 6-month enrollment window (October 2024–April 2025) raises concerns about adequate follow-up duration for thromboembolic and infectious adverse events.
Original Abstract
BACKGROUND
Tranexamic acid (TXA) reduces blood loss and transfusion requirements in patients who underwent primary total hip arthroplasty (THA). However, the optimal route of TXA administration remains unclear. This randomized controlled trial evaluated whether intraosseous (IO) TXA administration was noninferior to intravenous (IV) or topical administration.
METHODS
In this equal-proportion, noninferior randomized controlled trial, 126 patients undergoing primary THA from October 2024 to April 2025 were randomized to IO (20 mg/kg TXA applied in the cancellous bone of the femur and ilium), IV (20 mg/kg TXA applied five minutes before incision), or topical (20 mg/kg TXA applied before suture) group. The primary outcome was hemoglobin (Hb) reduction on the day of surgery (DOS) and postoperative days one to three (POD one to three). The secondary outcomes included blood loss, transfusion rate, and adverse events. Demographics were similar among the groups.
RESULTS
The mean Hb reduction was comparable on the DOS, POD one, POD two, and POD three (P = 0.431, 0.532, 0.479, and 0.443, respectively). Exploratory analyses showed lower mean calculated total blood loss in the IO group on the DOS and POD one than in the other groups (DOS and POD one: P = 0.005 and 0.016, respectively), although the clinical relevance of this finding remains uncertain. Transfusion rates were 2.3, 7.1, and 2.3% in the IO, IV, and topical group, respectively (P = 0.434). There was one patient in the topical group who developed deep vein thrombosis; no pulmonary embolism or infections were reported.
CONCLUSION
The blood-sparing efficacy of IO TXA administration is noninferior to that of IV and topical administration, with potential benefit in early postoperative blood loss control. Further high-quality studies are needed to confirm its superiority and establish its clinical value.