Use of IV tranexamic acid may not improve visual field clarity during hip arthroscopy
Key takeaways:
- This study reports results from a prospective, randomized, double-blind trial.
- Use of IV tranexamic acid did not significantly improve visual field clarity during hip arthroscopy vs. use of placebo.
Results of a study showed administration of IV tranexamic acid within 15 minutes of incision did not significantly improve surgeons’ visual field clarity during hip arthroscopy for femoroacetabular impingement.
“As orthopedic surgeons, we must continually reassess our protocols in light of emerging evidence,” Benedict U. Nwachukwu, MD, MBA, sports medicine surgeon at Hospital for Special Surgery, told Healio. “These findings challenge the assumption that tranexamic acid (TXA) universally improves arthroscopic visualization and improves surgical techniques.”
Nwachukwu and colleagues performed a prospective, randomized, double-blind trial of 78 patients who underwent arthroscopic hip preservation surgery for femoroacetabular impingement syndrome at a single institution between October 2023 and May 2024.
Nwachukwu and colleagues randomly assigned patients to receive either 1,000 mg of TXA in 100 mL of 0.9% saline bolus (n = 39; mean age, 37.3 years) or 100 mL of 0.9% saline bolus only (n = 39; mean age, 33.6 years) within 15 minutes of incision.
The primary outcome measure was visual field clarity (VFC), which Nwachukwu and colleagues had surgeons assess on a numeric rating scale (NRS) at 15-minute intraoperative intervals. According to the study, VFC grades included poor visibility with active bleeding that interfered with surgery (NRS = 1), fair visibility with mild bleeding (NRS = 2) and good visibility without obvious bleeding (NRS = 3).
Overall, no patient in either group had complications related to the treatment intervention.
Nwachukwu and colleagues found use of TXA was not associated with improved VFC at any intraoperative timepoint compared with use of the placebo. Composite overall VFC scores were 2.51 for the TXA group and 2.64 for the placebo group. In addition, Nwachukwu and colleagues found the TXA group had good VFC ratings in 56.4% of surgeries, while the placebo group had good VFC ratings in 66.4% of surgeries.
Nwachukwu and colleagues found similar results after performing multivariate regression analysis to control for demographic and intraoperative variables.
“While TXA remains invaluable in procedures with significant blood loss, its routine application in hip arthroscopy should be reconsidered unless further research identifies specific patient populations that may benefit,” Nwachukwu said. “There is an opportunity to continue refining protocols while also continuing research into optimal use cases for TXA.”
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