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Administration of Tranexamic Acid During Joint Replacement Surgery May Reduce Infection Risk

Administration of tranexamic acid (TXA) during total joint arthroplasty appears to reduce the risk of periprosthetic joint infections within 90 days of surgery, according to a study done at Hospital for Special Surgery (HSS) and presented at the virtual 2020 American Society of Anesthesiologists® Annual Meeting.1

TXA is widely used to minimize blood loss during total joint replacement surgeries. This reduction in blood loss and the reduced need for blood transfusions can have additional benefits for patients. “There is evidence suggesting that bleeding, the formation of hematomas and the need for blood transfusions is associated with infections,” said HSS anesthesiologist Stavros G. Memtsoudis, MD, PhD, MBA, lead author of the study. “Therefore, we evaluated if the use of TXA, which has been shown to reduce bleeding, actually relates to decreased infection risk.”

A single-institution study published in The Journal of Arthroplasty in March 2020 found that total joint arthroplasty patients who received TXA had a reduced risk of periprosthetic joint infections.2 Researchers at HSS sought to validate these findings using a large population-based database.

Using the Premier Healthcare database, they examined patients who underwent elective inpatient total hip or knee arthroplasty between 2012 and 2016. Out of 931,692 total joint arthroplasty patients, the overall incidence of periprosthetic joint infections was 0.14% (n=1269). Of the total number of total joint arthroplasty patients, 45.2% received TXA on the day of surgery.

After adjusting for various patient and hospital-related factors, the use of TXA was associated with 40% lower odds of a periprosthetic joint infection within 90 days of surgery (OR 0.60 CI 0.53, 0.68). The researchers also found that the odds of developing a periprosthetic joint infection within 90 days of surgery was approximately eight times higher with hematoma formation (OR 8.08 CI 5.59, 11.68).

While the incidence of periprosthetic joint infections in total joint arthroplasty patients is already relatively low, administration of TXA during the procedure appears to have a protective effect.

“TXA is effective in reducing blood loss, and by doing so can reduce downstream complications, including infections,” explained Dr. Memtsoudis. Given that it is known to prevent hematomas, and hematoma formation was associated with significantly increased odds of joint infections, the researchers believe this is likely the reason why TXA may reduce risk for infection.

The researchers concluded that patients who are considered at high risk of postoperative joint infection may benefit from administration of TXA.

“HSS is well-known for its extremely low infection rates,” noted Dr. Memtsoudis. “Interestingly, our anesthetic practice has always focused on reducing blood loss, most prominently through the use of controlled hypotension in hip arthroplasty patients. We believe that this contribution to perioperative care has significantly influenced our positive outcomes.”

Dr. Memtsoudis is recognized by his peers as going above and beyond for patient safety and was the recipient of the physician Marion Hare Patient Safety Champion Award in 2019.

“The ultimate goal of any perioperative clinician is to allow patients to undergo surgery and get them back to living their life without complications,” he said. “While we always prepare to treat adverse events, my philosophy has always been to prevent them in the first place. Therefore, research needs to focus on identifying risk factors and those at risk and the development of interventions that will prevent them.”


1. Lauren Wilson, MPH, Haoyan Zhong, MA, Jashvant Poeran, MD, PhD, Jiabin Liu, MD, PhD, Stavros G. Memtsoudis, MBA, MD, PhD. A3070. Tranexamic Acid Use During Total Joint Arthroplasty Is Associated With Reduced Odds Of Periprosthetic Joint Infection.” Presented at: 2020 American Society of Anesthesiologists® (ASA) Annual Meeting, October 2-5, 2020; virtual meeting.

2. Yazdi H, Klement MR, Hammad M, et al. Tranexamic Acid Is Associated With Reduced Periprosthetic Joint Infection After Primary Total Joint Arthroplasty. The Journal of Arthroplasty. 2020;35(3):840-844.

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.