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Risk Factors for Transfusion and Use of Tranexemic Acid in Patients with Rheumatoid Arthritis Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty

Utilization of total hip and total knee replacement remains high for patients with rheumatoid arthritis (RA), and most patients have moderate to high disease activity at the time of surgery. Risk of infection and a blood transfusion are higher in these individuals compared to patients with osteoarthritis, and a transfusion at the time of surgery increases the risk of perioperative infection. 

The use of tranexamic acid has become widespread, as it has been associated with a lower rate of blood transfusions in osteoarthritis patients having joint replacement surgery. Investigators set out to determine if the use of TXA could also reduce transfusions for patients with rheumatoid arthritis having a hip or knee replacement. The researchers found that TXA was not associated with a lower transfusion rate in patients with RA. They concluded that pre-surgical optimization should include assessment and treatment of anemia in patients with RA who are scheduled for a total joint replacement.

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.