Abstract
Objectives:
Previous studies in shoulder and knee arthroscopy have reported that tranexamic acid (TXA) may improve early functional recovery, prevent postoperative intra-articular bleeding, reduce subjective pain, and improve intra-operative visual field clarity. However, there is a paucity of literature describing the use of TXA in hip arthroscopy. Previous studies have reported statistically significant improvements in VAS pain and Modified Hip Harris scores. However, they used a limited subset of Patient Reported Outcome Measures (PROMs) and did not characterize the effects of TXA on visibility during arthroscopy. The primary objective of this study is to determine the role of TXA in hip arthroscopy based on assessment of postoperative pain and function. A second objective of this study is to determine whether TXA influences intra-operative visual clarity and pump pressures.
Methods:
This double blinded randomized controlled trial is enrolling 70 patients undergoing primary hip arthroscopy. Subjects are randomized to receive TXA (n=35) or not receive TXA (n=35). The TXA group receives 1g of TXA intravenously at the time of incision and another 1g of TXA during closure. For the duration of the surgery, arthroscopic visual field clarity is rated by the surgeon every 15 minutes as poor, fair, or good and assigned a score of 1, 2, and 3, respectively. Each time the visual clarity is rated, pump pressure is also recorded. Range of motion, VAS Pain, iHOT-12, HOS Sport and activities of daily living, PROMIS Physical Function (PF), and PROMIS Pain Interference (PI) scores are collected preoperatively and postoperatively at days 14 and 42. Additionally, VAS pain is assessed at postoperative day 1. At the completion of all study activities, patient charts are reviewed to determine whether they have requested any additional analgesic medication during the study.
Results:
The preliminary data for this study includes completed data from 16 (9 female, 7male) patients with a mean age of 44 years. The TXA and control groups had 9 and 7 patients, respectively. No significant difference in VAS pain scores were observed preoperatively, at 1 day postoperatively, or at 42 days postoperatively. There was a significant difference (p=0.01) in VAS pain scores between the two groups at 14 days postoperatively, with the TXA and control groups having mean scores of 2.22 ± 1.48 and 4.33 ± 1.21, respectively. Both groups have shown improvements in PROMs between preoperative scores and postoperative day 42, with larger improvements being seen in the TXA group (although failing to meet statistical significance). Complete preliminary data for PROMs can be seen in
examine the relationship between the distribution of grades (Good, Fair, Poor) and the treatment groups (TXA and Control). The test indicated no association between the two variables (Pearson’s χ² = 5.6, df = 2, p = 0.06). Although the p-value did not reach significance level (α<0.05), the preliminary data favored the TXA group in terms of visibility. Pump pressures did not show any significant difference between the TXA group and the control group at any of the time points. No patients have requested additional pain medications during their involvement in this study at this time.
Conclusions:
The use of TXA in hip arthroscopy descriptively demonstrated improvements in post-operative pain and function, but not intraoperative visual clarity. The trends in the preliminary data, particularly for visual clarity and the measures of pain such as VAS Pain (Figure 1) and PROMIS-PI (Figure 2), suggest a clinical benefit to intraoperative TXA use. Larger sample sizes are needed to establish the significance of these findings and further explore the relationship between TXA and postoperative outcomes, visual clarity, and pump pressures in hip arthroscopy.
