Joint Replacement Surgery

Blood loss is expected in a total joint replacement surgery. However, excessive intraoperative and postoperative bleeding can increase the patient’s risk for delayed healing, prolonged hospital stay, slowed progress with physical therapy, and blood transfusions (Suggs & Holt, 2015). An estimated 13 million packed red blood cells (PRBCs) are transfused every year in the United States with a majority being transfused in surgical patients (Hart, Khalil, & Carli et al., 2014). Reports of transfusion rates range from 18% to 68% in total hip replacements (THR) and 39% to 67% in total knee arthroplasties (TKA), respectively (Hart, Khalil, & Carli et al., 2014). Blood transfusions are not risk-free. They can be associated with sepsis, pneumonia,

The patient was transferred to the intensive care unit after finding that her hemoglobin was less than 6, she was symptomatic, and required numerous blood transfusions among other products. I later learned that TXA is used to reduce blood loss in major surgeries, including joint replacements; although its use is based on surgeon preference. The PICO question I formulated for this evidence-based paper is as follows: In patients undergoing joint replacement surgery, does the use of TXA intraoperatively reduce blood loss or the rate of postoperative blood transfusions as compared to no pharmacological

M., Pickett, A. M., Van Blarcum, G. S., Mack, A. W., & Newman, M. T. (2015). The use of intravenous tranexamic acid in patients undergoing total hip or knee arthroplasty: A retrospective analysis at a single military Institution. Military Medicine, 180(10), 1087-1090. doi:10.7205/MILMED-D-14-00657 The research design for this reference is a retrospective review of a single case-controlled study. Referencing the Table 1 level of evidence, this study would be categorized as level 2. The study reviewed all total hip arthroplasty (THA) and TKR surgeries that administered TXA intraoperatively from February 2012 to April 2014 (Formby, Pickett, & Van Blarcum et al., 2015). A total of 259 patients were identified; 165 TKA and 94 THA. Of the 165 TKA cases, 72 used TXA and 42 of the 94 THA cases used TXA (Formby, Pickett, & Van Blarcum et al., 2015). All patients underwent similar surgical approaches by the surgeon, received deep vein thrombosis prophylaxis treatment, and were screened and treated for a hemoglobin less than 7 (Formby, Pickett, & Van Blarcum et al., 2015). Researchers reviewed preoperative hemoglobin levels and postoperative hemoglobin levels from day 0 to 2, incidence of transfusions, and complication rates in those who received TXA compared those who had