Effectiveness of Tranexamic Acid in Primary Hip and Knee Arthroplasty: A Retrospective Cohort Study

Objective To determine the effectiveness of tranexamic acid (TXA) in reducing peri-operative blood loss quantified by postoperative hemoglobin decline and in lowering allogeneic transfusion requirements among patients undergoing primary total hip or knee arthroplasty. Methods We performed a single‑centre, retrospective cohort study, reviewing consecutive medical records of adults who underwent primary total hip or knee arthroplasty between 2015 and 2025. Patients who received TXA were compared with those who did not. Baseline characteristics, hemoglobin levels (pre‑ and post‑operative) and transfusion requirements were recorded. Changes in hemoglobin were analysed using Student’s t‑test or Mann–Whitney U, and transfusion rates were compared with the χ² or Fisher’s exact test. Results Of 184 eligible patients, 81 (44%) received TXA and 103 (56%) did not. The mean age was 64.7 ± 12.8 years; 63.9% were female and 78.5% underwent knee arthroplasty. Mean pre‑operative hemoglobin was similar in the TXA and non‑TXA groups (13.16 ± 1.31 vs. 13.13 ± 1.24 g/dL). TXA significantly reduced the average postoperative decrease in hemoglobin (1.53 ± 1.00 vs. 2.56 ± 1.25 g/dL; p < 0.001) and the need for transfusion (4.9% vs. 14.6%; RR 0.32, 95% CI 0.11–0.91; p = 0.022). No thromboembolic events attributable to TXA were observed. Conclusions Administration of TXA during hip and knee arthroplasty was associated with a significant reduction in postoperative hemoglobin decline and a 65% reduction in transfusion rate without safety concerns. Routine use of TXA enhances peri‑operative management and reduce exposure to blood products in similar settings. Level of evidence III.