Reducing bleeding in joint replacement surgery.
Safer surgery with Tranexamic acid.
Throughout my surgical training, and for my first few years as a consultant, patients having major operations like hip and knee replacements lost quite a lot of blood – sometimes 2 pints or more.
This left them feeling breathless and tired (the symptoms of anaemia or a low red blood cell count) just when they needed to have the energy to recover from surgery. Many required a couple of bags of donor transfused blood (which is expensive, slow and has some risks) – but someone else’s blood cells that have been stored in a fridge don’t work as well as your own cells do, and it takes many weeks for your body to restore your blood cell count to normal.
This was one of the main reasons that it was common to stay in hospital for a week or longer after a hip or knee replacement just 10 years ago.
But all that has changed. Patients often now go home just a day or two after surgery. And the biggest factor in that change? Not surgical technique or clever new artificial joints, but a drug that was developed over 50 years ago – Tranexamic Acid (TXA).
TXA was developed by a Japanese husband & wife team.
Shosuke and Utako Okamoto in 1962.
TXA was developed by Japanese husband and wife research team Shosuke and Utako Okamoto in 1962. For years it was used for troublesome bleeding – mainly by gynaecologists treating heavy periods and dentists extracting teeth. But it didn’t cross the radar of orthopaedic surgeons who have always been paranoid about anything that might increase the risk if blood clots (thrombosis) – one of the biggest worries after hip or knee surgery.
This started to change around 2010 when researchers (initially in China) published results of trials showing reduced blood loss in Orthopaedic patients, with a surprising lack of additional risks – confirmed in subsequent studies in Europe and North America.
TXA usage is now routine in all major surgery. It can be taken as a tablet, given as an intravenous injection or instilled directly into a joint after wound closure, and it’s CHEAP – about 20p per tablet or £1.50 for an injection. A patient having a knee replacement will typically get 3 doses, greatly reducing blood loss both during and after surgery – thereby reducing swelling and pain, and making recovery both easier and quicker.
Blood transfusions are now rare on the Orthopaedic ward – I’m struggling to remember the last time I had a patient who needed one!