Abstract
Objectives:
Tranexamic acid (TXA) has been widely investigated as a low-risk pharmacologic adjunct to surgery, with favorable hemostatic properties for patients undergoing both arthroscopic and open surgical procedures. An additional reported benefit in recent literature has pertained to improved visual field clarity throughout the extent of the procedure. However, the safety and efficacy of TXA during arthroscopic hip preservation surgery has not been investigated.
Methods:
Consecutive patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were randomized to receive an intravenous infusion of 1000mg of TXA in 100mL 0.9% normal saline (NS, treatment group) or an equivalent volume of NS placebo (control group) prior to creation of arthroscopic portals. The primary outcome for which this trial was powered to assess was arthroscopic visual field clarity assessed on a Likert-style numeric rating scale (NRS) by the operating surgeon (1= poor visibility with active bleeding to the degree that vision was too poor to perform the operation; 2= fair visibility (mild bleeding that interfered with vision, but the surgery could still be performed), and 3 = good visibility (clear vision without obvious blood). Visual field clarity was assessed every 15 minutes during and at the completion of the arthroscopic procedure. The percentage of good visual field clarity (percent of surgeon-ratings equal to 3 on the NRS scale throughout the duration of the procedure) was quantified for each patient. All data was explored for normality utilizing the Shapiro-Wilks test prior to analysis. Multivariate linear regression models, controlling for confounding intraoperative variables (mean arterial pressure, MAP; pump pressure; number of lavages; and length of surgery) were constructed to determine the association between TXA versus placebo intervention and visual field clarity.
Results:
A total of 78 patients were enrolled, with 39 patients randomized to each treatment arm (Table 1). There were no significant differences in the mean NRS score for visual field clarity at any intraoperative timepoint (Figure 1, Table 2), nor when the overall mean NRS score for all patients within a single treatment group (TXA: 2.51±0.41 vs. placebo: 2.64±0.42; p=0.16) were compared. Furthermore, there was no significant difference in the percentage of good visual field clarity ratings throughout the entirety of the procedures between treatment groups (TXA: 56.4%, placebo: 66.4%, p=0.17). Adjusted multivariate regression analysis did not demonstrate a significant association between TXA treatment intervention and mean visual field clarity rating (effect estimate = -0.16, p-value = 0.11) nor percentage of visual field clarity ratings that were good (effect estimate = -14.9, p-value = 0.08). No intraoperative complications related to the surgical intervention or administration of treatment intervention (TXA or placebo) were observed.
Conclusions:
Among patients with FAIS undergoing arthroscopic hip preservation surgery, administration of TXA did not improve arthroscopic visual field clarity when compared with placebo. Therefore, these results of this randomized trial do not support the routine use of TXA in arthroscopic hip preservation surgery for improvement in visualization.
