Topical Tranexamic Acid Increases Early Postoperative Pain After Total Hip Arthroplasty

Jeffery W. Wurtz, L. Daniel Wurtz, Mary Ziemba-Davis, Evan R. Deckard, R. Michael Meneghini

Research output: Contribution to journalArticle

1 Scopus citations


Background: Tranexamic acid (TXA) has reduced blood transfusion following total hip arthroplasty (THA). However, non-human studies have linked TXA exposure with increased pain and decreased periarticular cell viability and cell death. This study evaluated early pain following THA performed with and without topical TXA. Methods: A consecutive series of 213 THAs performed without TXA were compared to 169 THAs performed with topical TXA. A single surgeon using identical perioperative medical and pain control protocols performed procedures. Prospectively collected inpatient pain scores, time to first opioid, and opioid consumption in morphine milligram equivalents were evaluated in relation to TXA use and 10 additional covariates. Univariate relationships between independent and dependent variables with P ≤. 20 were entered into multivariate analysis using the General Linear Model. Results: Patients who received topical TXA reported higher mean 24-hour pain scores compared to patients who did not receive TXA (P = .006). Patients with topical TXA requested opioids significantly sooner (means of 152 vs 246 minutes, P = .033). An average of 56.07 morphine milligram equivalents were consumed during the first 24 hours after post-acute care unit discharge by patients who received topical TXA compared to 31.26 by patients who did not receive TXA (P < .001). Conclusion: Topical TXA use was associated with greater early postoperative pain and opioid consumption in primary THA patients. Findings were supported by the magnitude of observed effects and the likelihood of clinical relevance. Replication and consideration of potential adverse consequences of TXA use in elective settings is encouraged.

Original languageEnglish (US)
Pages (from-to)S219-S225
JournalJournal of Arthroplasty
Issue number6
StatePublished - Jun 2020


  • opioids
  • pain
  • topical tranexamic acid
  • total hip arthroplasty
  • total joint arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Fingerprint Dive into the research topics of 'Topical Tranexamic Acid Increases Early Postoperative Pain After Total Hip Arthroplasty'. Together they form a unique fingerprint.

  • Cite this