Total Ankle Arthroplasty and The Utilization of Tranexamic Acid: A Systematic Review and Meta-Analysis

Research Type: Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results Introduction/Purpose: Tranexamic acid (TXA) is frequently utilized in knee and hip arthroplasty due to vast research demonstrating benefits. The literature is very scarce on total ankle arthroplasty (TAA) and the effects of tranexamic acid. The current systematic review and meta-analysis aims to present all of the available literature on the subject. Methods: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. The search criteria were based on total ankle arthroplasty and the utilization of tranexamic acid. No date limitation was included. The MINORS score criteria was used to evaluate the strength and quality of the selected studies by two authors. Results: A total of eight studies including 491 surgeries were included. There were 272 TAA completed with the usage of TXA and 219 without TXA. The average blood loss and change in hemoglobin in the TXA group was 335.4 mL and 1.45 g/dL, respectively. In the non-TXA group, average blood loss and change in hemoglobin was 441.8 mL and 1.78 g/dL, respectively. The total complications and wound complications for the TXA group were 18.4% and 6.7%; in the non-TXA group 35% and 17.3% were observed. The difference in wound complication rate was statistically significant (p=0.014). The TXA group had a lower rate of transfusion and pulmonary embolism, deep venous thrombosis and cerebrovascular accident (p=0.087). Conclusion: The utilization of tranexamic acid in total ankle arthroplasty appears to be safe and effective. The data from this systematic review demonstrate a reduction in blood loss, hemoglobin decrease, wound complications, and total complications when utilizing tranexamic acid in total ankle arthroplasty. Larger prospective studies and randomized controlled trials are needed to further guide evidence based guidelines.