Tranexamic Acid Administration is Associated With Lower Transfusion Rates and Wound Complications Following Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

Background Tranexamic acid (TXA) is widely used in total joint arthroplasty, but data on its efficacy in periprosthetic joint infection (PJI) of the knee are scarce. We assessed TXA efficacy in revision total knee arthroplasty (TKA) for PJI. Methods A national database was queried for patients ≥18 years undergoing stage-one revision TKA for PJI from 2016 to 2023. Patients with and without TXA exposure were propensity matched. Multivariable logistic regression assessed primary outcomes (postoperative transfusion, bleeding complications, and wound complications) and secondary outcomes (thromboembolic complications). Results Overall, 13,247 TXA patients were matched 1:1 to 13,247 non-TXA patients on comorbidities, Charlson Comorbidity Index, demographics, hospital characteristics, and preoperative transfusion rates, all with standardized mean differences <0.10. Mean age was 67.4 years in both cohorts, with similar use of venous thromboembolic chemoprophylaxis. TXA was associated with decreased adjusted odds of postoperative transfusion (adjusted odds ratio [aOR]: 0.77, 95% confidence interval [CI]: 0.69-0.85, P < .001) and aggregate wound complications (aOR: 0.65, 95% CI: 0.60-0.70, P < .001), with similar odds of aggregate bleeding complications (aOR: 1.02, 95% CI: 0.95-1.09, P = .563). Odds of aggregate venous thromboembolism (aOR: 0.97, 95% CI: 0.82-1.13, P = .874), deep vein thrombosis (aOR: 1.00, 95% CI: 1.00-1.01, P = .309), and pulmonary embolism (aOR: 1.06, 95% CI: 0.83-1.34, P = .639) were similar. Conclusions TXA was associated with lower rates of transfusion and aggregate wound complications, without increased venous thromboembolism risk, during revision TKA for PJI.