Intravenous Tranexamic Acid Does Not Improve Visual Field Clarity During Hip Arthroscopy: A Double-Blind, Randomized, Placebo-Controlled Trial.

PURPOSE

To determine the effectiveness of administering intravenous (IV) tranexamic acid (TXA) on altering visual field clarity (VFC) during arthroscopic hip preservation surgery for patients with femoroacetabular impingement syndrome (FAIS).

METHODS

This randomized, double-blind, parallel-design trial was conducted over a 7-month period between October 2023 and May 2024 at a single tertiary musculoskeletal hospital. The inclusion criteria were consecutive patients who received a diagnosis of FAIS through clinical history, physical examination, and advanced imaging and was indicated for hip arthroscopy after failure of conservative management. This trial prospectively randomized 78 participants (39 assigned to receive 1,000 mg of TXA in a 100-mL/0.9% normal saline solution bolus and 39 assigned to receive a 100-mL/0.9% normal saline solution bolus only). Treatment intervention was administered within 15 minutes of incision. The primary outcome was arthroscopic VFC assessed on a Likert-style numeric rating scale and graded by the surgeon at 15-minute intervals as follows: 1, poor visibility (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 operation could still be performed); or 3, good visibility (clear vision without obvious blood). The percentage of good VFC ratings (i.e., the percentage of surgeon ratings equal to 3 on the numeric rating scale throughout the procedure) was quantified for each patient. No minimum follow-up was required because the primary endpoint was intraoperative.

RESULTS

The baseline characteristics of the TXA cohort (mean age, 37.3 years; 61.5% male sex; 76.9% white) were not significantly different from those of the placebo group (mean age, 33.6 years; 59% male sex; 86.8% white) (P > .05 for all). TXA was not associated with improved VFC compared with placebo at any intraoperative time point or when considering composite overall VFC scores (2.51 ± 0.41 in TXA group vs 2.64 ± 0.42 in placebo group, P = .16). Furthermore, no significant difference was observed in the percentage of good VFC ratings between treatment groups (56.4% in TXA group vs 66.4% in placebo group, P = .17). Multivariate regression analysis adjusted for demographic and intraoperative covariates did not show an association between TXA and VFC ratings (β = -0.14, P = .14) or percentage of good VFC ratings (β = -11.6, P = .15). No medical or intraoperative complications related to the treatment intervention were observed in either treatment arm.

CONCLUSIONS

Among patients with FAIS undergoing arthroscopic hip preservation surgery, administration of TXA did not improve arthroscopic VFC when compared with placebo. Therefore, the results of this randomized trial do not support the routine use of TXA in arthroscopic hip preservation surgery for improvement in arthroscopic visualization.

LEVEL OF EVIDENCE

Level I, prospective randomized controlled trial.