Skip to main content

Tranexamic acid lowers transfusion requirements and hospital length of stay following revision total hip or knee arthroplasty

A Correction to this article was published on 07 January 2022

This article has been updated



Intravenous tranexamic acid (TXA) has been shown to reduce blood loss in patients undergoing total joint arthroplasty without systemic complications. There is limited evidence of its effectiveness in revision procedures. This study evaluated intravenous TXA effect on blood loss, transfusion rates, and length of hospital stay in revision joint replacement.


One-hundred revision total joint arthroplasty patients were retrospectively reviewed [44 revision total hip arthroplasty (THA) and 54 revision total knee arthroplasty (TKA)] who underwent surgery from 2013 to 2016. Fifty-four revision joint patients (23 THA and 31 TKA) received intravenous TXA intra-operatively, while 46 revision joint patients (23 THA/TKA) did not. Primary outcome measures were blood loss, transfusion rates, and length of hospital stay.


The mean blood loss difference between revision THA patients who received TXA vs. not receiving TXA was 180ml in revision THA patients (p < .005). Mean length of hospital stay was 6 days in non-TXA vs. 3 days in TXA patients (p < .001). Eighteen patients received transfusions in the non-TXA revision TKA group compared to nine patients in the TXA revision TKA group (p < .001). Average length of hospital stay was 5 days in the non-TXA revision TKA group compared to 3 days in the TXA revision TKA group (p < .003). There was no increased risk of thromboembolic complications in TXA groups for either procedure.


Intravenous TXA reduced length of hospital stay in both revision cohorts, decreased blood loss in revision THA and decreased the rate of transfusion in revision TKA without an increase in thromboembolic complications.

Level of Evidence

Level III (Case-control study)


The number of total joint arthroplasty procedures performed each year continues to rise, leading to a consequential increase in the need for revision arthroplasty. It has been projected that by 2030, the rates of primary and revision arthroplasty will increase by 174 and 137 %, respectively, compared to the year 2005 in the United States [1]. Revision surgeries have been associated with higher mortality rates, increased hospital length of stay, an overall increased rate of re-admissions, and an increased rate of blood transfusions when compared to primary surgeries [2, 3]. Perioperative and postoperative blood loss has been a concern in primary arthroplasty, and recent studies have demonstrated that blood loss is even greater after a revision procedure [4]. In general, revision surgery is a more complex operation due to extensive bone loss caused by implant removal as well as fibrotic scar tissue formation seen during the exposure as a result of the primary surgery. This often leads to an increase in blood transfusions post-operatively due to difficulties in achieving adequate hemostasis which results in acute blood loss anemia [5]. Transfusions have been associated with complications including immunosuppression, infections, accidental mismatch reactions, transfusion-related acute lung injury, cardiovascular dysfunction, and even death [6]. Blood conserving techniques have been utilized to reduce the need for transfusion such as controlled intraoperative hypotension, regional anesthesia, tourniquet use, and autologous blood transfusions. However, these methods have not been proven to effectively reduce intraoperative blood loss. With an ever-increasing number of revision arthroplasty cases, the financial burden on the medical system will continue to increase as a result [7].

Tranexamic acid (TXA) is an anti-fibrinolytic agent that functions by reversibly binding to the lysine-binding sites of plasminogen, which in turn prevents plasminogen from binding to fibrin. Since plasminogen cannot bind to fibrin, the blood clot is stabilized, promoting an environment to maintain hemostasis [8]. TXA has become a popular blood conservation strategy and has shown to reduce the need for transfusions postoperatively after primary and revision arthroplasty procedures [9,10,11]. Both intravenous (IV) and topical TXA have shown effective results in decreasing the rates of transfusions and keeping hematocrit levels stable post-operatively [12, 13]. Improved hemostasis has been found with a second dose given at the time of closure without increasing the risk of thromboembolic events [14]. Although the literature has demonstrated a reduction in the number of allogenic blood transfusions, post-operative hemoglobin level drop, and reducing overall blood loss with the use of TXA in revision surgery, the evidence of its effectiveness in reducing length of hospital stay has not been as well established [8, 10, 11, 15,16,17].

The aim of this study was to (1) determine if intravenous TXA during revision total hip arthroplasty (THA) and revision total knee arthroplasty (TKA) reduces postoperative bleeding, transfusion rates, and length of hospital stay; (2) determine if TXA was associated with an increase in postoperative complications; (3) identify clinical parameters associated with an increased risk of blood transfusion.


Study Design

This was a single-center retrospective cohort study where all surgical procedures were performed by a single attending orthopedic joint reconstruction surgeon. The protocol was approved by the hospital’s Institutional review board.

Study population

Registry review yielded 46 (mean age, 69 years) and 54 patients (mean age, 66 years) that met inclusion criteria by undergoing revision THA and revision TKA between January 2013 and December 2016, respectively (Table 1). All revision arthroplasty patients were identified using CPT codes for revision total hip or knee arthroplasty (THA-27134, 27137, 27138; TKA-27486, 27487). Exclusion criteria consisted of patients having a primary arthroplasty or revision surgery for fractures/infections, patients on lifelong anticoagulation or patients who had a thromboembolic event within the 12 months preceding surgery.

Table 1 Total Cohort Demographics/Post-operative outcomes

Demographic and preoperative data including date of birth, age at time of surgery, gender, BMI, American Society of Anesthesiologists (ASA) score, medical comorbidities, date of surgery, and preoperative hemoglobin (Hb) and hematocrit (Hct) were collected and recorded. Intraoperative data including dose of TXA, tourniquet use, and total intraoperative blood loss were collected. Postoperative data points included postoperative Hb and Hct, incidence of blood transfusion, units given if patient was transfused, 24-hour drain output, method of DVT prophylaxis, complications/adverse events, and discharge date were collected and recorded. Revision type was quantified by the components removed during surgery. In the knee cohort, there were 29 both component revisions and 2 tibial revisions in the TXA group and 16 both component revisions, 3 tibial revisions, 3 polyethylene exchanges, and 1 patellar only revision in the non-TXA group (p = .07). As for the hip cohort, there were 17 both component revisions, 2 stem only revisions, 2 cup only revisions and 1 head and polyethylene exchange in the TXA group and 13 both component revisions, 6 cup only revisions, and 3 head and polyethylene exchanges in the non-TXA group (p = .14).

Tranexamic acid protocol

Patients who had a history of a thromboembolic or ischemic event, i.e. pulmonary embolism, deep vein thrombosis, ischemic cerebrovascular accident, acute myocardial infarction, or ischemic retinopathy, did not receive TXA. All other patients who did not meet the exclusion criteria received TXA. One gram of intravenous TXA was administered just prior to incision and a second dose just prior to closure.

Blood transfusion protocol

Hemoglobin and hematocrit levels were drawn and recorded every morning at 5AM. Two units of packed red blood cells (PRBCs) were transfused in patients with Hb levels < 7 g/dl in the general population or with Hb < 8 g/dl if the patient was symptomatic (shortness of breath, dizziness, hypotension, tachycardia), had a history of cardiac disease, or was over the age of 70 years. If transfusion was required, post-transfusion Hb and Hct levels were also drawn. The total number of units transfused was recorded.

Statistical analysis

Categorical variables were compared using the chi squared test and continuous variables were analyzed using the Kruskal-Wallis test. Modeling was done using robust linear regression to adjust for the influence of outliers; results were adjusted for all other variables included in the model. Alpha was set at 0.05. All analyses were conducted using Stata 13.1 (StataCorp LLC, College Station, TX).


A total of 46 revision THA patients (23 in the TXA group and 23 in the non-TXA group) were included in the study with similar demographic characteristics (Table 2). Fifty-four revision TKA patients (31 in the TXA group and 23 in the non-TXA group) were included for analysis (Table 3). In the revision TKA cohort, the TXA group tended to be younger (mean 65.6 years vs. 71.9 years, p = .025) and have a lower ASA class (mean 2.3 vs. 2.8, p < .001) than those in the non-TXA group. Revision joint patients receiving TXA had significantly shorter postoperative hospital stays than those not receiving TXA (THA: 3.2 days vs. 6.0, p < .001, Table 4) (TKA: 3.5 days vs. 5.2, p = .003, Table 5) and after adjustment for covariates, maintained statistical significance.

Table 2  Demographics THA
Table 3  Demographics TKA
Table 4  Postoperative outcomes by TXA status THA
Table 5  Postoperative outcomes by TXA status TKA

TXA revision hip patients also had less total blood loss (combined intra-operative and postoperative) than those not receiving TXA (297.7mL vs. 477.3mL, p = .005). After adjustment for covariates, this effect, while substantial, was no longer significant (-98.4mL, p = .143, Table 6). There was no significant difference in postoperative complications or thromboembolic events between the two revision THA groups.

Table 6 Effect of TXA and other variables on total blood loss, 24-hour drain output, postoperative length of stay, and transfusion rate adjusted for other covariates. THA

A significant reduction in transfusion rates in patients treated with TXA (9 total transfusions vs. 18, p < .001) in the revision TKA cohort was seen. Robust regression modeling revealed a non-significant reduction in total blood loss among TXA patients (-49.2mL, p = .092) when compared with non-TXA patients after adjustment for other covariates (Table 7). There was no significant difference in post-operative complications or thromboembolic events in the revision TKA groups.

Table 7 Effect of TXA and other variables on total blood loss, 24-hour drain output, and postoperative length of stay, adjusted for other covariates. TKA


These results demonstrated a reduction in length of hospital stay with the administration of two doses of intravenous TXA in revision arthroplasty procedures. A significant decrease in overall total blood loss was found in revision THA patients, 297.7mL vs. 477.3mL (p < .005). Previous studies have demonstrated similar findings when evaluating TXA in either primary or revision THA [8, 10, 11, 16, 18]. While this effect was substantial, it was no longer significant (-98.4mL, p = .143) when adjusting for covariates, suggesting that at least a portion of the effect could be explained by differences in the underlying patient population, though low study power may also have played a role. Furthermore, a decrease in transfusion rate in revision TKA who received TXA was found. There was no increase in postoperative complications or thromboembolic events in patients who received TXA in either revision arthroplasty groups. Although the effectiveness of TXA in reducing blood loss has been demonstrated when used in primary arthroplasty, there has been limited literature reporting on its role in revision cases and decreasing postoperative length of stay [19].

Revision surgeries require larger surgical exposures with dissection through fibrotic tissue in order to remove prior implants and place revision components. The tissue tends to be friable creating difficulties in achieving hemostasis and ultimately resulting in increased blood loss [18, 20]. When compared with primary procedures, studies have demonstrated that revision THA may result in up to 2000 mL of additional blood loss and increased transfusion rates have been reported with revision TKA procedures [21]. This acute blood loss anemia secondary to revision procedures can have a systemic effect on the patient and result in tachycardia, hypotension, and an increased risk of myocardial infarction [22, 23]. To counter these effects, transfusions are utilized to aid the patient in achieving homeostasis but they are not without risks of allergic reactions or worse, death [6]. This study demonstrates a reduction in transfusion rates in both revision surgery groups with statistical significance reached in revision TKA who received TXA which coincides with the literature. Park et al. reported a significantly decreased transfusion rate and hemoglobin change in patients who received two doses of IV TXA intraoperatively compared to patients who received no TXA [8]. Smit et al. performed a similar study using a single intraoperative dose of 20 mg/kg of TXA prior to tourniquet release in TKA and reported a significant reduction in hemoglobin loss, transfusion rate, and the volume transfused in patients treated with TXA [15]. Aguilera et al. also demonstrated a reduction in blood loss in patients receiving 1 g bolus dose of IV TXA 15–30 min before pneumatic tourniquet followed by a second dose 60–90 min after the first dose [24]. Additionally, Klement et al. recently showed that TXA use can reduce the risk of periprosthetic joint infection likely due to the decreased need of transfusions in these patients [25].

It is important to note that there has been no established protocol with regards to optimal dosing, timing, and administration of TXA [12, 13]. Although the literature has demonstrated positive effects in primary TKA with administration of intravenous, intra-articular, and oral TXA, there have been no studies evaluating the difference in outcomes in varying doses and schedules including, single bolus dose, repeated doses, continuous infusion, or during and/or after surgery [24, 26, 27]. Patients received two doses of 1 g IV TXA administered just prior to incision and just prior to closure. To date, there has been no consensus on the optimal timing and dosage of IV TXA during arthroplasty procedures. Previous studies have utilized either a standardized dose across patients versus a weight-based dose. Standard dosing typically ranges from 0.5 to 2 g IV TXA. IV TXA typically can be administered at several time points throughout the procedure including at the time of incision, after cementing the prosthesis, just prior to closure, after fascia closure, or after wound closure. In addition, there is no consensus on the number of doses effective for IV TXA administration. Although the optimal administration remains controversial, two intraoperative doses has shown to be effective in reducing blood loss, transfusion rates, and length of hospital stay.

In addition, this study has demonstrated a significant decrease in the length of hospital stay by an average of 2 and 3 days in revision TKA and THA patients who received IV TXA, respectively. Reduction in length of stay with TXA has been previously reported in primary THA and has been helpful in reducing overall healthcare costs [28, 29]. This study also demonstrated no difference in post-operative complications between patients treated with TXA compared to those who did not receive TXA. Therefore, reduction in both transfusion rates and length of hospital stay with no additional increase in complication rate can help reduce the financial burden on the healthcare system. A meta-analysis by Huang et al. evaluated TXA in primary TKA and showed that TXA reduced the number of blood transfusions per patient by 0.78 units; the volume of blood transfusion per patient by 205mL; and the total, intraoperative, and postoperative blood loss by 408, 124, and 214 mL, respectively [30]. Transfusion costs have been estimated to be $84.90 and require 0.13 man-hours to perform [31]. Smit et al. calculated a potential yearly cost savings of $22,300.00 with the introduction of TXA [15]. Similarly, Evangelista et al. calculated a larger yearly saving of $42,825 for THA and $56,644 for TKA. Mahadevan et al. found that patients who received blood transfusion after revision THA spent an additional 6 days in the hospital. They reported an additional hospital cost of £2,400 ($3,300) on prolonged hospital stay alone [32]. Although the evaluation of the cost-effectiveness was not within the scope of this study, the utilization of TXA in revision surgery reduces transfusion rates and decreases length of hospital, which can ultimately reduce overall hospital costs.

Identification of patients who may be at risk for blood loss and the need for transfusion can help determine who should be considered for preoperative blood conservation interventions. This study demonstrates higher transfusion rates with increasing age and increased ASA (American Society of Anesthesia) scores in revision THA patients. Even though these results were not significant when adjusting for covariates, previous studies have identified age and ASA scores as predictors for transfusion and blood loss in patients undergoing THA [33, 34]. Typically, these patients often required transfusions which prolonged overall length of stay. Therefore, aggressive correction of preoperative anemia and proper preoperative medical optimization may help reduce transfusion requirements, hospital stay, and costs.

There are inherent limitations associated with the design of a retrospective study, however the post-operative outcomes were objective measurements of blood loss, transfusion rates, and length of hospital stay, thereby limiting bias. This study also evaluated the use of two doses of intravenous TXA administered at standard time points during the procedure, therefore it is not possible to report whether dose or timing of administration have an effect on outcomes. Future research should be directed to determine the optimal route, timing, and dosage of TXA in arthroplasty procedures. This study also demonstrated that patients who received TXA tended to have lower ASA grades in revision TKA cases. It is important to underscore that TXA is used in patient groups that exclude patients with a history of DVT or PE, with thromboembolic disease, or heart disease. Therefore, patients with higher ASA scores, demonstrating more moderate to severe systemic disease, may not have been candidates to receive TXA. Additionally, there are confounding factors in the patient population that cannot be ignored. The non-TXA group had a higher average age and a higher average ASA score than their counterparts receiving TXA. Both of these factors have been shown to increase hospital length of stay in patients undergoing joint replacement surgery, previously [35, 36]. It is hard to separate these factors and they should all be considered when optimizing patients for their revision procedure.


This study demonstrates that administration of two 1 g doses of IV TXA reduces postoperative bleeding in revision THA procedures, rate of transfusion in revision TKA, and length of hospital stay in revision total joint arthroplasty with no increase in thromboembolic complications. TXA should become standard protocol for those indicated patients undergoing revision total joint arthroplasty.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Change history



American Society of Anesthesiologist score


Total Hip Arthroplasty




Body Mass Index


Total Knee Arthroplasty




Tranexamic Acid


  1. Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: A comparative analysis with projections for the United States. A study using the national joint registry dataset. Bone Jt J. 2015;97-B:1076–81.

    Article  CAS  Google Scholar 

  2. Lübbeke A, Katz JN, Perneger TV, Hoffmeyer P. Primary and revision hip arthroplasty: 5-Year outcomes and influence of age and comorbidity. J Rheumatol. 2007;34:394–400.

    PubMed  Google Scholar 

  3. Keswani A, Lovy AJ, Robinson J, Levy R, Chen D, Moucha CS. Risk factors predict increased length of stay and readmission rates in revision joint arthroplasty. J Arthroplasty. 2016;31:603–8.

  4. Cankaya D, Della Valle CJ. Blood Loss and Transfusion Rates in the Revision of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty Are Similar to Those of Primary Total Knee Arthroplasty But Are Lower Compared With the Revision Total Knee Arthroplasty. J Arthroplasty. 2016;31:339–41.

  5. Huff TW, Sculco TP. Management of Bone Loss in Revision Total Knee Arthroplasty. J Arthroplasty. 2007;22:32–6.

    Article  PubMed  Google Scholar 

  6. Madjdpour C, Spahn DR. Allogeneic red blood cell transfusions: Efficacy, risks, alternatives and indications. Br J Anaesth. 2005;95:33–42.

    Article  CAS  PubMed  Google Scholar 

  7. Bozic KJ, Kamath AF, Ong K, Ms EL, Kurtz S, Mph VC, et al. Comparative Epidemiology of Revision Arthroplasty : Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA. Clin Orthop Relat Res. 2015;2131–8.

  8. Park KJ, Couch CG, Edwards PK, Siegel ER, Mears SC, Barnes CL. Tranexamic Acid Reduces Blood Transfusions in Revision Total Hip Arthroplasty. J Arthroplasty. 2016;31:2850–2855.e1.

  9. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty. 2013;28:1080–3.

    Article  PubMed  Google Scholar 

  10. Hines JT, Hernandez NM, Amundson AW, Pagnano MW, Sierra RJ, Abdel MP. Intravenous tranexamic acid safely and effectively reduces transfusion rates in revision total hip arthroplasty. Bone Jt J. 2019;101-B:104–9.

    Article  CAS  Google Scholar 

  11. Hines JT, Petis SM, Amundson AW, Pagnano MW, Sierra RJ, Abdel MP. Intravenous Tranexamic Acid Safely and Effectively Reduces Transfusion Rates in Revision Total Knee Arthroplasties. J Bone Jt Surg - Am Vol. 2020;102:381–7.

    Article  Google Scholar 

  12. Fillingham YA, Darrith B, Calkins TE, Culvern C, Sershon RA, Della Valle CJ, et al. 2019 Mark Coventry Award: A multicentre randomized clinical trial of tranexamic acid in revision total knee arthroplasty: Does the dosing regimen matter? Bone Jt J. 2019;101 B:10–6.

    Article  Google Scholar 

  13. Sershon RA, Fillingham YA, Abdel MP, Malkani AL, Schwarzkopf R, Padgett DE, et al. The Optimal Dosing Regimen for Tranexamic Acid in Revision Total Hip Arthroplasty: A Multicenter Randomized Clinical Trial. J Bone Joint Surg Am. 2020;102:1883–90.

    Article  PubMed  Google Scholar 

  14. Iwai T, Tsuji S, Tomita T, Sugamoto K, Hideki Y, Hamada M. Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty. Int Orthop. 2013;37:441–5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Smit KM, Naudie DDR, Ralley FE, Berta DM, Howard JL. One dose of tranexamic acid is safe and effective in revision knee arthroplasty. J Arthroplasty. 2013;28:112–5.

  16. Wu Y, Zeng Y, Yang T, min, Si H bo, Cao F, Shen B. The Efficacy and Safety of Combination of Intravenous and Topical Tranexamic Acid in Revision Hip Arthroplasty: A Randomized, Controlled Trial. J Arthroplasty. 2016;31:2548–53.

  17. Kuo F-C, Lin P-Y, Wang J-W, Lin P-C, Lee MS, Chen AF. intravenous tranexamic acid use in revision total joint arthroplasty: a meta-analysis. Drug Des Devel Ther. 2018;12:3163–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sculco TP, Tate DE. Blood Management in Revision Total Hip Arthroplasty. In: Bono J, McCarthy J, Thornhill T, Bierbaum B, Turner R, editors. Revis Total Hip Arthroplast. New York: Springer; 1999. pp. 118–23.

    Chapter  Google Scholar 

  19. Tian P, Liu W, Bin, Li ZJ, Xu GJ, Huang YT, Ma XL. The efficacy and safety of tranexamic acid in revision total knee arthroplasty: A meta-analysis. BMC Musculoskelet Disord BMC Musculoskeletal Disorders. 2017;18:1–6.

    Article  Google Scholar 

  20. Aguilera X, Videla S, Almenara M, Fernandez J, Gich I, Celaya F. Effectiveness of tranexamic acid in revision total knee arthroplasty. Acta Orthop Belg. 2012;78:68–74.

    PubMed  Google Scholar 

  21. Bierbaum BE, Hill C, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Jt Surg - Ser A. 1999;81:2–10.

    Article  CAS  Google Scholar 

  22. Spence RK. Anemia in the patient undergoing surgery and the transfusion decision. A review. Clin Orthop Relat Res. 1998;19–29.

  23. Miller R, Von Ehrenburg W. Controversies in transfusion medicine: Indications for autologous and allogeneic transfusion should be the same: Con. Transfusion. 1995;35:450–2.

    Article  CAS  PubMed  Google Scholar 

  24. Aguilera X, Martínez-Zapata MJ, Hinarejos P, Jordán M, Leal J, González JC, et al. Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg. 2015;135:1017–25.

    Article  CAS  PubMed  Google Scholar 

  25. Klement MR, Padua FG, Li WT, Detweiler M, Parvizi J. Tranexamic Acid Reduces the Rate of Periprosthetic Joint Infection After Aseptic Revision Arthroplasty. J Bone Joint Surg Am. 2020;102:1344–50.

    Article  PubMed  Google Scholar 

  26. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: A prospective, randomised, double-blind study of 86 patients. J Bone Jt Surg - Ser B. 1996;78:434–40.

    Article  CAS  Google Scholar 

  27. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JVV, Niemelä HM, Mäntylä SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997;84:839–44.

    Article  CAS  PubMed  Google Scholar 

  28. Gillette BP, Maradit Kremers H, Duncan CM, Smith HM, Trousdale RT, Pagnano MW, et al. Economic impact of tranexamic acid in healthy patients undergoing primary total hip and knee arthroplasty. J Arthroplasty. 2013;28:137–9.

  29. Alshryda S, Mason J, Sarda P, Nargol A, Cooke N, Ahmad H, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: A randomized controlled trial (TRANX-H). J Bone Jt Surg - Ser A. 2013;95:1969–74.

    Article  Google Scholar 

  30. Huang F, Wu D, Ma G, Yin Z, Wang Q. The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: A meta-analysis. J Surg Res. 2014;186:318–27.

  31. Moskal JT, Harris RN, Capps SG. Transfusion Cost Savings with Tranexamic Acid in Primary Total Knee Arthroplasty from 2009 to 2012. J Arthroplasty. 2015;30:365–8.

  32. Mahadevan D, Challand C, Keenan J. Revision total hip replacement: Predictors of blood loss, transfusion requirements, and length of hospitalisation. J Orthop Traumatol. 2010;11:159–65.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Grosflam JM, Wright EA, Cleary PD, Katz JN. Predictors of blood loss during total hip replacement surgery. Arthritis Rheum. 1995;8:167–73.

    Article  CAS  Google Scholar 

  34. Feagan BG, Wong CJ, Lau CY, Wheeler SL, Sue-A-Quan G, Kirkley A. Transfusion practice in elective orthopaedic surgery. Transfus Med. 2001;11:87–95.

    Article  CAS  PubMed  Google Scholar 

  35. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthop. 2008;79:168–73.

    Article  PubMed  Google Scholar 

  36. Fang M, Noiseux N, Linson E, Cram P. The Effect of Advancing Age on Total Joint Replacement Outcomes. Geriatr Orthop Surg Rehabil. 2015;6:173–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


Not applicable.


No funding was received for any portion of this project.

Author information

Authors and Affiliations



BNS contributed to conception, design, data acquisition, data interpretation, manuscript drafting and editing. LGM contributed to data acquisition, data analysis, data interpretation, manuscript drafting and editing. SE contributed to data acquisition, data interpretation, manuscript drafting and editing. FAL contributed to conception, design, patients for data acquisition, manuscript drafting and editing. RSY contributed to conception, design, patients for data acquisition, manuscript drafting and editing. ALG is the first author of this article due to substantial contributions to the conceptualization, data collection, analysis/interpretation of the results, writing and editing of the published manuscript. RH is the third author of this article due to contributions to the conceptualization, methodology, statistical analysis and writing of the published manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Richard S. Yoon.

Ethics declarations

Ethics approval and consent to participate

WIRB approval (20171537) was obtained prior to study initiation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: due to additional authors need to be added on this article.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gianakos, A.L., Saad, B.N., Haring, R. et al. Tranexamic acid lowers transfusion requirements and hospital length of stay following revision total hip or knee arthroplasty. Patient Saf Surg 15, 21 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: