David Mitchell added Tranexamic acid to his local anaesthetic mixture for joint replacements in line with a number of other orthopaedic surgeons with the hope of reducing bleeding complications and swelling after joint replacements. No other surgeons have performed a study proving its value used in this manner, and this seems an ideal opportunity to asses how much value the TXA adds, and what our DVT rate is with or without it. We think our DVT rate is exceedingly low – other authors report 10% but perhaps our compression stocking have reduced this rate for us. We do see swelling problems after some knee replacements, but rarely blood clots. We would like patients to have have no bleeding, no need for transfusion, and no blood clots after their surgery, and this use of TXA may help us.
Patients inclined to bleed excessively or clot excessively won’t be included in the study. Patients having operations other than straightforward total hip or total knee replacement won’t be included. Of course patients need to give their consent to be involved in the study. Patients opting out of the study of course can still have their treatment with us, and can express a viewpoint about the two treatments (TXA or no TXA), and we will comply with their request. The question cannot be solved with a google search! The best way to resolve the question is to randomise 100 or so patients and compare their outcome. with the standard tests we do after joint replacements. Lake Imaging has kindly agreed to bulk bill these investigations, so there is no cost involved for the patients.
I’m hoping most patients can enthusiastically support our research, we see it as very low risk for the patients as we have treated people both ways. Our research has been approved by the Ethics Committee of Ballarat Base Hospital and St John of God.