Surgery on the hip or knee joint is a major step towards greater mobility and quality of life for many people. At the same time, these are also interventions that come with a certain risk - above all, the risk of blood loss. In the past, it was almost a matter of course that patients required a blood transfusion after hip replacement surgery (hip arthroplasty) or knee replacement surgery (knee arthroplasty). Today, thanks to modern medications and surgical techniques, this is almost no longer the case. One of the decisive factors for this is tranexamic acid.

In this comprehensive guide you will learn:

• What tranexamic acid is and how it works.
• How it is used in endoprosthetics (hip and knee prostheses).
• Why it is considered a 'game changer'.
• What side effects and contraindications there are.
• What the term off-label use means and why it is important for patients.
• Why the ENDOPROTHETICUM Rhein-Main relies on tranexamic acid to ensure maximum safety.

History and development of tranexamic acid

The tranexamic acid was developed in Japan in the 1960s. Researchers were looking for a medication that could inhibit the breakdown of blood clots. Soon they found that the active ingredient could help with operations, injuries, and heavy menstrual bleeding. Under the trade name Cyclokapron® tranexamic acid has been on the market for many decades and tested worldwide.

In orthopaedic surgery and trauma surgery, its use has only really become established over the last two decades. Only when studies clearly showed that tranexamic acid can significantly reduce bleeding did it become a standard component of endoprosthetics, particularly in the implantation of hip and knee replacements.

How does blood coagulation work?

To understand why Tranexamic acid is so effective, it is worth taking a look at the body's own blood clotting. When a blood vessel is injured, the body tries to stop the bleeding immediately. Three processes work together:

1. Vasoconstriction: The blood vessels constrict.
2. Blood platelets (thrombocytes) adhere to the injured area.
3. Fibrin – a kind of "adhesive" – ensures that a stable blood clot forms.

To maintain blood flow, the body also has mechanisms to dissolve clots again. This process is called Fibrinolysis . This is exactly where Tranexamic acid intervenes: It inhibits the enzyme Plasmin, which is responsible for the breakdown of clots. This keeps the clots stable and the bleeding stops faster.

How is Tranexamic acid administered?

Depending on the clinic and patient, there are different methods:

• Intravenous (i.v.): The substance is administered directly into the blood through the vein. This usually happens shortly before or during the operation.
• Oral (Tablets): In some clinics, patients are given tablets before or after surgery. Studies show that this form can be just as effective.
• Local / intra-articular: With this method, tranexamic acid is injected directly into the surgical area – e.g., into the knee joint. This acts directly at the site of the bleeding.

Many clinics combine intravenous and local application for hip and knee prostheses to enhance the effect. This combination is considered particularly safe and effective.

Tranexamic acid as a game changer in endoprosthetics (hip replacement, knee replacement)

Just 15 years ago, it was common for many patients to require a blood transfusion after surgery on the hip or knee joint. While these blood transfusions saved lives, they also carried risks: risk of infection, immune reactions, and sometimes even organ strain.

Since the introduction of tranexamic acid, these risks have been drastically reduced:

• The transfusion rates have dropped to below 5%.
• Patients can be mobilized more quickly.
• Complications such as infections or circulatory problems occur less frequently.

In combination with minimally invasive surgical techniques and modern Fast-Track concepts (rapid rehabilitation), tranexamic acid is a central component for safe endoprosthetics.

Tranexamic acid and Fast-Track concepts in endoprosthetics

The modern fast-track concept – sometimes also called "Enhanced Recovery After Surgery" (ERAS) – aims to make patients mobile and independent again as quickly as possible after hip or knee replacement surgery. Every hour you can get up and walk earlier reduces the risk of complications such as thrombosis, pneumonia, or muscle wasting.

Here, tranexamic acid plays a key role:

• Less blood loss means less weakness and circulatory problems.
• Patients require fewer blood transfusions, which could otherwise put additional strain on the circulatory system.
• With a more stable circulation, you can get up and start walking exercises earlier.
• Rapid mobilization in turn reduces the risk of infection and accelerates healing.

In short: Tranexamic acid is a crucial building block for fast-track concepts in endoprosthetics to work at all. It makes modern "fast recovery" safe and effective.

Why is the use of tranexamic acid partially considered off-label use?

Although tranexamic acid has been approved for decades, the approval does not automatically cover all conceivable applications. The intra-articular administration (i.e., direct injection into the joint) is not officially included in the approval in Germany, for example. If it is still used, for example in the context of a hip replacement or knee replacement, this is referred to as 'off-label use'.

This means that doctors are allowed to use the method, but they must inform you about it in advance. As a patient, you will know exactly that it is a safe and proven method, but it is not explicitly approved by the drug authority.

Contraindications – when is Tranexamic acid not given?

Tranexamic acid is a very safe medication. Nevertheless, there are situations in which it is not recommended:

• Severe kidney disease: Here, the active ingredient can accumulate in the body.
• Thrombosis or pulmonary embolism in the medical history.
• Epileptic seizures: Tranexamic acid can under certain circumstances promote seizures.

Before the operation, your doctor checks whether an application makes sense for you. This clarification is part of the safety standard.

Safety of Tranexamic acid – what do studies say?

Numerous international studies have shown that tranexamic acid does not increase the risk of thrombosis or embolism. This was a concern for many doctors for a long time. Today it is considered certain: the benefits clearly outweigh, and the safety is high. That is why tranexamic acid is now a worldwide standard for joint replacement surgeries such as hip or knee prostheses.

Patient Questions (FAQ)

1. Should I be afraid of side effects?
No, in the vast majority of cases, tranexamic acid is well tolerated. Your doctor checks whether you have risk factors before the operation.

2. Will I have less pain because of it?
Tranexamic acid is not pain-relieving. But due to the lower blood loss, you will be fit again more quickly and can start rehabilitation earlier.

3. Is the medication expensive?
No, tranexamic acid is a very affordable medication – especially compared to the costs and risks of a blood transfusion.

4. Will I automatically receive the treatment?
In most specialized clinics, tranexamic acid is now part of the standard therapy. Talk to your medical team directly about it. The application is explained in advance of the operation.

Tranexamic acid and modern endoprosthetics in Mainz

At the ENDOPROTHETICUM Rhein-Main under the direction of Prof. Dr. Karl Philipp Kutzner , the highest level of safety is ensured for hip and knee prostheses. Here, tranexamic acid is a standard part of the treatment concept. Combined with minimally invasive techniques and gentle rehabilitation programs, a holistic approach is created for a successful operation.

Summary

• Tranexamic acid (Cyclokapron®) is a medication that effectively reduces bleeding during operations.
• It is used for hip prostheses and knee prostheses – intravenously, orally or locally.
• Thanks to it, blood transfusions are almost unnecessary today in primary hip TEP or knee TEP operations.
• Some applications are considered off-label, but require only a brief clarification.
• Studies confirm: The risk of thrombosis is not increased.
• Patients benefit from greater safety and faster recovery.

Conclusion: Tranexamic acid is a gamechanger in modern endoprosthetics

Are you looking for a modern hip or knee prosthesis with maximum safety? Then you are in the right place at the ENDOPROTHETICUM Rhein-Main in Mainz. Under the direction of Prof. Dr. Karl Philipp Kutzner , you will receive individual counseling and therapy according to the latest scientific standards – including the use of tranexamic acid.

👉 Make an appointment now: www.endoprotheticum.de