For many people, hip or knee surgery represents a major step towards greater mobility and quality of life. At the same time, these procedures also carry certain risks – most notably the risk of blood loss. Previously, it was almost a given that patients would require a blood transfusion after hip replacement (total hip arthroplasty) or knee replacement (total knee arthroplasty). Today, thanks to modern medications and surgical techniques, this is almost never the case. One of the key factors in 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 replacements).
• Why it is considered a "game changer".
• What side effects and contraindications exist.
• What the term "off-label use" means and why it is important for patients.
• Why ENDOPROTHETICUM Rhein-Main relies on tranexamic acid to ensure maximum safety.

History and development of tranexamic acid

Tranexamic acid was developed in Japan in the 1960s. Researchers at the time were searching for a drug that could inhibit the breakdown of blood clots. It was soon discovered that the active ingredient could be helpful in cases of surgery, injuries, and even heavy menstrual bleeding. Under the trade name Cyclokapron® , tranexamic acid has been on the market for many decades and has been used extensively worldwide.

However, its use in orthopedics and trauma surgery only really became established in 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 total hip and knee replacements.

How does blood clotting work?

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

1. Vascular constriction : The blood vessels contract.
2. Blood platelets (thrombocytes) adhere to the injured area.
3. Fibrin – a kind of “glue” – ensures that a stable blood clot is formed.

To maintain blood flow, the body also has mechanisms to dissolve clots. This process is fibrinolysis . This is precisely where tranexamic acid comes into play: it inhibits the enzyme plasmin , which is responsible for breaking down clots. This keeps the clots stable, and the bleeding stops more quickly.

How is tranexamic acid administered?

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

• Intravenous (IV) : The substance is administered directly into the bloodstream via a vein. This usually occurs 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 : In this method, tranexamic acid is injected directly into the surgical area – e.g., into the knee joint. This acts specifically at the site of the bleeding.

intravenous and local administration in hip and knee replacements 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 hip or knee surgery. While these blood transfusions saved lives, they also carried risks: the danger of infection, immune reactions, and sometimes even organ damage.

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

• 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 key 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 get 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 atrophy.

Tranexamic acid plays a key role here:

• Less blood loss means less weakness and circulatory problems.
• Patients require blood transfusions less frequently , which could otherwise put additional strain on the circulatory system.
• The more stable circulatory system allows you to get up earlier and do walking exercises .
• Rapid mobilization, in turn, reduces the risk of infection and accelerates healing.

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

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

Although tranexamic acid has been approved for decades, this approval does not automatically extend to all conceivable uses. Intra-articular administration (i.e., direct injection into the joint) is not officially included in the approval in Germany, for example. If it is used nonetheless, such as in the context of total hip or knee replacement surgery, this is referred to as " . "

This means that doctors are allowed to use the method, but must inform you about it beforehand. This way, you as a patient know exactly that while it is a safe and proven method, it is not explicitly approved by the drug regulatory authority.

Contraindications – when is tranexamic acid not given?

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

• Severe kidney disease : In these cases, the active ingredient can accumulate in the body.
• A history of thrombosis or pulmonary embolism
• Epileptic seizures : Tranexamic acid may, under certain circumstances, promote seizures.

Before the operation, your doctor will check whether the procedure is suitable for you. This assessment is part of the standard safety procedure.

Tranexamic acid safety – what do studies say?

Numerous international studies have shown that tranexamic acid does not increase . This was a long-standing concern for many physicians. Today, it is considered certain that the benefits clearly outweigh the risks, and the safety profile is high. Therefore, tranexamic acid has become a standard treatment worldwide for joint replacement surgeries such as hip and knee replacements.

Patient Questions (FAQ)

1. Do I need to worry about side effects?
No, in the vast majority of cases tranexamic acid is well tolerated. Your doctor will check for any risk factors before the surgery.

2. Will this reduce my pain?
Tranexamic acid does not relieve pain. However, due to the reduced blood loss, you will recover faster and can begin rehabilitation sooner.

3. Is the medication expensive?
No, tranexamic acid is a very inexpensive 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. Ask your medical team about it directly. The use of this medication will be explained to you before 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 safety standards are paramount in hip and knee replacement surgery. Tranexamic acid is a standard component of the treatment concept. Combined with minimally invasive techniques and gentle rehabilitation programs, this creates a holistic approach to successful surgery.

Summary

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

Conclusion: Tranexamic acid is a game changer in modern endoprosthetics

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

👉 Book your appointment now: www.endoprotheticum.de