For patients undergoing surgery for elbow trauma, treatment with tranexamic acid (TXA) is associated with a decreased incidence of heterotopic ossification (HO), according to a study published online ahead of print by The Journal of Bone & Joint Surgery.
The study authors note that these findings “add new clinical evidence regarding the protective role of TXA with respect to the prevention of HO after elbow trauma.” They are from the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in China.
High Risk for HO
Heterotopic ossification has a reported prevalence of up to 40% after surgery for traumatic elbow fracture, with the inflammation that is common after limb trauma cited as an important factor in the occurrence of HO.
Tranexamic acid is increasingly used to reduce blood loss during orthopaedic surgery, and it has been shown to also reduce inflammatory responses postoperatively. In this study, the authors reviewed their experience to determine whether the use of TXA is associated with a lower risk of HO.
Their retrospective study included 2 matched groups of patients with a mean age of 44 years who underwent surgery for traumatic elbow fracture. One group received TXA during surgery and the other group did not. The incidence and severity of HO were compared between groups, including adjustment for other characteristics.
Reduction in Rate of HO
The overall rate of postoperative HO was 8.71% in patients who received TXA compared with 16.18% in those who did not. On adjusted analysis, the incidence of HO was reduced by half in the TXA group, with an odds ratio of 0.49.
The incidence of clinically important HO, based on the presence of functional limitations, was 2.07% in patients who received TXA compared with 5.80% in those who did not. For this outcome, risk was reduced by two-thirds in the TXA group, with an odds ratio of 0.34. Tranexamic acid was associated with a lower risk of HO across patient subgroups with differing characteristics.
HO and the Inflammatory Response
This study provides the first published evidence that using TXA during elbow trauma surgery can help lower the risk of postoperative HO. Previous reports have found that reducing inflammation can reduce HO formation – “indicating that the inflammatory response acts as a necessary starting factor for HO development,” the study author said.
They note the limitations of their retrospective analysis and highlight the need for larger studies, including those to assess laboratory markers of inflammation. In the meantime, the researchers conclude, “TXA prophylaxis may be an appropriate method for the prevention of HO following surgery for the treatment of elbow trauma.”
Liu H, Li J, Hu Y, et al. Association between tranexamic acid use and heterotopic ossification prevalence after elbow trauma surgery: a propensity-score-matched cohort study. J Bone Joint Surg Am. 2023 Jun 20. doi: 10.2106/JBJS.22.01212. Online ahead of print.