Association Between Tranexamic Acid Use and Heterotopic Ossification Prevalence After Elbow Trauma Surgery: A Propensity-Score-Matched Cohort Study

Hang Liu; Juehong Li; Yuehao Hu; Jingyi Guo; Tengfei Lou; Gang Luo; Shuai Chen; Wei Wang; Hongjiang Ruan; Ziyang Sun; Cunyi Fan

doi:10.2106/JBJS.22.01212

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 Jul 19;105(14):1093-1100. doi: 10.2106/JBJS.22.01212. Epub 2023 Jun 20.

Authors

Hang Liu^{1

2}, Juehong Li^{1

2}, Yuehao Hu³, Jingyi Guo⁴, Tengfei Lou^{1

2}, Gang Luo^{1

2}, Shuai Chen^{1

2}, Wei Wang^{1

2}, Hongjiang Ruan^{1

2}, Ziyang Sun^{1

2}, Cunyi Fan^{1

2}

Affiliations

¹ Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
² Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, People's Republic of China.
³ Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
⁴ Clinical Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

PMID: 37339180
DOI: 10.2106/JBJS.22.01212

Abstract

Background: Heterotopic ossification (HO) is a common complication of elbow trauma that can affect limb mobility. Inflammation is an initiating factor for HO formation. Tranexamic acid (TXA) can reduce the inflammatory response after orthopaedic surgery. However, evidence regarding the effectiveness of TXA use for HO prevention after elbow trauma surgery is lacking.

Methods: This retrospective observational propensity-score-matched (PSM) cohort study was conducted from July 1, 2019, to June 30, 2021, at the National Orthopedics Clinical Medical Center, Shanghai, People's Republic of China. A total of 640 patients who underwent surgery following elbow trauma were evaluated. The present study excluded patients with an age of <18 years; those with a history of elbow fracture; those with a central nervous system injury, spinal cord injury, burn injury, or destructive injury; and those who had been lost to follow-up. After 1:1 matching on the basis of sex, age, dominant arm, injury type, open injury, comminuted fracture, ipsilateral trauma, time from injury to surgery, and nonsteroidal anti-inflammatory drug use, the TXA group and the no-TXA group comprised 241 patients each.

Results: In the PSM population, the prevalence of HO was 8.71% in the TXA group and 16.18% in the no-TXA group (with rates of 2.07% and 5.80% for clinically important HO, respectively). Logistic regression analyses showed that TXA use was associated with a lower rate of HO (odds ratio [OR], 0.49; 95% CI, 0.28 to 0.86; p = 0.014) than no TXA use, as well as with a lower rate of clinically important HO (OR, 0.34; 95% CI, 0.11 to 0.91; p = 0.044). None of the baseline covariates significantly affected the relationship between TXA use and HO rate (p > 0.05 for all). Sensitivity analyses supported these findings.

Conclusions: TXA prophylaxis may be an appropriate method for the prevention of HO following elbow trauma.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Arm Injuries*
China / epidemiology
Cohort Studies
Elbow
Humans
Ossification, Heterotopic* / epidemiology
Ossification, Heterotopic* / etiology
Ossification, Heterotopic* / prevention & control
Prevalence
Retrospective Studies
Risk Factors
Tranexamic Acid* / therapeutic use

Substances

Tranexamic Acid