BSOA Project Grant

The most common complication of orthopaedic surgery is bleeding and the need for blood transfusion during and after the operation. Also such bleeding is associated with increased risk of wounded infection, delayed healing, delayed mobilisation and increased length of hospital stay for patients. Hence it is very important to optimise the patient's physiology to achieve early recovery and rehabilitation. This issue of blood loss is addressed by all possible methods including improved surgical techniques, providing appropriate anaesthetic and using drugs that minimise the blood loss. Hip and knee replacement surgeries are utilised to provide standard conditions for such studies.

Tranexamic acid has been used to avoid excessive bleeding in orthopaedic surgeries. It is given to the patient by mouth and also directly into blood before, during and after the operation. Giving it directly into patient's blood requires the understanding and skilled nursing, and resources like infusion pumps. This also delays the mobility and physiotherapy for the patient after the surgery. Studies have proved that tranexamic acid can be given by mouth and also intravenously directly into patients' blood. The effectiveness of either route of administration is observed and some studies have demonstrated that oral administration is more efficient in reducing blood loss when compared to intravenous administration. However it is much easier and cost-effective when it is given by mouth. When appropriately timed the effect of the drug can be harnessed to its best. Also as the patients are undergoing major surgery, it can also be given intravenously by the anaesthetist during the operation. This supplements the effects of orally administered drug by the nurses before the operation. It can also continue to be given orally after the surgery on the ward by the nurses if prescribed by the doctors appropriately.

This study is designed to identify the most effective method of administration of tranexamic acid in order to achieve its effects at its peak effect. It primarily focuses on the timing of administration to suite the operative time, method of administration to accommodate the skill mix of the professionals, and the dose administered to avoid overdosing and potential complications. These are performed in standard conditions where all patients recruited to the study will have similar surgery and will have similar set of medical conditions. The surgical techniques will be standardised and performed by one of the two surgeons. Our Enhanced Recovery Programme that takes patients through a pre-set journey through the hospital will greatly assist in identifying the effect of this interventional study. The study will also eliminate the bias of the participating staff members by randomising the patients recruited into the study and adapting double-blinding process.

The extensive data collected from the study will be analysed by the university statisticians and the results will be summarised to identify the best method of administration of tranexamic acid around the surgery. This will have a high potential to be disseminated across the medical profession as a guideline assisting to achieve best results after hip and knee replacement surgery.