Tranexamic Acid in Lower Extremity Endoprosthetic Reconstruction for Oncologic Indications: A Retrospective Comparative Study of 617 Patients

BACKGROUND AND OBJECTIVES: While tranexamic acid (TXA) reduces blood loss in orthopedic surgery, thromboembolic concerns in cancer patients have limited adoption in orthopedic oncology. This study evaluated TXA efficacy and safety in patients undergoing endoprosthetic reconstruction for oncologic indications. METHODS: This retrospective single-center study included 617 patients who underwent lower extremity endoprosthetic reconstruction for oncologic indications between 2000 and 2024. Patients were stratified by perioperative TXA administration (n = 166) versus no TXA (n = 451). The primary outcome was perioperative blood loss calculated using the Mercuriali method. Secondary outcomes included perioperative packed red blood cells (pRBC) transfusion, hospital length of stay, and 90-day venous thromboembolic (VTE) complications. RESULTS: TXA was associated with a 429 mL reduction in calculated perioperative blood loss (1878 ± 1168 mL vs. 2307 ± 1442 mL; p = 0.003). TXA was not associated with reduced intraoperative pRBC transfusion rates (31% vs. 33%; RR 0.96 [95% CI: 0.74-1.25], p = 0.752) but was associated with significantly reduced postoperative transfusion requirements (17% vs. 30%; RR 0.56 [95% CI: 0.39-0.81], p = 0.003). No significant differences existed in 90-day VTE complications, reoperation rates, or mortality. CONCLUSIONS: Perioperative TXA use was associated with reduced blood loss and postoperative transfusion requirements without a detectable increase in thromboembolic complications, supporting TXA as a beneficial adjunct in musculoskeletal oncology limb salvage procedures.