Tranexamic acid combined with fluid gelatin in perioperative blood loss management of total hip arthroplasty for elderly femoral neck fractures: a single-center retrospective analysis

Objective Tranexamic acid (TXA) and fluid gelatin (FG) are widely used to reduce perioperative blood loss in total hip arthroplasty (THA). However, the efficacy of single-method hemostatic strategies is increasingly insufficient for meeting clinical demands. The aim of this study was to evaluate the efficacy of TXA in combination with FG for perioperative blood management. Methods This retrospective study enrolled 301 patients with unilateral femoral neck fractures who underwent minimally invasive piriformis approach total hip arthroplasty (between 2019 and 2023) and received hemostatics. Patients were divided into TXA ( n = 93), FG ( n = 102), and TXA + FG ( n = 106) groups. A control group ( n = 107) with the same inclusion/exclusion criteria was selected. Collected data included demographic characteristics, fracture classification, perioperative clinical parameters, and laboratory findings. The primary and secondary outcome measures included total blood loss (TBL), visible blood loss, hidden blood loss, postoperative hemoglobin and hematocrit levels, blood transfusion, and postoperative complications. Results The clinical results of 408 patients indicated that the combination of TXA and FG significantly reduced perioperative blood loss in THA via MIS-TPA (550.68 ± 327.61 mL in the TXA + FG group, 732.50 ± 362.84 mL in the TXA group, 817.19 ± 375.46 mL in the FG group, and 982.99 ± 428.81 mL in the control group; p < 0.001) without an increase in thromboembolic events or wound-related complications. Conclusion Combined intravenous TXA and intra-articular FG administration provided superior perioperative blood loss control and did not increase the rate of complications.