Evidence map›Paper›PMID 39881376›Full record

ArticleJournal of orthopaedic surgery and research2025

From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty.

Robin M Pfister, Benjamin F Pfister, Ronald L Hager, Nathan Sandholtz, Daniel Abulafia, David Bradshaw

Abstract read
In one paragraph

Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Robin M PfisterHunter New England Health District, New Lambton Heights, NSW, 2305, Australia. robinpfister95@gmail.com.
Benjamin F PfisterCentral Coast Local Health District, Gosford, NSW, 2295, Australia.
Ronald L HagerDepartment of Exercise Sciences, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA.
Nathan SandholtzDepartment of Statistics, College of Computational, Mathematical, and Physical Sciences, Brigham Young University, Provo, UT, 84602, USA.
Daniel AbulafiaCentral Coast Local Health District, Gosford, NSW, 2295, Australia.
David BradshawCentral Coast Local Health District, Gosford, NSW, 2295, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe use of intravenous tranexamic acid (TXA), an antifibrinolytic agent, has been shown to effectively reduce total blood loss and transfusion rates in total knee arthroplasty (TKA). The aim of this paper is to evaluate the implementation lag and clinical uptake of the use of TXA for primary TKA after publication of two landmark studies. Additionally, it assessed the efficacy of TXA use in TKA in reducing post-operative blood transfusions and hospital length of stay (LOS).

methodsA total of 763 patients aged over 18 years of age underwent primary TKA at a level 4 metropolitan hospital in Australia between January 2011 and December 2017. Primary outcome measure was use of TXA at operative induction. Secondary outcome measures were post-operative blood transfusion, haemoglobin levels and in-hospital length of stay.

resultsThe rate of TXA uptake was ≥ 50% by April-June 2013, 1.5 years following landmark paper publication. TXA use was ≥ 90% by April-June 2015, equating to 3.5 years after landmark publication. For each additional year since publication, the odds that TXA was used in a TKA surgery increased by 254.3%, 95% CI (confidence interval) [195.2%, 334.1%]. There was a negative association between TXA use and blood transfusion rate (p < 0.001), while controlling for other variables. TXA use reduced the odds of blood transfusions occurring by 73.5%, 95% CI [35.8% and 89.8%]. Analysis showed that reduced LOS was seen even after controlling for post-operative blood transfusion (p < 0.05).

conclusionThe implementation lag from research to clinical practice, using ≥ 90% TXA use in TKA as a proxy, was 3.5 years. The use of TXA reduced LOS and blood transfusion rate in TKA patients.

Indexed as

Antifibrinolytic AgentsArthroplasty, Replacement, KneeBlood Loss, SurgicalTranexamic AcidAgedAged, 80 and overAustraliaBlood TransfusionFemaleHumansLength of StayMaleMiddle AgedAntifibrinolytic AgentsTranexamic AcidClinical uptakeEvidence based medicineImplementation lagTotal knee arthroplastyTranexamic acid

Identifiers

PMID39881376
PMCPMC11780759

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.