A Randomized Controlled Trial Examining the Effects of Extended Oral Tranexamic Acid on Postoperative Pain and Range of Motion Following Total Knee Arthroplasty
In brief
Three days of oral tranexamic acid adds no measurable benefit after knee replacement
In this randomized trial of 86 patients, adding oral tranexamic acid for three days after knee replacement did not improve pain, knee motion, opioid use, or walking compared with placebo through 12 weeks. All patients received intravenous tranexamic acid, so the findings address the added oral course; its routine use after primary knee replacement may not be warranted.
- Journal
- The Journal of arthroplasty (Q1)
- Published
- 2 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Matthew J Grosso, Gina Panek, Czarina Weinz, Alexander K Hahn, Jordan A Bauer
- PMID
- 42971442
- DOI
- 10.1016/j.arth.2026.10.034
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 3 November 2026): Randomized trial finds no added functional benefit from extended oral
Abstract
BACKGROUND: The implementation of perioperative intravenous tranexamic acid (TXA) protocols in total knee arthroplasty (TKA) has led to improved outcomes related to decreased blood loss and decreased transfusion rates. A recent randomized controlled trial (RCT) demonstrated that there may be additional benefits to extended oral TXA (EOTXA) for improving pain and function in the early postoperative period. In this double-blind RCT, we examined the effects of EOTXA following primary TKA on postoperative pain, range of motion (ROM), opioid usage, and ambulation status. METHODS: There were 86 patients undergoing primary total knee arthroplasty randomized to two groups: EOTXA versus placebo. All patients received one gram of intravenous TXA prior to incision and in the postoperative recovery area. Patients in the EOTXA group (n = 43) received 1.95 grams of oral TXA daily from postoperative day one through POD three. The primary outcome in this study was the visual analog scale (VAS) pain score in the three-month postoperative period. The secondary outcomes included ROM, ambulation status (assistive device usage), and opioid consumption. RESULTS: There was no statistically significant difference in VAS pain scores at any time point: POD one Placebo 4.7 versus EOTXA 5.4 (P = 0.16); POD two 4.1 versus 4.4 (P = 0.33); POD three 3.7 versus 4.0 (P = 0.49); POD7 3.6 versus 3.7 (P = 0.66); two weeks 3.0 versus 2.8 (P = 0.63); six weeks 2.2 versus 1.8 (P = 0.22); and 12 weeks 1.2 versus 1.1 (P = 0.86). In addition, there were no significant differences in ROM, daily opioid consumption, and ambulation status at two, six, and 12 weeks postoperatively (P > 0.10). CONCLUSIONS: In the largest RCT to date, this study found no significant difference in pain scores, opioid consumption, functional outcomes, or ambulation status with the addition of extended oral TXA following primary TKA. Based on these results, broad utilization of this protocol in primary TKA may not be warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.