Objective The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO). Methods PubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software. Results A total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] − 332.74 to − 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI − 1.34 to − 0.63, P < 0.00001; POD 2 95% CI − 1.07 to − 0.68, P < 0.00001; POD 5 95% CI − 1.46 to − 0.84, P < 0.00001), drain output (POD total 95% CI − 195.86 to − 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22). Conclusions This meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.

Osteoporosis-induced impaired bone regeneration would result in compromised osseointegration of hydroxyapatite-coated titanium and high rate of implant failure. Local administration of aspirin promotes osteoblast proliferation and inhibits osteoclast proliferation, and positively affects bone regeneration in osteoporotic condition. We hypothesized that reduced osteogenesis may account for poor osseointegration of hydroxyapatite-coated titanium which could be ameliorated by using local aspirin. The aim of this study was to confirm the effect of the local incorporation of aspirin into hydroxyapatite-coated titanium implants in the osteoporotic and normal condition. Twelve-week-old female Sprague–Dawley rats were used for this study. Twelve weeks after bilateral ovariectomy, all animals were randomly divided into three groups: group Sham, group OVX and group OVX + ASP, and the rats from OVX and Sham received hydroxyapatite-coated implants and animals belong to group OVX + ASP received aspirin-hydroxyapatite-coated implants until death at 12 weeks, respectively. After 12-week healing period, local treatment with aspirin revealed improved osseointegration compared to OVX, with significant improvement of the bone area ratio and bone-to-implant contact in histomorphometry, the bone mass and trabecular architecture in micro-CT evaluation, and the maximal push-out force in push out test. Moreover, group OVX + ASP presented the strongest effect on Jagged1, Notch1, and Hes-1(P < 0.05). These results demonstrated that local administration of aspirin could enhance hydroxyapatite-coated titanium implant osseointegration in OVX rats by activation Wnt signaling pathway to improve implant fixation in osteoporotic bone.

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