Chondrotoxic effects of tranexamic acid and povidone-iodine on the articular cartilage of rabbits

• Published in: International orthopaedics Vol. 47; no. 10; pp. 2429 - 2437
• Main Authors: Pimenta, Frederico Silva, de Oliveira Campos, Túlio Vinícius, de Abreu e Silva, Guilherme Moreira, Buzelin, Marcelo Araújo, Nunes, Cristiana Buzelin, de Andrade, Marco Antônio Percope
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2023
• Subjects: Medicine; Medicine & Public Health; Original Paper; Orthopedics; Articular cartilage; Tranexamic acid; Povidone-iodine
• DOI: 10.1007/s00264-023-05820-y
• EISSN: 1432-5195
• ISSN: 0341-2695

Purpose
To evaluate the chondrotoxic effects of intra-articular use of TXA 20 mg/kg and/or 0.35% PVPI on knee joint cartilage in an experimental model of rabbits.
Methods
Forty-four male New Zealand adult rabbits were randomly assigned to four groups (control, tranexamic acid (TXA), povidone-iodine (PVPI), and PVPI + TXA). The knee joint cartilage was accessed through an arthrotomy and exposed to physiological saline SF 0.9% (control group), TXA, PVPI, and PVPI followed by TXA. Sixty days after surgical procedure, the animals were sacrificed and osteochondral specimens of the distal femur were obtained. Histological sections of cartilage from this area were stained with hematoxylin/eosin and toluidine blue. The following cartilage parameters were evaluated by the Mankin histological/histochemical grading system: structure, cellularity, glycosaminoglycan content in the extracellular matrix, and integrity of the tidemark.
Results
The isolated use of PVPI causes statistically significant changes in cartilage cellularity (
p
-value = 0.005) and decrease glycosaminoglycan content (
p
= 0.001), whereas the isolated use of TXA decreased significantly the glycosaminoglycan content (
p
= 0.031). The sequential use of PVPI + TXA causes more pronounced alterations in the structure (
p
= 0.039) and cellularity (
p
= 0.002) and decreased content of glycosaminoglycans (
p
< 0.001) all with statistical significance.
Conclusion
Data suggest that intra-articular use of tranexamic acid 20 mg/kg and intraoperative lavage with 0.35% povidone-iodine solution for three min are toxic to the articular cartilage of the knee in an experimental in vivo study in rabbits.