{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:29:34Z","timestamp":1793773774734,"version":"4.6.1"},"reference-count":20,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIP International"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>This study applied the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to evaluate the statistical fragility of outcomes reported in RCTs evaluating TXA against a saline control in total hip arthroplasty (THA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>PubMed, Embase, and MEDLINE were searched for RCTs on TXA in THA compared to a saline control. FI and rFI were calculated for dichotomous outcomes, representing the number of outcome reversals required to alter significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      32 studies were included. Across 69 total outcomes, the median FI was 3.0 (IQR 2.0\u20136.0) with an associated median FQ of 0.031 (IQR 0.020\u20130.053), suggesting that 3 outcome event reversals would alter significance for 50% of all outcomes. 18 outcomes were statistically significant, with a median FI of 3.0 (IQR 1.0\u20135.0) and a median FQ of 0.026 (IQR 0.017\u20130.036). 51 outcomes were non-significant, with a median rFI of 4.0 (IQR 2.5\u20137.0) and a median FQ of 0.032 (IQR 0.020\u20130.066). Results designated as primary outcomes were more fragile (median FQ\u2009=\u20090.025,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200920) than non-primary outcomes (median FQ\u2009=\u20090.032,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200949).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      The efficacy of TXA use during THA from RCTs is statistically fragile, particularly among significant outcomes and those related to blood or platelet transfusion rates. We recommend combined reporting of\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      -values with FI and FQ metrics to help interpret clinical findings in RCT involving TXA use during THA.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11207000261442088","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T06:57:02Z","timestamp":1779346622000},"page":"964-971","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The statistical fragility of randomised controlled trials evaluating tranexamic acid against a saline control in total hip arthroplasty"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5715-4778","authenticated-orcid":false,"given":"Christoph A","family":"Schroen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"},{"name":"Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas H","family":"Koehne","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1624-9176","authenticated-orcid":false,"given":"Auston R","family":"Locke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyn Y","family":"Dawes","sequence":"additional","affiliation":[{"name":"Dartmouth College, Hanover, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel C","family":"Frohlich","sequence":"additional","affiliation":[{"name":"Dartmouth College, Hanover, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avanish","family":"Yendluri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikan K","family":"Namiri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J","family":"Corvi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L","family":"Parisien","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.01617"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-015-0188-6"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13348"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-200011000-00014"},{"key":"e_1_3_2_6_2","article-title":"The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis","volume":"33","author":"Fillingham YA","year":"2018","unstructured":"Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. J Arthroplasty 2018; 33: 3083\u20133089.e4.","journal-title":"J Arthroplasty"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000463"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001787"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001159"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0204551"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.00638"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.15960"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07188-9"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/15589447251315750"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.8689"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237879"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2024.11.014"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.03.032"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.97B7.35029"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2019.06.018"},{"key":"e_1_3_2_21_2","first-page":"47","article-title":"Efficacy and safety of the topical application of tranexamic acid in primary cementless hip arthroplasty: prospective, randomised, double-blind and controlled study","volume":"62","author":"Tavares S\u00e1nchez-Monge FJ","year":"2018","unstructured":"Tavares S\u00e1nchez-Monge FJ, Aguado Maestro I, Ba\u00f1uelos D\u00edaz A, et al. Efficacy and safety of the topical application of tranexamic acid in primary cementless hip arthroplasty: prospective, randomised, double-blind and controlled study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62: 47\u201354.","journal-title":"Rev Esp Cir Ortop Traumatol (Engl Ed)"}],"container-title":["HIP International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11207000261442088","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11207000261442088","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11207000261442088","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:21:33Z","timestamp":1793773293000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11207000261442088"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/11207000261442088"],"URL":"https:\/\/doi.org\/10.1177\/11207000261442088","relation":{},"ISSN":["1120-7000","1724-6067"],"issn-type":[{"value":"1120-7000","type":"print"},{"value":"1724-6067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]}}}