Blood Transfusion can be Avoided in Single-Anesthetic Bilateral Total Knee Arthroplasty

Cherian, Nathan; Hanish, Stefan; Ohnoutka, Cole; Keeney, James A.

doi:10.1016/j.arth.2022.05.003

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…In a retrospective single-center study in 475 patients undergoing single-anesthetic bilateral TKA from 2016 to 2019 with routine TXA administration, 22% of patients without a predeposit required an allogeneic transfusion 6 . Another retrospective single-center study had an allogeneic blood transfusion rate of 0% in 125 patients undergoing single-anesthetic bilateral TKA from 2015 to 2021 who routinely received TXA and had a preoperative hemoglobin level of >11.0 g/dL 7 . The results of our retrospective single-surgeon study add information about the clinical impact of predepositing autologous blood in patients undergoing single-anesthetic bilateral TKA in the setting of modern blood-conservation strategies.…”

Section: Discussionmentioning

confidence: 99%

“…It is notable that these rates of allogeneic transfusion were unacceptably high in both studies compared with recent studies despite using predeposit autologous transfusions 3,14 . Recent studies in which perioperative routine TXA use has become common have not had such high rates of allogeneic blood transfusion [5][6][7] . A retrospective multicenter study had an allogeneic transfusion rate of 29% in singleanesthetic bilateral TKA performed from 2013 to 2016 and showed that both the use of a drain and the use of a pneumatic tourniquet were independent risk factors for transfusion 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior to data collection, a sample size of 117 participants per group was calculated based on a noninferiority margin of 10 percentage points, 4% of patients with a predeposit requiring allogeneic transfusion, 6% of patients without a predeposit requiring allogeneic transfusion, a 1-sided alpha level of 0.025, and 80% power. We determined the noninferiority margin and the expected allogeneic transfusion rate for each group based on a consensus among a panel of researchers who reviewed studies assessing the allogeneic transfusion rate during the perioperative period in patients undergoing single-anesthetic bilateral TKA 3,5-7,14 . Two previous studies including patients who underwent single-anesthetic bilateral TKA had differences in allogeneic transfusion rates between patients without and with predeposited autologous blood transfusion of 39% 3 and 31% to 71% 14 .…”

Section: Methodsmentioning

confidence: 99%

“…voiding allogeneic blood transfusion in the perioperative period is crucial in patients undergoing total knee arthroplasty (TKA) because allogeneic transfusion is associated with the occurrence of adverse events, including periprosthetic infection, graft-versus-host disease, acute lung injury, hemolytic transfusion reaction, and deep vein thrombosis (DVT) 1,2 . Although the majority of patients undergoing singleanesthetic bilateral TKA required allogeneic transfusion in the early 2000s 3 , recent advances in blood management have markedly reduced the number of patients requiring such transfusions [4][5][6][7] .…”

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confidence: 99%

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Predeposited Autologous Blood Transfusion in Single-Anesthetic Bilateral Total Knee Arthroplasty with Modern Blood Conservation Strategy

Tsukada

Wakui²,

Kurosaka

et al. 2023

JBJS Open Access

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Background:This study was performed to examine the hypothesis that the rate of allogeneic blood transfusion in patients who did not predeposit an autologous blood transfusion before single-anesthetic bilateral total knee arthroplasty (TKA) would be noninferior to that in patients who did predeposit blood.Methods:We assessed the number of allogeneic transfusions required in 338 patients undergoing single-anesthetic bilateral TKA with a preoperative hemoglobin level of ≥11.0 g/dL. All TKAs were performed by a single surgeon according to the same operative and postoperative protocol. All patients received a combination of intravenous and intra-articular tranexamic acid. Neither a pneumonic tourniquet nor a drain was used. The difference in the risk of allogeneic transfusion between patients without and with autologous blood predeposit was compared with a noninferiority margin of 10 percentage points.Results:Allogeneic transfusion was required in 1 (0.5%) of 194 patients who predeposited autologous blood and 3 (2.1%) of 144 patients who did not predeposit blood. The difference in risk was −1.6 percentage points (95% confidence interval, −4.1 to 1.0 percentage points); the confidence interval did not include the noninferiority margin and included zero.Conclusions:In single-anesthetic bilateral TKA, allogeneic transfusion requirements in patients who did not predeposit autologous blood were noninferior to those in patients who predeposited blood.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Predeposited Autologous Blood Transfusion in Single-Anesthetic Bilateral Total Knee Arthroplasty with Modern Blood Conservation Strategy

Tsukada

Wakui²,

Kurosaka

et al. 2023

JBJS Open Access

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show abstract

“…For Hb progression, Cherian et al proved only a preoperative different level. Postoperative Hb levels and blood transfusion rates from 76 women and 49 men were equal after total knee arthroplasty [ 23 ]. On the other hand, Guler et al 2022 showed a significantly different Hb drop in men to women, but the groups were small and only ages 57–79 years were included.…”

Section: Discussionmentioning

confidence: 99%

Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty

Koettnitz¹,

Migliorini

Peterlein³

et al. 2023

BMC Musculoskelet Disord

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Introduction Total hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA. Methods Data from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28. Results There was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA. Conclusion Perioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.

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Analysis of gender differences with traditional posterior stabilized versus kinematic designs in total knee arthroplasty

Koettnitz¹,

Tigges²,

Migliorini

et al. 2023

Arch Orthop Trauma Surg

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Introduction Total knee arthroplasty (TKA) is a good treatment for end-stage knee osteoarthritis (KOA). Approximately 60% of the patients are females, and 40% are males. This study analyzed pre- and postoperative angle differences in the range of motion (ROM), and the occurrence of complications with traditional posterior stabilization versus kinematic TKA in relation to gender. Methods Data from 434 patients with primary cemented total knee arthroplasty from 2018 to 2021 were collected. Alpha and beta angles were determined pre- and postsurgery. The ROM was collected pre- and postoperatively and during follow-up. Additionally, perioperative complications, revision rate, and blood transfusion management were investigated. Results The pre- and postoperative alpha-angle between men and women was significantly different, as was the level of alpha-angle correction between men and women (p = 0.001; p = 0.003). Same-gender differences in pre- to postoperative alpha-angles between traditional and kinematic TKA were shown (women (w): p = 0.001; men (m); p = 0.042). High postoperative alpha angles led to less ROM in traditional TKA for women (p = 0.008). No significant gender differences in ROM, perioperative complications, or revision surgery and transfusion rates were found. Conclusion Despite high gender differences in pre- and postoperative angles, only female patients with traditional arthroplasty and high postoperative alpha angles showed less ROM in the follow-up. This leads to the assumption that gender-related pre- and postoperative angle differences, and the degree of angle correction, do not influence the ROM or perioperative occurrence of complications. Both designs present safe procedures for both genders with a wide spectrum of axis deformities.

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Blood Transfusion can be Avoided in Single-Anesthetic Bilateral Total Knee Arthroplasty

Cited by 3 publications

References 31 publications

Predeposited Autologous Blood Transfusion in Single-Anesthetic Bilateral Total Knee Arthroplasty with Modern Blood Conservation Strategy

Predeposited Autologous Blood Transfusion in Single-Anesthetic Bilateral Total Knee Arthroplasty with Modern Blood Conservation Strategy

Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty

Analysis of gender differences with traditional posterior stabilized versus kinematic designs in total knee arthroplasty

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