Identifying the period of greatest blood loss after lower limb arthroplasty

Abstract

BackgroundThe use of tranexamic acid (TXA) in total hip replacement (THR) typically reduces blood loss by approximately 400 mL, and typical total blood loss is still approximately 1 L. A barrier to harnessing the full potential of TXA is disagreement on the optimum timing of administration. To address this, we aimed to identify the period of greatest blood loss.MethodsWe analyzed the perioperative data of 870 patients who had undergone THR, total knee replacement, or unicompartmental knee replacement just before the introduction of TXA to our unit. Total blood loss was calculated on postoperative day (POD) 1 and POD2 using an equation based on change in hematocrit.ResultsAverage total blood loss at POD2 was 1505, 1322, and 611 mL for THR, total knee replacement, and unicompartmental knee replacement, respectively. Between 86% and 96% of this blood loss occurred in the period between skin closure and POD1. Intraoperative loss did not correlate with total loss at POD2. Blood transfusion was more likely if the patient was female (odds ratio [OR], 6.8) or if they had preoperative anemia (OR, 8.3) than if there was a high-volume blood loss (OR, 1.6).ConclusionsApproximately 90% of blood loss occurs between skin closure and the first postoperative 24 hours. “Intraoperative blood loss” and “transfusion rate” are not reliable markers of total blood loss. The full potential of TXA could be harnessed by using it during the period of greatest blood loss, that is, during the first postoperative 24 hours.

Rapidly Progressive Osteoarthritis and Acetabular Bone Loss Outcomes for Patients Undergoing Primary Total Hip Replacement

“…The rate of blood transfusion within this cohort was much higher than would be expected today with 38% of patients requiring at least 1 unit of packed red cells postoperatively. Comparatively, a recent publication by Magill et al [30] in 2018 revealed a transfusion rate of 12.5% in 393 patients undergoing THA under the care of the senior author. It is important to note that the rate of transfusion after THA was historically much higher over the past decade than that in the present day.…”

Do patients with von Willebrand disease exhibit higher blood loss and revision rates in hip and knee arthroplasty? A case‐control study

“…In contrast, in another large series, knee arthroplasty has been shown to be associated with higher volume of blood loss . While tourniquet use is expected to decrease the amount of bleeding in knee surgery, in fact, 90% of the bleeding in the perioperative period has been shown to be between the skin closure and the postoperative first day . Therefore, we think that the presence of a joint capsule that restricts bleeding in the knee, or the incision made between large muscle groups in the hip joint, potentially influences the amount of blood.…”

Short-term outcomes of total knee arthroplasty performed with and without a tourniquet

“…Patients were encouraged to move the surgical limb immediately and formal physiotherapy-led rehabilitation was commenced on the first post-operative day up until and including the discharge day. Blood loss was estimated using the following method [ 17 ]:…”