Perioperative Blood Management Strategies for Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.

Patient blood management in orthopedic surgery

“…Вместе с тем метаанализ показал, что предоперационное назначение пероральных препаратов железа в ортопедии позволяет повысить концентрацию гемоглобина, но не сопровождается статистически значимым снижением частоты и объема гемотрансфузии [22]. Основным недостатком пероральных препаратов железа является ограниченная абсорбция микроэлемента из кишечника, особенно при АХВ [12,23]. Таким образом, положительный эффект от назначения пероральных препаратов железа можно ожидать, если пациент не имеет противопоказаний к их приему, лечение начинается минимум за 4-6 нед до операции, лекарственный препарат хорошо переносится и можно назначать максимальные дозы, отсутствуют активное кровотечение или воспалительный процесс [12,17].…”

“…Эритропоэтин (ЭПО) широко используется для лечения различных типов анемии, в том числе для устранения предоперационной анемии в ортопедии [23]. Недавний метаанализ показал, что назначение ЭПО значительно снижает частоту и объем аллогенной гемотрансфузии и не повышает риск возникновения тромботических и других осложнений после ЭТС и ЭКС [28].…”

Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients?

“…[ 3 ] Intraoperative methods can be listed as hypotensive anesthesia, local or systemic tranexamic acid (TXA) administration, cell salvage, and tourniquet application. [ 6 , 7 ] Blood loss and consequent anemia may have several undesirable effects both on mortality and morbidity, such as prolonged length of hospital stay, difficulty in achieving rehabilitation goals, and even death. Besides, blood transfusion carries many risks, including fatal anaphylactic reactions and transmission of infectious diseases.…”

Changes of perioperative hemoglobin and hematocrit levels in patients receiving total knee arthroplasty, a prospective observational study for an optimal timing of determination

“…Total knee arthroplasty (TKA) is a successful, safe and cost-effective surgical procedure for endstaged knee arthritis to relieve pain, correct deformity and restore function [1,2]. However, TKA has long been associated with significant drop on thehemoglobin (Hb) and Hematocrit (Hct) levels because of perioperative visible and hidden blood loss, under which a blood transfusion is not uncommon in the early postoperative period thus rendering the patients at risks of transfusion reactions [3]. Several studies have highlighted the disadvantages of allogenic blood transfusion including a negative effect on postoperative complications, transfusion related issues, delayed length of hospital stay, higher cost and mortality [4][5][6].…”