Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

Abstract

Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

Mortality and morbidity in non‐transfusable and transfusable patients: A systematic review and meta‐analysis

“…The number of patients in the non‐transfusable cohort ranged from four to 322, and from 14 to 136,326 in the transfusable cohort. The most common clinical setting studied was cardiac surgery ( n = 16), 14,18,22,25,29,34,37,38,42–45,48–50,52 followed by orthopedic surgery ( n = 8) 17,20,27,28,33,40,53,54 and urology ( n = 4) 16,26,31,35 . Other disciplines included in our systematic review were obstetrics and gynecology, hematology, critical care, internal medicine, cardiology, and trauma.…”

“…Data on acute myocardial infarction were available from 16 studies 14,17,18,23,24,26,29,37,38,42,44,47,49,50,52,54 . Two studies reported significantly lower acute myocardial infarction events in non‐transfusable patients 42,47 .…”

“…Two studies reported significantly lower acute myocardial infarction events in non‐transfusable patients 42,47 . The remaining 14 reported no statistically significant differences between groups 14,17,18,23,24,26,29,37,38,44,49,50,52,54 . Seven studies of moderate risk of bias were included in the meta‐analysis for acute myocardial infarction 18,24,29,38,42,47,52 .…”

“…Seventeen studies reported length of hospital stay outcomes as either means or medians 14,21,23–26,30,33,35,38,39,41,45,46,49,50,54 . Of these data were available for mean and standard deviation length of hospital stay from eight studies 24–26,38,41,45,46,54 .…”

Revision Total Hip Arthroplasty in Jehovah’s Witnesses at a Public Hospital: Practical Recommendations for a Low-Resource Setting

“…Bloodless surgery protocols, developed in part to meet the needs of the JW population, are part of any contemporary arthroplasty program [5]. While several studies have reported successful outcomes of primary THA in the JW population, there remains a paucity of data on patients who undergo revision THA [6][7][8][9][10].…”