Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors

Abstract

BackgroundTotal knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively.Material and methodsThree hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors.ResultsTotal blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban.ConclusionsPosterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.

Is tranexamic acid effective on hidden blood loss in patients during total knee arthroplasty?

“…Total blood loss for patients with osteoarthritis undergoing primary TKA ranges in between 1,300 to 1,500 mL. [ 6 , 7 , 12 ] Most of the patients are in old age with several co-morbidities. Their cardiovascular system may not tolerate such amount of blood loss and complications may arise.…”

“…[ 6 ] Blood loss can be replaced by allogenic blood transfusions while this method has risks such as longer hospital stay, infection disease transmission, immunologic reaction, hemolytic and anaphylactic reactions, and increased mortality. [ 12 ]…”

“…[ 6 ] In their study which included 78 patients with primary osteoarthritis undergoing TKA, Iwai et al[ 13 ] reported that the mean estimated TBL volume was 1,538 mL and the mean volume of hidden blood loss was 548 mL. Hu et al[ 12 ] included 304 osteoarthritis patients undergoing unilateral primary TKA in their prospective study and indicated that TBL was 1,346±671 mL and hidden blood loss was 465±358 mL. As hidden blood loss is 35 to 50% of TBL, it has clinical importance and the volume of hidden blood loss needs to be estimated and strategies reducing hidden blood loss volume are required for postoperative blood management.…”

“…The results of the current study were compatible with the results published in the literature. [ 5 , 8 , 9 , 12 ]…”

Ultrasound-Accelerated Thrombolysis in High-Risk Perioperative Pulmonary Embolism: Two Case Reports and Review of Literature

“…The perioperative period itself is associated with severe bleeding complications. After knee arthroplasty, signi cant blood loss frequently occurs during the postoperative period, with the highest values at POD 3 [28]. Major liver surgery is associated with severe complications not only due to the surgical site, but also because the impaired function of the remaining liver presents an obstacle.…”