Femoral and tibial cementless fixation neither increases blood loss nor impedes early functional recovery: A randomized controlled trial

Abstract

BackgroundWhether cementless fixation on femoral and tibial components increases blood loss during total knee arthroplasty (TKA) is unclear. The purpose of this randomized controlled trial was to compare blood loss and early functional recovery between patients who underwent cementless or cemented TKA.MethodsBetween November 2021 and April 2022, sixty-one eligible patients at our medical center were randomized to cementless and cemented group. The primary outcome was total blood loss (TBL). Secondary outcomes were drainage, knee swelling, anemia, transfusion, hematological indicators, early functional recovery, and postoperative complications. The early functional recovery included range of motion (ROM), Hospital for Special Surgery (HSS) score, walking distance.ResultsA total of 61 patients were analyzed, of whom 30 underwent cementless fixation. On postoperative day 1, the mean TBL was 394.39 ml (SD 182.97 ml) in the cementless group and 382.41 ml (SD 208.67 ml) in the cemented group (P = 0.863). By postoperative day 3, the corresponding mean TBL was higher at 593.48 ml (SD 230.04 ml) and 603.80 ml (SD 213.16 ml) (P = 0.751). The two groups did not differ significantly in drainage, knee swelling, anemia, levels of hemoglobin or hematocrit or platelets, ROM, HSS score, walking distance, or rates of transfusion or postoperative complications.ConclusionsCementless fixation on femoral and tibial components during TKA does not increase blood loss or impede early functional recovery, which suggests that clinicians need not worry about blood loss and early functional recovery when deciding what type of fixation to perform during TKA.Trial registrationNumber: ChiCTR2100052857; Date: November 6, 2021.

Cementless Total Knee Arthroplasty

“…However, the literature on intraoperative and perioperative blood loss has been inconsistent. Some studies show no difference 118,128,129 while others suggest higher blood loss with cementless TKAs 130,131 . It is thought that cementation may tamponade bleeding 44 .…”

No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study

“…Studies involving early-generation porous-coated anatomic TKA, patients aged 55 years or younger, and simultaneous cemented and cementless TKA in the same patient for both knees have also indicated higher blood loss with cementless TKA [ 13 , 14 , 15 , 21 ]. However, recent studies using newer-generation cementless prostheses have reported comparable blood loss to cemented TKA in terms of drainage volume [ 22 ], estimated blood loss [ 18 , 23 ], and intraoperative bleeding [ 24 ]. On the other hand, one study using a modern cementless prosthesis estimated more intra-articular bleeding with cementless TKA based on the difference in drain reduction after tranexamic acid application.…”

“…This different result can be attributed to differences in PBM protocol, such as the dose/route of TXA administration, presence of drain clamping, and transfusion trigger. In addition, advancements in prostheses and surgical techniques may have contributed to these outcomes [ 17 , 18 ]. We demonstrate that SB TKA with newer-generation cementless implant did not increase blood loss nor transfusion rate in patients receiving contemporary strict PBM.…”

“…Recently, strict patient blood management (PBM) protocols have been implemented to reduce blood loss and transfusion rates after surgical procedures such as TKA [ 12 , 16 ]. Interestingly, recent studies that implemented PBM protocols showed similar post-TKA blood loss and transfusion rates between cementless and cemented TKA in patients who underwent unilateral TKA [ 17 , 18 ]. However, there is a lack of data regarding staggered bilateral (SB) cementless TKA.…”