Intraoperative Nonpharmacotherapeutic Blood Management Strategies in Total Knee Arthroplasty

Abstract

Substantial amounts of perioperative blood loss occur during total knee arthroplasty (TKA) that may require allogeneic transfusion in more than 30% of patients. Increased blood loss leads to poor physical functioning, increases infection risks, and prolongs hospitalization, which may eventually affect the overall clinical outcomes of TKA. In addition, allogeneic blood transfusions are associated with increased risks of transfusion reactions, immunosuppression, and a variety of immunological reactions. These concerns have led surgeons and anesthesiologists to develop various strategies to conserve blood, reduce costs, and decrease complications related to blood transfusions. Multiple nonpharmacologic intraoperative blood-saving measures have been used including acute normovolemic hemodilution, hypotensive anesthesia, tourniquets, bipolar sealants, intraoperative blood salvage systems, intramedullary femoral plugs, computer-assisted surgery, and the use of patient-specific instrumentation. However, no clear protocol exists currently to help surgeons choose the appropriate method for blood preservation. The aim of this article was to review the various nonpharmacologic intraoperative blood management strategies that have been used in TKA and to analyze their effectiveness and potential complications according to current evidence.

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

“…Despite this, the overall blood loss in the tranexamic acid group was 35% less than that in the control group. This was because most bleeding after arthroplasty tends to occur during the first 24 hours12345).…”

“…Total knee arthroplasty (TKA) is one of the most successful orthopedic surgeries in relieving pain and restoring joint function in end-stage osteoarthritis, either degenerative or secondary to inflammatory arthritis, trauma, tumors, or infection around the knee joint12345). However, the surgery is accompanied by an unavoidable risk of bleeding and subsequent requirement of blood transfusion123).…”

“…However, the surgery is accompanied by an unavoidable risk of bleeding and subsequent requirement of blood transfusion123). Transfusion of blood products is not a benign procedure and is associated with many possible risks such as infection, acute systemic reactions, and death4).…”

A non-randomized prospective study of the blood sparing effect of tranexamic acid in total knee replacement

“…TKA surgery has been shown to have significant blood loss that sometimes requires blood transfusions. [2][3][4] In some studies, transfusion rate after TKA has been as high as 30%. 3 Several techniques are available to minimize the likelihood of allogenic blood transfusion following total knee arthroplasties.…”

“…[2][3][4] In some studies, transfusion rate after TKA has been as high as 30%. 3 Several techniques are available to minimize the likelihood of allogenic blood transfusion following total knee arthroplasties. These techniques include autologous blood transfusion, hypotensive anesthesia, and perioperative blood salvage.…”