Predeposited Autologous Blood Transfusion in Single-Anesthetic Bilateral Total Knee Arthroplasty with Modern Blood Conservation Strategy

Abstract

Background:This study was performed to examine the hypothesis that the rate of allogeneic blood transfusion in patients who did not predeposit an autologous blood transfusion before single-anesthetic bilateral total knee arthroplasty (TKA) would be noninferior to that in patients who did predeposit blood.Methods:We assessed the number of allogeneic transfusions required in 338 patients undergoing single-anesthetic bilateral TKA with a preoperative hemoglobin level of ≥11.0 g/dL. All TKAs were performed by a single surgeon according to the same operative and postoperative protocol. All patients received a combination of intravenous and intra-articular tranexamic acid. Neither a pneumonic tourniquet nor a drain was used. The difference in the risk of allogeneic transfusion between patients without and with autologous blood predeposit was compared with a noninferiority margin of 10 percentage points.Results:Allogeneic transfusion was required in 1 (0.5%) of 194 patients who predeposited autologous blood and 3 (2.1%) of 144 patients who did not predeposit blood. The difference in risk was −1.6 percentage points (95% confidence interval, −4.1 to 1.0 percentage points); the confidence interval did not include the noninferiority margin and included zero.Conclusions:In single-anesthetic bilateral TKA, allogeneic transfusion requirements in patients who did not predeposit autologous blood were noninferior to those in patients who predeposited blood.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The necessity of suction drainage when intra-articular injection of tranexamic acid is used during primary total knee arthroplasty: a retrospective study

“…Concerning the use of ABT, it reportedly decreased transfusion rates compared with closed suction drainage but showed no difference in terms of postoperative Hb drop [ 27 , 28 ]. Although Tsukada et al stated that there was no need for ABT even in single-anesthetic bilateral TKA [ 29 ], Tomura et al reported that the perioperative Hb change was relatively small with ABT and the transfusion rate was 1%, suggesting that the cost-effectiveness of this method is debatable but nevertheless beneficial [ 30 ].…”