Reducing blood loss after total knee replacement

Abstract

Blood loss during total knee replacement (TKR) remains a significant concern. In this study, 114 patients underwent TKR, and were divided into two groups based on whether they received a new generation fibrin sealant intra-operatively, or a local infiltration containing adrenaline. Groups were then compared for mean calculated total blood volume (TBV) loss, transfusion rates, and knee range of movement. Mean TBV loss was similar between groups: fibrin sealant mean was 705 ml (281 to 1744), local adrenaline mean was 712 ml (261 to 2308) (p = 0.929). Overall, significantly fewer units of blood were transfused in the fibrin sealant group (seven units) compared with the local adrenaline group (15 units) (p = 0.0479). Per patient transfused, significantly fewer units of blood were transfused in the fibrin sealant group (1.0 units) compared with the local adrenaline group (1.67 units) (p = 0.027), suggesting that the fibrin sealant may reduce the need for multiple unit transfusions. Knee range of movement was similar between groups. From our results, it appears that application of this newer fibrin sealant results in blood loss and transfusion rates that are low and similar to previously applied fibrin sealants.

Estudo prospectivo sobre o impacto do uso do selante de fibrina humano livre de agentes estabilizadores de coágulo na artroplastia total de joelho

“…Reinhardt et al 13 observed that the total blood loss was similar in a retrospective cohort of 114 patients submitted to TKA, in which 1 group received the topical fibrin sealant (Evicel), and another group was submitted to a local infiltration containing epinephrine. Considering that local periarticular epinephrine injection reduces bleeding rates after TKA, the use of fibrin sealant may be considered effective.…”

Medical and Economic Advantages of Postoperative Blood Salvage in Total Knee Replacement

“…Od krycie cho rób prze no szo nych przez krew zwró ci ło większą uwa gę na po wi kła nia trans fu zji, po pu la ry zu jąc me to dy al ter na tyw ne [6,18]. Część z nich zo sta ła dokład nie zwe ry fi ko wana [4,10,[14][15][16][17][18][19]. Au to trans fu zja krwi po bie ra nej przed za bie giem, po mi mo efek tywno ści wy ma ga wcze śniej sze go za pla no wa nia i czę sto po ope ra cji oka zu je się zbęd na [18,20,21].…”

“…The discovery of blood-borne diseases drew more attention to complications of blood transfusion and the popularity of alternative methods grew [6,18]. Some of those alternative solutions have been thorou ghly verified [4,10,[14][15][16][17][18][19]. Auto transfu sion of blood collected from the patient before sur gery, although effective, requires prior plan ning and, after surgery, it often turns out to be unne ces sary [18,20,21].…”

Comparison of blood loss between intra-articular and intra-venous administration of tranexamic acid in primary total knee arthroplasty

“…Despite that advancements in fixation and design techniques of implants have substantially increased functional results and survival rates of total knee arthroplasty (TKA), during the procedure loss of blood is a major concern that is perioperatively estimated to be 850-1600 mL [1]. During TKA, Patient's recovery may be affected negatively by blood loss.…”