Skip to main content

Advertisement

SpringerLink
Log in

Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty

  • Review Article
  • Published:
HSS Journal ®

Abstract

Background

Effective blood management strategies are a major determinant of successful outcomes after one-stage bilateral total knee arthroplasty (BTKA). Proper patient selection with preoperative optimization and intra- and postoperative interventions can reduce transfusion risk and associated morbidity in these patients.

Questions/Purposes

The purpose of this study was to evaluate intraoperative blood management modalities based on three keystone questions: (1) What is the role of the anesthesiologist?, (2) Which are the surgeon-dependent strategies?, and (3) Is there any place for pharmacologic interventions?

Methods

We searched the established electronic literature database MEDLINE. After critical appraisal, 94 studies were deemed eligible from which to draw documented evidence.

Results

A number of blood-conserving methods are currently implemented in patients undergoing one-stage BTKA. Among them, regional anesthesia, tourniquet use, and tourniquet deflation after wound closure, femoral canal sparing or femoral canal plugging, avoidance of drains, and tranexamic acid use were the intraoperative strategies with documented efficacy in blood conservation.

Conclusion

Combined proper intraoperative anesthesiologic, surgical, and pharmacologic interventions reduce blood loss and need for transfusion in BTKA patients. However, contemporary relevant literature is lacking evidence-based guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abane L, Anract P, Boisgard S, Descamps S, Courpied JP, Hamadouche M. A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: a multicentre randomised controlled trial. Bone Jt J. 2015;97-B(1):56–63. https://doi.org/10.1302/0301-620X.97B1.34440.

    Article  CAS  Google Scholar 

  2. Aggarwal AK, Singh N, Sudesh P. Topical vs intravenous tranexamic acid in reducing blood loss after bilateral total knee arthroplasty: a prospective study. J Arthroplasty. 2016;31(7):1442–8. https://doi.org/10.1016/j.arth.2015.12.033.

    Article  PubMed  Google Scholar 

  3. Ahlberg A, Eriksson O, Kjellman H. Diffusion of tranexamic acid to the joint. Acta Orthop Scand. 1976;47(5):486–8.

    Article  PubMed  CAS  Google Scholar 

  4. Aksoy Y, Altinel L, Köse KÇ. The comparison of the effects of intraoperative bleeding control and postoperative drain clamping methods on the postoperative blood loss and the need for transfusion following total knee arthroplasty. Acta Orthop Traumatol Turc. 2011;45(3):190–4.

    Article  PubMed  Google Scholar 

  5. Aktas E, Kaya AV, Deveci MA, Ozler K, Akdeniz H, Yildirim H. Polysaccharide hemostatic system reduces blood loss in high-body-mass-index patients undergoing simultaneous bilateral total knee arthroplasty. J Orthop Sci. 2012;17(4):432–6. https://doi.org/10.1007/s00776-012-0221-0.

    Article  PubMed  CAS  Google Scholar 

  6. Al-Zahid S, Davies AP. Closed suction drains, reinfusion drains or no drains in primary total knee replacement? Ann R Coll Surg Engl. 2012;94(5):347–50. https://doi.org/10.1308/003588412X13171221590098.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Anderson LA, Engel GM, Bruckner JD, Stoddard GJ, Peters CL. Reduced blood loss after total knee arthroplasty with local injection of bupivacaine and epinephrine. J Knee Surg. 2009;22(2):130–6.

    Article  PubMed  Google Scholar 

  8. Bagsby DT, Samujh CA, Vissing JL, Empson JA, Pomeroy DL, Malkani AL. Tranexamic acid decreases incidence of blood transfusion in simultaneous bilateral total knee arthroplasty. J Arthroplasty. 2015;30(12):2106–9. https://doi.org/10.1016/j.arth.2015.06.040.

    Article  PubMed  Google Scholar 

  9. Banerjee S, Issa K, Kapadia BH, et al. Intraoperative nonpharmacotherapeutic blood management strategies in total knee arthroplasty. J Knee Surg. 2013;26(6):387–93. https://doi.org/10.1055/s-0033-1353993.

    Article  PubMed  Google Scholar 

  10. Banerjee S, Issa K, Pivec R, et al. Intraoperative pharmacotherapeutic blood management strategies in total knee arthroplasty. J Knee Surg. 2013;26(6):379–85. https://doi.org/10.1055/s-0033-1353992.

    Article  PubMed  Google Scholar 

  11. Bjerke-Kroll BT, Sculco PK, McLawhorn AS, Christ AB, Gladnick BP, Mayman DJ. The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplasty. 2014;29(5):895–9. https://doi.org/10.1016/j.arth.2013.10.027.

    Article  PubMed  Google Scholar 

  12. Boettner F, Sculco P, Altneu E, Capar B, Sculco TP. Efficiency of autologous blood donation in combination with a cell saver in bilateral total knee arthroplasty. HSS J. 2009;5(1):45–8. doi:https://doi.org/10.1007/s11420-008-9101-8.

    Article  PubMed  Google Scholar 

  13. Bottner F, Pavone V, Johnson T, Heitkemper S, Sculco TP. Blood management after bilateral total knee arthroplasty. Clin Orthop. 2003;(410):254–61. https://doi.org/10.1097/01.blo.0000063787.32430.6b.

    Article  Google Scholar 

  14. Bould M, Freeman BJ, Pullyblank A, Newman JH. Blood loss in sequential bilateral total knee arthroplasty. J Arthroplasty. 1998;13(1):77–9.

    Article  PubMed  CAS  Google Scholar 

  15. Cankaya D, Ozkurt B, Aydin C, Tabak AY. No difference in blood loss between posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-stabilized total knee arthroplasties. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1865–9. https://doi.org/10.1007/s00167-013-2818-z.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cushner FD, Scott WN, Scuderi G, Hill K, Insall JN. Blood loss and transfusion rates in bilateral total knee arthroplasty. J Knee Surg. 2005;18(2):102–7.

    Article  PubMed  Google Scholar 

  17. Deloughry JL, Griffiths R. Arterial tourniquets. Contin Educ Anaesth Crit Care Pain. 2009;9(2):56–60. https://doi.org/10.1093/bjaceaccp/mkp002.

    Article  Google Scholar 

  18. Demirkale I, Tecimel O, Sesen H, Kilicarslan K, Altay M, Dogan M. Nondrainage decreases blood transfusion need and infection rate in bilateral total knee arthroplasty. J Arthroplasty. 2014;29(5):993–7. https://doi.org/10.1016/j.arth.2013.10.022.

    Article  PubMed  Google Scholar 

  19. Dennis DA, Kittelson AJ, Yang CC, Miner TM, Kim RH, Stevens-Lapsley JE. Does tourniquet use in TKA affect recovery of lower extremity strength and function? A randomized trial. Clin Orthop. 2016;474(1):69–77. https://doi.org/10.1007/s11999-015-4393-8.

    Article  PubMed  Google Scholar 

  20. Dhillon MS, Bali K, Prabhakar S. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage. Indian J Orthop. 2011;45(2):148–52. https://doi.org/10.4103/0019-5413.77135.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fabi DW, Mohan V, Goldstein WM, Dunn JH, Murphy BP. Unilateral vs bilateral total knee arthroplasty risk factors increasing morbidity. J Arthroplasty. 2011;26(5):668–73. https://doi.org/10.1016/j.arth.2010.07.011.

    Article  PubMed  Google Scholar 

  22. Fajardo M, Collins J, Landa J, Adler E, Meere P, Di Cesare PE. Effect of a perioperative intra-articular injection on pain control and early range of motion following bilateral TKA. Orthopedics. 2011;34(5):354. https://doi.org/10.3928/01477447-20110317-11.

  23. Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C. Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop. 2006;30(4):253–6. https://doi.org/10.1007/s00264-005-0050-2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Goodnough LT, Monk TG, Despotis GJ, Merkel K. A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total knee arthroplasty. Vox Sang. 1999;77(1):11–6.

    Article  PubMed  CAS  Google Scholar 

  25. Han CD, Shin DE. Postoperative blood salvage and reinfusion after total joint arthroplasty. J Arthroplasty. 1997;12(5):511–6.

    Article  PubMed  CAS  Google Scholar 

  26. Han SB, Kim HJ, Kim TK, et al. Computer navigation is effective in reducing blood loss but has no effect on transfusion requirement following primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016;24(11):3474–81. https://doi.org/10.1007/s00167-016-4053-x.

    Article  PubMed  Google Scholar 

  27. Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG. Simultaneous bilateral versus unilateral total knee arthroplasty: A comparison of 30-day readmission rates and major complications. J Arthroplasty. 2016;31(1):31–5. https://doi.org/10.1016/j.arth.2015.07.031.

    Article  PubMed  Google Scholar 

  28. He P, Zhang Z, Li Y, Xu D, Wang H. Efficacy and safety of tranexamic acid in bilateral total knee replacement: A meta-analysis and systematic review. Med Sci Monit. 2015;21:3634–42. https://doi.org/10.12659/MSM.895027.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V. Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty. 2013;28(10):1888–91. https://doi.org/10.1016/j.arth.2013.03.018.

    Article  PubMed  Google Scholar 

  30. Hernandez-Vaquero D, Noriega-Fernandez A, Fernandez-Carreira JM, Fernandez-Simon JM, Llorens de Los Rios J. Computer-assisted surgery improves rotational positioning of the femoral component but not the tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22(12):3127–34. https://doi.org/10.1007/s00167-014-3233-9.

    Article  PubMed  Google Scholar 

  31. Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK. Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty. 2012;27(6):1177–82. https://doi.org/10.1016/j.arth.2011.12.028.

    Article  PubMed  Google Scholar 

  32. Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H. Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br. 2011;93(3):351–6. https://doi.org/10.1302/0301-620X.93B3.25296.

    Article  PubMed  CAS  Google Scholar 

  33. Jain S, Wasnik S, Mittal A, Hegde C. Outcome of subvastus approach in elderly nonobese patients undergoing bilateral simultaneous total knee arthroplasty: A randomized controlled study. Indian J Orthop. 2013;47(1):45–9. https://doi.org/10.4103/0019-5413.106900.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jain S, Wasnik S, Mittal A, Sohoni S, Kasture S. Simultaneous bilateral total knee replacement: a prospective study of 150 patients. J Orthop Surg Hong Kong. 2013;21(1):19–22.

    Article  PubMed  Google Scholar 

  35. Juelsgaard P, Møller M, Larsen U. Preoperative acute normovolaemic hemodilution (ANH) in combination with hypotensive epidural anaesthesia (HEA) during knee arthroplasty surgery. No effect on transfusion rate. A randomized controlled trial [ISRCTN87597684]. BMC Anesthesiol. 2002;2(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Jules-Elysee KM, Wilfred SE, Memtsoudis SG, et al. Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial. J Bone Joint Surg Am. 2012;94(23):2120–7. https://doi.org/10.2106/JBJS.K.00995.

    Article  PubMed  Google Scholar 

  37. Kakar PN, Gupta N, Govil P, Shah V. Efficacy and safety of tranexamic acid in control of bleeding following TKR: A randomized clinical trial. Indian J Anaesth. 2009;53(6):667–71.

    PubMed  PubMed Central  CAS  Google Scholar 

  38. Kamath AF, Austin DC, Derman PB, Clement RC, Garino JP, Lee G-C. Saline-coupled bipolar sealing in simultaneous bilateral total knee arthroplasty. Clin Orthop Surg. 2014;6(3):298–304. https://doi.org/10.4055/cios.2014.6.3.298.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Karaaslan F, Karaoğlu S, Mermerkaya MU, Baktir A. Reducing blood loss in simultaneous bilateral total knee arthroplasty: combined intravenous-intra-articular tranexamic acid administration. A prospective randomized controlled trial. The Knee. 2015;22(2):131–5. https://doi.org/10.1016/j.knee.2014.12.002.

    Article  PubMed  Google Scholar 

  40. Karam JA, Bloomfield MR, DiIorio TM, Irizarry AM, Sharkey PF. Evaluation of the efficacy and safety of tranexamic acid for reducing blood loss in bilateral total knee arthroplasty. J Arthroplasty. 2014;29(3):501–3. https://doi.org/10.1016/j.arth.2013.08.005.

    Article  PubMed  Google Scholar 

  41. Kim G-H, Park S-W, Kim J-H, In Y. The efficacy of unilateral use of a blood reinfusion device in one-stage bilateral total knee arthroplasty. Knee Surg Relat Res. 2014;26(1):7–12. https://doi.org/10.5792/ksrr.2014.26.1.7

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kim TK, Chang CB, Kang YG, et al. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1870–8. https://doi.org/10.1007/s00167-013-2492-1.

    Article  PubMed  Google Scholar 

  43. Kinzel V, Shakespeare D, Derbyshire D. The effect of aprotinin on blood loss in bilateral total knee arthroplasty. The Knee. 2005;12(2):107–11. https://doi.org/10.1016/j.knee.2004.03.009.

    Article  PubMed  Google Scholar 

  44. Kiss H, Raffl M, Neumann D, Hutter J, Dorn U. Epinephrine-augmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement. Clin Orthop. 2005;(436):184–9.

    Article  Google Scholar 

  45. Ko PS, Tio MK, Tang YK, Tsang WL, Lam JJ. Sealing the intramedullary femoral canal with autologous bone plug in total knee arthroplasty. J Arthroplasty. 2003;18(1):6–9. https://doi.org/10.1054/arth.2003.50001.

    Article  PubMed  CAS  Google Scholar 

  46. Koh IJ, Kang YG, Chang CB, et al. Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):916–22. https://doi.org/10.1007/s00167-010-1051-2.

    Article  PubMed  Google Scholar 

  47. Koh IJ, Kang YG, Chang CB, Song J, Jeon Y-T, Kim TK. Use of reduced-dose periarticular injection for pain management in simultaneous bilateral total knee arthroplasty. J Arthroplasty. 2012;27(9):1731–6.e1. https://doi.org/10.1016/j.arth.2012.03.054.

    Article  PubMed  Google Scholar 

  48. Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg. 2014;22(6):361–71. https://doi.org/10.5435/JAAOS-22-06-361.

    Article  PubMed  Google Scholar 

  49. Liu TK, Chen SH. Simultaneous bilateral total knee arthroplasty in a single procedure. Int Orthop. 1998;22(6):390–3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  50. Lombardi AV, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop. 2004;(428):125–30.

    Article  Google Scholar 

  51. MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty. 2011;26(1):24–8. https://doi.org/10.1016/j.arth.2009.11.013.

    Article  PubMed  Google Scholar 

  52. Madadi F, Mehrvarz AS, Madadi F, Boreiri M, Abachizadeh K, Ershadi A. Comparison of drain clamp after bilateral total knee arthroplasty. J Knee Surg. 2010;23(4):215–21.

    Article  PubMed  Google Scholar 

  53. Mähringer-Kunz A, Efe T, Fuchs-Winkelmann S, Schüttler KF, Paletta JR, Heyse TJ. Bleeding in TKA: posterior stabilized vs. cruciate retaining. Arch Orthop Trauma Surg. 2015;135(6):867–70. https://doi.org/10.1007/s00402-015-2209-7.

    Article  PubMed  Google Scholar 

  54. Malone KJ, Matuszak S, Mayo D, Greene P. The effect of intra-articular epinephrine lavage on blood loss following total knee arthroplasty. Orthopedics. 2009;32(2):100.

    PubMed  Google Scholar 

  55. Marulanda GA, Ragland PS, Seyler TM, Mont MA. Reductions in blood loss with use of a bipolar sealer for hemostasis in primary total knee arthroplasty. Surg Technol Int. 2005;14:281–6.

    PubMed  Google Scholar 

  56. Marulanda GA, Krebs VE, Bierbaum BE, et al. Hemostasis using a bipolar sealer in primary unilateral total knee arthroplasty. Am J Orthop (Belle Mead NJ). 2009;38(12):E179–83.

    PubMed  Google Scholar 

  57. Matsuda K, Nozawa M, Katsube S, Maezawa K, Kurosawa H. Activation of fibrinolysis by reinfusion of unwashed salvaged blood after total knee arthroplasty. Transfus Apher Sci. 2010;42(1):33–7. https://doi.org/10.1016/j.transci.2009.10.005.

    Article  PubMed  Google Scholar 

  58. Memtsoudis SG, Hargett M, Russell LA, et al. Consensus statement from the consensus conference on bilateral total knee arthroplasty group. Clin Orthop. 2013;471(8):2649–57. https://doi.org/10.1007/s11999-013-2976-9.

    Article  PubMed  Google Scholar 

  59. Merz MK, Bohnenkamp FC, Sulo S, Goldstein WM, Gordon AC. Perioperative differences in conventional and computer-assisted surgery in bilateral total knee arthroplasty. Am J Orthop (Belle Mead NJ). 2014;43(6):262–6.

    PubMed  Google Scholar 

  60. Niki Y, Katsuyama E, Takeda Y, Enomoto H, Toyama Y, Suda Y. Comparison of postoperative morbidity between simultaneous bilateral and staged bilateral total knee arthroplasties: serological perspective and clinical consequences. J Arthroplasty. 2014;29(3):504–9. https://doi.org/10.1016/j.arth.2013.07.019.

    Article  PubMed  Google Scholar 

  61. Nilsson IM. Clinical pharmacology of aminocaproic and tranexamic acids. J Clin Pathol Suppl (R Coll Pathol). 1980;14:41–7.

    Article  CAS  Google Scholar 

  62. Noticewala MS, Nyce JD, Wang W, Geller JA, Macaulay W. Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplasty. 2012;27(6):961–7. https://doi.org/10.1016/j.arth.2011.10.008.

    Article  PubMed  Google Scholar 

  63. Olsfanger D, Fredman B, Goldstein B, Shapiro A, Jedeikin R. Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement. Br J Anaesth. 1997;79(3):317–21.

    Article  PubMed  CAS  Google Scholar 

  64. Patel N, Solovyova O, Matthews G, Arumugam S, Sinha SK, Lewis CG. Safety and efficacy of continuous femoral nerve catheter with single shot sciatic nerve block vs epidural catheter anesthesia for same-day bilateral total knee arthroplasty. J Arthroplasty. 2015;30(2):330–4. https://doi.org/10.1016/j.arth.2014.09.015.

    Article  PubMed  Google Scholar 

  65. Patil N, Wakankar H. Morbidity and mortality of simultaneous bilateral total knee arthroplasty. Orthopedics. 2008;31(8):780–9.

    Article  PubMed  Google Scholar 

  66. Petäjä J, Myllynen P, Myllylä G, Vahtera E. Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand. 1987;153(11–12):647–51.

    PubMed  Google Scholar 

  67. Pfeiffer M, Bräutigam H, Draws D, Sigg A. A new bipolar blood sealing system embedded in perioperative strategies vs. a conventional regimen for total knee arthroplasty: results of a matched-pair study. Ger Med Sci GMS E-J. 2005;3:Doc10.

    Google Scholar 

  68. Plymale MF, Capogna BM, Lovy AJ, Adler ML, Hirsh DM, Kim SJ. Unipolar vs bipolar hemostasis in total knee arthroplasty: a prospective randomized trial. J Arthroplasty. 2012;27(6):1133–7.e1. https://doi.org/10.1016/j.arth.2011.09.016.

    Article  PubMed  Google Scholar 

  69. Poultsides L, Memtsoudis S, Gonzalez Della Valle A, et al. Perioperative morbidity and mortality of same-day bilateral TKAs: incidence and risk factors. Clin Orthop. 2014;472(1):111–20. https://doi.org/10.1007/s11999-013-3156-7.

    Article  PubMed  Google Scholar 

  70. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007;31(1):39–44. https://doi.org/10.1007/s00264-006-0096-9.

    Article  PubMed  Google Scholar 

  71. Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop. 2015;39(4):653–8. doi:https://doi.org/10.1007/s00264-014-2455-2.

    Article  PubMed  Google Scholar 

  72. Rathod PA, Deshmukh AJ, Cushner FD. Reducing blood loss in bilateral total knee arthroplasty with patient-specific instrumentation. Orthop Clin North Am. 2015;46(3):343–50, ix. https://doi.org/10.1016/j.ocl.2015.02.003.

    Article  PubMed  Google Scholar 

  73. Reidy CM, Beach ML, Gallagher JD, Sites BD. Postoperative hemodynamic instability after simultaneous bilateral total knee arthroplasty. J Patient Saf. 2010;6(4):233–7.

    Article  PubMed  Google Scholar 

  74. Schäfer M, Elke R, Young JR, Gancs P, Kindler CH. Safety of one-stage bilateral hip and knee arthroplasties under regional anaesthesia and routine anaesthetic monitoring. J Bone Joint Surg Br. 2005;87(8):1134–9. https://doi.org/10.1302/0301-620X.87B8.16207.

    Article  PubMed  Google Scholar 

  75. Seo JG, Lee BH, Moon Y-W, Chang MJ, Park SH. Disparate postoperative results in the first and second knees on simultaneous bilateral total knee arthroplasty. J Arthroplasty. 2014;29(12):2331–6. https://doi.org/10.1016/j.arth.2014.07.025.

    Article  PubMed  Google Scholar 

  76. Sepah YJ, Umer M, Ahmad T, Nasim F, Chaudhry MU, Umar M. Use of tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement. J Orthop Surg. 2011;6:22. https://doi.org/10.1186/1749-799X-6-22.

    Article  Google Scholar 

  77. Shinde A, Sobti A, Maniar S, Mishra A, Gite R, Shetty V. Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population. Asian J Transfus Sci. 2015;9(2):168–72. https://doi.org/10.4103/0973-6247.154251.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  78. Singla A, Malhotra R, Kumar V, Lekha C, Karthikeyan G, Malik V. A randomized controlled study to compare the total and hidden blood loss in computer-assisted surgery and conventional surgical technique of total knee replacement. Clin Orthop Surg. 2015;7(2):211–6. https://doi.org/10.4055/cios.2015.7.2.211.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Skovgaard C, Holm B, Troelsen A, et al. No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty: a randomized, double-blind, placebo-controlled study. Acta Orthop. 2013;84(2):153–8. https://doi.org/10.3109/17453674.2013.769082.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Stundner O, Chiu Y-L, Sun X, et al. Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty. Reg Anesth Pain Med. 2012;37(6):638–44. https://doi.org/10.1097/AAP.0b013e31826e1494.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Thorey F, Stukenborg-Colsman C, Windhagen H, Wirth CJ. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care. 2008;16(2):85–92.

    PubMed  Google Scholar 

  82. Tsukada S, Wakui M, Hoshino A. Pain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia. J Bone Joint Surg Am. 2015;97(5):367–73. https://doi.org/10.2106/JBJS.N.00373.

    Article  PubMed  Google Scholar 

  83. Vulcano E, Regazzola GMV, Murena L, Ronga M, Cherubino P, Surace MF. Femoral bone plug in total knee replacement. Orthopedics. 2015;38(10):617–8. https://doi.org/10.3928/01477447-20151002-03.

    Article  PubMed  Google Scholar 

  84. Watanabe T, Muneta T, Yagishita K, Hara K, Koga H, Sekiya I. Closed suction drainage is not necessary for total knee arthroplasty: A prospective study on simultaneous bilateral surgeries of a mean follow-up of 5.5 years. J Arthroplasty. 2016;31(3):641–5. https://doi.org/10.1016/j.arth.2015.10.005.

    Article  PubMed  Google Scholar 

  85. Weng Y-J, Hsu RW-W, Hsu W-H. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty. 2009;24(5):668–73. https://doi.org/10.1016/j.arth.2008.03.006.

    Article  PubMed  Google Scholar 

  86. Whitehead DJ, MacDonald SJ. TKA sans tourniquet: let it bleed: opposes. Orthopedics. 2011;34(9):e497–9. https://doi.org/10.3928/01477447-20110714-44.

    Article  PubMed  Google Scholar 

  87. Wu Q, Zhang H-A, Liu S-L, Meng T, Zhou X, Wang P. Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials. Eur J Orthop Surg Traumatol. 2015;25(3):525–41. https://doi.org/10.1007/s00590-014-1568-z.

    Article  PubMed  Google Scholar 

  88. Yau WP, Tang WM, Ng TP, Chiu KY. Factors leading to blood transfusion among Chinese patients undergoing total knee replacements: a retrospective study. J Orthop Surg Hong Kong. 2004;12(2):153–7.

    Article  PubMed  CAS  Google Scholar 

  89. Yildiz C, Koca K, Kocak N, Tunay S, Basbozkurt M. Late tourniquet release and drain clamping reduces postoperative blood loss in total knee arthroplasty. HSS J. 2014;10(1):2–5. https://doi.org/10.1007/s11420-013-9363-7.

    Article  PubMed  Google Scholar 

  90. Zan PF, Yang Y, Fu D, Yu X, Li GD. Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty. 2015;30(1):31–7. https://doi.org/10.1016/j.arth.2014.07.034.

    Article  PubMed  Google Scholar 

  91. Zhang W, Liu A, Hu D, Tan Y, Al-Aidaros M, Pan Z. Effects of the timing of tourniquet release in cemented total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg. 2014;9:125. https://doi.org/10.1186/s13018-014-0125-0.

    Article  Google Scholar 

  92. Zhao Y-T, Chu H-J, Feng D-F, Lei J, Bloem R. Comparison of the effectiveness and safety of one-stage versus two-stage bilateral total knee arthroplasty. Acta Orthop Belg. 2015;81(4):784–9.

    PubMed  Google Scholar 

  93. Zhaohui L, Wanshou G, Qidong Z, Guangduo Z. Topical hemostatic procedures control blood loss in bilateral cemented single-stage total knee arthroplasty. J Orthop Sci. 2014;19(6):948–53. https://doi.org/10.1007/s00776-014-0621-4.

    Article  PubMed  Google Scholar 

  94. Zhu M, Chen JY, Tan YR, et al. Effects of anesthetic technique on blood loss and complications after simultaneous bilateral total knee arthroplasty. Arch Orthop Trauma Surg. 2015;135(4):565–71. https://doi.org/10.1007/s00402-015-2188-8.

    Article  PubMed  Google Scholar 

  95. Zhu M, Chen JY, Yew AK, Chia SL, Lo NN, Yeo SJ. Intra-articular tranexamic acid wash during bilateral total knee arthroplasty. J Orthop Surg Hong Kong. 2015;23(3):290–3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Metropolitan Hospital, 9 Ethnarchou Makariou St, 18547, N. Faliro, Greece

    Vasileios Soranoglou MD, PhD

  2. Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Vasileios Soranoglou MD, PhD, Lazaros A. Poultsides MD, PhD, Georgios K. Triantafyllopoulos MD, Ivan De Martino MD & Thomas P. Sculco MD

  3. Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Ivan De Martino MD & Thomas P. Sculco MD

  4. Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Stavros G. Memtsoudis MD, PhD

Authors
  1. Vasileios Soranoglou MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lazaros A. Poultsides MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georgios K. Triantafyllopoulos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivan De Martino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stavros G. Memtsoudis MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas P. Sculco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vasileios Soranoglou MD, PhD.

Ethics declarations

Conflict of Interest

Vasileios Soranoglou, MD, PHD; Lazaros A. Poultsides, MD, PHD; Georgios K. Triantafyllopoulos, MD; Ivan De Martino, MD; and Stavros G. Memtsoudis, MD, PHD, declare that they have no conflict of interest. Thomas P. Sculco, MD, receives royalties from Exactech and serves as a board member of the Knee Society and an editorial board member of the American Journal of Orthopedics and HSS Journal.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

N/A

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Electronic supplementary material

ESM 1

(PDF 1224 kb)

ESM 2

(PDF 1224 kb)

ESM 3

(PDF 1224 kb)

ESM 4

(PDF 1224 kb)

ESM 5

(PDF 1224 kb)

ESM 6

(PDF 1224 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soranoglou, V., Poultsides, L.A., Triantafyllopoulos, G.K. et al. Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty. HSS Jrnl 14, 202–210 (2018). https://doi.org/10.1007/s11420-017-9590-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-017-9590-4

Keywords

Search

Navigation