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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 11, pp 2756–2762 | Cite as

Post-operative blood loss in total knee arthroplasty: knee flexion versus pharmacological techniques

  • Pierluigi Antinolfi
  • Bernardo Innocenti
  • Auro Caraffa
  • Giuseppe Peretti
  • Giuliano Cerulli
Knee

Abstract

Purpose

To compare the blood loss and the blood transfusion between a control group and a group of patients following either a local administration of tranexamic acid or a mechanical post-operative knee flexion, a controlled randomized study was performed.

Methods

Sixty patients affected by primary knee osteoarthritis and candidates to receive a primary unilateral total knee arthroplasty were enrolled in a prospective, randomized, controlled study. Exclusion criteria were the following: tranexamic acid allergy, the use of pharmacological anticoagulant therapy, previous knee surgery and renal failure. For each patient, the following parameters were investigated: the blood loss volume, the haemoglobin and haematocrit concentrations and the blood transfusion needs.

Results

Compared to the control group, the administration of systemic tranexamic acid significantly reduces (p < 0.05) both the blood loss (average reduction 39.8 %) and the blood transfusion needs (64 %). Furthermore, the tranexamic acid group shows a significant reduction (p < 0.05) compared to the knee flexion group of the blood loss (average reduction 31.8 %) and the transfusion needs (65 %). However, even if the knee flexion technique slightly reduces the blood loss (average reduction 11.6 %) compared to the control group, this difference is not statistically significant (n.s.). Moreover, this treatment did not reduce the transfusion needs compared to the control group (n.s.). Incidence of complications was not influenced by any of the treatments.

Conclusions

The use of tranexamic acid compared to knee flexion and to control group significantly reduces blood loss and transfusion needs, without wound complications or symptomatic deep vein thrombosis.

Level of evidence

Prospective therapeutic study, Level I.

Keywords

TKA Blood loss Tranexamic acid post-operative knee flexion 

References

  1. 1.
    Abdel-Salam A, Eyres K (1995) Effects of tourniquet during total knee arthroplasty: a prospective randomised study. J Bone Joint Surg Br 77:250–253PubMedGoogle Scholar
  2. 2.
    Akizuki S, Yasukawa Y, Takizawa T (1997) A new method of hemostasis for cementless total knee arthroplasty. Bull Hosp Jt Dis 56:222–224PubMedGoogle Scholar
  3. 3.
    Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F (2008) Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 48:519–525PubMedCrossRefGoogle Scholar
  4. 4.
    Antinolfi P, Innocenti B, Caraffa A, Cerulli G (2010) Blood loss in total knee replacement: pharmacological vs mechanical hemostasis. Knee Surg Sports Traumatol Arthrosc 18:s288–s289Google Scholar
  5. 5.
    Benoni G, Fredin H (1996) Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double- blind study of 86 patients. J Bone Joint Surg Br 78:434–440PubMedGoogle Scholar
  6. 6.
    Bland JM, Altman DG (1995) Multiple significance tests: the Bonferroni method. BMJ 310:170PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Cid J, Lozano M (2005) Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta-analysis of randomized controlled trials. Transfusion 45:1302–1307PubMedCrossRefGoogle Scholar
  8. 8.
    Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160PubMedCrossRefGoogle Scholar
  9. 9.
    Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191PubMedCrossRefGoogle Scholar
  10. 10.
    Gildone A, Punginelli B, Manfredini M, Artioli A, Faccini R (2007) A comparison of two rehabilitation protocols after total knee arthroplasty: does flexion affect mobility and blood loss? J Orthop Traumatol 8:6–10CrossRefGoogle Scholar
  11. 11.
    Good L, Peterson E, Lisander B (2003) Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 90:596–599PubMedCrossRefGoogle Scholar
  12. 12.
    Grzelak I, Zaleska M, Olszewski WL (1998) Blood transfusions downregulate hematopoiesis and subsequently downregulate the immune response. Transfusion 38:1104–1114PubMedCrossRefGoogle Scholar
  13. 13.
    Hiippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J, Niemela H (1995) Tranexamic acid (Cyklokapron) reduces peri-operative blood loss associated with total knee arthroplasty. Br J Anaesth 74:534–537PubMedCrossRefGoogle Scholar
  14. 14.
    Ido K, Neo M, Asada K, Kondo K, Morita T, Sakamoto T, Hayashi R, Kuriyama S (2000) Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Arch Orthop Trauma Surg 120:518–520PubMedCrossRefGoogle Scholar
  15. 15.
    Insall J (1971) A midline approach to the knee. J Bone Joint Surg Am 53:1584–1586PubMedGoogle Scholar
  16. 16.
    Jain S, Dinah A, Palmer S (2009) Knee flexion significantly reduces blood loss and transfusion rate after uncemented total knee arthroplasty. Internet J Orthop Surg 11:1Google Scholar
  17. 17.
    Janssens M, Joris J, David JL, Lemaire R, Lamy M (1994) High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology 80:23–29PubMedCrossRefGoogle Scholar
  18. 18.
    Klein HG (1995) Allogeneic transfusion risks in the surgical patient. Am J Surg 170:21–26CrossRefGoogle Scholar
  19. 19.
    Klenerman L, Chakrabarti R, Mackie I, Brozovic M, Stirling Y (1977) Changes in haemostatic system after application of a tourniquet. Lancet 1:970–972PubMedCrossRefGoogle Scholar
  20. 20.
    Kourtzis N, Pafilas D, Kasimatis G (2004) Blood saving protocol in elective total knee arthroplasty. Am J Surg 187:261–267PubMedCrossRefGoogle Scholar
  21. 21.
    Levy O, Martinowitz U, Oran A, Hashomer T, Tauber C, Horoszowski H (1998) The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty: a prospective randomised multicentre study. J Bone Joint Surg Am 81:1580–1588Google Scholar
  22. 22.
    Lotke PA, Faralli VJ, Orenstein EM, Ecker ML (1991) Blood loss after total knee replacement: effect of tourniquet release and continuous passive motion. J Bone Joint Surg Am 73:1037–1040PubMedGoogle Scholar
  23. 23.
    Ma T, Khan R, Carey Smith R, Nivbrant B, Wood D (2008) Effect of flexion/extension splintage post total knee arthroplasty on blood loss and range of motion—a randomised controlled trial. Knee 15:15–19PubMedCrossRefGoogle Scholar
  24. 24.
    Molloy DO, Archbold HAP, Ogonda L, McConway J, Wilson RK, Beverland DE (2007) Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement a prospective, randomised controlled trial. J Bone Joint Surg Br 89:306–309PubMedCrossRefGoogle Scholar
  25. 25.
    Ong SM, Taylor GJ (2003) Can knee position save blood following total knee replacement? Knee 10:81–85PubMedCrossRefGoogle Scholar
  26. 26.
    Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86:1146–1152PubMedCrossRefGoogle Scholar
  27. 27.
    Ralley FE, Berta D, Binns V, Howard J, Naudie DD (2010) One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res 7:1905–1911CrossRefGoogle Scholar
  28. 28.
    Sazama K (1990) Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 30:583–590PubMedCrossRefGoogle Scholar
  29. 29.
    Sculco TP (1998) Global blood management in orthopaedic surgery. Clin Orthop Relat Res 357:43–49PubMedCrossRefGoogle Scholar
  30. 30.
    Sehat KR, Evans RL, Newman JH (2000) How much blood is really lost in total knee arthroplasty: correct blood management should take hidden loss into account. Knee 7:151–155PubMedCrossRefGoogle Scholar
  31. 31.
    Tartter PI (1995) Immunologic effects of blood transfusion. Immunol Investig 24:277–288CrossRefGoogle Scholar
  32. 32.
    Wylie BR (1993) Transfusion transmitted infection: viral and exotic diseases. Anaesth Intensive Care 21:24–30PubMedGoogle Scholar
  33. 33.
    Zohar E, Fredman B, Ellis MH, Ifrach N, Stern A, Jedeikin R (2001) A comparative study of the postoperative allogenic blood-sparing effects of tranexamic acid and of desmopressin after total knee replacement. Transfusion 41:1285–1289PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Pierluigi Antinolfi
    • 1
  • Bernardo Innocenti
    • 2
  • Auro Caraffa
    • 3
  • Giuseppe Peretti
    • 4
  • Giuliano Cerulli
    • 3
  1. 1.Orthopedic and Traumatology ClinicS. Maria della Misericordia HospitalPerugiaItaly
  2. 2.BEAMS Department (Bio Electro and Mechanical Systems)Université Libre de BruxellesBrusselsBelgium
  3. 3.Section of Orthopedic and Traumatology ClinicUniversity of PerugiaPerugiaItaly
  4. 4.Department of Biomedical Sciences for Health University of Milan, IRCCS Istituto Ortopedico GaleazziMilanItaly

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