Unicompartmental Knee Arthroplasty pp 161-167 | Cite as
Blood Preservation Strategies in Total Knee and Unicompartmental Knee Arthroplasty
Chapter
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Abstract
Total and unicompartmental knee arthroplasties can be associated with significant blood loss, which may ultimately require transfusion in up to 38% of patients. Allogeneic blood transfusions can impart significant morbidity and mortality and delay patient recovery. A comprehensive patient blood management protocol (PBM), including preoperative, intraoperative, and postoperative strategies, can help diminish perioperative blood loss, maintain hemostasis, and improve patient outcomes. A comprehensive review of currently available blood management strategies is presented in this chapter.
Keywords
Blood management strategy Unicompartmental knee arthroplasty Total knee arthroplasty Blood transfusion Blood lossReferences
- 1.Sehat K, Evans R, Newman J. How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. Knee. 2000;7(3):151–5.CrossRefPubMedGoogle Scholar
- 2.Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JVV, Niemela HM, Mantyla SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997;84(4):839–44.CrossRefPubMedGoogle Scholar
- 3.Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90(5):596–9.CrossRefPubMedGoogle Scholar
- 4.Biarnés AS, Ciércoles EJ, Márquez EM, Medel JR, Godet CG, Roigé JS. Risk factors for transfusion in primary knee arthroplasty. Revista espanola de anestesiologia y reanimacion. 2006;53(1):18–24.Google Scholar
- 5.Kalairajah Y, Simpson D, Cossey A, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg. 2005;87(11):1480–2.CrossRefGoogle Scholar
- 6.Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty1. J Arthroplast. 2004;19(3):281–7.CrossRefGoogle Scholar
- 7.Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. JBJS. 1999;81(1):2–10.CrossRefGoogle Scholar
- 8.Goodnough L, Verbrugge D, Marcus R. The relationship between hematocrit, blood lost, and blood transfused in total knee replacement. Implications for postoperative blood salvage and reinfusion. Am J Knee Surg. 1995;8(3):83–7.PubMedGoogle Scholar
- 9.Freedman J, Luke K, Monga N, Lincoln S, Koen R, Escobar M, et al. A provincial program of blood conservation: the Ontario Transfusion Coordinators (ONTraC). Transfus Apher Sci. 2005;33(3):343–9.CrossRefPubMedGoogle Scholar
- 10.Jeer PJ, Cossey AJ, Keene GC. Haemoglobin levels following unicompartmental knee arthroplasty: influence of transfusion practice and surgical approach. Knee. 2005;12(5):358–61.CrossRefPubMedGoogle Scholar
- 11.Schwab P-E, Lavand’homme P, Yombi JC, Thienpont E. Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3494–500.CrossRefPubMedGoogle Scholar
- 12.Berend KR, Morris MJ, Lombardi AV. Unicompartmental knee arthroplasty: incidence of transfusion and symptomatic thromboembolic disease. Orthopedics. 2010;33(9):8–10.CrossRefPubMedGoogle Scholar
- 13.Stulberg BN, Zadzilka JD. Blood management issues: Using blood management strategies. J Arthroplast. 2007;22(4):95–8.CrossRefGoogle Scholar
- 14.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.CrossRefPubMedGoogle Scholar
- 15.Glossary IC. Society for the advancement of blood management. 2012.Google Scholar
- 16.Pierson JL, Hannon TJ, Earles DR. A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty. JBJS. 2004;86(7):1512–8.CrossRefGoogle Scholar
- 17.Salido JA, Marín LA, Gómez LA, Zorrilla P, Martínez C. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. JBJS. 2002;84(2):216–20.CrossRefGoogle Scholar
- 18.Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. JBJS. 2004;86(1):57–61.CrossRefGoogle Scholar
- 19.Nelson CL, Fontenot HJ, Flahiff C, Stewart J. An algorithm to optimize perioperative blood management in surgery. Clin Orthop Relat Res. 1998;357:36–42.CrossRefGoogle Scholar
- 20.Keating EM, Ritter MA. Transfusion options in total joint arthroplasty. J Arthroplast. 2002;17(4):125–8.CrossRefGoogle Scholar
- 21.Bezwada HP, Nazarian DG, Henry DH, Booth RE Jr. Preoperative use of recombinant human erythropoietin before total joint arthroplasty. JBJS. 2003;85(9):1795–800.CrossRefGoogle Scholar
- 22.Kourtzis N, Pafilas D, Kasimatis G. Blood saving protocol in elective total knee arthroplasty. Am J Surg. 2004;187(2):261–7.CrossRefPubMedGoogle Scholar
- 23.Cuenca J, García-Erce JA, Martínez F, Cardona R, Pérez-Serrano L, Muñoz M. Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement. Int J Surg. 2007;5(2):89–94.CrossRefPubMedGoogle Scholar
- 24.Lachance K, Savoie M, Bernard M, Rochon S, Fafard J, Robitaille R, et al. Oral ferrous sulfate does not increase preoperative hemoglobin in patients scheduled for hip or knee arthroplasty. Ann Pharmacother. 2011;45(6):764–70.CrossRefPubMedGoogle Scholar
- 25.Deutsch A, Spaulding J, Marcus RE. Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J Arthroplast. 2006;21(5):628–35.CrossRefGoogle Scholar
- 26.Lee D-H, Padhy D, Lee S-H, Kim T-K, Choi J, Han S-B. Shed blood re-transfusion provides no benefit in computer-assisted primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):926–31.CrossRefPubMedGoogle Scholar
- 27.Bezwada HR, Nazarian DG, Henry DH, Booth JR, Mont MA. Blood management in total joint arthroplasty. Am J Orthop (Belle Mead NJ). 2006;35(10):458–64.Google Scholar
- 28.Barsoum WK, Klika AK, Murray TG, Higuera C, Lee HH, Krebs VE. Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer. JBJS. 2011;93(6):513–8.CrossRefGoogle Scholar
- 29.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.CrossRefPubMedGoogle Scholar
- 30.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.CrossRefPubMedGoogle Scholar
- 31.Juelsgaard P, Møller MB, Larsen UT. 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.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Whitehead DJ, MacDonald SJ. TKA sans tourniquet: let it bleed: opposes. Orthopedics. 2011;32(9):680.Google Scholar
- 33.Tai T-W, Lin C-J, Jou I-M, Chang C-W, Lai K-A, Yang C-Y. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1121–30.CrossRefPubMedGoogle Scholar
- 34.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.CrossRefPubMedGoogle Scholar
- 35.Hernandez-Castanos D, Ponce V, Gil F. Release of ischaemia prior to wound closure in total knee arthroplasty: a better method? Int Orthop. 2008;32(5):635–8.CrossRefPubMedGoogle Scholar
- 36.Turner NS III, Pagnano MW, Sim FH. Total knee arthroplasty after ipsilateral peripheral arterial bypass graft: acute arterial occlusion is a risk with or without tourniquet use. J Arthroplast. 2001;16(3):317–21.CrossRefGoogle Scholar
- 37.Rama KRBS, Apsingi S, Poovali S, Jetti A. Timing of tourniquet release in knee arthroplasty: meta-analysis of randomized, controlled trials. JBJS. 2007;89(4):699–705.Google Scholar
- 38.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 Arthroplast. 2012;27(6):1133–7. e1.CrossRefGoogle Scholar
- 39.Marulanda GA, Krebs VE, Bierbaum BE, Goldberg VM, Ries M, Ulrich SD, et al. Hemostasis using a bipolar sealer in primary unilateral total knee arthroplasty. Am J Orthop (Belle Mead NJ). 2009;38(12):E179–E83.Google Scholar
- 40.Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K, et al. The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. J Arthroplast. 2018;33(10):3083–9. e4.CrossRefGoogle Scholar
- 41.Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K, et al. The efficacy of tranexamic acid in total knee arthroplasty: a network meta-analysis. J Arthroplast. 2018;33(10):3090–3098.e1.CrossRefGoogle Scholar
- 42.Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470(9):2605–12.CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Wong J, Abrishami A, El Beheiry H, Mahomed NN, Davey JR, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. JBJS. 2010;92(15):2503–13.CrossRefGoogle Scholar
- 44.Sarzaeem MM, Razi M, Kazemian G, Moghaddam ME, Rasi AM, Karimi M. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty. J Arthroplast. 2014;29(8):1521–4.CrossRefGoogle Scholar
- 45.Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Bini SA, Clarke HD, et al. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplast. 2018;33(10):3065.CrossRefGoogle Scholar
- 46.Notarnicola A, Moretti L, Martucci A, Spinarelli A, Tafuri S, Pesce V, et al. Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty. Blood Coagul Fibrinolysis. 2012;23(4):278–84.CrossRefPubMedGoogle Scholar
- 47.Skovgaard C, Holm B, Troelsen A, Lunn TH, Gaarn-Larsen L, Kehlet H, 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.CrossRefPubMedPubMedCentralGoogle Scholar
- 48.So-Osman C, Nelissen R, Te Slaa R, Coene L, Brand R, Brand A. A randomized comparison of transfusion triggers in elective orthopaedic surgery using leucocyte-depleted red blood cells. Vox Sang. 2010;98(1):56–64.CrossRefPubMedGoogle Scholar
- 49.Transfusion PB. Practice guidelines for perioperative blood transfusion and adjuvant therapies. Anesthesiology. 2006;105(1):198–208.CrossRefGoogle Scholar
- 50.Carson JL, Duff A, Berlin JA, Lawrence VA, Poses RM, Huber EC, et al. Perioperative blood transfusion and postoperative mortality. JAMA. 1998;279(3):199–205.CrossRefPubMedGoogle Scholar
- 51.Weiskopf RB, Viele MK, Feiner J, Kelley S, Lieberman J, Noorani M, et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA. 1998;279(3):217–21.CrossRefPubMedGoogle Scholar
- 52.Robinson PM, Obi N, Harrison T, Jeffery J. Changing transfusion practice in total hip arthroplasty: observational study of the reduction of blood use over 6 years. Orthopedics. 2012;35(11):e1586–e91.CrossRefPubMedGoogle Scholar
- 53.Moonen AF, Knoors NT, Van Os JJ, Verburg AD, Pilot P. Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial. Transfusion. 2007;47(3):379–84.CrossRefPubMedGoogle Scholar
- 54.Martin A, Von Strempel A. Transfusion of autologous blood from reinfusion systems in total knee arthroplasty. Int Orthop. 2006;30(6):541–4.CrossRefPubMedPubMedCentralGoogle Scholar
- 55.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.CrossRefPubMedGoogle Scholar
- 56.Kirkley S, Cowles J, Pellegrini V, Harris C, Boyd A, Blumberg N. Blood transfusion and total joint replacement surgery: T helper 2 (TH2) cytokine secretion and clinical outcome. Transfus Med (Oxford, England). 1998;8(3):195–204.CrossRefGoogle Scholar
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