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The use of patient-specific instruments does not reduce blood loss during minimally invasive total knee arthroplasty?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Blood loss can be substantial and will influence morbidity and mortality after total knee arthroplasty. This study evaluated whether patient-specific instruments (PSI) can reduce blood loss because the intramedullary canal is not opened during the procedure and whether hidden blood loss can be reduced by its use.

Methods

Seventy-five patients operated with the Signature PSI technique were compared with a matched group operated with conventional instruments. Maximal drop in haemoglobin (Hb) and hematocrit (HTC) level were compared at day 2 and day 4. Transfusions were noted. Clinical outcomes like range of motion and knee society scores were studied as secondary outcomes.

Results

No statistically significant difference for calculated blood loss, maximal drop in Hb or HTC and transfusions were found. No clinical differences in range of motion or knee society scores were observed.

Conclusions

The use of PSI-assisted total knee arthroplasty (TKA) did not result in less blood loss compared with conventional minimally invasive TKA with tourniquet. No reduction in hidden blood loss was observed either. According to this study, the argument of reduced transfusion cost should not be used in cost-effectiveness calculations of PSI-assisted TKA.

Level of evidence

III.

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References

  1. Ajwani SH, Jones M, Jarrat JW, Shepard GJ, Ryan WG (2012) Computer assisted versus conventional total knee replacement: a comparison of tourniquet time, blood loss and length of stay. Knee 19:606–610

    Article  PubMed  Google Scholar 

  2. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM (2011) Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Jt Surg Br 93:1577–1585

    Article  CAS  Google Scholar 

  3. Baldini A, Adravanti P (2008) Less invasive TKA: extramedullary femoral reference without navigation. Clin Orthop Relat Res 466:2694–2700

    Article  PubMed Central  PubMed  Google Scholar 

  4. Bali K, Walker P, Bruce W (2012) Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplast 27:1149–1154

    Article  Google Scholar 

  5. Bao N, Zhou L, Cong Y, Guo T, Fan W, Chang Z, Zhao J (2013) Free fatty acids are responsible for the hidden blood loss in total hip and knee arthroplasty. Med Hypotheses 81:104–107

    Article  CAS  PubMed  Google Scholar 

  6. Brunson ME, Alexander JW (1990) Mechanisms of transfusion-induced immunosuppression. Transfusion 30:651–658

    Article  CAS  PubMed  Google Scholar 

  7. Conteduca F, Massai F, Ioro R, Zanzotto E, Luzon D, Ferretti A (2009) Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop 33:1609–1613

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Cushner FD, Friedman RJ (1991) Blood loss in total knee arthroplasty. Clin Orthop Relat Res 269:98–101

    PubMed  Google Scholar 

  9. Diamond PT, Conaway MR, Mody SH, Bhirangi K (2006) Influence of hemoglobin levels on inpatient rehabilitation outcomes after total knee arthroplasty. J Arthroplast 21:636–641

    Article  Google Scholar 

  10. 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 90:596–599

    Article  CAS  PubMed  Google Scholar 

  11. Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280

    Article  CAS  PubMed  Google Scholar 

  12. Heyse T, Haas SB, Drinkwater D, Lyman S, Kim HJ, Kahn BA, Figgie MP (2014) Intraarticular fibrinogen does not reduce blood loss in TKA: a randomized clinical trial. Clin Orthop Relat Res 472:272–276

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hinarejos P, Corrales M, Matamalas A, Bisbe E, Caceres E (2009) Computer-assisted surgery can reduce blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:356–360

    Article  PubMed  Google Scholar 

  14. Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ (2005) Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Jt Surg Br 87:1480–1482

    Article  CAS  Google Scholar 

  15. Khanna A, Gougoulias N, Longo UG, Mafulli N (2009) Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin N Am 40:479–489

    Article  Google Scholar 

  16. Kim HJ, Fraser MR, Kahn B, Lyman S, Figgie MP (2012) The efficacy of a thrombin-based hemostatic agent in unilateral total knee arthroplasty: a randomized controlled trial. J Bone Jt Surg Am 94:1160–1165

    Google Scholar 

  17. Ko PS, Tio MK, Tang YK, Tsang WL, Lam JJ (2003) Sealing the intramedullary femoral canal with autologous bone plug in total knee arthroplasty. J Arthroplast 18:6–9

    Article  CAS  Google Scholar 

  18. Kumar N, Saleh J, Gardiner E, Devadoss VG, Howell FR (2000) Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss. J Arthroplast 15:947–949

    Article  CAS  Google Scholar 

  19. McConnell J, Dillon J, Kinninmonth A, Sarung M, Picard F (2012) Blood loss following total knee replacement is reduced when using computer-assisted versus standard methods. Acta Orthop Belg 78:75–79

    PubMed  Google Scholar 

  20. Mohanial PK, Sandiford N, Skinner JA, Samsani S (2013) Comparison of blood loss between computer assisted and conventional total knee arthroplasty. Indian J Orthop 47:63–66

    Article  Google Scholar 

  21. Nunley RM, Ellison BS, Ruh EL, Williams BM, Foreman K, Ford AD, Barrack RL (2012) Are patient-specific cutting blocks cost-effective for total knee. Clin Orthop Relat Res 470:889–894

    Article  PubMed Central  PubMed  Google Scholar 

  22. Oremus K, Sostaric S, Trkulja V, Haspi M (2014) Influence of tranexamic acid on postoperative autologous blood retransfusion in primary total hip and knee arthroplasty: a randomized controlled trial. Transfusion 54:31–41

    Article  CAS  PubMed  Google Scholar 

  23. Pietsch M, Djahani O, Zweiger C, Plattner F, Radl R, Tschauner C, Hofmann S (2013) Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes. Knee Surg Sports Traumatol Arthrosc 21:2234–2240

    Article  CAS  PubMed  Google Scholar 

  24. Plymale MF, Capogna BM, Lovy AJ, Adler ML, Hirsch DM, Kim SJ (2012) Unipolar vs bipolar hemostasis in total knee arthroplasty: a prospective randomized trial. J Arthroplast 27:1133–1137

    Article  Google Scholar 

  25. Prasad N, Padmanabhan V, Mullaji A (2007) Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop 31:39–44

    Article  PubMed Central  PubMed  Google Scholar 

  26. Raut VV, Stone MH, Wroblewski BM (1993) Reduction of postoperative blood loss after press-fit condylar knee arthroplasty with use of a femoral intramedullary plug. J Bone Joint Surg Am 75:1356–1357

    CAS  PubMed  Google Scholar 

  27. Sehat KR, Evans RL, Newman JH (2004) Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Jt Surg Br 86:561–565

    CAS  Google Scholar 

  28. Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7:151–155

    Article  PubMed  Google Scholar 

  29. Stahl DL, Groeben H, Kroepfl D, Gautam S, Eikermann M (2012) Development and validation of a novel tool to estimate peri-operative blood loss. Anaesthesia 67:479–486

    Article  CAS  PubMed  Google Scholar 

  30. Stronach BM, Pelt CE, Erickson J, Peters CL (2013) Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res 471:169–174

    Article  PubMed Central  PubMed  Google Scholar 

  31. Tai TW, Chang CW, Lai KA, Lin CJ, Yang CY (2012) Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Jt Surg Am 94:2209–2215

    Article  Google Scholar 

  32. Thiengwittayaporn S, Junsee D, Tanavalee A (2009) A comparison of blood loss in minimally invasive surgery with and without electromagnetic computer navigation in total knee arthroplasty. J Med Assoc Thai 92:S27–S32

    PubMed  Google Scholar 

  33. Vundelinckx BJ, Bruckers L, De Mulder K, De Schepper J, Van Esbroeck G (2013) Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplast 28:964–970

    Article  Google Scholar 

  34. Watts CD, Pagnano MW (2012) Minimising blood loss and transfusion in contemporary hip and knee arthroplasty. J Bone Jt Surg Br 94(Suppl):8–10

    Article  CAS  Google Scholar 

  35. Wind TC, Barfield WR, Moskal JT (2013) The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplast 28:1080–1083

    Article  Google Scholar 

  36. Yang ZG, Chen WP, Wu LD (2012) Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Jt Surg Am 94:1153–1159

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200, Brussels, Belgium

    Emmanuel Thienpont, Frederic Paternostre & Pierre-Emmanuel Schwab

  2. Department of Anesthesiology, Cliniques Universitaires Saint Luc, Brussels, Belgium

    Irina Grosu

  3. Department of Internal and Perioperative Medicine, Cliniques Universitaires Saint Luc, Brussels, Belgium

    Jean Cyr Yombi

Authors
  1. Emmanuel Thienpont
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  2. Irina Grosu
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  3. Frederic Paternostre
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  4. Pierre-Emmanuel Schwab
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  5. Jean Cyr Yombi
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Correspondence to Emmanuel Thienpont.

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Thienpont, E., Grosu, I., Paternostre, F. et al. The use of patient-specific instruments does not reduce blood loss during minimally invasive total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 23, 2055–2060 (2015). https://doi.org/10.1007/s00167-014-2952-2

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  • DOI: https://doi.org/10.1007/s00167-014-2952-2

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