Perioperative bleeding in total knee arthroplasty
DOI:
https://doi.org/10.1016/j.rccot.2022.05.005Keywords:
Total Knee Arthroplasty, Blood loss surgical, Blood transfusionAbstract
Introduction: Total knee arthroplasty (TKA) is the treatment of choice for knee osteoarthritis in advanced stages. The number of procedures has increased exponentially in recent years, but because it is a surgery, complications are inherent, with perioperative bleeding being one of those that generates the most interest in the profession due to its high associated morbidity and mortality. The objective of this research was to describe the clinical factors involved in major perioperative bleeding and the need for blood transfusion in TKA.
Material and methods: Descriptive observational study based on retrospective data in patients undergoing TKA. An analysis of the variables was made, taking into account perioperative blood loss and the need for allogeneic red blood cell transfusion.
Results: 777 patients were recruited, with a mean age of 69 years (SD: 9.7). Four patients were transfused with cumulative incidence of 0.5% (95% CI: 0.14 - 1.3), 3 of them were revision surgeries. The blood loss of the patients who required transfusion was on average 1590 ml vs 730 ml of those who did not require it, the surgical time was 115 minutes vs 74 minutes and the preoperative hemoglobin 14.8 g/dl vs 12.7 g/dl respectively.
Conclusions: Allogeneic transfusions in TKA occurred more frequently in surgeries with prolonged surgical time and in revision surgeries. No statistically significant differences were found between age, gender and body mass index (BMI).
Level of evidence: Level III; Retrospective study.
Downloads
References
Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the u.s., 2014 to 2030. J Bone Jt Surg - Am Vol. 2018;100:1455-60.
Hu Y, Li Q, Wei BG, Zhang XSen, Torsha TT, Xiao J, et al. Blood loss of total knee arthroplasty in osteoarthritis: An analysis of influential factors. J Orthop Surg Res. 2018;13:1-8.
Liu D, FRACS, Dan M, Martos SM, Beller E. Blood Management Strategies in Total Knee Arthroplasty. Knee Surg Relat Res. 2016;28:179-87.
Bhamber NS, Waterson B, Toms A. Aseptic complications of total knee replacement and treatment options. Orthop Trauma. 2021;35:2-7, http://dx.doi.org/10.1016/j.mporth.2020.12.008.
Abebe MM, Arefayne NR, Temesgen MM, Admass BA. Incidence and predictive factors associated with hemodynamic instability among adult surgical patients in the post-anesthesia care unit, 2021: A prospective follow up study. Ann Med Surg. 2022;74(December 2021):103321, http://dx.doi.org/10.1016/j.amsu.2022.103321.
Hatzidakis AM, Mendlick RM, McKillip T, Reddy RL, Garvin KL. Preoperative autologous donation for total joint arthroplasty: An analysis of risk factors for allogenic transfusion. J Bone Joint Surg Am. 2000;82:89-100, doi: 10.2106/00004623-200001000-00011.
Song K, Pan P, Yao Y, Jiang T, Jiang Q. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J Orthop Surg Res. 2019;14:4-9.
Newman ET, Watters TS, Lewis JS, Jennings JM, Wellman SS, Attarian DE, et al. Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty. J Bone Joint Surg Am. 2014;96:279-84, doi: 10.2106/JBJS.L.01041.
Klasan A, Dworschak P, Heyse TJ, Malcherczyk D, Peterlein CD, Schüttler KF, et al. Transfusions increase complications and infections after hip and knee arthroplasty: An analysis of 2760 cases. Technol Heal Care. 2018;26:825-32.
Loftus TJ, Spratling L, Stone BA, Xiao L, Jacofsky DJ. A Patient Blood Management Program in Prosthetic Joint Arthroplasty Decreases Blood Use and Improves Outcomes. J Arthroplasty. 2016;31:11-4, http://dx.doi.org/10.1016/j.arth.2015.07.040.
Gross J. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58, http://library1.nida.ac.th/termpaper6/sd/2554/19755.pdf.
Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty. 2004;19:281-7.
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 Arthroplasty. 2018;33, http://dx.doi.org/10.1016/j.arth.2018.04.043, 3090-3098.e1.
Bailey A, Eisen I, Palmer A, Gagné S, Touchie D, Tinmouth A, et al. Preoperative Anemia in Primary Arthroplasty Patients--Prevalence, Influence on Outcome, and the Effect of Treatment. J Arthroplasty. 2021;36.
Guerin S, Collins C, Kapoor H, McClean I, Collins D. Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med. 2007;17:37-43.
Noticewala MS, Nyce JD, Wang W, Geller JA, Macaulay W. Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplasty. 2012;27:961-7, http://dx.doi.org/10.1016/j.arth.2011.10.008.
Mesa-Ramos F, Mesa-Ramos M, Maquieira-Canosa C, Carpintero P. Predictors for blood transfusion following total knee arthroplasty: A prospective randomised study. Acta Orthop Belg. 2008;74:83-9.
Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD. Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty. 2014;29 9 SUPPL:189-92, http://dx.doi.org/10.1016/j.arth.2014.03.048.
Ahmed I, Chan JKK, Jenkins P, Brenkel I, Walmsley P. Estimating the transfusion risk following total knee arthroplasty. Orthopedics. 2012;35:1465-72.
World Medical Association. Declaración de Helsinki de la AMM - Principios éticos para las investigaciones médicas en seres humanos. BMJ. 2013:1-9.
Ministerio de salud, Resolucion numero 8430 de 1993. Minist salud. 1999; https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF.
