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Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

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Abstract

Purpose

Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion.

Methods

We retrospectively compared the rate of postoperative blood transfusion in 418 cases of primary TKA during 2010 from a single institution with two different groups of patients, allocating cases to the group with MBLPA (group 1, study group, N = 71) and controls to the group without MBLPA (group 2, standard group, N = 347). MBLPA procedure included pre-operative haemoglobin (Hb) optimisation; femoral canal obturation; limited incision and release; peri- and intra-articular use of saline with adrenalin, morpheic chloride, tobramycin, betamethasone and ropivacaine; tourniquet release after skin closure; 24 hour drain under atmospheric pressure; and two doses of tranexamic acid (TXA) IV. In the control group, surgeons followed the standard procedure without blood-saving techniques. Case–control comparison and blood transfusion risk factors were analysed.

Results

Group 1 had a zero transfusion rate (0/71), whereas 27.4 % of patients (95/347) in group 2 received allogenic blood transfusion. Significant transfusion risk factors were pre-operative Hb <12 g/dl), American Society of Anesthesiologists (ASA) status III and nonobese body mass index (BMI); Age and gender were not significant risk factors.

Conclusions

MBLPA in primary TKA was highly effective, with a zero transfusion rate. Risk factors for transfusion were determined, and eliminating them contributed to the avoidance of allogeneic blood transfusion in our study series.

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References

  1. Barr PJ, Donnelly M, Cardwell C, Alam SS, Morris K, Parker M, Bailie KE (2011) Drivers of transfusion decision making and quality of the evidence in orthopedic surgery: a systematic review of the literature. Transfus Med Rev 25(4):304–316. doi:10.1016/j.tmrv.2011.04.003, e301-306

    Article  PubMed  Google Scholar 

  2. Couvret C, Tricoche S, Baud A, Dabo B, Buchet S, Palud M, Fusciardi J (2002) The reduction of preoperative autologous blood donation for primary total hip or knee arthroplasty: the effect on subsequent transfusion rates. Anesth Analg 94(4):815–823, table of contents

    Article  PubMed  Google Scholar 

  3. Etchason J, Petz L, Keeler E, Calhoun L, Kleinman S, Snider C, Fink A, Brook R (1995) The cost effectiveness of preoperative autologous blood donations. N Engl J Med 332(11):719–724. doi:10.1056/NEJM199503163321106

    Article  CAS  PubMed  Google Scholar 

  4. Tan J, Chen H, Liu Q, Chen C, Huang W (2013) A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res. doi:10.1016/j.jss.2013.03.099

    Google Scholar 

  5. Madjdpour C, Spahn DR (2005) Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesth 95(1):33–42. doi:10.1093/bja/aeh290

    Article  CAS  PubMed  Google Scholar 

  6. Watts CD, Pagnano MW (2012) Minimising blood loss and transfusion in contemporary hip and knee arthroplasty. J Bone Joint Surg Br 94(11 Suppl A):8–10. doi:10.1302/0301-620X.94B11.30618

    Article  CAS  PubMed  Google Scholar 

  7. Gandhi R, Evans HM, Mahomed SR, Mahomed NN (2013) Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis. BMC Res Notes 6(1):184. doi:10.1186/1756-0500-6-184

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. 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 Joint Surg Am 94(13):1153–1159. doi:10.2106/JBJS.K.00873

    Article  PubMed  Google Scholar 

  9. Zhang H, Chen J, Chen F, Que W (2012) The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20(9):1742–1752. doi:10.1007/s00167-011-1754-z

    Article  PubMed  Google Scholar 

  10. Iwai T, Tsuji S, Tomita T, Sugamoto K, Hideki Y, Hamada M (2013) Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty. Int Orthop 37(3):441–445. doi:10.1007/s00264-013-1787-7

    Article  PubMed  Google Scholar 

  11. Wind TC, Barfield WR, Moskal JT (2013) The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty. doi:10.1016/j.arth.2012.11.016

    Google Scholar 

  12. Kim TK, Chang CB, Kang YG, Seo ES, Lee JH, Yun JH, Lee SH (2013) 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. doi:10.1007/s00167-013-2492-1

    PubMed Central  Google Scholar 

  13. Evans S, O’Loughlin E, Bruce J (2011) Retrospective audit of blood transfusion and comparison with haemoglobin concentration in patients undergoing elective primary and revision lower limb arthroplasty. Anaesth Intensive Care 39(3):480–485

    CAS  PubMed  Google Scholar 

  14. Guerin S, Collins C, Kapoor H, McClean I, Collins D (2007) Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med 17(1):37–43. doi:10.1111/j.1365-3148.2006.00698.x

    CAS  PubMed  Google Scholar 

  15. Mesa-Ramos F, Mesa-Ramos M, Maquieira-Canosa C, Carpintero P (2008) Predictors for blood transfusion following total knee arthroplasty: a prospective randomised study. Acta Orthop Belg 74(1):83–89

    PubMed  Google Scholar 

  16. Conteduca F, Massai F, Iorio 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(6):1609–1613. doi:10.1007/s00264-008-0651-7

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Ortega-Andreu M, Perez-Chrzanowska H, Figueredo R, Gomez-Barrena E (2011) Blood loss control with two doses of tranexamic Acid in a multimodal protocol for total knee arthroplasty. Open Orthop J 5:44–48. doi:10.2174/1874325001105010044

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, Kubo S, Matsumoto T, Matsushita T, Chin T, Iguchi T, Kurosaka M, Kuroda R (2011) Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 35(11):1639–1645. doi:10.1007/s00264-010-1205-3

    Article  PubMed Central  PubMed  Google Scholar 

  19. Aggarwal AK, Shashikanth VS, Marwaha N (2013) Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study. Int Orthop. doi:10.1007/s00264-013-2136-6

    Google Scholar 

  20. Parvizi J, Chaudhry S, Rasouli MR, Pulido L, Joshi A, Herman JH, Rothman RH (2011) Who needs autologous blood donation in joint replacement? J Knee Surg 24(1):25–31

    Article  PubMed  Google Scholar 

  21. Noticewala MS, Nyce JD, Wang W, Geller JA, Macaulay W (2012) Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplasty 27(6):961–967. doi:10.1016/j.arth.2011.10.008

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital La Paz, Madrid, Spain

    Sara Moráis, Miguel Ortega-Andreu, Emerito Carlos Rodríguez-Merchán & Enrique Gómez-Barrena

  2. Department of Anaesthesiology, Hospital La Paz, Madrid, Spain

    Hanna Pérez-Chrzanowska & Reyes Figueredo-Zalve

  3. Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    Sara Moráis, Emerito Carlos Rodríguez-Merchán, Norma G. Padilla-Eguiluz & Enrique Gómez-Barrena

  4. IdiPaz, Health Research Institute, Madrid, Spain

    Emerito Carlos Rodríguez-Merchán, Norma G. Padilla-Eguiluz & Enrique Gómez-Barrena

  5. Hospital de Traumatología 1ª Planta, Hospital Universitario “La Paz”, Pº Castellana 261, 28046, Madrid, Spain

    Enrique Gómez-Barrena

Authors
  1. Sara Moráis
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  2. Miguel Ortega-Andreu
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  3. Emerito Carlos Rodríguez-Merchán
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  4. Norma G. Padilla-Eguiluz
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  5. Hanna Pérez-Chrzanowska
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  6. Reyes Figueredo-Zalve
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  7. Enrique Gómez-Barrena
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Corresponding author

Correspondence to Enrique Gómez-Barrena.

Additional information

An investigation performed at La Paz University Hospital, Madrid, Spain.

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Moráis, S., Ortega-Andreu, M., Rodríguez-Merchán, E.C. et al. Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. International Orthopaedics (SICOT) 38, 347–354 (2014). https://doi.org/10.1007/s00264-013-2188-7

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  • DOI: https://doi.org/10.1007/s00264-013-2188-7

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