Postoperative Intravenous Iron Supplementation Does Not Improve Hemoglobin Level and Transfusion Rate Following Staged Bilateral Total Knee Arthroplasty

Abstract Background: Total knee arthroplasty (TKA) involves significant blood loss, which increases the risk for postoperative anemia and allogenic blood transfusion. Intravenous (IV) iron supplementation protects against postoperative anemia; however, the effectiveness of IV iron, given one day before TKA, on postoperative anemia and transfusion rates is unknown.Methods: A retrospective cohort study was conducted using two consecutive groups of patients who underwent TKA. One group received 500 mg iron isomaltoside intravenously one day before TKA (iron group, n=46), whereas the other group did not (non-iron group, n=46). After propensity score matching, transfusion rate, hemoglobin (Hb) level, ferritin and transferrin saturation, and rate of functional iron deficiency anemia (IDA) were compared at postoperative days (PODs) 2, 4, 6, and 14.Results: Age, sex, body mass index, and the American Society of Anesthesiologists Physical Status score did not differ between the groups. The iron group had higher Hb levels at POD 14 (p=0.021) and higher ferritin and transferrin saturation at PODs 2, 4, 6, and 14 than the non-iron group. The rate of functional IDA was significantly higher in the non-iron group than in the iron group at PODs 2 (p<0.001), 4 (p<0.001), 6 (p=0.001), and 14 (p=0.002). The rate of transfusion was not different between the groups (p=0.238).Conclusion: IV iron administered one day before TKA improved postoperative anemia recovery, but did not lower the postoperative transfusion rate. Because approximately half of the patients undergoing TKA experience postoperative functional IDA, clinicians should consider IV iron supplementation to improve iron availability.

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Efficacy and Safety of Intravenous Ferric Carboxymaltose in Patients with Postoperative Anemia Following Same-Day Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10071457 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1457

Author(s):

Man Soo Kim ◽

In Jun Koh ◽

Keun Young Choi ◽

Sung Cheol Yang ◽

Yong In

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Transferrin Saturation ◽

Life Assessment ◽

Ferric Carboxymaltose ◽

Control Group ◽

Transfusion Rate ◽

Efficacy And Safety ◽

Bilateral Total Knee Arthroplasty ◽

Total Knee

(1) Background: The purpose of this study was to evaluate the efficacy and safety of intravenous (IV) ferric carboxymaltose (FCM) to treat acute postoperative anemia following same-day bilateral total knee arthroplasty (TKA). (2) Methods: A total of 118 patients who underwent same-day bilateral TKA were randomly assigned to two groups: an FCM group (FCM infusion, 58 patients) and a Control group (placebo with normal saline, 60 patients). The primary endpoint was the number of responders with a Hb increase of two or more points by the second postoperative week. The secondary endpoints were Hb level, iron metabolism variables and blood transfusion rate at 2, 6 and 12 weeks after surgery. (3) Results: The FCM group had more Hb responders than the Control group (62.1% vs. 31.6%, p < 0.001). The Hb level was significantly higher in the FCM group during 12 weeks after surgery (all p < 0.05). Ferritin, iron and transferrin saturation levels were significantly higher in the FCM group from 2 to 12 weeks postoperatively (all p < 0.05). There was no difference in transfusion rate after surgery (p > 0.05). (4) Conclusion: In patients with postoperative anemia after same-day bilateral TKA, IV FCM infusion significantly improved Hb response two weeks after surgery without severe adverse events compared to placebo. In contrast, transfusion rate and various parameters of quality of life assessment up to 12 weeks did not vary between these groups. Level of evidence: Level I.

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Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1712100 ◽

2020 ◽

Author(s):

Antonio Klasan ◽

Sven Edward Putnis ◽

Wai Weng Yeo ◽

Darli Myat ◽

Brett Andrew Fritsch ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Selection ◽

Knee Arthroplasty ◽

Major Complication ◽

The Elderly ◽

Complication Rates ◽

Bilateral Total Knee Arthroplasty ◽

Proper Patient Selection ◽

Patient Reported ◽

Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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