Comparative analysis of hidden blood loss in total knee arthroplasty

The aim of the study was to investigate the influential factors for hidden blood loss after a total knee arthroplasty and their relationship with the total blood loss. Total knee arthroplasty (TKA) is a crucial treatment of late-stage knee osteoarthritis. Measured blood loss is significantly inconsistent with the hemoglobin (HB) drop postoperatively. Fifty-four patients, 20 males and 34 females, were retrospectively analyzed. The preoperative blood loss and therefore the hidden blood loss following TKA were calculated by the Gross formula. The typical perioperative blood loss was found to be 780±220 ml and therefore the average hidden blood loss was 280±180 ml. No significant differences were found in hidden blood loss for males compared to females. Hidden blood loss may not be reduced by hemostasis during operation with a deflated tourniquet.

Download Full-text

Multimodal Peri-articular Injection with Tranexamic Acid can reduce postoperative blood loss versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Controlled Trial

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02685-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hui-ming Peng ◽

Wei Wang ◽

Jin Lin ◽

Xi-sheng Weng ◽

Wen-wei Qian ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Total Blood Loss ◽

Postoperative Blood Loss ◽

Total Blood ◽

Randomized Controlled ◽

Hidden Blood Loss ◽

Total Knee

Abstract Background Tranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA). However, the optimal administration route continues to be debated. The aim of this trial was to compare the effectiveness of intravenous (IV) versus peri-articular injection (PAI) application of tranexamic acid in patients undergoing total knee arthroplasty. Methods We conducted a randomized controlled, double-blinded study. A total of 93 patients undergoing primary unilateral TKA were randomly distributed between 2 groups: the IV group (47 cases; 1 g TXA IV) and the PAI group (46 cases; 1 g TXA injected peri-articularly). The amount of total and hidden blood loss (HBL), drainage, transfusion rate, hemoglobin and hematocrit drift, and complications were recorded. Results Peri-articular injection of TXA reduced total blood loss (P < 0.001) and HBL more than IV use of TXA (P < 0.001). No patients in either group received a transfusion. No symptomatic deep venous thrombosis or other severe complications occurred. Conclusion Peri-articular injection of TXA significantly reduced total blood loss and hidden blood loss to a greater degree than IV injection in total knee arthroplasty without reduction of drainage volume. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010270. Date of registration: December 27, 2016.

Download Full-text

Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without

Acta Orthopaedica Belgica ◽

10.52628/87.3.11 ◽

2021 ◽

Vol 87 (3) ◽

pp. 461-468

Author(s):

Simon Joufflineau ◽

Emmanuel Thienpont

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Low Pressure ◽

Total Blood Loss ◽

Transfusion Rate ◽

Total Blood ◽

Hidden Blood Loss ◽

Total Knee ◽

No Tourniquet

Tourniquet-use has been described in litera- ture as a surgical factor leading to increased post-operative hidden blood loss in total knee arthroplasty (TKA). The hypothesis for this retro- spective study was that low-pressure tourniquet TKA would offer the benefits of tourniquet surgery without the potential negative effects on late blood loss after the procedure. Therefore, this study evaluated total (TBL) and hidden blood loss (HBL) in TKA with or without a tourniquet. We retrospectively compared two groups : one group (n= 54) undergoing TKA without a tourniquet and one group with a low-pressure tourniquet (n= 110). The outcomes compared were hemoglobin levels 2 weeks before surgery and at days 2 and 4 after surgery to calculate total and hidden blood loss, transfusion rate, and functional outcome. A higher total blood loss was observed in the no tourniquet group with a mean loss of 1073 mL against 890 mL in the tourniquet group (p-value = 0,003). Hidden blood loss values between both groups were statistically not significant : in the no-tourniquet group, Hb drop between D2 and D4 was 0.5 g/dL against 0.4 g/ dL in the low-pressure tourniquet group. The tourniquet-less group did not present with better functional scores. This study showed that low- pressure tourniquet use reduces TBL without increasing HBL in TKA.

Download Full-text

Use of tranexamic acid in total knee arthroplasty

Joints ◽

10.11138/jts/2016.4.4.202 ◽

2016 ◽

Vol 04 (04) ◽

pp. 202-213 ◽

Cited By ~ 7

Author(s):

Francesco Marra ◽

Federica Rosso ◽

Matteo Bruzzone ◽

Davide Bonasia ◽

Federico Dettoni ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Demographic Data ◽

Level Of Evidence ◽

Total Blood ◽

Prospective Comparative Study ◽

Total Knee ◽

Student’S T

Purpose: different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. Methods: we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. Results: the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. Conclusions: the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level of evidence: Level II, prospective comparative study.

Download Full-text

Ultrasonography of the late-stage knee osteoarthritis prior total knee arthroplasty: comparison of the ultrasonographic, radiographic and intra-operative findings

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2018.02.852 ◽

2018 ◽

Vol 26 ◽

pp. S445-S446

Author(s):

M.T. Nevalainen ◽

J. Pylväläinen ◽

K. Kauppinen ◽

K. Pamilo ◽

M. Pesola ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Late Stage ◽

Total Knee ◽

Operative Findings

Download Full-text

Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2885-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Hao-Yang Wang ◽

Liu Wang ◽

Ze-Yu Luo ◽

Duan Wang ◽

Xin Tang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Total Blood ◽

Significant Difference ◽

Group A ◽

Total Knee ◽

Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

Download Full-text

Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02010-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Yimin Zhang ◽

Bao Lang ◽

Guifeng Zhao ◽

Fengming Wang

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Study Results ◽

Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

Download Full-text