Strategies to Decrease Blood Loss in Patients Who Undergo Total Knee Replacement: A Prospective Study of One Hundred and Fifty Cases

Abstract

We calculated the total blood loss in a non-randomized study of 150 total knee replacements which were performed under regional anaesthesia by a mini-subvastus surgical approach without the use of a tourniquet. In all knees, tranexamic acid was used perioperatively. The skin, subcutaneous tissue and joint capsule were infiltrated with saline adrenaline prior to making surgical incision. After cementing the prostheses, the surgical wound was packed alternately with hydrogen peroxide and Feracrylum-soaked packs for 3 minutes. Tourniquet and postoperative drain were not used in any of the knees. In our series, the mean perioperative blood loss was 433 mL (SD 74), the mean RBC volume loss was 234 mL (SD 40.4), and the mean reduction in hemoglobin level was 1.6 gm/dL. The mean preoperative hemoglobin was 12.01gm/dL (SD 1.4) and the mean postoperative hemoglobin was 10.4 gm/dL (SD 1.4). The mean preoperative hematocrit was 37.04 (SD 2.8) and the mean postoperative hematocrit was 31.29 (SD 2.7). One of our patients developed cerebral thromboembolism three days after the surgery. Postoperative hemoglobin of less then 8 g/dL was considered an indication for blood transfusion; however, none of our patients required blood transfusion in the present series. Study Design: Therapeutic case series; Level of Evidence, IV. Keywords: Tranexamic acid; Antifibrinolytic agent; Decreased blood loss; Total knee arthroplasty