Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(04): 463-469
DOI: 10.1055/s-0040-1715511
Artigo Original
Joelho

Predictive Factors for Blood Transfusion after Total Knee Arthroplasty[*]

Article in several languages: português | English
Alan de Paula Mozella 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Hugo Alexandre de Araújo Barros Cobra 
1   Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Maria Eugênia Leite Duarte 
2   Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objectives The present paper aims to (1) verify the incidence and volume of blood transfusion among patients undergoing unilateral cemented total knee arthroplasty (TKA) in a single Brazilian reference center; (2) identify pre and perioperative variables to determine subjects with higher risk (i.e., predictive factors) for blood transfusion within 48 hours following surgery; (3) estimate the risk of blood transfusion during the first 48 hours after the procedure.

Methods The initial sample consisted of all patients undergoing TKA from August 2010 to August 2013. After applying the exclusion criteria, 234 patients aged 30 to 83 years old and diagnosed with primary or secondary osteoarthritis due to rheumatoid arthritis remained in the study.

Results Preoperative hemoglobin levels ≤ 12.3 g/dL and ischemia time ≥ 87 minutes were independent predictors for post-TKA blood transfusion, with a relative risk of 2.48 and 1.78, respectively. Approximately half of the TKA patients (51.3%) presenting these two variables required a blood transfusion.

Conclusion The incidence of post-TKA blood transfusion was 33.7%. On average, each transfused patient received 480 mL of packed red blood cells. Preoperative hemoglobin levels ≤ 12.3 g/dL (p < 0.001) and ischemia time ≥ 87 minutes (p < 0.047) were independent predictors for blood transfusion in TKA using a pneumatic cuff, with a relative risk of 2.48 and 1.78, respectively. Age, gender, diagnosis, or body mass index were not considered independent predictors for the need for blood transfusion up to 48 hours after the procedure.

Keywords

arthroplasty, replacement, knee - blood transfusion - osteoarthritis, knee

* Work developed at Centro de Cirurgia do Joelho do Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.


Financial Support

There was no financial support from public, commercial, or non-profit sources.




Publication History

Received: 13 December 2019

Accepted: 01 June 2020

Article published online:
02 November 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br 2004; 86 (04) 561-565
    CrossrefPubMedGoogle Scholar
  • 2 Marulanda GA, Ragland PS, Seyler TM, Mont MA. Reductions in blood loss with use of a bipolar sealer for hemostasis in primary total knee arthroplasty. Surg Technol Int 2005; 14: 281-286
    PubMedGoogle Scholar
  • 3 Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop 2007; 31 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 4 Pedersen AB, Mehnert F, Overgaard S, Johnsen SP. Allogeneic blood transfusion and prognosis following total hip replacement: a population-based follow up study. BMC Musculoskelet Disord 2009; 10: 167
    CrossrefPubMedGoogle Scholar
  • 5 Browne JA, Adib F, Brown TE, Novicoff WM. Transfusion rates are increasing following total hip arthroplasty: risk factors and outcomes. J Arthroplasty 2013; 28 (8, Suppl) 34-37
    CrossrefPubMedGoogle Scholar
  • 6 Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am 2014; 96 (23) 1945-1951
    CrossrefPubMedGoogle Scholar
  • 7 Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg 2014; 22 (06) 361-371
    CrossrefPubMedGoogle Scholar
  • 8 Rosencher N, Kerkkamp HE, Macheras G. et al. OSTHEO Investigation. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 2003; 43 (04) 459-469
    CrossrefPubMedGoogle Scholar
  • 9 Basora M, Tió M, Martin N. et al. Should all patients be optimized to the same preoperative hemoglobin level to avoid transfusion in primary knee arthroplasty?. Vox Sang 2014; 107 (02) 148-152
    CrossrefPubMedGoogle Scholar
  • 10 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) 189-192
    CrossrefPubMedGoogle Scholar
  • 11 Klein HG. How safe is blood, really?. Biologicals 2010; 38 (01) 100-104
    CrossrefPubMedGoogle Scholar
  • 12 Barsoum WK, Klika AK, Murray TG, Higuera C, Lee HH, Krebs VE. Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer. J Bone Joint Surg Am 2011; 93 (06) 513-518
    CrossrefPubMedGoogle Scholar
  • 13 Friedman R, Homering M, Holberg G, Berkowitz SD. Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am 2014; 96 (04) 272-278
    CrossrefPubMedGoogle Scholar
  • 14 Newman ET, Watters TS, Lewis JS. 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 (04) 279-284
    CrossrefPubMedGoogle Scholar
  • 15 Rohde JM, Dimcheff DE, Blumberg N. et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 2014; 311 (13) 1317-1326
    CrossrefPubMedGoogle Scholar
  • 16 Gómez-Lesmes SP, Tornero E, Martínez-Pastor JC, Pereira A, Marcos M, Soriano A. Length of storage of transfused red blood cells and risk of prosthetic joint infection after primary knee arthroplasty. J Arthroplasty 2014; 29 (10) 2016-2020
    CrossrefPubMedGoogle Scholar
  • 17 Ballantyne A, Walmsley P, Brenkel I. Reduction of blood transfusion rates in unilateral total knee arthroplasty by the introduction of a simple blood transfusion protocol. Knee 2003; 10 (04) 379-384
    CrossrefPubMedGoogle Scholar
  • 18 Salido JA, Marín LA, Gómez LA, Zorrilla P, Martínez C. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am 2002; 84 (02) 216-220
    CrossrefPubMedGoogle Scholar
  • 19 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 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 20 Noticewala MS, Nyce JD, Wang W, Geller JA, Macaulay W. Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplasty 2012; 27 (06) 961-967
    CrossrefPubMedGoogle Scholar
  • 21 Ogbemudia AE, Yee SY, MacPherson GJ, Manson LM, Breusch SJ. Preoperative predictors for allogenic blood transfusion in hip and knee arthroplasty for rheumatoid arthritis. Arch Orthop Trauma Surg 2013; 133 (09) 1315-1320
    CrossrefPubMedGoogle Scholar
  • 22 Ahmed I, Chan JK, Jenkins P, Brenkel I, Walmsley P. Estimating the transfusion risk following total knee arthroplasty. Orthopedics 2012; 35 (10) e1465-e1471
    CrossrefPubMedGoogle Scholar
  • 23 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 (03) 281-287
    CrossrefPubMedGoogle Scholar
  • 24 Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 2013; 95 (19) 1777-1783
    CrossrefPubMedGoogle Scholar