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J Knee Surg 2013; 26(06): 395-400
DOI: 10.1055/s-0033-1357491
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Blood Loss Prevention in Total Knee Arthroplasty

Samik Banerjee
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Bhaveen H. Kapadia
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Kimona Issa
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Mark J. McElroy
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Harpal S. Khanuja
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Steven F. Harwin
2   Division of Adult Reconstruction, Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

20 June 2013

25 August 2013

Publication Date:
11 October 2013 (online)

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Abstract

Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.

Keywords

blood - management - postoperative - knee - arthroplasty
 

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