Abstract
BackgroundTotal knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively.Material and methodsThree hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors.ResultsTotal blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban.ConclusionsPosterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.
Highlights
Total knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis
Averagely 750 ± 392 mL blood loss was found in the third day less than that in the fifth day after Total knee arthroplasty (TKA)
In the present study, we found that total blood loss was 1346 mL in OA patients undergoing TKA
Summary
Total knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively. Total knee arthroplasty (TKA) is regarded as the most effective treatment for severe knee OA, with rates of excellent or good long-term outcomes reaching 98% [2,3,4]. The total blood loss even reached 1500 mL in average [5,6,7,8], which led to high transfusion rate. Up to 70% of patients who undergo total joint arthroplasty received blood transfusion [9]. Allogeneic blood transfusion might increase the risk of longer hospital stays, infectious disease transmission, immunologic reactions, hemolytic and anaphylactic reactions, and increased mortality [10]
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