Les pertes sanguines sont 1,38 à 2,17 fois plus importantes après reprise de PTG qu’après PTG primaire : analyse rétrospective de 898 cas

Abstract

BackgroundThere are a number of factors that influence blood loss during and after primary total knee arthroplasty (TKA) and revision TKA (rTKA). The purpose of this study was to provide a factorial assessment that would aid surgeons in managing expected blood loss in rTKA, when compared to TKA. The first question asked was the blood loss and transfusions between TKA and rTKA and the second question were risk factors for blood loss after rTKA. HypothesisBlood loss in any rTKA is higher than in TKA by a factor of 2. Patients and methodsA retrospective single-center consecutive series of rTKA between 2006 and 2018 was performed. Based on the rTKA types identified in joint registries, 4 rTKA cohorts were created: aseptic minor rTKA, aseptic major rTKA, 1st stage, and 2nd stage septic rTKA. A consecutive TKA cohort from the same study period was used to create a propensity score matched cohort with the aseptic major rTKA cohort. ResultA total of 622 rTKA were identified. Aseptic major rTKA had double the median blood loss than TKA. The lowest blood loss was observed in the TKA group followed by aseptic minor rTKA, and the highest in 2nd stage septic rTKA. The median total blood loss was higher in all rTKA by a factor ranging between 1.38 and 2.17. Higher age, female gender, lower preoperative hemoglobin, chronic heart disease and history of myocardial infarction were risk factors for increased blood loss. The type of rTKA performed was not predictive of blood loss in the linear regression analysis. DiscussionBlood loss after rTKA is 1.38- to 2.17-fold higher than after TKA. The blood loss observed in 2nd stage septic rTKA and aseptic major rTKA was the highest. Older, female patients, with a low preoperative hemoglobin were identified to be at the highest risk of blood loss after rTKA. Strategies for further blood loss reductions need to be utilized to the fullest extent for these procedures. Level of evidenceIII; retrospective prognostic study.