Research advances on perioperative blood management for total knee arthroplasty

Abstract

Acute blood loss anemia is the most common surgical complication of total knee arthroplasty. Currently, allogeneic transfusion has been the major method of managing postoperative anemia. Although allogeneic transfusion can correct anaemic condition temporarily, it can lead to severe complications, such as postoperative infection, prolongation of physical recovery, increased length of hospital stay, and increased mortality. Perioperative blood management can effectively reduce blood loss and transfusion rate. These strategies mainly focus on three parts: therapy for anemia and autologous blood donation before operation; application of a tourniquet, antifibrinolytic drugs, topical hemostatic agents and acute normovolemic hemodilution during operation; selection of reinfusion systems, restrictive transfusion thresholds, drainage and knee position after operation. Perioperative blood management should run throughout the perioperative period, which mainly aims at reducing blood loss and blood transfusion, improving prognosis, promoting the postoperative recovery and lowering the medical cost. Depending on the actual situations of patients, surgeons should combine different major characteristics of each strategy and weigh the pros and cons to make effective and reasonable individualized treatment plan.