022 23805673
Nilen A. Shah, MBBS, D. Orth., MS Orth. (Bombay, India), MCh Orth. (Liverpool, U.K.)†, Anand Gupta, DNB Orth.§, and Dipak V. Patel, MD (USA), MSc Orth. (London, U.K.), MS Orth., D. Orth., FCPS Orth. (Bombay, India)¥
Abstract
We calculated the total blood loss in a non-randomized study of 150 total knee replacements which were performed under regional anaesthesia by a mini-subvastus surgical approach with-out the use of a tourniquet. In all knees, tranexamic acid was used perioperatively. The skin, subcutaneous tissue and joint capsule were infiltrated with saline adrenaline prior to making surgical incision. After cementing the prostheses, the surgical wound was packed alternately with hydrogen peroxide and Feracrylum-soaked packs for 3 minutes. Tourniquet and postop-erative drain were not used in any of the knees. In our series, the mean perioperative blood loss was 433 mL (SD 74), the mean RBC volume loss was 234 mL (SD 40.4), and the mean reduc-tion in hemoglobin level was 1.6 gm/dL. The mean preoperative hemoglobin was 12.01gm/dL (SD 1.4) and the mean postoperative hemoglobin was 10.4 gm/dL (SD 1.4). The mean preop-erative hematocrit was 37.04 (SD 2.8) and the mean postoperative hematocrit was 31.29 (SD 2.7). One of our patients developed cerebral thromboembolism three days after the surgery. Postoperative hemoglobin of less then 8 g/dL was considered an indication for blood transfu-sion; however, none of our patients required blood transfusion in the present series.
Introduction
Total knee arthroplasty is associated with post-operative blood loss necessitating allogeneic blood transfusion in 10% to 38% of patients [1-4]. The re-ported amounts of blood loss have ranged from 1,450 to 1,790 mL [5-9]. It is well known that allogeneic blood transfusion carries the risk of immunological and non-immunological adverse effects (such as a higher rate of postoperative infections and transmission of diseases), and furthermore has a high medi-cal cost. Several techniques are available to minimize