VARIABLES AFFECTING INCREASED BLOOD LOSS, DURING TOTAL KNEE REPLACEMENT SURGERY.

Main Article Content

Saeedullah
Faridullah Khan Zimri
Tanveer Sadiq
S Shujaat Ali Shah

Keywords

tourniquet, total knee replacement, blood loss

Abstract

Background: A safe, cost-effective operation that improves the quality of life for those with advanced knee arthritis is total knee arthroplasty (TKA). Rheumatoid arthritis and osteoarthritis, which are characterized by pain, deformity, and instability, are the most common causes of total knee replacement. Significant blood loss happens during the TKA operation, which may necessitate a blood transfusion. A gauge of blood loss is the volume of blood that accumulates in drains. In total knee replacement (TKR) surgery, orthopedic surgeons typically use a tourniquet to reduce bleeding and improve surgical visibility. Nonetheless, questions have been raised about how well a tourniquet works to stop blood loss.


Objective: To determine the variables affecting increased blood loss during total knee replacement surgery.


Study design: A retrospective study


Place and Duration: This study was done at, Zimri Orthopedic Hospital Islamabad Pakistan for the period of one year.


Methodology: There were 40 patients in each group, for a total of 80 patients engaged in the study. Both groups had their blood loss assessed; the case group had a tourniquet applied during the procedure, while the control group had surgery performed without tourniquet. People with persistent osteoarthritis, of both genders, diagnosed between the ages of 40 and 70 years, were included in the study.


Results: A total of 80 patients were enrolled for this research. All of them were equally divided into 2 groups having 40 patients each. One was a tourniquet group while the other was a non-tourniquet group. The average age, height, and weight of the patients in both groups did not differ significantly. However, at a significance threshold of 0.01, a significant difference in the mean blood loss between the two groups was found. The tourniquet group lost less blood than the control group, which showed somewhat greater amounts.


Conclusion: Using a tourniquet during total knee replacement (TKR) is advised since it is linked to lower blood loss, shorter operating times, and fewer instances of blood transfusions.

Abstract 47 | PDF Downloads 33

References

1. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. JBJS. 1991 Aug 1;73(7):1037-40.
2. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. The Knee. 2000 Jul 1;7(3):151-5.
3. Cundy WJ, Theodoulou A, Ling CM, Krishnan J, Wilson CJ. Blood loss in total knee arthroplasty. The Journal of Knee Surgery. 2017 Jun;30(05):452-9.
4. Boutsiadis A, Reynolds RJ, Saffarini M, Panisset JC. Factors that influence blood loss and need for transfusion following total knee arthroplasty. Annals of translational medicine. 2017 Nov;5(21).
5. White IV CC, Eichinger JK, Friedman RJ. Minimizing blood loss and transfusions in total knee arthroplasty. The Journal of Knee Surgery. 2018 Aug;31(07):594-9.
6. Schnettler T, Papillon N, Rees H. Use of a tourniquet in total knee arthroplasty causes a paradoxical increase in total blood loss. JBJS. 2017 Aug 16;99(16):1331-6.
7. Abdel-Salam AN, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. The Journal of Bone and Joint Surgery. British volume. 1995 Mar;77(2):250-3
8. Burkart BC, Bourne RB, Rorabeck CH, Kirk PG, Nott L. The efficacy of tourniquet release in blood conservation after total knee arthroplasty. Clinical Orthopaedics and Related Research®. 1994 Feb 1;299:147-52
9. Christodoulou AG, Ploumis AL, Terzidis IP, Chantzidis P, Metsovitis SR, Nikiforos DG. The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement. The knee. 2004 Aug 1;11(4):313-7
10. CUSHNER FD, FRIEDMAN RJ. Blood loss in total knee arthroplasty. Clinical Orthopaedics and Related Research (1976-2007). 1991 Aug 1;269:98-101
11. Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. Journal of critical care. 2005 Jun 1;20(2):187-91.
12. Dy CJ, Franco N, Ma Y, Mazumdar M, McCarthy MM, Gonzalez Della Valle A. Complications after patellofemoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis. Knee surgery, sports traumatology, arthroscopy. 2012 Nov;20:2174-90
13. Juelsgaard P, Larsen UT, Sørensen JV, Madsen F, Søballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Regional anesthesia and pain medicine. 2001 Mar 1;26(2):105-10.
14. Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. The Journal of bone and joint surgery. British volume. 2005 Nov;87(11):1480-2.
15. Mercuriali F, Inghilleri G. Proposal of an algorithm to help the choice of the best transfusion strategy. Current medical research and opinion. 1996 Jan 1;13(8):465- 78.
16. Olivecrona C, Tidermark J, Hamberg P, Ponzer S, Cederfjäll C. Skin protection underneath the pneumatic tourniquet during total knee arthroplasty: a randomized controlled trial of 92 patients. ActaOrthopaedica. 2006 Jan 1;77(3):519-23.
17. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. International orthopaedics. 2007 Feb;31:39-44.
18. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. The Knee. 2000 Jul 1;7(3):151-5.
19. Skou ST, Roos EM, Laursen MB, Rathleff MS, ArendtNielsen L, Simonsen O, Rasmussen S. A randomized, controlled trial of total knee replacement. New England Journal of Medicine. 2015 Oct 22;373(17):1597-606
20. Suarez-Almazor ME, Richardson M, Kroll TL, Sharf BF. A qualitative analysis of decision-making for total knee replacement in patients with osteoarthritis. JCR: Journal of Clinical Rheumatology. 2010 Jun 1;16(4):158-63.