Abstract
Background: Patients undergoing total knee arthroplasty (TKA) frequently require allogenic blood transfusion. The incidence of blood transfusion varies between 1.4 and 24.5% in the published literature.
Purpose of the study: In order to determine the incidence of allogenic blood transfusion in patients undergoing primary TKA at our centre, we performed retrospective analysis of prospectively collected data for all patients who underwent TKA between 1 April 2006 and 31 March 2008.
Material and Methods: 1488 eligible patients were categorized into two groups: those who underwent TKA in year 2006 (group I, n= 647) and in year 2007 (group II, n = 841), respectively. Patients with haematological diseases, coagulation disorders or with a known malignancy or infection were excluded.
Data were collected for haemoglobin levels (pre-operative, postoperative and predischarge), duration of operation, ASA grade, number of transfusions, use of tranexamic acid and suction drains with relevant clinical data including postoperative medical and surgical complications. Allogenic blood transfusions were administered according to hospital policy. The transfusion threshold was haemoglobin of 8g/dl or less or a symptomatic patient.
Results: The two groups were similar with respect to age, gender, ASA, BMI, duration of operation, pre and post-op haemoglobin and tranexamic acid usage. A significantly greater proportion of patients in group I required allogenic blood transfusion when compared to group II. (4.2% vs. 1.2%, group I vs. group II, p < 0.001; respectively).
In group I, the usage of suction drain was significantly greater when compared to group II (48% vs. 20%, group I vs. group II, p = 0.27 respectively). The medical complications in group I, included superficial wound infections (two patients), myocardial ischemia (one patient) and reversible acute renal failure (one patient), while in group II, one patient developed a superficial wound infection, which was treated with oral antibiotics.
Conclusion: A low rate of allogenic blood transfusion can be achieved by using tranexamic acid and minimising insertion of suction drains. To the best of our knowledge, we report the lowest rate of allogenic blood transfusion for primary TKA. Our data have important implications in the management of patients undergoing TKA.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
