Abstract
Introduction
The ideal type of total knee arthroplasty (TKA) prosthesis remains a debatable topic with many different options available. Uncemented TKA has been a viable option due to its decreased operating room (OR) time but also because of its proposed improved long term fixation. Unfortunately, in the past uncemented TKA was associated with increased blood loss. Surgical technique and perioperative treatments have changed since these original studies and tranexamic acid (TXA) has become the gold standard for TKA blood loss management. The objective of this study was to evaluate if there was a difference in hemoglobin and hematocrit change, along with blood loss volume during surgery between cemented and cementless TKA when modern blood loss techniques are utilized
Methods
We retrospectively reviewed data from TKAs performed by three high volume surgeons between 2016 and 2019. We excluded bilateral TKA, revisions, hardware removal intraoperatively and other indications for TKA than primary OA. Power analysis determined 85 patients in both the cementless and cemented TKA groups. Patients were matched 1:1 for age, sex, BMI and surgeon. Use of TXA, intraoperative blood loss, differences in hemoglobin and hematocrit pre- and postoperatively days one, two, and three were recorded. Continuous variables were analyzed using T-tests and categorical variables were evaluated using Chi-squared tests.
Results
No significant difference was observed between the cementless and cemented groups for hemoglobin (p=0.214), hematocrit (p=0.164), or intraoperative blood loss volume (p=0.343). A trend towards significantly shorter OR time was seen in the cementless group (p = 0.058).
Conclusion
With modern TKA surgery, including the use of TXA, there is no difference in perioperative blood loss between cemented and cementless TKA. Unlike previous studies, the use of modern blood loss salvage techniques in conjunction with cementless TKA fixation, does not result in more blood loss during the perioperative period.
