Intraoperative Nonpharmacotherapeutic Blood Management Strategies in Total Knee Arthroplasty

Samik Banerjee; Kimona Issa; Bhaveen H. Kapadia; Harpal S. Khanuja; Steven F. Harwin; Vincent K. McInerney; Michael A. Mont

doi:10.1055/s-0033-1353993

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2013; 26(06): 387-394
DOI: 10.1055/s-0033-1353993

Special Focus Section

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intraoperative Nonpharmacotherapeutic Blood Management Strategies in Total Knee Arthroplasty

Autor*innen

Samik Banerjee

¹Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
Kimona Issa

¹Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
Bhaveen H. Kapadia

¹Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
Harpal S. Khanuja

¹Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
Steven F. Harwin

²Department of Orthopedic Surgery, Beth Israel Medical Center, New York, New York
Vincent K. McInerney

³Department of Orthopedic Surgery, St Joseph's Hospital, Seton Hall University, Paterson, New Jersey
Michael A. Mont

¹Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland

Abstract

Substantial amounts of perioperative blood loss occur during total knee arthroplasty (TKA) that may require allogeneic transfusion in more than 30% of patients. Increased blood loss leads to poor physical functioning, increases infection risks, and prolongs hospitalization, which may eventually affect the overall clinical outcomes of TKA. In addition, allogeneic blood transfusions are associated with increased risks of transfusion reactions, immunosuppression, and a variety of immunological reactions. These concerns have led surgeons and anesthesiologists to develop various strategies to conserve blood, reduce costs, and decrease complications related to blood transfusions. Multiple nonpharmacologic intraoperative blood-saving measures have been used including acute normovolemic hemodilution, hypotensive anesthesia, tourniquets, bipolar sealants, intraoperative blood salvage systems, intramedullary femoral plugs, computer-assisted surgery, and the use of patient-specific instrumentation. However, no clear protocol exists currently to help surgeons choose the appropriate method for blood preservation. The aim of this article was to review the various nonpharmacologic intraoperative blood management strategies that have been used in TKA and to analyze their effectiveness and potential complications according to current evidence.

Keywords

blood - loss - prevention - nonpharmacotherapeutic - knee - arthroplasty

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Referenzen

References
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