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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

Samik Banerjee
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Kimona Issa
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Bhaveen H. Kapadia
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Harpal S. Khanuja
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Steven F. Harwin
2   Department of Orthopedic Surgery, Beth Israel Medical Center, New York, New York
,
Vincent K. McInerney
3   Department of Orthopedic Surgery, St Joseph's Hospital, Seton Hall University, Paterson, New Jersey
,
Michael A. Mont
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

08 June 2013

01 July 2013

Publication Date:
19 August 2013 (online)

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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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