Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty?

The effect of topical tranexamic acid on functional outcomes and quality of life in patients undergoing unicompartmental knee arthroplasty

INTRODUCTION

Tranexamic acid (TXA) is being increasingly utilized to reduce blood loss after knee joint arthroplasty. However, there is a lack of studies on the effect of topical TXA on the functional outcomes and quality of life after Unicompartmental Knee Arthroplasty (UKA). The aim of this study was to determine the effect of topical TXA on functional outcomes and quality of life scores in patients undergoing UKA.

MATERIALS AND METHODS

We retrospectively analysed patients undergoing unilateral UKA at a single tertiary hospital from 2005 to 2017. Patients were divided into 2 groups: (1) The control group which did not receive TXA (n = 742); (2) The TXA group which received topical TXA (n = 331). Functional outcomes were assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS) and Oxford Knee Score (OKS), while quality of life was evaluated with the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 (SF-36) preoperatively and at 6 months and 2 years follow-up.

RESULTS

At 6 months and 2 years post-surgery, there were no significant differences in the functional scores between the groups. The number of patients who attained minimum clinically important difference (MCID) for each of the functional scores was also comparable between the groups.

CONCLUSIONS

In patients undergoing UKA, functional outcomes and quality of life scores were comparable between those who received topical TXA and those who did not. There was no significant improvement or impairment in knee function associated with topical TXA administration in UKA up to 2 years follow-up.

Efficacy and Safety of Bioabsorbable Bone Hemostatic Agent in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Although a bioabsorbable bone hemostatic agent (BBHA) was developed approximately 20 years ago to overcome the shortcomings of conventional bone wax, its bleeding control capacity has not yet been studied. This study was aimed at investigating the efficacy and safety of BBHA in total knee arthroplasty (TKA). Sixty-two patients who underwent unilateral primary TKA for knee osteoarthritis were included and randomized to the control or BBHA group. Before releasing the tourniquet, BBHA was applied on the bone-cut surface that was not covered by implants. The primary variable was the drainage volume during the postoperative period. The secondary outcomes were total estimated blood loss (EBL), hemoglobin level, hematocrit level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, range of motion (ROM), pain visual analog scale (VAS) score, and rate of complications. There were no significant differences in drainage volume or EBL between the 2 groups. Hemoglobin and hematocrit levels were higher in the BBHA group during the 4-week postoperative period; however, the intergroup differences were not significant. The ESR, CRP, ROM, and pain VAS scores in the BBHA group were not significantly different from the corresponding values in the control group. No specific complications were observed. Although BBHA was found to be safe without complications, it did not decrease bleeding after TKA in general cases. Further studies are necessary to evaluate the efficacy of BBHA in patients with coagulation problems.

Effects of continuing use of aspirin on blood loss in patients who underwent unilateral total knee arthroplasty

PURPOSE

Concerning the ongoing debate on the effects of continuing aspirin therapy on blood loss in knee arthroplasty, we conducted a retrospective investigation to test the hypothesis that continuation of aspirin prior total knee arthroplasty (TKA) will not cause more blood loss.

METHODS

From a database of patients who underwent unilateral TKA between 2011 and 2016, we identified two groups: the aspirin group (patients continued aspirin during perioperative period) and the nonaspirin group (patients had no current or recent history of aspirin usage). We extracted and compared patient demographic information, comorbidity index, baseline serum hemoglobin (Hb), and creatinine level between the two groups. We also compared our primary outcomes, including the total blood loss, transfusion requirement, and length of hospitalization between the two groups. A multivariate logistic regression for analyzing the risk factors of requiring transfusion was performed.

RESULTS

We found that apart from preoperative serum creatinine level, there was no difference in the baseline Hb level, perioperative change in Hb, total blood loss, or length of hospitalization between the two groups. The percentage of transfusion utilization was also comparable between the two groups. Our regression analysis shows that the risk of requiring transfusion after TKA is not significantly associated with patients taking aspirin therapy before operation.

CONCLUSION

Patients who underwent TKA with continuation of low-dose aspirin did not result in more blood loss. Current blood loss management has provided sufficient reduction of blood loss to accommodate aspirin therapy perioperatively. We suggest that it is safe to continue aspirin prior to TKA.

Is chemoprophylaxis required after total knee and total hip arthroplasty in the Asian population? A systematic review and network meta-analysis

INTRODUCTION

Although chemoprophylaxis against venous thromboembolism (VTE) after Total Joint Arthroplasty (TJA) is commonly practiced, epidemiology studies have shown Asians have a much lower incidence of VTE. The authors aim to investigate if chemoprophylaxis is really necessary in the Asian population undergoing TJA.

MATERIAL AND METHODS

Literature searched was conducted for randomized controlled trials or quasi-experimental studies investigating efficacy and/or safety of chemoprophylaxis for TJA without language restrictions. Network meta-analysis, comparing the incidence of 'VTE to be treated', 'VTE not to be treated', 'Minor bleeding', and 'Major bleeding' amongst the different interventions was performed using multivariate meta-regression model.

RESULTS

38 studies (11,769 patients) were included. Total incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 14.2% and 0.73% respectively. For outcome on efficiency, edoxaban, low-molecular-weight-heparin (LMWH), fondaparinux, and enoxaparin showed significantly lower Risk Ratio (RR) for 'VTE to be treated' compared to Control/Placebo. Although no interventions showed increased incidence of major bleeding, LMWH and fondaparinux showed higher RR for minor bleeding. Enoxaparin displayed the best efficacy and safety profile. Total incidence of symptomatic DVT in studies involving enoxaparin was 1.98% (1.07% in patients who received enoxaparin, 2.92% in Control/Placebo). Total incidence of proximal DVT was 2.93% (2.67% in patients who received enoxaparin, 3.11% in Control/Placebo).

CONCLUSION

Asian population has a much lower incidence of VTE events after TJA compared to the Western population. Although Enoxaparin is still efficacious in reducing symptomatic and proximal DVT after TJA, its benefit-to-risk ratio is much lower than described in the Western literature.

A rare and uncommon complication after use of hydrogen peroxide (H2O2): A review of use of H2O2 in orthopaedics

Hydrogen peroxide (H2O2) is a commonly used chemical agent in orthopaedic practice for antisepsis, haemostasis and preparation of bone bed for cementation. However, the associated risks of H2O2 usage are not widely known. We report a case of suspected air embolism after use of H2O2 during drainage of a septic arthritis of the shoulder.

Upon our literature review, we were able to demonstrate H2O2 to be beneficial in antisepsis and care of chronic wounds. However, it has not been proven to be superior to other antiseptics commonly used in orthopaedic surgery. Regarding its use in cementation, there is evidence to show it is more effective than saline however, the use of pulsatile lavage appears to be the most important factor affecting the quality of cementation. H2O2 has not been shown to be helpful with haemostasis. Prior to the use of H2O2, one should be cautious and understand its associated risks and precautions.

Use of bone wax reduces blood loss and transfusion rates after total knee arthroplasty

BACKGROUND

Unnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA.

METHODS

A total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed.

RESULTS

The mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used.

CONCLUSIONS

The use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion.

LEVEL OF EVIDENCE

Level III, Therapeutic studies.

Modified Robert Jones bandage can not reduce invisible blood loss after total knee arthroplasty: a randomized-controlled trial

INTRODUCTION

To compare the efficacy and safety of modified Robert Jones bandage (MRJB) and non-compressive dressing (NCD) on reducing invisible blood loss (IBL) after total knee arthroplasty (TKA).

MATERIALS AND METHODS

Eighty patients who underwent unilateral TKA were randomly assigned into two groups: MRJB and NCD groups. Pre- and post-operative hematocrit levels, amount of drained blood and transfused blood were measured and calculated into IBL. Pain score, amount of morphine usage, range of motion (ROM) at discharge, blood transfusion rate, and complications were also recorded and compared between both groups.

RESULTS

There was no significant difference in the mean IBL between MRJB (221.2 ± 233.3 ml) and NCD groups (158.5 ± 186.7 ml) (p = 0.219). Post-operative pain score at rest and during ambulation, amount of morphine usage, ROM at discharge, blood transfusion rate, and complications were also similar between two groups.

CONCLUSIONS

This study cannot determine the benefit of MRJB over NCD. The use of MRJB may not be necessary after primary TKA.

Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty

BACKGROUND

Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA.

METHODS

After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation.

RESULTS

TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed.

CONCLUSION

Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients.

Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty

BACKGROUND

Total knee arthroplasty (TKA) is associated with major blood loss and blood transfusion is often required. This study aimed to evaluate the efficacy of bone wax in reducing blood loss and transfusion rates after TKA.

METHODS

A prospective randomized controlled study that included 100 patients undergoing primary unilateral TKA with cement was conducted in a tertiary center between March 2014 and June 2014. The bone wax group received 2.5 g of bone wax, applied onto the uncovered bone around the prostheses and the nail holes before the tourniquet was released, whereas the control group had hemostasis achieved using electrocautery only. Total blood loss was calculated using the hemoglobin balance method.

RESULTS

There were no demographic differences between the 2 groups. The preoperative serum hemoglobin levels were comparable between the 2 groups. The drop in serum hemoglobin levels at 24 h post-TKA was 1.6 ± 0.9 and 2.1 ± 1.1 g/dL in the bone wax and control groups respectively (P = .021), while the drop in serum hemoglobin levels at 72 h post-TKA was 2.7 ± 1.1 and 3.6 ± 1.2 g/dL respectively (P = .013). Total blood loss at 72 h post-TKA was 987.9 and 1183.5 mL for the bone wax and control groups respectively (P = .017). There was no adverse event associated with the use of bone wax at the 3-month follow-up.

CONCLUSION

The application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels.

The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

Background: Despite the advances in the design and fixation of implants in total knee replacement (TKR). the amount of postoperative bleeding is still an important issue that has not been resolved. This study aimed to measure the effectiveness of various tranexamic acid administration. Methods: This was a randomized controlled trial study, held from August 2014 to February 2016 at Cipto Mangunkusumo Hospital, Jakarta. Twenty two patients having TKR were divided into three groups: the control group, the tranexamic acid intra-articular-intraoperative group, and the intravenous preoperative group. Intraoperative bleeding, haemoglobin (Hb) level on preoperative to five-day-post-surgery, total drain production, total blood tranfusion needed and the drain removal timing were recorded and compared. Numerical data were analyzed by using parametric and non-parametric test, depended on the normality of the data. Results: The amount of blood transfusion needed in both the intra-articular group (200±SD 100 mL) and the intravenous group (238±SD 53 mL) were significantly different compared to those in the control group (1,016±SD 308.2 mL) (p=0.001). Meanwhile, there was no significant difference between the amount of blood transfusion needed in the intra-articular group and the intravenous group. Total drain production in the intra-articular group (328±SD 193 mL) and intravenous group (391±SD 185 mL) was significantly different compared to the control group (652±SD 150 mL) (p=0.003). No significant difference between the levels of both preoperative and postoperative haemoglobin, the amount of intraoperative bleeding, and the duration of drain usage. Conclusion: Intravenous and intra-articular tranexamic acid effectively decreased transfusion volume and drain production in patients undergoing TKR.

Hydrogen Peroxide Wound Irrigation in Orthopaedic Surgery

As the burden of deep hardware infections continues to rise in orthopaedics, there is increasing interest in strategies for more effective debridement of colonized tissues and biofilm. Hydrogen peroxide has been used medically for almost a century, but its applications in orthopaedic surgery have yet to be fully determined. The basic science and clinical research on the antiseptic efficacy of hydrogen peroxide have demonstrated its efficacy against bacteria, and it has demonstrated potential synergy with other irrigation solutions such as chlorhexidine and povidone-iodine. While hydrogen peroxide is effective in infection reduction, there are concerns with wound healing, cytotoxicity, and embolic phenomena, and we recommend against hydrogen peroxide usage in the treatment of partial knee replacements, hemiarthroplasties, or native joints. Additionally, due to the potential for oxygen gas formation, hydrogen peroxide should not be used in cases of dural compromise, when pressurizing medullary canals, or when irrigating smaller closed spaces to avoid the possibility of air embolism. Finally, we present our protocol for irrigation and debridement and exchange of modular components in total joint arthroplasty, incorporating hydrogen peroxide in combination with povidone-iodine and chlorhexidine.

Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery

Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery.

Drain use in total knee arthroplasty is neither associated with a greater transfusion rate nor a longer hospital stay

PURPOSE

In recent years, the exclusion of a drain in total knee arthroplasty (TKA) is gaining popularity. This retrospective study aims to investigate a tertiary hospital's experience with the use of a drain in TKA. The authors hypothesise that the use of a drain will: (1) increase the peri-operative total blood loss (TBL) and transfusion rate; (2) increase the length of hospital stay (LOS); (3) reduce the 30-day readmission rate and incidence of additional surgical procedure performed.

METHODS

Patients who underwent a unilateral primary TKA in 2012 were included. Seven surgeons performed 575 TKAs with the use of drains, while nine other surgeons performed 902 TKAs without the use of drains. The patients were prospectively followed-up for two years. Peri-operative TBL was calculated using the haemoglobin balance method. All patients followed the hospital's transfusion and post-operative rehabilitation protocol.

RESULTS

There was a bigger drop in haemoglobin level by 0.5 g/dl (95 % CI, 0.4, 0.6) and greater TBL by 169 ml (95 % CI, 126, 181) in the drain group (both p < 0.001). However, the transfusion rate was 37/575 (6.4 %) and 48/902 (5.3 %) in the drain and no drain groups respectively (p = 0.370), while the LOS was four (IQR, 4, 5) and four (IQR 3, 5) days respectively (p = 0.228). The 30-day readmission rate was 10/575 (1.7 %) in the drain group, compared with 26/902 (2.9 %) in the no-drain group (p = 0.165). The incidence of additional surgical procedure performed was 5/575 (0.9 %) in the drain group, compared with 15/902 (1.7 %) in the no-drain group (p = 0.198).

CONCLUSIONS

Although the use of a drain in TKA is associated with greater peri-operative TBL, this additional amount of blood loss does not translate into an increased transfusion rate or a longer LOS. It also does not reduce the 30-day readmission rate and incidence of additional surgical procedure performed on the same knee.

Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial

BACKGROUND

Despite the proven efficacy of both intravenous (IV) and intra-articular (IA) tranexamic acid (TXA) in reducing blood loss during total knee arthroplasty (TKA), the ideal route of administration remained debatable. This study aimed to compare the effect of IV versus IA TXA on transfusion incidences, perioperative blood loss and postoperative lower limb swelling during TKA.

METHODS

One hundred patients were prospectively randomised into two groups: 1) IV TXA; and 2) IA TXA. In both groups, TXA was administered intraoperatively after cementing the prostheses. The perioperative blood loss was calculated using the haemoglobin balance method. The thigh, suprapatellar, and calf girths were measured preoperatively and on postoperative day (POD) 4.

RESULTS

Two patients in the IV group and one patient in the IA group required blood transfusion (p=0.500). The median and interquartile range (IQR) of perioperative blood loss on POD1 and POD4 was 530 (IQR 386,704) and 730 (IQR 523,925) ml for the IV group, compared with 613 (IQR 506,703) and 799 (IQR 563,1067) ml for the IA group (p=0.090 and p=0.232 respectively). The median increment in thigh, suprapatellar, and calf girths were 1.5 (IQR 0, 3.0), 2.0 (IQR 0.5, 4.0) and 0 (IQR 0, 1.0) cm for the IV group, compared to 2.0 (IQR 1.0, 4.0), 2.0 (IQR 0, 4.5) and 0 (IQR 0, 1.5) cm for the IA group (p=0.246, p=0.562, and p=0.937 respectively).

CONCLUSIONS

Both IV and IA TXA had comparable effect on transfusion incidences, perioperative blood loss, and postoperative lower limb swelling during TKA. IA TXA is an alternative to IV TXA.

LEVEL OF EVIDENCE

I.

Intra-articular tranexamic acid wash during bilateral total knee arthroplasty

PURPOSE

To compare the outcome after simultaneous bilateral total knee arthroplasty (TKA) with or without an intra-articular tranexamic acid (TXA) wash in terms of blood loss, haemoglobin change, and transfusion requirement.

METHODS

35 women and 10 men (mean age, 67.5 years) who underwent primary simultaneous bilateral TKA by a single senior surgeon were compared with 45 matched controls. In the TXA group, 1500 mg of TXA diluted in 100 ml of 0.9% sodium chloride was administered as a wash after cementing of implant and before closure of the retinaculum. At least 5 minutes of contact time was allowed before wound closure and tourniquet deflation. No drain was used.

RESULTS

No patients had thromboembolic complication. Compared with controls, the TXA group had lower perioperative blood loss (920 vs. 657 ml, p=0.001), total blood loss (997 vs. 679 ml, p<0.001), blood transfusion rate (60% vs. 37.8%, p=0.035), percentage of patients requiring more than one blood unit (24.4% vs. 8.9%, p=0.048), and length of hospitalisation (6 vs. 4 days, p<0.001). Nonetheless, the 2 groups were comparable in blood units and volume transfused.

CONCLUSION

An intra-articular TXA wash during simultaneous bilateral TXA reduced total blood loss and resulted in a difference of 22.2% in blood transfusion rate and a 2-day reduction in the length of hospital stay.

Intra-articular administration of tranexamic acid in total hip arthroplasty

PURPOSE

To evaluate the effectiveness of intraarticular tranexamic acid (TXA) in reducing blood loss and the need for blood transfusion during total hip arthroplasty (THA).

METHODS

Records of 19 men and 31 women aged 46 to 83 (mean, 62) years who underwent primary THA with intra-articular administration of TXA were reviewed. They were compared with a matched cohort of 17 men and 33 women aged 40 to 87 (mean, 62) years who underwent the same procedure by the same surgeon without use of TXA. Postoperatively, a standard thromboembolic prophylaxis protocol was followed. A serum haemoglobin level of <80 g/l was the trigger for blood transfusion.

RESULTS

The 2 groups were comparable in terms of age, gender, body mass index, side involved, and anaesthesia method. No patient developed infection, wound haematoma, symptomatic deep vein thrombosis, or pulmonary embolism within 30 days. Compared with controls, patients in the TXA group had a higher median postoperative serum haemoglobin level (103 vs. 112 g/l, p=0.013), lower median drop in serum haemoglobin level (31 vs. 20 g/l, p<0.001), lower median total blood loss (900 vs. 575 ml, p<0.001), and lower transfusion rate (32% vs. 10%, p=0.007). The TXA treatment cost S$19.50 per patient, whereas one unit of allogenic blood cost S$123 per patient. Respectively in the control and TXA groups, the mean cost per patient was S$39.36 and S$31.80, indicating a 19% difference.

CONCLUSION

Intra-articular administration of TXA is a cost-effective and safe means to reduce blood loss and the need for blood transfusion during THA, without increasing the risk of thromboembolic events.

No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial

OBJECTIVE

Drainage is a common procedure in unicompartmental knee arthroplasty (UKA), but evidence regarding its effectiveness is lacking. The aim of this study was to investigate the benefits of drainage after minimally invasive UKA with effective blood loss management.

METHODS

This was a prospective, randomized, controlled trial to determine whether drainage after UKA provides benefits with respect to blood loss, drainage volume, complications, pain score, knee score, range of motion and cost. The 96 patients who underwent surgery between January 2012 and March 2013 were randomly divided into two groups: group A (n = 48) was treated without drainage, and group B (n = 48) with drainage. All UKA procedures were performed with the same minimally invasive surgical technique. Tranexamic acid and bone wax were used for the management of blood loss in all patients. The preoperative baseline parameters of the two groups did not differ significantly.

RESULTS

The mean drainage volume in group B was 75.7 ± 51.2 mL when the drainage was present. Total blood loss in group A and group B was 240.3 ± 73.3 mL and 274.1 ± 99.5 mL, respectively. These amounts did not differ significantly but both were significantly lower than the data reported for total knee arthroplasty. There was no difference in mean postoperative hemoglobin and hematocrit between groups. Differences in wound infection, incidence of deep vein thrombosis, postoperative Hospital for Special Surgery knee score, visual analog score, and range of motion were not statistically significant between groups. Hospitalization costs for UKA were lower in the absence of drainage.

CONCLUSIONS

The use of drainage in unilateral UKA provides no apparent advantage. With effective blood loss management and a minimally invasive procedure, blood loss and drainage volume in UKA are very low. Drainage does not improve the results. Foregoing non-drainage after UKA reduces both hospital costs and visible blood loss. Therefore, drainage is unnecessary in routine UKA.

Effects of anesthetic technique on blood loss and complications after simultaneous bilateral total knee arthroplasty

AIMS

Anesthetic technique affects perioperative outcomes, but less was known in simultaneous bilateral total knee arthroplasty (BTKA). A single center, retrospective analysis was carried out to prove the hypothesis that utilization of regional anesthesia would result in favorable perioperative outcomes.

METHODS

Medical records of patients admitted for simultaneous BTKA between 2004 and 2013 were analyzed. Two groups, the general anesthesia (GA) and regional anesthesia (RA) group, were identified. Patient preoperative characteristics were compared. Perioperative outcomes measured included blood loss, transfusion requirement, length of hospitalization, operating time, and 30-day perioperative complications.

RESULTS

A total of 513 patients were identified, 54.6% were performed under GA, and 45.4% under RA. Patient characteristics were similar between the two groups, except that patients operated under GA were younger than those under RA. RA was associated with significantly less perioperative blood loss (981 vs. 1075 mL, p = 0.017) and 30-day complications (6.4 vs. 13.2%, p = 0.016). Systemic and organ specific infections were particularly lower in the RA group (0.4 vs. 3.9%, p = 0.009). Transfusion requirement, length of hospitalization, and operating time were similar between the two groups. After correcting for covariates, RA offered a 92 mL (p = 0.023) reduction in blood loss and 49% less overall complications (p = 0.047), compared to GA.

CONCLUSION

Patients who underwent simultaneous BTKA under RA had lesser blood loss and lower complication rate than GA. The impact of RA can be further exploited to improve perioperative outcomes of simultaneous BTKA in addition to various other interventions.