title: Efficient strategy for controlling postoperative hemorrhage in total knee arthroplasty.
abstract: OBJECTIVE
  The objective of the present study was to compare the intraoperative use of tranexamic acid (TNA) plus intra-articular diluted-epinephrine (DEP) with preoperative autologous blood donations and transfusions in reducing an allogeneic blood transfusion (ABT) in primary unilateral total knee arthroplasty (TKA).
  
  
  METHODS
  Patients (n=133) treated with unilateral primary TKA were divided into three groups retrospectively: patients administered autologous blood transfusions were assigned to group A (n=51); patients administered preoperative injections of TNA and postoperative intra-articular injections of DEP were assigned to group B (n=42); and patients treated with the drain-clamp method in addition to injections of TNA and DEP were assigned to group C (n=40). The rate of avoidance of ABTs, postoperative blood loss, and complications (DVT/PE, skin problems) were examined.
  
  
  RESULTS
  The differences among the three groups were not significant in terms of the proportion of patients requiring no ABTs (94% in group A, 93% in group B and 95% in group C, n.s.). The total blood loss calculated was 1,140±451 ml, 852±343 ml, and 850±296 ml, respectively (group B>A, group C>A, P=0.0009). The significant complications were not observed in three groups.
  
  
  CONCLUSIONS
  The results of the study showed that the TNA plus DEP combination exerted a comparable effect with preoperative autologous blood transfusion in avoiding ABTs in unilateral primary TKA. Considering several problems of preoperative autologous blood donation, the use of TNA plus DEP is recommended. In addition, it is highly possible that allogeneic blood transfusions can be avoided for patients with preoperative Hb values≥10.5 using the method described in this study, and the need for preoperative autologous blood donations can be decreased.
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan. sasakou@pop12.odn.ne.jp
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sasanuma
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekiya
authors.forename: Kenzou
authors.initials: K
authors.lastname: Takatoku
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takada
authors.forename: Naoya
authors.initials: N
authors.lastname: Sugimoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hoshino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007201:Indicator Dilution Techniques; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014148:Tranexamic Acid; D004837:Epinephrine