title: Intraoperative nonpharmacotherapeutic blood management strategies in total knee arthroplasty.
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.
authors: Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland.
authors: Samik
authors: S
authors: Banerjee
authors: Kimona
authors: K
authors: Issa
authors: Bhaveen H
authors: BH
authors: Kapadia
authors: Harpal S
authors: HS
authors: Khanuja
authors: Steven F
authors: SF
authors: Harwin
authors: Vincent K
authors: VK
authors: McInerney
authors: Michael A
authors: MA
authors: Mont
mesh_terms: D000758:Anesthesia / Q000379:methods; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006438:Hemodilution; D006489:Hemostatic Techniques; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007430:Intraoperative Care; D057725:Operative Blood Salvage; D014111:Tourniquets