title: Postoperative blood loss prevention in total knee arthroplasty.
abstract: Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.
authors.affiliation: Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Samik
authors.initials: S
authors.lastname: Banerjee
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.forename: Mark J
authors.initials: MJ
authors.lastname: McElroy
authors.forename: Harpal S
authors.initials: HS
authors.lastname: Khanuja
authors.forename: Steven F
authors.initials: SF
authors.lastname: Harwin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D058128:Compression Bandages; D000075202:Contraindications; D017679:Cryotherapy; D006801:Humans; D057725:Operative Blood Salvage; D011183:Postoperative Complications / Q000517:prevention & control*; D011187:Posture; D013396:Suction / Q000379:methods