title: Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach.
abstract: OBJECTIVE
  Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion.
  
  
  METHODS
  We retrospectively compared the rate of postoperative blood transfusion in 418 cases of primary TKA during 2010 from a single institution with two different groups of patients, allocating cases to the group with MBLPA (group 1, study group, N = 71) and controls to the group without MBLPA (group 2, standard group, N = 347). MBLPA procedure included pre-operative haemoglobin (Hb) optimisation; femoral canal obturation; limited incision and release; peri- and intra-articular use of saline with adrenalin, morpheic chloride, tobramycin, betamethasone and ropivacaine; tourniquet release after skin closure; 24 hour drain under atmospheric pressure; and two doses of tranexamic acid (TXA) i.v.. In the control group, surgeons followed the standard procedure without blood-saving techniques. Case-control comparison and blood transfusion risk factors were analysed.
  
  
  RESULTS
  Group 1 had a zero transfusion rate (0/71), whereas 27.4% of patients (95/347) in group 2 received allogenic blood transfusion. Significant transfusion risk factors were pre-operative Hb <12 g/dl), American Society of Anesthesiologists (ASA) status III and nonobese body mass index (BMI); Age and gender were not significant risk factors.
  
  
  CONCLUSIONS
  MBLPA in primary TKA was highly effective, with a zero transfusion rate. Risk factors for transfusion were determined, and eliminating them contributed to the avoidance of allogeneic blood transfusion in our study series.
authors: Department of Orthopaedic Surgery, Hospital La Paz, Madrid, Spain.
authors: Sara
authors: S
authors: Moráis
authors: Miguel
authors: M
authors: Ortega-Andreu
authors: Emerito Carlos
authors: EC
authors: Rodríguez-Merchán
authors: Norma G
authors: NG
authors: Padilla-Eguiluz
authors: Hanna
authors: H
authors: Pérez-Chrzanowska
authors: Reyes
authors: R
authors: Figueredo-Zalve
authors: Enrique
authors: E
authors: Gómez-Barrena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015992:Body Mass Index; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D004322:Drainage / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014111:Tourniquets; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid