Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2017; 8(6): 441-454
Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.441
Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?
Tzatzairis Themistoklis, Vogiatzaki Theodosia, Kazakos Konstantinos, Drosos I Georgios
Tzatzairis Themistoklis, Kazakos Konstantinos, Drosos I Georgios, Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Vogiatzaki Theodosia, Department of Anaesthesia, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Drosos I Georgios, MD, PhD, Associate Professor of Orthopaedics, Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, St. Niarhos Street 1, Dragana, 68100 Alexandroupolis, Greece. drosos@otenet.gr
Telephone: +30-255-1352209
Received: January 25, 2017
Peer-review started: February 3, 2017
First decision: March 8, 2017
Revised: March 20, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: June 18, 2017
Processing time: 142 Days and 5.1 Hours
Abstract

Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

Keywords: Total knee replacement; Transfusion; Total knee arthroplasty; Blood loss; Autologous blood donation; Blood management; Perioperative; Tranexamic acid; Tourniquet; Haemodilution; Anaemia; Transfusion protocol

Core tip: Total knee replacement is one of the most common elective surgeries in orthopaedics. Blood loss during surgery is putting the patient at risk for a blood transfusion. A number of reviews and meta-analyses have tried to analyze the best blood conservation strategy. Our objective is to review any blood saving method/strategy into the preoperative, intraoperative and postoperative period and analyze their possible combination. A zero allogenic blood transfusion rate with safe and cost-effective methods should be the aim and an achievable goal.