Page 28 - ISAKOS 2018 Newsletter Volume 2
P. 28

 CURRENT CONCEPTS
Strategies to Minimize Blood Loss in TKR Surgery
Currently, with improved perioperative blood-conservation methods such as spinal anesthesia and routine use of anti- fibrinolytic therapy with use of TXA, prolonged tourniquet use during TKR surgery does not appear to have a significant clinical impact on perioperative blood loss and transfusion requirements and may not be justified given its known association with higher rates of postoperative complications and slowed functional recovery.
Postoperative Blood-Management Protocol
Use of Drains
Drains historically have been used in knee replacement surgery for the theoretical benefits of preventing wound hematoma, improving wound-healing, and preventing infection. However, drains have never been definitively shown to be of any benefit in THR or TKR surgery. Meta-analyses comparing drains and no drains consistently have shown that drains result in increased total blood loss and increased requirements for blood transfusion without any difference in terms of hematoma formation, surgical sight infection, or reoperation for any reason. A 2007 Cochrane review of the available data indicated that there was insufficient evidence to support of use of closed suction drainage in orthopaedic surgery.
Positioning the Knee in Flexion Immediately Postoperatively
Postoperative knee flexion is a simple and cost-effective intervention that can reduce postoperative blood loss and transfusion requirements. Positioning the knee in high flexion (>90°) over a bent pillow for 6 hours immediately postoperatively has been shown to significantly reduce blood loss compared with positioning the knee either in flexion for 3 hours or in full extension, with no detrimental effect on the ultimate range of movement.
Conclusion
An effective blood-management strategy in TKR surgery focuses on minimizing perioperative blood loss, reducing the blood transfusion rate, and maximizing the Hgb level and oxygen-carrying capacity in the postoperative period. There is no single intervention that will reduce blood loss in TKR surgery. A multimodal blood-management strategy should include preoperative assessment and Hgb optimization, intraoperative use of TXA along with meticulous hemostasis, and immobilization in high flexion during the immediate postoperative period. A proactive approach to blood management will have a positive effect on early and long- term outcomes and will lead to greater success in the care of TKR patients.
Reference
1. Liu D, Dan M, Martinez Martos S, Beller E. Blood Management Strategies in Total Knee Arthroplasty. Knee Surgery & Related Research. 2016;28(3):179-187. 2. Su E, Su S, Strategies for reducing peri- operative blood loss in total knee arthroplasty 3. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: A meta-analysis. J Bone Joint Surg Am. 2012;94:1153-9. 4. Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. 5. Napier RJ, Bennett D, McConway J, Wilson R, Sykes AM, Doran E, O’Brien S, Beverland DE The influence of immediate knee flexion on blood loss and other parameters following total knee replacement Bone Joint J 2014;96-B:201–9.
26 ISAKOS NEWSLETTER 2018: VOLUME II
2025
ISAKOS Congress Request For Proposal
We are pleased to announce
the Request for Proposal for the 15th Biennial ISAKOS Congress. The ISAKOS Site Selection Committee asks all members to consider their region as a future Congress location. Please note, the rotation of locations indicates the 2025 Congress would most likely be in Europe.
2025 ISAKOS Congress – Europe
Expression of Interest Forms Due: January 1, 2019
Members: RFP information and form can be found in your myISAKOS Dashboard
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