Quality of Life Research

, Volume 28, Issue 1, pp 85–98 | Cite as

Association between preoperative anaemia and blood transfusion with long-term functional and quality of life outcomes amongst patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study

  • Hairil Rizal Abdullah
  • Niresh Ranjakunalan
  • William Yeo
  • Mann Hong Tan
  • Ruban Poopalalingam
  • Yilin Eileen SimEmail author



Preoperative anaemia affects up to one-third of patients undergoing total knee arthroplasty (TKA) and is associated with increased blood transfusion and prolonged hospitalisation. Prior studies have associated preoperative anaemia with poorer functional recovery after total hip arthroplasty. However, the association between preoperative anaemia and functional outcomes following TKA is unknown. We aim to determine whether preoperative anaemia and perioperative blood transfusion affect health-related quality of life (HRQoL) and functional outcomes following TKA.


Retrospective analysis of 1994 patients who underwent primary unilateral TKA from 2013 to 2014 was performed. Anaemia was defined according to the World Health Organisation definition. Baseline and 6-month postoperative HRQoL was assessed with the 36-Item Short Form Survey (SF-36), while function was assessed with Oxford Knee Score (OKS) and Knee Society Function Score (KSFS). Physical function (PF), role physical (RP), bodily pain (BP), social function (SF) and role emotional (RE) domains of SF-36, OKS and KSFS demonstrated significant change greater than the minimal clinically important difference between baseline and 6 months. Analysis of covariance (ANCOVA) was performed to identify predictors of 6-month scores.


The incidence of preoperative anaemia was 22.3%. 4.3% of patients received blood transfusions. Preoperative anaemia and perioperative blood transfusion did not significantly affect SF-36, KSFS and OKS scores at 6 months postoperatively. Poor baseline SF-36, KSS and OKS scores and high BMI ≥ 37.5 kg/m2 are consistently associated with lower scores at 6 months.


Preoperative anaemia and perioperative blood transfusion did not significantly affect HRQoL and functional outcomes following primary TKA. Poor baseline and obesity were associated with poorer outcomes.


Anaemia Arthroplasty Knee replacement Quality of life Functional outcome Perioperative blood transfusion Obesity 



We would like to express our gratitude to the staff at the Singapore General Hospital Orthopaedic Diagnostics Centre for helping us to collect data regarding preoperative and postoperative outcomes. We would also like to thank Ms. Sudha Harikrishnan, from the Department of Anaesthesiology, for her invaluable assistance in data extraction. Dr. Geoffrey Liew and Dr. Lin Geng Yu also assisted us significantly in data acquisition and we would like thank them. Lastly, we would also like to thank Dr. Chan Yiong Huak, Head, Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore for his invaluable help in data analysis and interpretation. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author contributions

HRA contributed to the study conception and design, data acquisition, analysis and interpretation, drafting and final approval of the manuscript. NR contributed to data acquisition, analysis and interpretation, drafting, revision and final approval of the manuscript. WY contributed to data acquisition, analysis and interpretation and final approval of the manuscript. MHT contributed to the study conception and design, drafting of the manuscript and final approval. RP contributed to the study conception and design, drafting of the manuscript and final approval. YES contributed to data acquisition, analysis and interpretation, drafting, revision and final approval of the manuscript.


This research was funded by the Department of Anesthesiology, Singapore General Hospital.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As this is a retrospective study that did not involve any patient contact, waiver of formal consent is approved by our institutional review board (Singhealth Centralised Institutional Review Board).


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Hairil Rizal Abdullah
    • 1
  • Niresh Ranjakunalan
    • 2
  • William Yeo
    • 3
  • Mann Hong Tan
    • 4
  • Ruban Poopalalingam
    • 1
  • Yilin Eileen Sim
    • 1
    Email author
  1. 1.Department of AnaesthesiaSingapore General HospitalSingaporeSingapore
  2. 2.Yong Loo Lin School of MedicineSingaporeSingapore
  3. 3.Orthopaedic Diagnostic CenterSingapore General HospitalSingaporeSingapore
  4. 4.Department of Orthopaedic SurgerySingapore General HospitalSingaporeSingapore

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