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How to Reduce Blood Transfusion to a Minimum in Total Knee Arthroplasty

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Perioperative Medical Management for Total Joint Arthroplasty
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Abstract

Primary total knee arthroplasty (TKA) and even more revision knee arthroplasty are surgical procedures which can lead to a significant amount of blood loss with the consequence of a high rate of blood transfusions if not properly addressed (Keating et al. 2002).

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References

  • Abdel-Salam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 77:250

    CAS  PubMed  Google Scholar 

  • Adalberth G, Bystrom S, Kolstad K et al (1998) Postoperative drainage of knee arthroplasty is not necessary: a randomized study of 90 patients. Acta Orthop Scand 69:475

    CAS  PubMed  Google Scholar 

  • Adie S, Naylor JM, Harris IA (2010) Cryotherapy after total knee arthroplasty a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 25(5):709–715

    PubMed  Google Scholar 

  • Aglietti P, Baldini A, Vena LM et al (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop 371:169–177

    PubMed  Google Scholar 

  • Ajwani SH, Jones M, Jarrat JW et al (2012) Computer assisted versus conventional total knee replacement: a comparison of tourniquet time, blood loss and length of stay. Knee 19:606–610

    PubMed  Google Scholar 

  • Albala DM, Lawson JH (2006) Recent clinical and investigational applications of fibrin sealant in selected surgical specialties. J Am Coll Surg 202:685–697

    PubMed  Google Scholar 

  • Alcelik I, Pollock RD, Sukeik M et al (2012) A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 27(3):331–340

    PubMed  Google Scholar 

  • An HS, Mikhail WE, Jackson WT et al (1991) Effects of hypotensive anesthesia, nonsteroidal antiinflammatory drugs, and poly- methylmethacrylate on bleeding in total hip arthroplasty patients. J Arthroplasty 6:245–250

    CAS  PubMed  Google Scholar 

  • Baldini A, Adravanti P (2009) Less invasive TKA: extramedullary femoral reference without navigation. Clin Orthop Relat Res 466(11):2694–2700

    Google Scholar 

  • Berman AT, Fabiano D, Bosacco SJ et al (1990) Comparison between intermittent (spring- loaded) and continuous closed suction drainage of orthopedic wounds: a controlled clinical trial. Orthopedics 13:309–314

    CAS  PubMed  Google Scholar 

  • Blanié A, Bellamy L, Rhayem Y et al (2013) Duration of postoperative fibrinolysis after total hip or knee replacement: a laboratory follow-up study. Thromb Res 131(1):e6–e11

    PubMed  Google Scholar 

  • Bong MR, Patel V, Chang E et al (2004) Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 3:281–287

    Google Scholar 

  • Cao L, Ablimit N, Mamtimin A et al (2009) Comparison of no drain or with a drain after unilateral total knee arthroplasty: a prospective randomized controlled trial. Zhonghua Wai Ke Za Zhi 47:1390–1393

    PubMed  Google Scholar 

  • Cardone D, Klein AA (2009) Perioperative blood conservation. Eur J Anesth 26:722–729

    Google Scholar 

  • Carless PA, Henry DA, Anthony DM (2003) Fibrin sealant use for minimising peri- operative allogeneic blood transfusion. Cochrane Database Syst Rev 2:CD004171

    Google Scholar 

  • Christodoulou AG, Ploumis AL, Terzedis IP et al (2004) The role of timing on tourniquet release and cementing on perioperative blood loss in total knee replacement. Knee 11:313–317

    PubMed  Google Scholar 

  • Cleeland CS, Demetri GD, Glaspy J et al (1999) Identifying hemoglobin level for optimal quality of life: results of an incremental analysis (Abstract). Proc Am Soc Clin Oncol 18:547a

    Google Scholar 

  • Clement RC, Kamath AF, Derman PB et al (2012) Bipolar sealing in revision total hip arthroplasty for infection: efficacy and cost analysis. J Arthroplasty 27(7):1376–1381

    PubMed  Google Scholar 

  • Cohen JA, Brecher ME (1995) Preoperative autologous blood donation: benefit or detriment; a mathematical analysis. Transfusion 35:640–644

    CAS  PubMed  Google Scholar 

  • Cowell HR (1937) Editorial. Prior deposit of autologous blood for transfusion. J Bone Joint Surg 69A:319

    Google Scholar 

  • Davis NJ, Jennings JJ, Harris WH (1974) Induced hypotensive anesthesia for total hip replacement. Clin Orthop 101:93–98

    PubMed  Google Scholar 

  • Derman PB, Kamath AF, Lee GC (2013) Saline-coupled bipolar sealing in revision total knee arthroplasty for infection. Am J Orthop (Belle Mead NJ) 42(9):407–411

    Google Scholar 

  • Diiorio TM, Burkholder JD, Good RP et al (2012) Platelet-rich plasma does not reduce blood loss or pain or improve range of motion after TKA. Clin Orthop Relat Res 470(1):138–143

    PubMed Central  PubMed  Google Scholar 

  • Din R, Geddes T (2004) Skin protection beneath the tourniquet. A prospective randomized trial. ANZ J Surg 74:721

    PubMed  Google Scholar 

  • Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005

    CAS  PubMed  Google Scholar 

  • Engel JM, Jojaus T, Ruwoldt R et al (2001) Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin. Anesth Analg 92:775

    CAS  PubMed  Google Scholar 

  • Eroglu A, Uzunlar H, Erciyes N (2005) Comparison of hypotensive epidural anesthesia and hypotensive total intravenous anesthesia on intraoperative blood loss during total hip replacement. J Clin Anesth 17:420–425

    CAS  PubMed  Google Scholar 

  • Esler CN, Blakeway C, Fiddian NJ (2003) The use of a closed- suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 85:215

    CAS  PubMed  Google Scholar 

  • Eubanks JD (2010) Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg 92:775

    Google Scholar 

  • Everts PAM, Devilee RJJ, Brown MC et al (2006) Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty. Acta Anaesthesiol Scand 50:593–599

    CAS  PubMed  Google Scholar 

  • Everts PAM, Devilee RJJ, Oosterbos CJM et al (2007) Autologous platelet gel and sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis. Knee Surg Sports Traumatol Arthrosc 15:888–894

    PubMed  Google Scholar 

  • Falez F, Meo A, Panegrossi G et al (2013) Blood loss reduction in cementless total hip replacement with fibrin spray or bipolar sealer: a randomised controlled trial on ninety five patients. Int Orthop 37(7):1213–1217

    PubMed Central  PubMed  Google Scholar 

  • Fedi S, Gori AM, Falciani M et al (1999) Procedure-dependence and tissue factor-independence of hypercoagulability during orthopaedic surgery. Thromb Haemost 81(6):874–878

    CAS  PubMed  Google Scholar 

  • Flordal PA, Neander G (1991) Blood loss in total hip replacement: a retrospective study. Arch Orthop Trauma Surg 111:34–38

    CAS  PubMed  Google Scholar 

  • Flynn JC, Csenesitz TA (1979) Present status of intraoperative blood recovery during orthopaedics surgery. Jefferson Orthop J 8:22–25

    Google Scholar 

  • Guay J (2006) Postoperative pain significantly influences postoperative blood loss in patients undergoing total knee replacement. Pain Med 7(6):476–482

    PubMed  Google Scholar 

  • Haien Z, Yong J, Baoan M et al (2013) Post-operative auto-transfusion in total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. PLoS One 8(1):e55073. doi:10.1371/journal.pone.0055073

    PubMed Central  PubMed  Google Scholar 

  • Harvey EJ, Leclerc J, Brooks CE et al (1997) Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty 12(3):291–296

    CAS  PubMed  Google Scholar 

  • Heyse T, Haas SB, Drinkwater D et al (2014) Intraarticular fibrinogen does not reduce blood loss in TKA: a randomized clinical trial. Clin Orthop Relat Res 472:272–276

    PubMed  Google Scholar 

  • Holt BT, Parks NL, Engh GA et al (1997) Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty. Orthopedics 20:1121–1124

    CAS  PubMed  Google Scholar 

  • Huang Z, Shen B, Ma J et al (2012) Mini-midvastus versus medial parapatellar approach in TKA: muscle damage and inflammation markers. Orthopedics 35(7):e1038–e1045

    PubMed  Google Scholar 

  • Hughes DL, Crosby AC (1995) Treatment of knee sprains: modified Robert Jones or elastic support bandage?. J Accid Emerg Med 12(2):115–8

    CAS  PubMed Central  PubMed  Google Scholar 

  • Irvine GB, Chan RN (1986) Arterial calcification and tourniquets. Lancet 2:1217

    CAS  PubMed  Google Scholar 

  • Ishii Y, Matsuda Y (2005) Effect of the timing of tourniquet release on perioperative blood loss associated with cementless total knee arthroplasty: a prospective randomized study. J Arthroplasty 20(8):977–983

    PubMed  Google Scholar 

  • Jans Ø, Jørgensen C, Kehlet H et al (2014) Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty. Transfusion 54(3):717–726

    PubMed  Google Scholar 

  • Jones AP, Harrison M, Hui A (2007) Comparison of autologous transfusion drains versus no drain in total knee arthroplasty. Acta Orthop Belg 73(3):377–385

    PubMed  Google Scholar 

  • Jou IM, Lai Ka, Yang CY (1993) Blood loss associated with total knee arthroplasty. J Orthop Surg (ROC) 10:213

    Google Scholar 

  • Juelsgaard P, Møller M, Larsen U (2002) Preoperative Acute Normovolaemic Hemodilution (ANH) in combination with Hypotensive Epidural Anaesthesia (HEA) during knee arthroplasty surgery. No effect on transfusion rate. A randomized controlled trial [ISRCTN87597684]. BMC Anesthesiol 2(1):1

    PubMed Central  PubMed  Google Scholar 

  • Jung WH, Chun CW, Lee JH et al (2013) No difference in total blood loss, haemoglobin and haematocrit between continues and intermittent wound drainage after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(12):2831–2836

    PubMed  Google Scholar 

  • Keating EM (1999) Current options and approaches for blood management in orthopaedic surgery. Instr Course Lect 48:655–665

    CAS  PubMed  Google Scholar 

  • Keating EM, Meding JB (2002) Perioperative blood management practices in elective orthopaedic surgery. J Am Acad Orthop Surg 10:393–400

    PubMed  Google Scholar 

  • Keating EM, Ritter MA (2002) Transfusion options in total joint arthroplasty. J Arthroplasty 17(Suppl 1):125–128

    PubMed  Google Scholar 

  • Keating EM, Meding JB, Faris PM et al (1998) Predictors of transfusion risk in elective knee surgery. Clin Orthop 357:50–59

    PubMed  Google Scholar 

  • Keating EM, Faris PM, Meding JB et al (1999) Comparison of the midvastus muscle-splitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty 14:29–32

    CAS  PubMed  Google Scholar 

  • Kilicarslan K, Yalcin N, Cicek H et al (2011) The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc 19(6):932–935

    PubMed  Google Scholar 

  • Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res 347:188–193

    PubMed  Google Scholar 

  • Kim HJ, Fraser MR, Kahn B et al (2012) The efficacy of a thrombin-based hemostatic agent in unilateral total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94:1160–1165

    PubMed  Google Scholar 

  • Kim TK, Chang CB, Koh IJ (2014) Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 22(8):1849–1858

    Google Scholar 

  • Kiss H, Raffl M, Neumann D et al (2005) Epinephrine-augmented hypotensive epidural anesthesia replace tourniquet use in total knee replacement. Clin Orthop Relat Res 436:184–189

    PubMed  Google Scholar 

  • Kluba T, Fiedler K, Kunze B et al (2012) Fibrin sealant in orthopaedic surgery: practical experiences derived from use of QUIXIL in total knee arthroplasty. Arch Orthop Trauma Surg 132:1147–1152

    PubMed  Google Scholar 

  • Ko PS, Tio MK, Tang YK et al (2003) Sealing the intramedullary femoral canal with autologous bone plug in total knee arthroplasty. J Arthroplasty 18:6–9

    CAS  PubMed  Google Scholar 

  • Kumar A (2009) Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med 76:112–118

    Google Scholar 

  • Kumar N, Saleh J, Gardiner E et al (2000) Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss. J Arthroplasty 15:947–949

    CAS  PubMed  Google Scholar 

  • Lee GC, Hawes T, Cushner FD et al (2005) Current trends in blood conservation in total knee arthroplasty. Clin Orthop Relat Res 440:170–174

    PubMed  Google Scholar 

  • Leeman MF, Costa ML, Costello E, Edwards D (2006) Timing of re-transfusion drain removal following total knee replacement. Ann R Coll Surg Engl 88(2):134–5

    CAS  PubMed Central  PubMed  Google Scholar 

  • Lemaire R (2008) Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br 90:1128–1136

    CAS  PubMed  Google Scholar 

  • Levy O, Martinowitz U, Oran A et al (1999) The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Joint Surg Am 81(11):1580–1588

    CAS  PubMed  Google Scholar 

  • Li B, Wen Y, Liu D et al (2012) The effect of knee position on blood loss and range of motion following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(3):594–599

    PubMed  Google Scholar 

  • Li ZJ, Fu X, Tian P (2014) Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis. Knee Surg Sports Traumatol Arthrosc Feb 12. [Epub ahead of print]

    Google Scholar 

  • Liu J, Cao JG, Wang L et al (2014) Effect of fibrin sealant on blood loss following total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 12(2):95–102. doi:10.1016/j.ijsu.2013.11.011. Epub 2013 Dec 4

    PubMed  Google Scholar 

  • Lotke PA, Barth P, Garino JP et al (1999) Predonated autologous blood transfusions after total knee arthroplasty: immediate versus delayed administration. J Arthroplasty 14:647–650

    CAS  PubMed  Google Scholar 

  • Mallory TH (1973) Hypotensive anesthesia in total hip replacement. JAMA 224:248

    CAS  PubMed  Google Scholar 

  • Maniar RN, Kumar G, Singhi T et al (2012) Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res 470(9):2605–2612

    PubMed Central  PubMed  Google Scholar 

  • Martin A, Prenn M, Spiegel T et al (2004) Relevance of wound drainage in total knee arthroplasty–a prospective comparative study. Z Orthop Ihre Grenzgeb 142:46–50

    CAS  PubMed  Google Scholar 

  • Mcvay PA, Toy PT (1996) Very severe outcomes associated with autologous blood donation [letter]. Transfusion 36:761

    CAS  PubMed  Google Scholar 

  • Mengal B, Aebi J, Rodriguez A et al (2001) A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 87:29

    CAS  PubMed  Google Scholar 

  • Mohanial PK, Sandiford N, Skinner JA et al (2013) Comparison of blood loss between computer assisted and conventional total knee arthroplasty. Indian J Orthop 47:63–66

    Google Scholar 

  • Moonen AF, Neal TD, Pilot P (2006) Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury 37S:511–516

    Google Scholar 

  • Napier RJ, Bennett D, McConway J et al (2014) The influence of immediate knee flexion on blood loss and other parameters following total knee replacement. Bone Joint J 96-B(2):201–209

    CAS  PubMed  Google Scholar 

  • Nelson CL, Bowen WS (1986) Total hip arthroplasty in Jehovah’s Witnesses without blood transfusion. J Bone Joint Surg Am 68:350–353

    CAS  PubMed  Google Scholar 

  • Newman RJ (1984) Metabolic effects of tourniquet ischaemia studied by nuclear magnetic resonance spectroscopy. J Bone Joint Surg Br 66-B:434

    Google Scholar 

  • Niemi TT, Syrijala M, Rosenbemrg PH (2000) Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty. Acta Anaesthesiol Scand 44:457–464

    CAS  PubMed  Google Scholar 

  • Notarnicola A, Moretti L, Martucci A et al (2012) Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty. Blood Coagul Fibrinolysis 23(4):278–284

    CAS  PubMed  Google Scholar 

  • Noticewala MS, Nyce JD, Wang W et al (2012) Predicting need for allogenetic transfusion after total knee arthroplasty. J Arthoplasty 27(6):961–967

    Google Scholar 

  • Nuttall GA, Santrach PJ, Oliver WC Jr et al (1996) The predictors of red cell transfusions in total hip arthroplasties. Transfusion 36:144–149

    CAS  PubMed  Google Scholar 

  • O’Leary AM, Veall G, Butler P et al (1990) Acute pulmonary oedema after tourniquet release. Can J Anaesth 37:826

    PubMed  Google Scholar 

  • Omonbude D, El MM, O'Connor PJ et al (2010) Measurement of joint effusion and haematoma formation by ultrasound in assessing the effectiveness of drains after total knee replacement: a prospective randomised study. J Bone Joint Surg Br 92:51

    CAS  PubMed  Google Scholar 

  • Ong SM, Taylor GJ (2003) Can knee position save blood following total knee replacement? Knee 10(1):81–85

    PubMed  Google Scholar 

  • Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A:1146

    PubMed  Google Scholar 

  • Pfeiffer M, Bräutigam H, Draws D, Sigg A (2005) A new bipolar blood sealing system embedded in perioperative strategies vs. a conventional regimen for total knee arthroplasty: results of a matched-pair study. Ger Med Sci 13;3:Doc10.

    Google Scholar 

  • Pietsch M, Djahani O, Zweiger C et al (2013) Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes. Knee Surg Sports Traumatol Arthrosc 21(10):2234–2240

    CAS  PubMed  Google Scholar 

  • Pinsornsak P, Chumchuen S (2013) Can a modified Robert Jones bandage after knee arthroplasty reduce blood loss? A prospective randomized controlled trial. Clin Orthop Relat Res 471:1677–1681

    PubMed Central  PubMed  Google Scholar 

  • Plymale MF, Capogna BM, Lovy AJ et al (2012) Unipolar vs bipolar hemostasis in total knee arthoplasty: a prospective randomized trial. J Arthroplasty 27(6):1133–1137

    PubMed  Google Scholar 

  • Pornrattanamaneewong C, Narkbunnam R, Siriwattanasakul P et al (2012) Three-hour interval drain clamping reduces postoperative bleeding in total knee arthroplasty: a prospective randomized controlled trial. Arch Orthop Trauma Surg 132(7):1059–1063

    PubMed  Google Scholar 

  • Prasad N, Padmanabhan V, Mullaji A (2007) Blood loss in total Knee arthroplasty: an analysis of risk factors. Int Orthop 31:31–44

    Google Scholar 

  • Rama KR, Apsingi S, Poovali S et al (2007) Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 89:699–705

    PubMed  Google Scholar 

  • Randelli F, D’Anchise R, Ragone V et al (2014) Is the newest fibrin sealant an effective strategy to reduce blood loss after total knee arthroplasty? A randomized controlled study. J Arthroplasty. doi:10.1016/j.arth.2014.02.024, pii: S0883-5403(14)00116-8

    PubMed  Google Scholar 

  • Raut VV, Stone MH, Wroblewski BM (1993) Reduction of postoperative blood loss after press-fit condylar knee arthroplasty with use of a femoral intramedullary plug. J Bone Joint Surg Am 75:1356–1357

    CAS  PubMed  Google Scholar 

  • Reinhardt KR, Osoria H, Nam D et al (2013) Reducing blood loss after total knee replacement: a fibrin solution. Bone Joint J 95-B(11 Suppl A):135–139

    CAS  PubMed  Google Scholar 

  • Rosencher N, Bellamy L, Chabbouh T et al (2008) Blood conservation approaches in orthopedic surgery. Transfus Clin Biol 15(5):294–302

    CAS  PubMed  Google Scholar 

  • Schmied H, Kurz A, Sessler DI et al (1995) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 147:289–292

    Google Scholar 

  • Sculco TP, Ranawat C (1975) The use of spinal anesthesia for total hip-replacement arthroplasty. J Bone Joint Surg Am 57:173–177

    CAS  PubMed  Google Scholar 

  • Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7:151–155

    PubMed  Google Scholar 

  • Sehat KR, Evans RL, Newman JH (2004) Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br 86(4):561–565

    CAS  PubMed  Google Scholar 

  • Senthil KG, Von Arx OA, Pozo JL (2005) Rate of blood loss over 48 hours following total knee replacement. Knee 12(4):307–309

    Google Scholar 

  • Sharrock NE, Salvati EA (1996) Hypotensive epidural anesthesia for total hip arthroplasty. Acta Orthop Scand 67:91–107

    CAS  PubMed  Google Scholar 

  • Sharrock NE, Mineo R, Urquhart B et al (1993) The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under lumbar epidural anesthesia. Anesth Analg 76:580–584

    CAS  PubMed  Google Scholar 

  • Shen PC, Jou IM, Lin YT et al (2005) Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty. J Arthroplasty 20:909–913

    PubMed  Google Scholar 

  • Silver R, De la Garza J, Rang M et al (1986) Limb swelling after release of a tourniquet. Clin Orthop Relat Res 206:86

    PubMed  Google Scholar 

  • Skovgaard C, Holm B, Troelsen A et al (2013) No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty: a randomized, double-blind, placebo-controlled study. Acta Orthop 84(2):153–158

    PubMed Central  PubMed  Google Scholar 

  • Smith TO, Hing CB (2010) Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee 17(2):141–147

    PubMed  Google Scholar 

  • Stucinskas J, Tarasevicius S, Cebatorius A et al (2009) Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial. Int Orthop 33(5):1275–1278

    PubMed Central  PubMed  Google Scholar 

  • Su EP, Perna M, Boettner F et al (2012) A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br 94(11 Suppl A):153–156

    CAS  PubMed  Google Scholar 

  • Tai TW, Jou IM, Chang CW et al (2010) Non-drainage is better than 4-hour clamping drainage in total knee arthroplasty. Orthopedics 33(3):156–160

    Google Scholar 

  • Tai TW, Lin CJ, Jou IM et al (2011) Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19(7):1121–1130

    PubMed Central  PubMed  Google Scholar 

  • Tanaka N, Sakahashi H, Sato E et al (2001) Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg Br 83:702–705

    CAS  PubMed  Google Scholar 

  • Tao K, Wu HS, Li XH et al (2006) The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study. Zhonghua Wai Ke Za Zhi 44:1111–1114

    PubMed  Google Scholar 

  • Thiengwittayaporn S, Junsee D, Tanavalee A (2009) A comparison of blood loss in minimally invasive surgery with and without electromagnetic computer navigation in total knee arthroplasty. J Med Assoc Thai 92:S27–S32

    PubMed  Google Scholar 

  • Thienpont E, Grosu I, Paternostre F (2014) The use of patient-specific instruments does not reduce blood loss during minimally invasive total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc Mar 27. [Epub ahead of print]

    Google Scholar 

  • Thoms RJ, Marwin SE (2009) The role of fibrin sealants in orthopaedic surgery. J Am Acad Orthop Surg 17:727–736

    PubMed  Google Scholar 

  • Vundelinckx BJ, Bruckers L, De Mulder K et al (2013) Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplasty 28:964–970

    PubMed  Google Scholar 

  • Wellisz T, An YH, Wen X et al (2008) Infection rates and healing using bone wax and soluble polymer material. Clin Orthop Relat Res 466:481–486

    PubMed Central  PubMed  Google Scholar 

  • Wind TC, Bartfield WR, Moskal JT (2013) The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty. J Arthroplasty 28:1080–1083

    PubMed  Google Scholar 

  • Wong J, Abrishami A, El Beheiry H et al (2010) Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trials. J Bone Joint Surg Am 92:2503–2513

    PubMed  Google Scholar 

  • Yomtovian R (1996) Autologous transfusion complications. In: Popovsky MA (ed) Transfusion reactions. American Association of Blood Banks Press, Bethesda, pp 237–280

    Google Scholar 

  • Zamora-Navas P, Collado-Torres F, de la Torrie-Solis F (1999) Closed suction drainage after knee arthroplasty. A prospective study of the effectiveness of the operation and of bacterial contamination. Acta Orthop Belg 65(1):44–47

    CAS  PubMed  Google Scholar 

  • Zeh A, Messer J, Davis J et al (2010) The Aquamantys system – an alternative to reduce blood loss in primary total hip arthroplasty? J Arthroplasty 25(7):1072–1077

    PubMed  Google Scholar 

  • Zhang QD, Guo WS, Zhang Q et al (2011) Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis. J Arthroplasty 26(8):1265–1272

    PubMed  Google Scholar 

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Miniati, I., Guarducci, C., Baldini, A., Thienpont, E. (2015). How to Reduce Blood Transfusion to a Minimum in Total Knee Arthroplasty. In: Baldini, A., Caldora, P. (eds) Perioperative Medical Management for Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-07203-6_2

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