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J Knee Surg 2024; 37(06): 416-425
DOI: 10.1055/a-2160-2931
Original Article

Postoperative Intravenous Iron Supplementation Increases Hemoglobin Level in Total Knee Arthroplasty

Hee Seung Nam
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Jade Pei Yuik Ho
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Seung Yun Park
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Joon Hee Cho
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Yong Beom Kim
2   Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, South Korea
,
Yong Seuk Lee
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Abstract

Iron supplementation provides iron storage and facilitates effective production of hemoglobin. The purpose of this study was to investigate the effect of early postoperative intravenous (IV) iron supplementation in different types of total knee arthroplasty (TKA) surgery. We retrospectively analyzed 863 patients who underwent TKA between September 2017 and September 2021. The IV iron (I) and non-IV iron (NI) groups were compared. Hemoglobin responders, defined as patients who showed a change in hemoglobin level of ≥2 g/dL at 6 weeks of surgery compared to the baseline immediate postoperative hemoglobin level, were identified and they were compared with the nonresponders. After logistic regression analysis, the patients were classified according to the type of surgery (unilateral TKA, staged bilateral TKA, and simultaneous bilateral TKA). A subgroup analysis was performed according to the comorbidity as Charlson Comorbidity Index (CCI). The type of surgery and the rate of hemoglobin responders differed between the I and NI groups. The surgery type and iron supplementation significantly affected the hemoglobin responder in the logistic regression model. In each surgery type, hemoglobin drop in the I group was generally lower in the second and sixth weeks than that in the NI group. It was also effective in reducing hemoglobin drop on the first day of the second surgery in staged bilateral TKA. In addition, the number of hospital days was lower in the IV iron supplementation group who underwent a staged bilateral TKA. CCI did not affect hemoglobin responder, hemoglobin drop, and transfusion rate in both the I and NI groups. Postoperative IV iron supplementation affected the outcome of hemoglobin responders. In addition, it reduced early postoperative hemoglobin drop. However, iron supplementation did not affect the transfusion rate, complications, and clinical outcome, regardless of the type of surgery.

Level of evidence Level III, case-control study.

Keywords

knee - total knee arthroplasty - hemoglobin - iron supplementation - surgery type - hemoglobin responder


Publication History

Received: 19 October 2022

Accepted: 24 August 2023

Accepted Manuscript online:
25 August 2023

Article published online:
18 September 2023

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