Abstract
Substantial amounts of perioperative blood loss occur during total knee arthroplasty
(TKA) that may require allogeneic transfusion in more than 30% of patients. Increased
blood loss leads to poor physical functioning, increases infection risks, and prolongs
hospitalization, which may eventually affect the overall clinical outcomes of TKA.
In addition, allogeneic blood transfusions are associated with increased risks of
transfusion reactions, immunosuppression, and a variety of immunological reactions.
These concerns have led surgeons and anesthesiologists to develop various strategies
to conserve blood, reduce costs, and decrease complications related to blood transfusions.
Multiple nonpharmacologic intraoperative blood-saving measures have been used including
acute normovolemic hemodilution, hypotensive anesthesia, tourniquets, bipolar sealants,
intraoperative blood salvage systems, intramedullary femoral plugs, computer-assisted
surgery, and the use of patient-specific instrumentation. However, no clear protocol
exists currently to help surgeons choose the appropriate method for blood preservation.
The aim of this article was to review the various nonpharmacologic intraoperative
blood management strategies that have been used in TKA and to analyze their effectiveness
and potential complications according to current evidence.
Keywords
blood - loss - prevention - nonpharmacotherapeutic - knee - arthroplasty
