Abstract
Blood loss is a serious concern during lower extremity total joint arthroplasty with
the estimated reduction in hemoglobin concentration known to vary between 2 and 4
g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used
to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular
risks in up to 50% of such cases with a high volume of blood loss. However, these
transfusions are associated with the risks of immunologic reactions, immunosuppression,
and infection transmission. Multiple blood-saving strategies have been developed to
minimize blood loss, to reduce transfusion rates, to decrease complications, and to
improve outcomes in the postoperative period. Currently, there are no clear guidelines
on the blood management strategies adopted to lessen the blood loss associated with
TKA. The aim of this study was to review the literature and provide a broad summary
of the efficacy and complications associated with several blood-saving measures that
are currently used in the postoperative period. Evidence suggests that simple techniques
such as limb elevation, cryotherapy, compression dressings, and drain clamping may
reduce external drainage, however, whether these techniques lead to less allogeneic
transfusions is currently debatable. Further research on using a combination of these
strategies and their cost-effectiveness are needed.
Keywords
blood - management - postoperative - knee - arthroplasty
