Surgeries at Department of Orthopedic, Amam Ali Hospital, Medical University of North Khorasan, Bojnord, Iran
Introduction: Total knee arthroplasty (TKA) is an operation performed to relieve the pain caused by severe arthritis. The most important challenge in TKA is to reduce postoperative and intraoperative blood loss. Excessive blood loss may bring up the need for allogenic blood transfusion (ABT) which is normally associated with complications such as blood-borne infections, immunological reactions and high treatment costs. This systemic review aimed to find articles in relation to blood loss prevention in TKA via searching in databases such as PubMed and Google Scholar during 2005-2015. Materials and Methods: In this study, we included all the articles focusing on the evaluation of blood loss during TKA using specific treatment methods to reduce blood loss. Open-label, single-blinded, and double-blinded studies focusing on the evaluation of blood loss during TKA were selected for the present review. Moreover, we included the studies with control groups and placebo subjects, and other studies were excluded from this review. Exclusion criteria of this study were as follows: 1) articles performed on pediatric patients; 2) articles without control or placebo groups; 3) previous reviews, meta-analyses, expert opinions, consensus statements, case reports, editorials, and letters; 4) qualitative studies and 5) articles published in languages other than English. In total, 68 articles mainly focusing on the prevention of blood loss using standard techniques were investigated. One of us examined and verified the collected data, and different factors were assessed in this review. In addition, the obtained results of each of the surveyed articles were summarized and evaluated based on the objectives of this study. Results: 68 studies performed on 8,355 patients were included in this review, 18 of which were double-blinded, and 40 were open-label.. In addition, 8 studies involved primary knee arthroplasty, and 60 involved TKA. In one of the investigated articles, there were reports on the use of a specific transfusion protocol, which resulted in a significant difference between the control and experimental groups in all the cases. Moreover, a significant difference observed in the transfusion thresholds of all the reviewed studies. According to our findings, frequency of prophylactic deep venous thrombosis (DVT) varied in the reviewed studies due to the use of different techniques to prevent blood loss after TKA; the incidence of DVT was reported in 15 articles. Conclusion: Since ABT involves high risks and even morbidity, new techniques should be applied to prevent blood loss. Although several techniques are available to reduce blood loss in TKA, ABT is frequently practiced and might lead to anemia. On the other hand, the effectiveness of new methods used to prevent blood loss remains a matter of question since all these methods are associated with certain adverse side effects. Proper investigation of the methods used for blood loss prevention in TKA patients will lead to the better understanding and management of this health issue.