The Journal of Bone and Joint Surgery, Vol 73, Issue 7 1037-1040, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion

PA Lotke, VJ Faralli, EM Orenstein and ML Ecker
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104.

We prospectively studied the cases of 121 patients who were being operated on for insertion of a unilateral total knee prosthesis with cement, and we placed them randomly in four groups. In Group I, the tourniquet was inflated throughout the operative procedure, and we released it postoperatively after a compressive dressing had been applied; a splint was used postoperatively for three days. In Group II, the tourniquet remained inflated throughout the operation, but no splint was applied postoperatively, and continuous passive motion was started immediately in the recovery room. In Group III, the tourniquet was released intraoperatively, and hemostasis was achieved by cauterization; postoperatively, a compressive dressing was applied, and a splint was used for three days. In Group IV, the tourniquet was released intraoperatively, hemostasis was established, and then the tourniquet was reinflated; a compressive dressing was applied, and continuous passive motion was started immediately in the recovery room. Hemoglobin and hematocrit values were monitored in all patients. Blood loss in suction drainage was recorded, and the total blood loss was calculated. The results show that total knee arthroplasty is associated with major loss of blood (mean, 1518 milliliters). The calculated blood loss for Groups I, II, and III averaged 1443 milliliters, while that for Group IV averaged 1793 milliliters. Loss in suction drainage correlated with total estimated blood loss and averaged 511 milliliters. The magnitude of blood loss after total knee arthroplasty should be appreciated, and special attention should be paid to the availability of adequate fluid and blood products, preferably blood donated by the patient preoperatively.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				K. R. B. S. Rama, S. Apsingi, S. Poovali, and A. Jetti Timing of Tourniquet Release in Knee Arthroplasty. Meta-Analysis of Randomized, Controlled Trials J. Bone Joint Surg. Am., April 1, 2007; 89(4): 699 - 705. [Abstract] [Full Text] [PDF]

				Y. Kalairajah, D. Simpson, A. J. Cossey, G. M. Verrall, and A. J. Spriggins Blood loss after total knee replacement: EFFECTS OF COMPUTER-ASSISTED SURGERY J Bone Joint Surg Br, November 1, 2005; 87-B(11): 1480 - 1482. [Abstract] [Full Text] [PDF]

				H. P. Bezwada, D. G. Nazarian, D. H. Henry, and R. E. Booth Jr. Preoperative Use of Recombinant Human Erythropoietin Before Total Joint Arthroplasty J. Bone Joint Surg. Am., September 1, 2003; 85(9): 1795 - 1800. [Abstract] [Full Text] [PDF]

				R. Iorio and W. L. Healy Commentary J. Bone Joint Surg. Am., August 1, 2001; 83(8): 1282 - 1282. [Full Text]

				O. LEVY, U. MARTINOWITZ, A. ORAN, C. TAUBER, and H. HOROSZOWSKI 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., November 1, 1999; 81(11): 1580 - 8. [Abstract] [Full Text]

				M. J. LEMOS and W. L. HEALY Current Concepts Review - Blood Transfusion in Orthopaedic Operations J. Bone Joint Surg. Am., August 1, 1996; 78(8): 1260 - 71. [Full Text]